The booming industry that attracts foreigners to Israel for medical procedures is chipping away at the nation’s equal access to healthcare, according to an annual State Comptroller’s report issued this month in response to research by Haaretz, a portal devoted to news in the Middle East.
Despite the establishment of a Health Ministry committee to implement government supervision of the growing industry, regulation drafted by the ministry in June 2011 based on recommendations by an expert panel has yet to be formally adopted. Just recently, Haaretz published data received under the Freedom of Information Law that shows that in the absence of government supervision, health tourism at government-owned hospitals grew 220 percent in the two years between 2009 and 2011. According to data presented during the Knesset debate following the research findings, in the first half of 2009 alone more than 23,000 tourists arrived in Israel for medical treatments.
The State Comptroller’s findings are that medical tourism is akin to private healthcare, and, thus, harms the principle of equality. The comptroller’s report warned that as medical tourism grows at privately run hospitals, a likely result will be the poaching of staff from public hospitals.
Medical tourists from the United States, Africa, the Middle East and Eastern Europe travel to Israel for its state-of-the-art facilities and highly skilled physicians who are trained to handle complex treatments that may not be available in other countries and at a fraction of the cost. Israel is ranked among the top 28 healthcare systems in the world because of its cancer, fertility and IVF treatments and neurosurgery and oncology surgeries.
Despite almost two years since it was first publicized, nothing in the Health Ministry’s draft of the regulation has yet been implemented. The draft states, among other things, that every hospital will give preferential treatment to Israeli residents ahead of medical tourists; medical tourism services will not exceed 5 percent of the medical center’s turnover; profits from medial tourism will be used for developing hospital infrastructure; and that a certain percentage of government hospitals’ profits from medical tourism will be dedicated to the development of hospitals in Israel’s geographic periphery.
“The ministry supervises medical tourism in the hospitals, reviewing operations every year in order to verify that they do not exceed the level recommended by the expert committee,” the Health Ministry stated. “The committee recommendations were formulated in a director-general’s memo, but at a certain stage following a different policy expressed in discussions with the director general of the Prime Minister’s Office and in accordance with the new policy formulated by the ministry with the goal of regulating the area of medical tourism in Israel, it was requested to hold-off [issuing] the memo until a comprehensive policy decision is reached by all relevant authorities. The position of the Health Ministry and the Finance Ministry on this matter is identically and medical tourism will be restricted at hospitals that don’t supply available services to the public health system.”
Clinical organ transplantation has been recognized as one of the great medical advances of the century. However, they have raised many ethical, moral and societal issues regarding supply, the methods of organ allocation, and the use of living donors including minors. It has also led to the practice of organ sale as transplant tourism in some parts of the world. Prof. Dr. E.F.Ehtuish will address the many ethical questions associated with organ transplantation, organ trafficking, and transplant tourism at this year’s 6th World Medical Tourism & Global Healthcare Congress to be held this November 3-5 in Las Vegas.
Prof. Dr. E.F.Ehtuish is the Director of the Libyan National Organ Transplant Program. He has written many books in both Arabic and English including one on the topic of the ethics of organ transplantation. To read more about his extensive experience including his many administrative and academic appointments, PLEASE CLICK HERE TO READ HIS FULL BIOGRAPHY or visit his website, www.ehtuish.net.
As the world economy struggles to get back on its feet, the government of Taiwan is working to fill the shoes of industrial transformation and national development with free trade zones. The Council for Economic Planning and Development identified high value-added agricultural processing, cross-border collaboration in strategic sectors, international medical care and smart logistics as avenues for business activity at facilities within the planned zones.
This means medical tourism could get a bump if the government follows through on the tax-free zones, which would foster economic development, investment in healthcare infrastructure and international and international standards of excellence; establish world-class clusters of hospitals, life sciences and medical research and education; and serve patients locally, regionally and internationally.
“In the past half century, Taiwan underwent several rounds of trade liberalization that helped drive the country’s economic growth,” said Kuan Chung-ming, the minister for CEPD, the agency in charge of mapping out and implementing the FEZ initiative. “The project will leverage Taiwan’s advantages in human resources, information and communication technologies, pivotal location in East Asia and special economic ties with mainland China to develop high value-added economic activity.”
The core concepts behind the zones are globalization and trade liberalization, according to Kuan. The initiative will also bring Taiwan closer to global markets and help create conditions necessary for the country’s participation in regional economic integration through such alliances as the Regional Comprehensive Economic Partnership and Trans-Pacific Partnership.
According to the Department of Health, Taiwan is poised to become an international medical tourism center given its leading medical technology, quality service and reasonable prices.
“DOH will focus efforts on implementing regulatory easing and other supporting measures to ratchet sector output up to NT$30 billion (US$1 billion) in five years while boosting other industries such as biomedical devices, insurance and tourism,” a DOH official said.
To attract foreign investment to the region, firms registered outside of Taiwan will be allowed to hold a maximum one-third stake in medical institutions operating in the FEZs. The official stressed that these facilities will be staffed primarily by local health professionals.
“These institutions cannot offer services under the national health insurance plan, but ROC citizens can use the services at their own expense,” the official said.
CEPD has initially designated Taiwan’s five free trade ports ― Keelung, Kaohsiung, Su-ao, Taichung and Taipei ― and Taiwan Taoyuan International Airport as trial sites for the project. Other municipalities can also apply to become FEZs if they meet certain qualifications.
State support including tax incentives and streamlined procedures for immigration and land procurement will be offered to qualified individuals and companies operating in the zones.
The CEPD initiative was green-lighted, April 26, by the Cabinet, which is in the process of organizing a task force headed by Vice Premier Mao Chi-kuo to review implementation of the project.
All related agencies have been directed to prepare concrete action plans for developing the four designated business categories in the next two months. If everything goes as planned, the project will kick off in July.
Turkey’s economy is getting a facelift, a hair-raising experience of sorts that is not only sprouting the growth of whiskers above the upper lip, but profits in the country’s booming medical tourism sector as well. Long favored as a destination for the follicly challenged, Turkey’s cosmetic surgeons have for years offered hair implants to those balding on top. Now, moustache transplants for the face are growing in popularity, cosmetic surgeons and tourism agencies say, as men from the Middle East, Europe and Asia are coming to Istanbul seeking a virile addition for their upper lips.
The procedure uses a technique called follicle-hair extraction, in which doctors remove clusters of hair from the more hirsute areas of the body and implant them along the lip or cheeks to magnify a mustache or beef-up a beard.
Performed under local anesthetic, the surgery takes around five hours and can cost up to $5,000, cosmetic surgeons say. Medical tourism agencies have begun offering “transplant packages” combining facial-hair operations with a shopping vacation in Istanbul or beachside retreat on the Mediterranean coast.
Most customers are foreigners, according to surgeons, as Turkey’s emergence as a place for facial-hair transplants comes as the number of Turks wearing mustaches has declined sharply.
Selahattin Tulunay is one of the surgeons profiting from this bewhiskered boom. From his surgery clinic in an upscale neighborhood known as Istanbul’s Beverly Hills, Dr. Tulunay started facial follicle transplants two years ago and now says he completes up to 60 such operations a month.
“The mustache is making a comeback,” he told the Wall Street Journal as he leafed through a photo album showcasing his most-prized creations. “If a man’s mustache doesn’t grow, he wants to know he can have one as a mark of masculinity. Our customers know that if they pay, we can deliver the results.”
A 34-year-old businessman from Erbil, in northern Iraq, said he traveled to Dr. Tulunay’s clinic after years of low self-esteem over the patchy hair growth on his upper lip.
“The mustache is very important in our culture and my wife supported me to get the operation,” he said. “Now, I feel much better. I’ve recommended it to my friends.”
Facial-hair transplants are at the fringe of a broader medical tourism boom in Turkey, which last year generated $1 billion in revenues. The number of visitors Turkey welcomed specifically for surgical procedures rose to 270,000 last year from 156,000 in 2011, according to data from a 2012 report by Turkey’s Health Ministry.
The report showed 100,000 people traveled to Turkey specifically for plastic surgery in 2012, although the numbers don’t break out figures for facial-hair transplants.
The mustachioed and bearded stars of Turkish soap operas — wildly popular across the Middle East, North Africa and the Balkans — have helped again make facial hair a popular symbol of virility and machismo. Surgeons say many patients request the full-bodied mustache worn by Turkish singer Ibrahim Tatlises, which has long set the standard for top-drawer whiskers. Another popular style is the stubble beard worn by Turkish TV show heartthrob and model Kivanç Tatlitug, surgeons say.
“My patients often bring pictures of the stars they want to look like, but I never do what they say because it wouldn’t suit their face,” said Canan Melike Koksuz, a surgeon at Isom, an Istanbul cosmetic surgery practice, which says it has welcomed chief executives and celebrities from as far away as China and Australia for hair transplants. “Once there was less demand because facial hair was more political, but now mustaches and beards are more fashionable, and people want to look trendy.”
It isn’t only men who are seeking ways to emulate Turkey’s rising stars. Clinics in the Middle East have reported that Arab women, who previously favored the full lips, small noses and protruding cheekbones of Lebanese singers, are now requesting the more natural looks of Turkish soap stars.
“Turkish TV series have introduced the natural look. Women who had nose remodeling operations in the past are now unhappy with the shape; they want their tip-tilted noses to look more natural,” said Zekeriya Kul, a plastic surgeon who says he recently moved from Dubai to his native Turkey to profit from the surgery boom.
According to surgeons and agencies specializing in medical tourism, the vast majority of clients come from the Middle East, where facial hair still bristles with political meaning. To be clean shaven has for decades been a political statement of solidarity with the secular, Westernizing elites who were pre-eminent across much of the Arab world until the series of uprisings that came to be known as the Arab Spring.
Despite Turkey’s emergence as a hub for facial hair transplants, the number of Turkish men wearing mustaches has declined rapidly, according to pollsters. A study by Istanbul’s TNS Market Research Company found that while 77 percent of Turkish men had mustaches in 1993, the figure fell to 34 percent in 2011 and is still sliding.
Even the possibility was enough to provoke actress Angelia Jolie to go to any length to prevent cancer down the road. In an op-ed published in the New York Times, the Academy Award winner announced that she had a double mastectomy after learning she carried a faulty gene linked to a high chance that she would develop both breast and ovarian cancer. Her mother, Marcheline Bertrand, got ovarian cancer in her late ‘40s and died at the age of 56.Bertrand’s mother died at the age of 45. When doctors told Jolie she had an 87 percent chance of getting breast cancer, the 37-year-old made the unenviable choice to have pre-emptive surgery.
Jolie’s announcement sent not only shockwaves, but words of encouragement through any woman with a family history of breast or ovarian cancer. The surgeries to remove her breast were not cheap and could be a concern to any potential candidate without top-level insurance.
Fraction of Cost Overseas
The good news is that medical tourism destinations in Mexico, India, Turkey, Jordan and South Korea have the physical infrastructure and highly trained doctors to surgically perform a mastectomy at 40-80 percent less of what it costs in the United States.
Mastectomy involves the complete or partial removal of either, one or both the breasts. The procedure is commonly used for the management of carcinomas of the breast. It is the second most-common cancer among women in the United States, and also attributes to one percent of cancer-related deaths in males.
The decision to have a mastectomy was not easy, but Jolie says she is happy she made it. She said the chances of her developing breast cancer have dropped from 87 percent to under 5 percent. She can now tell her six children that they don’t need to fear they will lose their mother to breast cancer.
Many patients, for a variety of reasons including low prices, easy accessibility and procedures not yet available in the United States, choose to seek treatment overseas for cancer. Treatments for breast, prostate and thyroid cancers are among the most are the most heavily trafficked to medical tourism destinations.
If you think medical procedures have to be a taxing experience, think again.
Maybe you’ve heard that medical tourism can ease some of the worries related to rising costs or limited access to readily available healthcare procedures. What you may not have known is that medical expenses incurred overseas can be deducted under IRS Publication 502. Do you wish you knew this last month before filing your taxes?
So, if you’re thinking about combing elective surgery or another medical procedure with a short vacation overseas, it might be a good idea to start planning for next year’s tax returns. Before you know it, the April 15th deadline will be right around the corner.
IRS Publication 502 states that “Medical expenses are the costs of diagnosis, cure, mitigation, treatment or prevention of disease, and the costs for treatments affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes. Medical care expenses must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are merely beneficial to general health, such as vitamins or a vacation.”
Are You Covered?
Now, if you are wondering if a trip overseas to El Salvador for expensive dental implants you cannot afford in the United States will be deductible or a cancer treatment your wife is scheduled to have in India is a medical expense, consider this: is the travel made solely for the purpose of medical treatment and not a vacation. You are then covered, not only for medical costs, but airfare and transportation to the doctor’s office and lodging while you are being seen as well.
You also should know you are not alone in making these itemizations. More and more people are traveling to places all over the world to get healthcare including all sorts of surgeries not available or affordable to them in the United States. In the meantime, they are getting great quality care and saving thousands of dollars. You don’t have to tell the IRS you are making a vacation out of it, either; but, you will not be able to deduct expenses directly related to personal excursions.
It is important to understand that medical expenses in general are only deductible as an itemized tax deduction and only to the extent the medical expenses exceed 7.5 percent of the patient’s Adjusted Gross Income. Don’t forget to have authentic documentation for proof of expenses and, perhaps, comparable quotes for procedures from a physician at home. You can keep the sightseeing photos to yourself.
Some might call it a miracle. Others say it’s a trachea made of plastic fibers mixed with stem cells. A two-year-old girl knows only that it is breathing life into her tiny body that only a month earlier was given little hope of survival.Thanks to surgery that connected the transplanted artificial windpipe to her mouth and lungs, doctors say Hannah Warren, who was born without a trachea, is breathing on her own and responding to hospital staff.Warren, a Korean-Canadian, is only the sixth patient in the world to undergo the surgery and first in the United States to receive the transplant pioneered by Dr. Paolo Macchiarini, director of the Advanced Center for Regenerative Medicine at the Karolinska Institute in Stockholm.
Survival Chances Upgraded
Macchiarini performed the nine-hour operation, April 9, at the Children’s Hospital of Illinois, after carefully creating the windpipe using stem cells from Warren’s bone marrow that were saturated over a matrix of plastic fibers shaped into a tube. Children born without a trachea are given a 1 percent chance of survival.
Exactly what happens to the windpipe after the transplant isn’t clear, but researchers believe that placing stem cells, which are capable of developing into different types of body cells, can pick up signals from their environment and integrate with existing tissues.
Macchiarini told the New York Times that the body’s regenerative capabilities may help such bioengineered organs to integrate with existing tissues. Children may make ideal patients for these procedures because they have natural and active abilities to heal and grow.
“Hannah’s transplant has completely changed my thinking about regenerative medicine,” said Macchiarini, who wants to conduct a clinical trial in the United States to properly assess the risks and benefits of the procedure, and document how bodies react to the transplanted devices.
The Food and Drug Administration has approved the transplant as only an experimental procedure. Stem cell treatment is not permitted in most countries, and it is only permitted to some extent in the United States. While research and procedures are somewhat restricted in the United States, scientists from around the globe continue to explore the efficacies of embryonic and adult stem cells with astonishing results.
Demand Increases Abroad
Now, as the public becomes increasingly aware of these treatments, the demand for stem cell therapies has moved more and more patients from the United States and Europe to travel abroad to seek experimental procedures.
About one in 50,000 children worldwide are born with a windpipe defect or without one. For these patients and others with defective or diseased organs, manipulating stem cells to generate healthy tissues or organs could be their only chance at survival.
Macchiarini performed all five of the previous transplants of the bioengineered windpipes; four of the patients have done well, while another who received his trachea in Stockholm died. Because of the small number of patients he has treated, critics say it’s hard to determine how valid Macchiarini’s bioengineering technique is in treating patients like Warren.
The days of foreigners travelling to Britain to take advantage of the United Kingdom’s free healthcare services may be numbered. Health Secretary Jeremy Hunt wants non-permanent residents to qualify for nothing other than accident- or emergency related care free-of-charge.
As it stands now, anyone referred to a general practitioner for surgery is given a number, which entitles them to care. Hunt believes the system is too easy for “health tourists” who have fallen ill unexpectedly while in Great Britain and “completely unacceptable” that they are awarded care without more in-depth questioning concerning their entitlements.Government officials believe foreigners taking advantage of Britain’s cash-strapped National Health Service has reached epidemic proportions, costing the United Kingdom billions of dollars each year.
‘World’s Maternity Wing’
A leading NHS surgeon last month said Britain had become the “world’s maternity wing” and an attractive destination for expectant mothers to give birth. Thousands of others travel to the country for cancer, HIV, kidney and infertility treatment – and then leave without paying, he said.
The concerns raised eyebrows last year when the wife of a wealthy businessman admitted that she travelled to London to specifically give birth to two boys and three girls by Caesarean section. As a Nigerian national, she said she was not eligible to receive free treatment through NHS, but it was highly unlikely that she would be made to repay the more than $200,000 in treatment costs.
Hunt has said that anyone with a “questionable” residency status should be issued only a temporary NHS number and be charged for anything other than accident- or emergency related care. Under this kind of scrutiny, hospital or surgeons would be responsible for validating any free treatments or for referring cases to a central governing body to assess charges.
Strain on Healthcare System
The strain on the health system has prompted Germany, Austria and the Netherlands to join forces with Britain to curb free movement and put an end to rampant abuse of benefits by tourists within the European Union. The four members want to make it harder for people from other member states to gain access to healthcare benefits within weeks of arriving in an EU country.
British Prime Minister David Cameron said he was determined to end his country’s reputation as a “soft touch” on immigration and welfare. Beginning next year, arrivals from the EU will be stripped of jobseeker benefits after six months unless they can prove they’ve been actively seeking employment and stand a “genuine chance” of finding it.
Doctor’s orders may now include packing bags, leaving Puerto Rico and becoming medical tourists.
Already frustrated with long lines and a scarcity of specialists, patients in Puerto Rico are finding they may have little choice, but to follow the mass exodus of doctors and nurses off the Caribbean territory and seek treatment elsewhere.
In the last five years, some of the top doctors in Puerto Rico have left for the United States in search of higher salaries and greater reimbursement from healthcare insurers. According to the island’s Medical Licensing and Studies Board, the number of doctors in Puerto Rico fell 13 percent, from 11,397 to 9,950. The biggest loss came from primary care physicians and specialists.
Of the roughly 400 cardiologists who practiced in Puerto Rico about five years ago, only 150 or so remain. The number of anesthesiologists has dropped from roughly 300 to about 100 in the same time period, the island’s Association of Surgeons reported.
Medical professionals say they expect the situation will worsen, but what opportunities healthcare professionals can expect when they get to the United States and are confronted by new federal laws is uncertain.
Some believe President Obama’s new healthcare law – dubbed ObamaCare – may mean the United States will need more doctors amid an influx of patients who may have greater access to healthcare. But, beyond that, definitive implications from the controversial legislation remain muddied for both patients and providers.
So, the question begs whether or not those same Puerto Ricans needing treatment may be able to find affordable care on the mainland or, as a result, may have no alternative than to seek other medical tourism destinations instead.
At the same time residents of Puerto Rico may be forced to leave their homes for care, like a revolving door, medical tourism is attracting foreign patients to the island in their place. Already, two new hospitals are being built in Manati and Bayamon for the purpose of and catering mostly to travelers from elsewhere in the Caribbean, and even some from the U.S. mainland. Many of these U.S. tourists seek cosmetic surgery while their Caribbean counterparts look for specialists.
The island of 3.7 million people has no more than two pediatric neurosurgeons, even though guidelines require at least one pediatric neurosurgeon per roughly 80,000 people. Puerto Rico also lacks 93 full-time primary care physicians to adequately cover the medical needs of the population, according to statistics from the U.S. Health Resources and Services Administration, which tracks areas suffering from a shortage of health professionals. Of the island’s 78 municipalities, 37 need more healthcare professionals including the capital of San Juan and Ponce, the island’s second largest city. The island has roughly 7,000 primary care physicians.
Family and general practitioners in Puerto Rico earn about $72,000 a year, compared to $180,000 for those in the United States, according to 2012 statistics from the U.S. Bureau of Labor. That’s partly due to the lower wages on the island, where the median income is less than $28,000 a year, far below mainland standards. Puerto Rican healthcare providers also get less reimbursement from Medicare for particular services than do those in any other U.S. state or territory.
Currently, more than 670,000 people in Puerto Rico use Medicare. While the U.S. government is scheduled to revise how Medicare reimbursements are determined next year, that won’t stop doctors from leaving – and patients to follow. Whether or not Puerto Rican patients make the United States a stop or choose a destination somewhere else, will depend on how Obamacare plays out, beginning next year.
A recent study commissioned by the island’s Association of Surgeons found the doctor shortage to be aggravated by retiring doctors, and by the fact that fewer doctors are studying allergy, endocrinology, geriatrics and urology. The study also warned about a scarcity of specialists including cardiologists, anesthesiologists and orthopedic surgeons.
Researchers say the likelihood of developing Alzheimer’s disease increases substantially over time so that half the population above the age of 85 suffers with problems of memory, thinking and behavior.
If dementia has become so severe that lapses are beginning to interfere with daily tasks, there’s some good news to report that may be worth remembering.
A U.S.-based pharmaceutical company is claiming to have developed a medical device that can stop the progression of the debilitating disease. Though numerous treatments have been developed in the past to slow down Alzheimer’s, none have yet stopped the build-up of disease-causing proteins.Clinical scientists at Amylex Pharmaceuticals, Inc., believe they have come up with a solution that involves the principles of neuroscience and a device that reduces proteins in the brain and distinguishes itself from previous neurostimulants, inhibitors and vaccines.The therapy, called Betaclear™, is designed to eliminate the build-up of harmful beta-amyloid toxins before they can disrupt the connection and proper functioning of brain cells. Because the device’s process of combating the disease is extracorporeal or takes place outside the body, Amylex claims that side effects are not likely, an improvement from previous treatments.
Boon for Philippines
What’s more, Amylex plans to register Betaclear™ for clinical trials, first in the Philippines, giving the island nation a leg up on medical tourists desperate to find Alzheimer’s treatments for themselves or a loved-one.
Officials at Amylex said the decision to re-validate Betaclear™ in the Philippines came down to which country could develop the device cheaper and faster, possibly saving years and millions of dollars compared to processes from discovery to commercialization in the United States.
That doesn’t mean governing authorities in the Philippines will be any more lax in approval protocols, at least from the theoretical end, which, at this point, may be of least concern to the nearly 36 million people around the world with Alzheimer’s disease or other dementias. By 2050, that number can triple, according to a 2011 report by Alzheimer’s Disease International.
A study by the University of Washington’s Institute for Health Metrics and Evaluation (IHME) claims that Alzheimer’s jumped to ninth among leading causes of premature death in the United States, up from 32 in 1990, making it the fastest growing health threat in the nation.
Betaclear is far from a drug, but rather a “nanomachine.” As a medical process, the device has been compared to dialysis, in which a patient’s blood is coursed out and cleansed before returning to the body.
Beta amyloids are known to develop in the body and circulate through the blood stream before depositing in the brain. Accordingly, Betaclear attracts the beta amyloids out of a patient’s blood by using a special molecule that can be likened to “a magnet.” To this end, the patient’s blood goes through a chamber, from which nearby molecules in another compartment cleanse and separate the beta amyloids.