Patients in Emerging Markets

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Whether fully emerged or in the beginning stages for making upward advancements in healthcare each of the 87 countries represented at the 2011 Congress were there to at the very least learn about their options for broadening the scope of healthcare.


While some countries are going full speed ahead with branding their countries as a destination for healthcare  others are trying to improve the quality ensure proper coverage or work with another country or region to manage the outbound patient flow because the care offered at home is just not adequate.


Realizing the needs of your patients what they are looking for and why they are leaving are the first steps to take to improve the fundamentals in a healthcare system. Ministers of Health physicians tourism boards governments and hospitals traveled from all parts of the world to learn and share best practices for overcoming challenges and improving the current situation in their home country and emerging markets.

Specialized Hospitals in Healthcare

Establishing specialized hospitals is one step in the direction of branding your country as a destination for healthcare. Selin YÄldÄrÄm Peker Excecutive Vice President for Dünyagöz Hospital - World Eye Group explained the many advantages to developing these facilities at the 2011 Congress.


Practice makes perfect. Having more focus on a specific condition allows hospitals to become extremely comfortable with every aspect in this form of healthcare. If the patient were to go to a general hospital they would be able to be treated but those doctors do not handle that type of case on a daily basis.


Additional medical advantages include: maximum diagnosis reliability lower complication rate and time efficiency.When the patients decides on a specialized hospital they are receiving care from the most expert physicians in the field using the most state-of-the-art technology due to investments made for equipments used specifically for a certain condition said Peker. Patients can be assured that the physician treating them has experience in that field she added.

Dünyagöz Hospital  Levels of Excellence

Since the first Dünyagöz Hospital went into service in 1996 there have been significant developments in the quality of care and number of facilities primarily in Turkey and other countries around the world. By developing branches of hospitals outside of Turkey they are able to offer their level of eye healthcare and training to a larger population of people and create centers of referral to their Turkish hospitals.


There are 12 facilities in Turkey and they have expanded locations to Berlin Amsterdam Cologne and Belgium Albania and England. The majority of branches outside of Turkey are pre-treatment centers which provides pre-operative examinations and laboratory tests for patients that plan to travel to Turkey for the actual surgery.


By building clinics and hospitals in destination countries Dünyagöz Group aimed to brand themselves as the go to country/hospital for eye health.In addition to having high quality of care Dünyagöz has implemented customer service strategies successfully by developing an operational cycle and travel/operation packages.


The operation cycle assists patients with appointment setting airport pickup and transfers between airport-hospital-hotel airport accommodation in 5-star facility onsite consultation and assistance in Visa procedures city tour organization and guidance in international insurances.


Traveling into Turkey for healthcare is a $ 2.4 billion dollar market said Peker. In 2010 there were 487000 health tourism visitors that was a 35 percent increase from 2009 she explained. In 2002 one percent of patents at Dünyagöz were foreign now in 2011 35 percent of patients they treat are from other countries.


Patients have traveled into Turkey for a number of procedures some of which include eye treatment oncology IVF dental medicine and plastic or reconstructive surgery. The majority of patients traveling to Turkey are from Africa Europe and the Middle East due to strategic positioning.


No waiting time for patients and competitive pricing compared to other regions is enough to attract them combined that with the world class facilities doctors and hospitality and Turkey could be considered a healthcare hub.

Oxana Lutsenko-The Russian-Speaking Patients Portrait

Russia has been responsible for some major developments in healthcare such as laser eye surgery and breakthroughs in relation to heart surgery and there are several medical facilities and doctors all throughout the country the potential for exceptional healthcare exists.


Even so healthcare has fallen behind military and industrial developments in the level of financial priority.i With the continued lack of funds medical equipment supplies and proper organization of healthcare delivery an acceptable level of service cannot be reached.


Policy makers put the goals of health protection behind other protected state priorities. Therefore the healthcare system is for the moment financed just at the survival level. iiOperating at survival level means cutting costs.


Facilities had to switch to cheaper and less advanced technologies construction and reconstruction are out of the question leaving hospitals to operate with whatever they already have. The available funds are spent on the needs of right now such as salary payments which of course are below an acceptable level.


Russian nationalized medical care is financed by the federal budget and is free of charge but the quality varies. The facilities that do approach acceptable standards have limited spaces and do not accept all cases. The majority of quality hospitals restrict services to business hours or to patients that pay for health services in advance.


Until the situation improves this population of people will be in search of quality healthcare elsewhere.300 million people throughout the world speak Russian it is the 5th most spoken language worldwide. Given the current healthcare status in Russia this could be an opportunity for healthcare destinations to directly market to Russian speaking patients.


Oxana Lutsenko Founder/CEO of Medvoyage.info quoted some statistics at the 2011 Congress.Out of the 300 million Russians around the world:

  • 270 million are in the CIS territory
  • 17 million have income above $1000
  • 11 million go on vacation abroad
  • 2.5 million live in Germany
  • 3.5 million live in the U.S.

Medvoyage.info is a website based on promotion of outbound medical tourism from Russia. The purpose of this website is to offer information about diagnostics treatment and health tourism abroad. This is a portal for Russian speaking people who are interested in traveling for medical care. Russia Ukraine and Kazakhstan are the three countries with the highest website traffic.

Healthcare in the Middle East

For many years a top priority for medical providers around the world has been to attract medical tourists from the Middle East. Now times have changed and the Middle East is looking to bring in medical tourists from countries where the cost of healthcare and wait times in getting treatment is very high.


There are many challenges to overcome for countries in the Middle East to become a destination for healthcare but there are also many opportunities.At the 2011 Congress Mouhanad Hammami President of the National Arab American Medical Association (NAAMA) and Dr. Hisham Diwani Ministry of Health-Syria discussed the challenges and possibilities of medical tourism between Arab and American countries.

Fixing the Problem at Home

The GCC region has experienced an increase in the demand for healthcare as a result of population growth limited investment and increase in affluent health disorders. Even though the healthcare systems have improved the availability and quality of care is not always satisfactory.


There is a lack of super specialty services and many hospitals are ill-equip to handle emergency cases. Billions of dollars have been spent on healthcare outsourcing. With the undersupply of sources affordability is a major factor in seeking healthcare in the Middle East.iii


Proper health insurance is another area where some ME countries falter. For example for years health insurance in Syria was a very limited option. The Syrian Insurance Company (SIC) was the only way to get coverage for decades. With no competition there was no need to lower the rates they were in the position to name the price.


By the time the 1990's came around there started to be signs of change within the insurance industry. By 2005 the Syrian government had introduced an insurance control legislation which permitted the establishment of private insurers finally giving the SIC some competition with lower rates.


Even with the establishment of new insurance legislations allowing private insurers to offer services to a larger variety of people health coverage is still limited and geared more towards people of a higher socioeconomic status.


Out of pocket payments are the norm for most households in the Middle Eastern countries which accounts for more than half of the total health spending said Dr. Diwani.Public hospitals are available to everyone for primary secondary or tertiary care but that is not the option people take when they are looking for the best and timely care.


Most pay medical personnel privately in cases of disease or accidents or high cost medical treatment families cannot afford it. The issues with healthcare in Arab countries are driving patients to find treatment elsewhere.


These countries are working to improve the healthcare system becoming an emerging market. While improving standards to keep their own they are also taking strides to attract outside patients that cannot get what they need from their home country.

Attracting the Medical Tourist

According to the McKinsey report trends in medical tourism for these countries show that 58 percent of the Arab patients are traveling to the Americas while 2 percent of Americans travel to the Middle East. Different religions and cultures can have a major role in affecting healthcare.


Being prepared for your patient's religious and cultural beliefs is just an extra step to take to gain the patients trust and fully understand their medical history. For example in Latin America some patients visit a local healer for a different style of treatment that should be disclosed in the patient information so the doctors can be prepared for any complications that might arise.


Another example Muslims follow a certain diet of non-pork or strictly vegetarian meals the hospital should be prepared for this type of patient and take into consideration how this comes into play with the patient's medical history Hammami said.


While cultural challenges can affect the patient directly the political challenges are factors that can make it difficult or impossible to travel to and from Arab countries. Factors such as visa restrictions anti-Muslin rhetoric and the turmoil and unrest in the Arab world combine with the terrorist attacks on 9/11 have caused a decline in the number of patients traveling to and from these countries.


Continuation of care is one of the major things that the Medical Tourism AssociationTM advocates for. Sure traveling to another country for a procedure may go well but what happens when you arrive back to your home country and there is a complication?


When your doctor is locally based follow-up visits are not a problem nor are retrieval of medical records not all technologies are the same in every country. In some cases in the U.S. physicians will not treat patients that received surgery outside of the U.S.

Opportunities to Grow

While cultural differences can be a challenge it can also be an opportunity to attract a larger variety of patients. Most U.S. centers with international programs employ native certified interpreters that can be assigned to patients from the same country that speak the same language and are familiar with the religious background.Sensitizing to both social/culture and gender requirements will help providers communicate better with patients and develop a trusting and long-lasting relationship explained Dr. Hammami.Some hospitals are beginning to introduce e-health.


Better continuity of care can be provided with advanced technology offering telemedicine and teleconsult. The Eastern Mediterranean Health Journal published the countries likely to introduce e-health the UAE led regionally with Syria coming in last at a level 12 ranking.


Becoming an accredited facility is a big step to take to put a hospital on the map as a destination for healthcare. As of 2011 the JCI Accredited Arab hospitals consist of 35 in the UAE 35 in KSA nine in Jordan and five in Qatar plus more.Partnerships between the U.S. and Arab countries have already starting developing. So far the leading U.S. based partnerships include:

  • University of Pittsburgh Medical Center-Qatar
  • Harvard Medicine- Dubai
  • Cornell Medical School- Qatar
  • Johns Hopkins Hospital- UAE & Lebanon
  • Cleveland Clinic  Abu Dhabi

The percentage of tourists coming to Syria for treatment is 5% of total tourists said Dr. Diwani. This means that this type of tourism is expected to increase if invested properly he added.Improving the quality and availability of healthcare is vital to attracting patients but it is not the only thing that will draw them in.


Part of the appeal of traveling for medical care is going to another location and experiencing the culture and history. While branding as a destination for healthcare marketing the tourism aspects is a key factor. Dr. Diwani explained how Syria focuses on the rich history combine with lower priced hotels food and transport and easy access for patients from Arab countries Turkey and Iran that do not need Visas to enter.


In some of the medical tourism best practices establishing a healthcare cluster has proven to be beneficial. This gathers hospitals governments and tourism boards from one country they form a system of handling patient flow.


Doctors travel agents hotels and governments can all be on the same page with the patients treatment and after care before and during the experience offering the best care possible and maybe even a little sightseeing if their recovery permits.


How can the current healthcare system be improved to keep and attract patients is a question many countries are asking and a problem many have solved. Looking at what others have done and implementing a system that works for your country could be the key to improving a less than desirable healthcare situation and really starting to brand your country.


Sources

i http://www.allianzworldwidecare.com/healthcare-in-russia

ii http://www.rand.org/pubs/conf_proceedings/CF124/CF124.chap5.html

iii http://medicaltourismmag.com/article/MiddleEastern-Patient.html

About the Author

Olivia Goodwin is the Associate Editor for the Medical Tourism Magazine. She travels around networking developing ideas and original content for the Magazine and the Association. Olivia holds a degree in Multimedia Journalism from Florida Atlantic University. Contact Olivia for media inquires and details for contributing articles. She may be reached at Olivia@MedicalTourismAssociation.com