The Road Ahead for Medical Tourism to Jordan
Jordan’s baseline is quality healthcare. Whether the number of patients traveling to Jordan is going up or down this year, or if these patients are actually considered “medical tourists,” the fact remains that Jordanian Hospitals have exceptional quality to offer. People are traveling there to receive treatment, whether it’s out of necessity or choice. Even though Jordan saw a drop in the number of patients traveling to Jordan for healthcare in 2011 due to the “Arab Spring,” their efforts towards its healthcare sector over the years has culminated in the International Medical Tourism Wellness & Spa Congress organized by the Private Hospitals Association (PHA) in collaboration with the Medical Tourism Association™.
Boasting 102 hospitals, ten of which are accredited by the Joint Commission International (JCI), Jordanian healthcare rises to the top of the ever growing list of international healthcare destinations. Factors weighing in are no wait periods, English speaking staff and surgeons, and potential cost savings on procedures with market value lower than those offered in the US and Europe by a percentage of 25 – 40 percent and a percentage of 5 – 10 percent less of those offered in India, Singapore and Thailand.
Alongside the JCI, Jordan has also implemented its own national accreditation association – Health Care Accreditation Council (HCAC)
Health Care Accreditation Council (HCAC)
The HCAC was registered as an independent, non-profit private shareholding company in December 2007. It is a national investment characterized by the unity of stakeholders in regards to healthcare quality and patient safety.
The HCAC has on its Board of Directors the major providers of healthcare in Jordan: the Ministry of Health, Royal Medical Services, Private Hospital Association, university teaching hospitals and the professional healthcare syndicates and associations. In addition to these, there is representation from the communities of academia, law, business and economic sectors.
HCAC was conceived as a joint initiative from the Ministry of Health and the USAID under the Jordan Health Accreditation Project (JHAP). JHAP worked to develop the HCAC’s technical and financial capacity to become the leader and key propagator of continuous healthcare quality improvement in Jordan and the region.
The mission and goal of the HCAC is to promote continuous quality improvement and excellence in healthcare services through the philosophy and process of healthcare accreditation.
Jordan is located on the east bank of the Jordan River and bordered by Syria, Iraq, Saudi Arabia and Palestine, and shares the Dead Sea with Israel. This country is home to a population of 6,316,000, most of whom are bilingual in Arabic and English.
The appeal of Jordan is vast, offering a variety of attractions: spiritual, therapeutic, historical or adventurous.
One of the most well-known attractions, also one of the Seven Wonders of the World is Petra. This unique city is carved completely into the sheer rock of a mountain by Nabateans, an industrious Arab civilization. The huge rocks are colorful, mostly pink, and the entrance to the ancient city is through a 1.25 km, roughly three quarters of a mile of narrow gorge in the mountain called the Siq.
The city is filled with various structures, all are carved into rock of which its most famous monument without a doubt is the Treasury or Al Khazneh, which is located at the end of the Siq. It was used as an import junction for silk, spice and other trade routes that linked China, India, and Southern Arabia with Egypt, Syria, Greece and Rome.
While Jordan boasts its excellence in quality medical care, it is also an attraction for spa and wellness due to it being the home of the Dead Sea.
The benefits from Dead Sea bathing are attributed to a natural tar in the water and also to high level of minerals that may affect the rate of skin cell growth. Dead Sea mud is considered helpful in two ways: the dark mud helps UV light get absorbed and mud packs stimulate blood circulation around joints affected by Psoriatic Arthritis.
It is also known to heal wounds, and helps slow down the all around aging process of the skin. A rare chemical composition of Chloride, Bicarbonate, Sulphate, Sodium, Potassium, Calcium and Magnesium bestows the Dead Sea with its substantial curative properties.
The water of the Dead Sea is effective in healing allergies, psoriasis, eczema and purulent rashes. It also aids blood circulation and improves one’s metabolism by relaxing the nervous system. It cleanses the skin and improves its outer appearance and its elasticity.
Today, many world class hotels and spas have been built on the shores of the Dead Sea so people can enjoy the healing properties of the indigenous mud and water available in this region.
“The Jordanian medical and wellness healthcare will flourish bearing in mind the uniqueness of the Dead Sea on one hand and its 10% excess Oxygen to any other location on earth, and because of the high demand there is high return for investors in the field,” said Michael Nazzal, Senator and president of Jordan Hotel Association. “More investments in medical establishments will take place in the few coming years,” he added.
Healthcare in Jordan
Jordan has 102 operating hospitals 59 of them are private hospitals, 30 are public, 11 are royal medical services and 2 are university hospitals.
The public sector is under the responsibility of the Ministry of Health which accounts for 37 per cent of all the hospital beds in the country. The private sector provides 36 per cent of the hospital beds and the rest are run by the Jordanian military service.
Part of the advancement in medical care was contributed to Jordan being the first country in the Middle East to: perform an open heart surgery, laparoscopic surgery, heart transplant, kidney, liver and bone marrow transplant and to have the first IVF baby born.
Infection control is taken very serious in Jordan. It is closely monitored by the government, and the disease infection rates are very minimal like TB and HIV which are the lowest in the region. Diseases like Malaria and Cholera no longer exist in Jordan since the early 80’s.
The number of resources in the medical sector is another major element Jordan posses. Over 42,000 people are employed in the medical sector, and 90 percent of the physicians are educated internationally. Percentages of physicians reach up to 24.5 doctors per 10,000 populations compared to 26 in the U.S., 19 in Libya and three in Thailand.
“The health sector in Jordan benefited from the high education quota and people’s desire to enhance their knowledge which is clearly reflected on the number of doctors and private hospitals,” said Nazzal. “A comprehensive social medical system exists in Jordan, although there is certain need for improvements.”
In 2010 around 234,000 foreign patients (in and out patients) from 102 countries were treated in Jordanian private hospitals, medical centers and clinics constituting a percentage of 23 percent of the total patients treated in the kingdom and the total income generated from medical tourism that year exceeded 1.2 billion USD the growth percentage reached up to 10 percent annually.
These foreign patients came to Jordan to have treatment in all specialties and especially in cardiac, neurology, orthopedics, cancer, ophthalmic, kidney and liver transplant, hip and knee replacement and others.
“With Jordan being a prime contender as a leading medical tourism destination, more investment from the public and private sector is being poured into the industry to develop the healthcare delivery, access and health information systems,” explained Prem Jagyasi, a medical tourism consultant.
Numbers in the medical tourism sector did drop in 2011, due to the turmoil in the Middle East. Foreign patients fell to 180,000 in 2011 but steps are being taken to counteract that. Plans were announced in December by the ministerial council of the GCC to fund a five-year development aid program for Jordan, which has been invited to be a full member of the political and economic bloc. According to data obtained by The Media Line, during the first eight months of 2011 at least 26% more visitors from the Gulf GCC states came to Jordan.
In addition to the five-year plan, the International Medical Tourism, Wellness and Spa Congress and the 2012 Jordan Health Care Exhibition were planned to assist in bringing those numbers back up.
According to the Insurance Market Report by AXCO, medical tourism is a potential growth industry. The sector represented 8.3% of GDP and 7.3% of employment in 2011.
The target market for Jordan is regional from the MENA countries and international the U.S., Canada, UK, Russia and Former Soviet Union countries.
“As a way to develop relationships with these markets buyers from all these countries are invited to the Congress,” said Awni Bashir, president of Jordan Hospital, which is affiliated with the PHA.
Continued frustration over living standards, police violence, rampant unemployment and lack of human rights were the reasons leading up to the major political statement made on December 17, 2010. In Tunisia, a 26-year-old man, who supported his family by selling fruits and vegetables set himself on fire in front of a local municipal office after police confiscated his cart because he did not have a permit.
This was the start of the uprising in the Middle East. Word spread quickly and other countries soon followed with uprisings of their own. It spread to Egypt, Yeman, Bahrain, Libya and Syria. These uprisings have impacted the entire Middle East. Jordan’s political stability and prominent respect within the region have sheltered it to some degree from its neighbor’s violence. However, this does not mean it is not feeling the impact.
The previous challenges in attracting international patients were mostly due to the violence in Jordan’s surrounding countries.
“Traditionally not all Middle Eastern countries are known for their world-class quality healthcare facilities which can cater with ease to international patients,” said Jagyasi.
Now, with the ongoing uprisings it will be a greater challenge to bring in patients outside of the M.E.
“Not only is it affecting medical tourism, but also the tourism sector in general,” said Jagyasi.
While international patient numbers have dropped, Bashir feels that the changes have positively affected Jordan since they are a stable, secure and clean country. “We have more patients especially from countries that witnessed changes.”
The tourism and medical sector in Jordan are hosting conferences to counteract the increased concerns about traveling there. Their goal this year is to brand Jordan as a destination on its own. The Minister of Tourism and Antiquities Nayef Al Fayez said in an interview in the Jordan Times that, “the sector will focus on promoting Jordan as a standalone destination this year to avoid the repercussions that hurt the industry last year due to Jordan being promoted as part of joint packages with neighboring countries, such as Syria and Egypt.”
Libyan patients coming to Jordan
“Libyan patients have been coming to Jordan for medical treatment since 10 years ago and Jordanian medical services are known in Libya with its excellence, high quality care services and competitive prices, and because of that Libyan patients and new Libyan government have chosen Jordan as their first and desirable destination for medical treatment both for wounded people and people with other required medical specialties and treatments,” said Dr. Abdallah Hindawi, CEO of Private Hospitals Association .
Ali Bin Jalil, head of the Libyan Medical Committee in Jordan, said in an article by the Jordan Times that 58,000 Libyans entered the Kingdom of Jordan since last February, but only 48,000 came for medical treatment, others came for tourism.
Since such a large number of patients from Libya have been filling hospital beds in Jordan, there has been speculation in the media that these patients have been overcharged and that the Libyan government now owes the government in Jordan a large sum of money and they are having difficulty collecting payment.
This is not the case for the PHA.
They signed an agreement with the Libyan government on November 7, 2011 in which fixed prices were approved based on the hospitals pricelist approved by the Ministry of Health in Jordan and the official prices for Jordan Medical Association (2008). This is the same price list for medical treatments offered to local patients.
“Libyan patients are treated with the same prices local patients have to pay,” said Hindawi. “The Libyan government is only down 25 percent of the total invoice that they have to pay to private hospitals,” he added.
The PHA and Libyan government made an agreement for a payment arrangement.
“After extensive pressure from the Private Hospitals Association and continuous follow up and lobbying with both cabinets in Jordan and Libya; they promised to pay another 50 percent of dues by the end of March 2012,” explained Hindawi. “The remaining balance will be paid within one month and after hospital invoices are audited.”
Hindawi also mentioned that the number of Libyan patients who traveled to Jordan for medical treatment constituted 65 percent of the total patients that left the country for treatment and the Jordanian medical invoice was only 8 percent of what they had spent on treatment abroad.
Public versus private sector healthcare
At the medical tourism conference held in March, another very important issue was raised pertaining to the Jordanian “rescue missions” in Libya, Iraq and Syria. One medical director of a public hospital in Jordan vocalized his concern that since the Jordanian government was supporting the influx of patients both from Libya, Iraq and Syria, then public hospitals should be receiving “their share” of these patients and the business from abroad. There was also a comment that medical tourism should not be a public sector enterprise but that it should involve all hospitals within Jordan.
Needless to say the role and responsibilities of treating international patients would be best held in those facilities which not only have the proper capacity and medical expertise, but also the ability to treat international patients and have the resources to ensure continuum of care.
It has not been resolved as to whether these claiming hospitals have such capacity, however what is clear is that the efforts of the Private Hospital Association in achieving international accreditation status for patient safety and quality and in promoting Jordan for international healthcare has not gone unnoticed.
International Medical Tourism Wellness & Spa Congress
“In the past five years, Jordan has streamlined its efforts to become a medical tourism hub, participating in a plethora of international events in targeted markets. This participation increased awareness of Jordan as a desirable medical destination, with medical sector revenues increasing to $400 million by 2011. To take advantage of its emerging profile in the medical services sector, Jordan hosted this forum,” said Hindawi.
Held at the Kempinski-Ishtar Hotel Dead Sea- Jordan, this conference was host to academics, researchers, healthcare buyers, innovators and decision-makers working in areas such as: governments, healthcare, travel and embassies. This Congress provided a platform for sharing and learning about the wider issues of the future of medical tourism, quality assurance and accreditation, e-health, Jordan as a wellness destination and medical liability issues.
“It was a great success for Jordan and gathered over 300 industry participants from the medical tourism field and insurance companies as well as official delegations representing Dubai Health Authority, Ministry of Health In Bahrain, Ministry of Defense in Sultanate of Oman and, Ministries of Health and International Trade, Turkish HealthCare Travel Council who all appreciated the organization of the congress and the high level of international participation,” said Hindawi.
“Observing the experiences and expertise of others and exchanging constructive ideas in the field of medical tourism is important for the growth of this sector,” said Qadhi Saeed Al Murooshid, director-general of the Dubai Health Authority, in an article by Trade Arabia.
“This knowledge will then be used to fortify the position that the Emirate of Dubai has come to hold in this sector, particularly since the medical tourism industry has became a sector of interest and all countries around the world are keen to support the growth of this sector,” said Al Murooshid.
Private Hospitals Association (PHA), host of the Congress, is a private voluntary, non-profit organization that was established in 1984 representing the private hospitals interests in Jordan. The PHA membership comprises Independent Private Hospitals in Jordan, they currently have 39 members. Their mission is to assist members in providing integrated high quality health care services to their patients and building the hospitals’ capacity to become globally competitive.
In addition to the main goals, the PHA has incorporated medical tourism to their list. Some of their objectives for this industry are :
- Developing the quality and safety of services hospitals are offering
- Improving the financial efficiency of member hospitals
- Improving operations, human and physical resources of PHA and its capacity to provide services for its members
- Assisting the member hospitals in acquiring local and international accreditation
- Encouraging more favorable government regulations and policies for private hospitals especially those related to patients’ rights and the medical liability law and regulations
- Increasing promotional opportunities for member hospitals to be competitive internationally
- “I was delighted to represent DNV Healthcare in the Congress. Jordan’s Ministry of Health and the PHA are to be applauded for their commitment and ongoing efforts to enhance the provision of safe and quality care, anchored by their support of standards and accreditation as a mechanism for ongoing sustainability,” shared Karen Timmons, global patient safety officer for DNV Healthcare and speaker at the Congress.
Last year’s Congress had the support of USAID, a U.S. program that extends assistance to countries recovering from disaster, trying to escape poverty and engaging in democratic reforms. They also have a focus on global health. Jordan was an area they were working closely with through its SABEQ Program. This program was a member of the Jordan Medical Tourism Cluster and was in place for five and a half years. SABEQ ended in March 2012, but the technical assistance effectively ended in December 2011.
“We are planning a new program to replace SABEQ, this new program will continue to support and provide technical assistance to the medical tourism/services sector. We hope this new program will start late summer 2012,” said Paul Bruning, director, Office of Economic Growth, USAID/Jordan.
Throughout the partnership some key achievements were made, they included:
- Working with the stakeholders in the sector on quality assurance and accreditation issues, such as the JCI accreditation. Assisted eight hospitals in achieving JCI accreditation.
- Building alliances with international organizations to create visibility and improve service delivery.
- Supporting the Jordanian Nursing Council (JNC) in achieving American Nurses Credentialing Center accreditation.
- Trained nursing educators from Jordanian universities and nurses from 15 hospitals on evidence-based nursing practices.
- Established a continuing education facility for nurses through the JNC.
- Supported private hospital officials in attending the second and third World Medical Tourism & Global Healthcare Congresses.
- Established the Medical Services Innovation Cluster.
- Established and supported the Medical Liability Law Task force to develop recommendations for passage of a proposed law outlining the rights of medical professional and patients.
Even without the support from the USAID, the PHA had the desire to continue hosting this Congress in collaboration with the MTA and receiving support from its member hospitals and other medical tourism cluster members.
“Investing in such an event will definitely showcase Jordan as a smart medical destination for international medical tourism and insurance companies from all over the world,” noted Hindawi.
Destination Guide to Health and Wellness in Jordan
In efforts to further the growth of this industry, the Private Hospital Association and Medical Tourism Association™ unveiled the Jordan Health & Wellness Destination Guide to all attendees at the conference. The guide provides a comprehensive list of resources with pages of clinical listings, hotels and attractions.
It was designed with the consumer in mind and compiles all of the options Jordan has to offer for health, wellness and tourism. This was the second Destination Guide the MTA has released since the program began in 2011. This will put Jordan another step ahead when marketing themselves, it will paint the whole picture for the consumer.
“We believed that more efforts should be made by our association to attract and increase the number of patients who select Jordan as their medical and wellness destination, this will assist hospitals in entering new regional and international markets,” said Hindawi.
“The guide was welcomed with enthusiastic support from conference participants and we are excited for the rest of the world to have access to Jordan’s top medical tourism resources. We are proud to have partnered with the MTA and look forward to years more of collaboration,” he added.
“At a time of rising healthcare costs, and reduced public spending throughout the globe, a more knowledgeable healthcare consumer will seek timely access, affordable, safe and quality care. Jordan’s healthcare sector appears to be well aligned with these goals and the commitment of Jordanian hospitals to seek objective third party assessment of their compliance with standards should continue to enhance their reputation as a medical travel destination,” said Timmons.
Jordan clearly has no plans of slowing down in their efforts of branding the country as the go to destination for high quality affordable care. Even with a few roadblocks or a decreased amount of foreign patients, they are still going strong and firmly believe that the medical services Jordan has to offer will put them at the top of this industry. This is a challenge they have accepted, and are not backing down from.
“Due to the continuous efforts PHA and its members are promoting in medical services abroad it is aimed and expected that by the year 2015 more investors will be investing in building hospitals and medical centers and the number of medical beds in the private sector are expected to reach up to 6,000 by the year 2015,” said Hindawi.