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Medical Travel Today is a publication of CPR Strategic Marketing Communications, a public relations firm based near New York City that specializes in healthcare and life sciences, with an international clientele. CPR, its Partners, and clients are at the nexus of where medical travel is today, and where it will be tomorrow.
Laura Carabello
Laura Carabello
Managing Editor
Megan Kennedy
Table of Contents
From the Editor: This week in Medical Travel Today, Laura Carabello
Turkey to Organize Health Tourism Summit in London
Medical Tourism, Like Proton Therapy, Bringing Economic Impact to Jacksonville
Medical Tourism Taking Off in Hainan
Should Australia Look to Become More Friendly to Medical Tourism?
Principal Solar, Inc. Announces Launch of Proposed Initial Public Offering
David Newman, Ph.D., J.D., Executive Director, Health Care Cost Institute
I. Glenn Cohen, Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School
Connecting the Travel Industry to the Medical Tourism Industry - Part Two
Reflections Going Forward: The IMTJ Summit 2015
Dubai Envisions Becoming a Leading Medical Tourism Choice
Could Medical Travel be a Sustainable Option for Global Obesity Problems?
Health City Cayman Islands Awarded JCI Accreditation
Apollo White Dental Launches 'HOLI-DENT' Scheme to Embrace Travelers Seeking Dental Treatment in India
NYU Researchers Examine Obesity Perceptions Among Chinese-American Adults in NYC
International Medical Travel & Global Healthcare Business Summit
Help Save a Life and Support MatchingDonors
Upcoming Events
6th Annual International Medical Travel & Global Healthcare Business Summit
Destination: Health Canadian Medical Tourism Trade Show
2nd Istanbul Medical, Health, Geriatrics, Termal, Spa & Wellness Tourism Fair & Congress
Arab Health: International Medical Travel Exhibition and Conference
9th Annual 2015 Global Spa & Wellness Summit
23rd Moscow International Travel & Tourism Exhibition
Volume 8, Issue 14
Dear Colleagues:
As the push for transparency continues to streamline the healthcare industry, employers, insurers and others may begin to modify plan designs based on readily available information.
Earlier this year, the Health Care Cost Institute (HCCI) launched its new site Guroo.com, which provides individuals with the average price paid in a specific market for healthcare services.
Although many consumers will continue to purchase plans based on convenience, physician referrals and word-of-mouth recommendations, price transparency is necessary for a properly functioning market.
According to David Newman, Ph.D., J.D., executive director, HCCI, "When you think about transparency, you must focus on services that are 'shoppable,' discretionary or schedulable. For example, if I'm having a heart attack, I'm not going to pull out my iPhone in the ambulance and ask the driver to pass by two local hospitals because the price is cheaper in a distant location."
That said, it is imperative that consumers, patients and providers establish a foundation for open communication about price and quality concerns prior to treatment. A free, informative platform like Guroo.com makes it much easier to do this.
We're starting to hear from many hospitals, independent surgi-centers and provider groups that want to be better positioned to serve self-funded employers offering medical/surgical travel options. If you have a good story to tell us, please be in touch! We want to boost opportunities for Centers of Excellence nationwide.
Tell us:
What distinguishes your service offering in terms of cost, patient experience and satisfaction, outcomes, or other quality indicators.
Send us your descriptor, including photos or charts, and we will evaluate for publication in this newsletter.
Please be in touch and let me know how you are surviving and thriving in this emerging marketplace.
Laura Carabello
Editor and Publisher
Medical Travel Today
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David Newman, Ph.D., J.D., Executive Director, Health Care Cost Institute
About David Newman, Ph.D., J.D.
Prior to joining HCCI, Dr. Newman was a specialist in healthcare financing at the Congressional Research Service, and previously served as a consultant to the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the U.S. Army and Navy, the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, and the U.S. Agency for International Development.
Dr. Newman possesses a Ph.D. in Political Science from the University of Rochester and a J.D. from the University of New Hampshire Law School. He has held academic appointments at Georgetown University, the National University of Singapore and Lingnan University in Hong Kong.
About Health Care Cost Institute
The Health Care Cost Institute (HCCI) is an independent, non-profit organization with a public-interest mission. Launched in 2011, HCCI is now a leader in research and reporting on healthcare expenditures and utilization. HCCI holds data for over 50 million covered lives from the privately insured population and Medicare Advantage, resulting in one of the most comprehensive claims datasets in the country. In addition, HCCI is the first national Qualified Entity (QE) entitled to hold Medicare data for the 50 million individuals covered by the program. For more information, visit www.healthcostinstitute.org or follow us on Twitter @healthcostinst.
Medical Travel Today (MTT): What led to the establishment of the Health Care Cost Institute (HCCI)?
David Newman (DN): In 2011, Aetna, Humana, United and Kaiser Permanente formed the organization.
Upon launch, HCCI was immediately turned over to an independent board comprised principally of academic economists at major universities - the provost at Harvard University, the present administrator of Brigham and Women's Faulkner Hospital and independent actuaries.
The institute was created to do public reporting on cost and utilization trends among the commercially insured.
Historically, most of what people originally knew about healthcare in this country came from Medicare data, which was not reflective of the country's overall population.
MTT: What is the focus of HCCI?
DN: Initially, our mission was to report on national cost and utilization trends and to license the data to academic researchers for non-proprietary, non-commercial research.
In January of 2012, we began to pull the claims data from the insurers. We currently hold 13 billion claim lines representing more than 25 percent of the commercially insured population in the U.S. Building a cross-payer data set of that size is an immense task. This data set contains the allowed amount of co-pays, deductibles and co-insurance on each of those paid claims. As a result, we know how much everyone actually gets paid.
We began reporting on trends in May of 2012, and since then, our reports have become the definitive source of information on the commercially insured population.
Next, we set out on a mission to support academic group research, and so, we created the Academic Research Partnership Program, which includes Dartmouth, University of Pennsylvania, University of Michigan, Minnesota, Northwestern and MD Andersen. Also, we have the Congressional Budget Office, Medicare Payment Advisory Commission, and two actuarial societies licensing our data to uncover the cost drivers with respect to healthcare trends in the U.S.
Finally, in May of 2014, we announced our price transparency initiative, and were recently able to launch Guroo.com.
We've added Assurant Health as another data contributor to the initiative, and have become the first nationally qualified entity in the U.S., which gives us rights to all of the Medicare data.
By the end of 2015 we hope to hold data on more than 100 million people.
MTT: How does the consumer benefit from Guroo.com?
DN: Guroo.com provides the average price paid in a specific market for healthcare services. Later in the year, we'll be launching another website that will ultimately integrate the two.
If a consumer's insurance company participates in this initiative, individuals will receive a password that uses their identification to allow them to register. In the future, we are hoping to add quality-related information to the site.
This issue in and of itself will not solve the "quality conundrum." Until we have a good set of quality measures that are calculable by claims data, or we are able to bring in other data, quality will always be problematic. We will be able to point out quality measures calculable by claims data, and we'll be bringing in new information going forward.
MTT: How do you differ from competitors in the marketplace?
DN: At this point, there are no other competitors in the marketplace that possess the tremendous data set.
You must possess a massively large data set in order to tell a consumer what their out-of-pocket expense will be in a specific location, given their diagnosis and what procedure they are seeking.
Guroo.com is based on more than three billion claim lines over the last two years - nobody has that data!
Most competitors are selling services, and our websites will be free. This is a broad-based consumer initiative that's cross-industry. We are trying to make it the commercial equivalent of www.medicare.gov - a place for all of the commercially insured.
For example, if an employer changes its employees' insurance, the employees can still access the same website - they won't need to learn a new URL. If an employer has multiple insurers, they don't have to promote multiple websites. It is one place for everyone to get the information that they need. Ultimately, it will build out one of the best consumer experiences, beyond price and quality, to make it easier for consumers to use this information.
It is important to note that this is an independent, not-for-profit organization - we have no vested interest in the results.
MTT: Do you think consumers have a good understanding of transparency?
DN: No, I don't think consumers have a handle on what it means, but transparency alone is not a silver bullet.
When you think about transparency, you must focus on services that are "shoppable," discretionary or schedulable. For example, if I'm having a heart attack, I'm not going to pull out my iPhone in the ambulance and ask the driver to pass by two local hospitals because the price is cheaper in a distant location.
In many communities, especially when there are multiple hospitals in the same town, one facility might specialize in cardiology, and the other in orthopedics.
My advice to individuals who are very ill is to get set up with a system that will provide high-quality care at an affordable cost.
Consumers will continue to purchase based on convenience and physician referrals - as well as recommendations from friends, family and existing relationships. But, at the end of the day, price transparency is necessary for a properly functioning market. Consumers in high deductible health plans and millennials will most likely adopt these tools earlier - and faster.
Transparency is a major new initiative, and employers, insurers and others may begin to change plan designs and respond to the information that is now available.
MTT: Is it valuable for patients to travel to facilities where the best price represents the highest quality?
DN: Well, of course, we want consumers to presume there is value in the healthcare system. Value is equating price and quality, and of course, there will always be uncertainty when it comes to outcomes - no question about it.
From an economic standpoint, we assume that two decision-makers with identical information can make different decisions - neither one being irrational.
What is really important is establishing full understanding between consumers, patients and providers. Patients have to be comfortable communicating price and quality concerns to their providers. Conversely, providers must be responsive to consumers and respond in a manner that doesn't close down conversation.
INTERVIEW: I. Glenn Cohen, Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School
About I. Glenn Cohen
I. Glenn Cohen is professor of Law at Harvard Law School, and director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics. He is one of the world's leading experts on the intersection of bioethics (or medical ethics), and the law, as well as health law. He also teaches civil procedure. Prior to becoming a professor, he served as a law clerk to Judge Michael Boudin of the U.S. Court of Appeals for the First Circuit, and as a lawyer for U.S. Department of Justice, Civil Division, Appellate Staff, where he handled litigation in the Courts of Appeals and in the U.S. Supreme Court. He was selected as a Radcliffe Institute Fellow (2012-2013) and by the Greenwall Foundation to receive a Faculty Scholar Award in Bioethics. He also leads the Ethics and Law initiative as part of the multi-million dollar NIH-funded Harvard Catalyst for The Harvard Clinical and Translational Science Center program. Professor Cohen is the author of more than 80 articles and chapters, and his award-winning work has appeared in leading legal law review journals, including: Stanford, Cornell, and Southern California; medical journals including the New England Journal of Medicine, and JAMA; bioethics journals including the American Journal of Bioethics, the Hastings Center Report; and for public health, the American Journal of Public Health. He is the editor of The Globalization of Healthcare: Legal and Ethical Issues (Oxford University Press, 2013) and the author, editor or co-editor of six other books already published or in production. His newest book, Patients with Passports: Medical Tourism, Law, and Ethics, is now available from Oxford University Press http://www.amazon.com/Patients-Passports-Medical-Tourism-Ethics/dp/0199975094 . The Press has allowed him to post the first two chapters of the book, containing the book's introduction and the most up to date and complete data on the medical tourism industry online for free download: http://ssrn.com/abstract=2514371 .
About Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School
The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School was founded in 2005 through a generous gift from Joseph H. Flom and the Carroll and Milton Petrie Foundation, with the goal of promoting interdisciplinary analysis and legal scholarship in these fields. The Center is not an advocacy organization, but rather is dedicated to the unbiased analysis of pressing questions facing health policymakers.
The future promises to raise new and fascinating issues that will make these interdisciplinary analyses all the more important. Scientific advances are pushing the boundaries of existing thinking on everything from what defines a human life to what constitutes an ethically tenable area of research, as well as raising complex issues about the appropriate role of intellectual property. At the same time, transformations in healthcare financing and business practices, changes in the role of health law, and the growing realization that the environment's direct link to human health has upset traditional professional and market paradigms.
The founding vision of the Petrie-Flom Center is to promote scholarly inquiry that breaks away from existing disciplinary lines and brings the totality of these disciplinary methodologies under its compass to inform policy. To achieve this goal, the Center fosters a community of leading intellectuals, practitioners and policymakers from a variety of backgrounds and at all stages in their careers.
Medical Travel Today (MTT): Give our readers some background on your newest book: Patients with Passports: Medical Tourism and Law and Ethics.
I. Glenn Cohen (IGC): Before this publication, I spent a great deal of time as an academic bystander in the medical travel space. To enhance my knowledge about the industry, I began to attend FAM tours and regional meetings, and engage in conversations with health geographers, lawyers and medical travel enthusiasts.
As I gradually expanded my background, I realized there are many unanswered inquiries around the legal and ethical issues of the industry - which is what motivated me to author this piece.
MTT: Give us a preview of the contents.
IGC: The first 260 pages of the book are devoted to the legal side of medical travel, and the latter half pinpoints the borders of medical travel legality or illegality.
The initial half details medical tourism as it is most widely known: patients traveling for high-quality, affordable and legal treatment services in a foreign location.
The second portion of the book addresses consumers traveling to foreign locations to seek illegal treatments, which may include: abortion, assisted suicide, stem cell therapy that is not yet approved by the FDA, reproductive technology, etc.
The book begins with my attempt to gather all of the medical travel data that is currently available, but more broadly encompasses the nature of the industry, i.e., popular treatment destinations, pricing, etc.
Unfortunately, the majority of data available on the industry is more hype than fact, with only estimates available for public review.
The initial section details quality, and in particular, the way information is and is not available, as well as the travel of pathogens between locations, multi-drug resistant bacteria, and more.
In this era of Ebola, we are very much aware of the way the law does, or does not, generate incentives to provide information to patients and insurers who need to make a medical decision.
MTT: Does the book address legal liability and other aspects of insurance?
IGC: Yes, and it includes when one can sue a medical practice if involved in medical travel, and how treating destination hospitals can protect themselves against legal action.
In the third chapter of the first half of the book, I discuss private health insurance in the U.S., employers that utilize a medical travel benefit in their plans, what law governs whether insurers can offer incentives and coverage, the liabilities an insurer or employer face, and plan design.
Next, it focuses on public health insurance, especially in the E.U., issues regarding prior authorization, and when home countries must reimburse others. I also briefly make a suggestion that Medicaid and Medicare should provide coverage which enables medical tourism, and examine the way in which one U.S. government plan allows portable coverage - the TRICARE policy for military veterans who retire abroad.
The final chapter in the first half of the book glances at the effects of medical tourism on destination countries, examines the existing empirical literature on the positive and negative effects of the industry, and questions what our obligations are to these countries.
MTT: Do you focus on Americans traveling outside of the country?
IGC: Americans are my primary focus, but I am also interested in inbound medical tourism, inter- European medical tourism, and Middle Eastern medical tourism.
MTT: How would you characterize the current volume of medical travelers?
IGC: The destinations where you will find the best data comes from places such as Malaysia, where the government collects the data.
When it comes to Americans traveling for care, the Affordable Care Act (ACA) has slightly changed the composition in terms of who is engaging in medical travel.
As an increasing number of individuals are getting insurance, and therefore gaining healthcare coverage, the number of individuals traveling and paying out-of-pocket is decreasing.
On the other hand, I see a growing number of employers and insurers opting for a medical travel benefit, and sending employees and their dependents to a number of different locations.
We must not forget about the undocumented aliens in America who are omitted from participating in the exchanges - these individuals are major medical travel enthusiasts, often forced to pay out-of-pocket.
MTT: Will the growth of U.S. domestic travel have an impact on the outbound market?
IGC: Yes, the growth of U.S. domestic travel for medical services will have some impact on the outbound market, but the price differentials in the U.S. are not large enough to be in competition with the price differentials in the international market.
When patients travel within the U.S. it's more often than not based on quality, accessibility or specialty care, rather than cost.
Most of the outbound medical travel in the U.S. is based on price competition or "price shopping" because an insurer has issued a check.
MTT: Which treatments seem to be the most popular among patients traveling internationally?
IGC: I see a lot of patients traveling for heart bypasses and valve replacements, hip replacements, knee replacements, spinal fusions, hip resurfacing, gastric bypasses and mastectomies.
Dental procedures, including crowns, teeth whitening and implants, have become quite attractive to medical travelers, as well.
Lastly, cosmetic surgeries are prevalent among medical travelers - breast augmentations, rhinoplasties, etc.
MTT: Do you see a definite move toward bundled pricing, including revisions, readmissions or any problematic outcomes?
IGC: Certainly as the market becomes more competitive between countries, bundled pricing will be marketed as a selling point.
Patients seem to find bundled pricing attractive, but the actual percentage of individuals who utilize this approach is unknown at this point.
For me, a more attractive approach encompasses legal liability, which bundles a form of insurance which provides coverage for medical malpractice and doesn't require the traveler to return abroad to take legal action if necessary.
MTT: What does that legal realm of medical travel consist of now?
IGC: I always tell individuals, "If you go abroad for medical travel and treatment goes wrong, your ability to recover in the court is very, very weak."
On one hand, it is very unlikely you will be able to sue international facilities or providers in a U.S. court, and if one does sue them, they would be governed by a medical malpractice law, that by American standards, merits lower remuneration.
If you look at the medical malpractice law in Thailand, or Malaysia, or Mexico, the kind of recoveries you see Americans making, in terms of top dollars, are almost nonexistent.
If one has to sue an international facility or provider in a foreign court, they are in an even worse position because there is a major delay in many of the court hearings for medical malpractice action -local officials and doctors must testify.
There is only one published decision I've ever seen about a case that went to trial and had a decision, and the fact pattern is very unlike medical tourism. As I recall it involved someone in police/prison custody. Either people are discouraged from taking legal action, or in many cases, foreign hospitals have a strong public relations team to settle the cases quickly and quietly.
Most facilities are unwilling to provide data on adverse events, which makes it hard to tell if we are not seeing lawsuits because there are not a lot of errors, or because patients think it's too hard to win.
MTT: Have you interviewed employers in different countries that are concerned with liability?
IGC: I've talked with a number of employers who are very interested in the medical travel industry as a whole.
First, employers must make sure the Employee Retirement Income Security Act (ERISA) interacts with state insurance law in a way that allows them to build medical travel into their plans. The ERISA preemption states that if you are a self-insured employer you can virtually avoid the majority of state level regulation of health insurance, which is good news because that regulation will often make medical tourism legally problematic.
Many employers are more concerned with the way medical travel looks from a public relations perspective rather than a cost-savings standpoint.
Since the ACA requires all Americans to have health insurance, many employers are under pressure to find affordable plans, leading to medical travel.
MTT: Do you think the medical travel market will explode or grow steadily?
IGC: Personally, I believe it is a watershed moment for the industry when ABC News produces a positive story on a company that gives it's employed individuals the option of traveling to Costa Rica for care.
The initial media coverage on medical travel was very negative, and now, coverage is based on curiosity and interest.
Employers are still trying to resume balance after the implementation of the ACA, but I do believe that this is an industry that will grow steadily, especially on the insurance side.
MTT: When choosing locations, hospitals and providers outside the U.S., is there any value to an accreditation program? Is Joint Commission International (JCI) still the benchmark?
IGC: Yes, JCI and its accreditation standards still seem to be the benchmark for institutions.
For international facilities, collaborating with well-known U.S. institutions seems to be a marketing tactic, as well.
If you observe the way JCI accredits, it's really a process-based accreditation system, rather than an outcome-based system, and just because those requirements have been met doesn't guarantee that the morbidity and mortality rates will be excellent.
The reason I would rather travel to a JCI -ccredited institution is because, to me, it means that the destination country picked this institution to be its flagship - it has invested a lot of time and resources to ensure positive publicity.
A portion of my book argues that we still need a plan to push facilities to disclose more data, regardless of accreditation.
MTT: What are your thoughts on patients traveling to the U.S. for treatment?
IGC: Again, the data is not great, but I do believe most people see the growth of outbound medical tourism, and in particular, inter-regional tourism.
Post 9/11 and post-9/11 security has turned some of the Arab world away from seeking medical treatment in the U.S.
There has been a rise in the number of individuals traveling for care from one middle-income country to another, but if these individuals want the best cancer treatment or high-tech surgery, they will travel to the U.S. regardless.
MTT: Are U.S. hospitals marketing more aggressively to attract foreign patients?
IGC: Marketing plans are definitely in place, but hospitals are in a much more competitive situation now than they were five or 10 years ago. Again, the growth of outbound medical tourism from the U.S., and elsewhere in the world, has allowed facilities in Malaysia, Korea, Singapore, Thailand and others to look attractive to patients now, but may not have been viable 10 years ago.
MTT: Do you see potential for a medical travel benefit to be incorporated into Medicare, Medicaid and/or Workers' Compensation?
IGC: I would think Workers' Compensation might be the easiest to incorporate a medical travel benefit, in part because it is mostly state law, not federal. Medicare is completely federal, and Medicaid is joint federal and state. But to be honest this is not an area I have studied so I would want to research more before giving a firm answer.
As I mention in my book, the one place government will pay for medical travel is the retirement plan for individuals who serve in the military - the Tricare plan. If you are an individual who retires abroad, the U.S. government will cover your healthcare and pay for it with U.S. federal government dollars.
MTT: What are the less common procedures that people travel abroad for?
IGC: I call this "circumvention tourism" because people are trying to circumvent domestic rules.
Many individuals travel, particularly to China, for stem cell therapy, in an effort to curb conditions ranging from Autism to impotence to Down-Syndrome. We have very little evidence that stem cells are useful outside of areas such as blood source human stem cells.
There have been documented cases where some children have developed brain tumors, and there's very little regulation and disclosure about what type of stem cell is being used during treatment. There are many reasons to be concerned with this practice, but on the other hand, despite the serious risks, I'm very sympathetic to these situations - especially with parents who have terminally ill children.
MTT: What are your thoughts on the negativity around surrogacy?
IGC: I believe there are two sets of issues around surrogacy. One issue is the exploitation of surrogates in the developing world and whether they are really being exploited or treated appropriately.
The other issue is about the recognition of children born abroad. Parents are now faced with great immigration difficulties when they try to bring the child back to their home country, and that is a concern that many parents haven't fully wrapped their heads around.
I would advise anybody who is considering traveling abroad for surrogacy, or any reproductive technology, to meet with a family law expert who can handle a case like this to guarantee they will be able to bring their child home.
Connecting the Travel Industry to the Medical Tourism Industry
Part Two (continued from MTT Volume 8, Issue 13)
by Jack Schafer
Prior to a patient arriving at a foreign hospital, that patient has had nothing but phone calls and internet contact with the provider/facility. Perhaps the ability to reach out and connect (one on one) with the patient, as only the hometown travel professional can provide, is the missing component in making medical tourism an exciting opportunity versus a threatening alternative to staying home.
(A good sales point here would be exploring the world during your recovery process versus staying home, laying in bed and watching Jerry Springer while you recover...)
Here, we've talked about international travel for medical tourism, yet the reality is, there is another side to medical travel, as well - domestic. More and more patients are now shopping their procedures outside of their hometown hospitals, and traveling to Centers of Excellence that can specialize in certain procedures and provide them at a more favorable price point than staying home. Many self-insured companies are saving millions of dollars by contracting with medical facilities in different parts of the country to deliver specific procedures to their employees. Some insurance companies are doing the same. A medical traveler might be a client/patient from New York, who finds a hospital in Miami that they want to use for their procedure. So, they make the arrangements with that hospital, and the hospital puts them in touch with their travel professional, who arranges a two-week holiday around that three-day procedure for the patient and their family... including a trip to Disney, or maybe even a cruise. The possibilities are endless, as are the opportunities - which brings on the final opportunity for travel professionals.
Over time you will naturally gain the experience and knowledge of the entire process, by working with your facilitators and provider contacts, and start incorporating the medical procedures side into your expertise. There is a defined process for this to happen. First, you will take a qualifying course, and upon completion you can start building your business by making contacts and developing partnerships with medical tourism facilitators and offshore (and domestic) medical and surgical providers. Like any business, there needs to be a process, and perhaps the process in medical tourism is coordinating these relationships and generating leads in a single niche area. Some people select dentistry, where offshore procedures are typically less than 60 percent of those here in the U.S. There are millions of Americans and Canadians a year that visit Mexico and the Caribbean to enjoy a great vacation and simultaneously save thousands of dollars on a procedure.
Countless Americans leave the U.S. for cosmetic surgery and think nothing of it. Today, you can advertise about medical travel and hang a sign in the front of a local business!
Perhaps an even larger market possibility than medical tourism is health and wellness travel. Today, 60 percent more leisure travelers take advantage of some "health and wellness" product during their cruise or stay. Whether it is a spa or mineral bath, there in no greater market potential today.
Some of the components are the Healing Ashrams in India, Buddhist Temples in Tibet (where visitors spend a day to a week living with the monks), and Chinese medicine facilities (where health and healthcare is seen in a whole new light, and patients are healed by touch, needles, and energy). YES, 80 percent of clients believe in the possibility of energy being a significant component in the healing and health process. This defines health and wellness travel - and in a very real way, we're back at the very beginning of the medical tourism process.
Grab hold, climb on, absorb what we do, and then bring your own uniqueness into the process. We're not hurting anyone here. We're focused in every way to support them - individually and uniquely, to make available to them everything the world can medically and/or surgically provide. None of us can ever promise healing or perfection -- that IS a God thing. All we can do is throw our own hat, expertise and experience in the ring and promote possibilities that most of us have never known were possible.
This world IS becoming a smaller place geographically, and historically, but the more we are exposed to worldwide opportunities, the more we're pushed into redistribution of wealth and limited/equal opportunities for all. Yet, when it comes to our healthcare, we not only have the right, but also the responsibility to seek and explore every opportunity that is available to us. Having and investing one's financial resources to seek superior healthcare and services is and should remain a personal choice. Now, the world has opened up to show us opportunities beyond our borders and limited experience. Medical tourism is the wave of the future.
Reflections Going Forward: The IMTJ Summit 2015
by Sharon Kleefield. Ph.D.
I was fortunate to participate in the IMTJ Summit 2015. It was indeed an opportunity to share expertise and knowledge, and better understand the ongoing themes of patient involvement beyond borders. The stakeholders were well represented from around the globe: providers, travel companies, brokers/facilitators, national medical tourist groups, media, accreditors, business start-ups and patients. The medical tourism industry is a web of relationships among private and public, commerce and patient care (G. Cohen, Patients with Passports, 2015). It is growing and evolving while still in flux, but the welfare of patients is always front and center. The need for good quality of care was a theme throughout the Summit, both as a global and regional concern.
The attendees echoed the importance of good health for human well-being and the quality of life. Assessing quality of care is still difficult to ascertain, but patients are willing to travel in order to fix a painful hip or knee, or to fix teeth that are in need of complex but yet affordable treatment. Patients make informed choices as best they can, based on limited information. But are we, as an industry, doing enough to help patients understand what 'signals' to look for when assessing quality of care, and compared to what?
From the consumer/patient perspective, choice is typically based on word-of-mouth: How good are the physicians/surgeons? Where have they been trained? How many procedures in a particular specialty have been successful? What about facility accreditation? Data in the public domain is difficult to find, even for individual patient experiences, similar to a Tripadvisor. Other factors influencing choice have to do with the distance and ease of travel, familiarity with language, local culture, amenities of the facility and cost. When asked, patients tell me that they would not sacrifice quality for cost, but that they are unsure about what to ask regarding quality and safety of care oversees. Data regarding clinical outcomes is very limited, if available at all. What we do know is that medical travelers are subject to similar healthcare risks as other patients. (World Health Organization)
Going Forward, IMTJ 2016
Promoting high standards for the medical traveler does not imply the need for regulation although there was a show of hands at the Summit when asked if regulation was necessary. With 15 years of healthcare quality experience across 15 different countries, I am suggesting an approach that provides signals for quality and safety that are defined and comparable across borders. More than 20 years of research in healthcare quality and safety allows for the identification of such signals, often referred to as metrics or indicators. The most recent report from The Lancet, "Global Surgery 2030," is an example of research that identifies such signals for safe surgical and anesthesia care globally. Examples include: training/experience of the providers; decontamination and sterilization protocols; blood safety; prophylactic antibiotic use; availability of necessary medicines; nosocomial infection rates; available ICU services and adequate nursing care. I have added additional considerations: hospital accreditation(s), patient satisfaction rates, availability of medical subspecialties for unexpected complications; hand hygiene practice; universal precautions; isolation protocols; and unexpected mortality rates. Definitions and standardized rates would assist facilities as to how and what to measure. Competition to become Centers of Excellence would be driven by a clearer view of quality of care by facility.
Promoting case studies from those facilities that promote high standards would be a giant step forward for the medical travel industry and consumer protection. An effort to share these best practices would promote competition and position this industry for participation in discussions of global quality and safety. It would bring the medical travel industry into the broader efforts to improve global care and safety for all patients.
Suggested topics and presentations for the Summit 2016 should provide the stimulus for case studies and aid organizing a working group, whose mission would be to advocate transparency in cross-border quality of care.
I would be eager to assist in working on case studies, to develop criteria and peer review of data, and to work with IMTJ 2016 in supporting leadership for quality and safety.
Industry News
Dubai Envisions Becoming a Leading Medical Tourism Choice
by HospiMedica International staff writers
Hospimedica.com-Dubai healthcare officials have outlined their vision of becoming one of the world's most popular medical tourism destinations.
The Dubai medical tourism project initiative involves both the public and private health sectors, as well as various government entities such as the Department of Tourism and Commerce Marketing, the Department of Economic Development, the Dubai Health Authority (DHA; UAE), the General Directorate of Residency and Foreigners Affairs, and Dubai HealthCare City (UAE). In terms of services, the authority will focus on orthopedic and sports medicine, plastic surgery, ophthalmology, dental procedures, dermatology, preventive health check-ups, and wellness and skin care services.
The first phase of the initiative, which will run until 2016, will see the launch of a dedicated internet portal for medical tourism, with special medical tourism packages to be promoted in international markets. A second phase, which will be in effect until 2020, will aim to further develop facilities and branding to put Dubai firmly on the global medical tourism map. The target markets for the initiative will be Russia, The Commonwealth of Independent States (CIS), South Asia, and the neighboring Gulf Cooperation Council (GCC) countries.
"We are focusing on developing Dubai's medical tourism initiatives. The aim of the strategy is to ensure Dubai features among the top medical tourism destinations around the world," said engineer Essa Al Maidoor, director-general of the Dubai Health Authority. "We have carefully selected health services to be promoted taking quality and prices into consideration to attract tourists to the emirate."
"Dubai aims to build on its growing tourism market and its health sector which currently features about 2,500 facilities, with more than 70 percent internationally accredited, "said Ramadan Ibrahim, M.D., director of the DHA Health Regulation Department and director of the Medical Tourism project. "All these factors will help drive the medical tourism initiative."
Dubai is investing heavily in developing the medical tourism sector, revamping the emirate's Rashid hospital, as well as opening three new hospitals and 40 health centers. The number of medical tourists who visited Dubai in 2012 totaled 107,000, with revenues reaching USD 177.5 million. By 2016, medical tourists are expected to rise to 170,000 and generate revenues of USD 300 million, with the eventual goal being 500,000 medical tourists by 2020, bringing to Dubai USD 700 million in revenues.
Dubai also hosted the 2nd edition of the International Medical Travel Exhibition and Conference (IMTEC; Dubai, UAE) during March 2014, with over 100 exhibitors and 2,000 attendees representing the global medical travel industry.
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Placidway.com-Obesity is affecting more people each day. Statistics show that since 1980 the number of obese people has double. What is more worrying is the fact that it started to affect children too, even those under five years old.
The World Health Organization statistics are alarming. In 1980 there were 857 million overweight and obese people worldwide. By 2013 the number had increased to 2.1 billion, adults up 28 percent and children 47 percent. The highest rates of obesity are in the U.S., China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, New Zealand, Bahrain, Kuwait, the U.K., Canada, Saudi Arabia and South Africa, but other nations are being quickly added to the list.
This means that no matter how high the efforts would be, obesity is not decreasing. In fact by 2020 two out of three people are to be affected by obesity. With more than 2.8 million adults killed by obesity each year, the condition has become the fifth leading risk for global deaths.
The 21st century, the era of speed and technology, has also brought significant changes in our lifestyles. We live faster, we have less time to take care of ourselves, we are stressed and worried all the time, we try to cope with the fast rhythm but, unfortunately, we cannot dodge its negative effects. It is not only the problem of obesity by itself, but primarily the associated medical conditions and diseases: diabetes and other chronic diseases, heart problems, high blood pressure, stroke, sleep apnea, various types of cancer, musculoskeletal disorders such as osteoarthritis, gallstones, reproductive problems, just to mention a few.
What is obesity?
Obesity is a condition that leads to the accumulation of so much body fat that it negatively affects the overall health of the person. A person is called obese if he/she has a BMI (Body Mass Index) of more than 30. The factors leading to obesity vary from genetic conditions and various types of medication to causes which can be controlled. Lack of exercise, increased stress, a sedentary life, eating more food than necessary, eating fast food or processed products, smoking or increased alcohol intake are just few of the factors which could be kept under control.
Diets and exercise are not a viable option for many obese people. Only few of them find the time, patience or money for these two options, and in many cases they do not even work. The frustration of not being able to lose weight, will lead to comfort eating and increase the number of problems and weight.
That is why an increasing number of patients turn to obesity surgery. The variety of bariatric surgery options, the quick recovery time thanks to modern equipment, the relatively fast weight loss and the hope to a healthy life, push obese patients into choosing this path.
How is medical tourism helping?
Usually, patients choosing bariatric surgery abroad can be divided into two categories: those who look for affordable prices and those who do not have access to high quality procedures in their home country.
"Obesity is a growing problem worldwide, and immediate attention to this matter is needed. PlacidWay aims to inform people dealing with the condition on the variety of options they have. Whether it is a healthy lifestyle or choosing bariatric surgery to solve the problem faster, PlacidWay can help with answers, information and the streamlining process of making choices. The possibilities are endless and people need to know they have options to choose from," says Pramod Goel, CEO and founder of PlacidWay.
Many countries offer attractive bariatric surgery packages, each trying to differentiate from the others. Over the past years, emerging countries have managed to increase their efforts in the medical tourism industry, and even reach the same quality level found in the highly industrialized countries. Such is the case with India, Turkey and Mexico, three of the top options when it comes to weight loss surgery abroad.
India - a growing destination for Africans, Middle Easterners and SAARC Countries
India has quickly climbed among the top obesity surgery destinations. With surgeons trained abroad bringing innovative methods back home, modern equipment, affordable prices and accredited medical facilities, India caters to the needs of patients coming from Asia, the Middle East and Africa.
Among its numerous obesity clinics, Asian Bariatrics is among the top ones, dealing with diseases related to the gastrointestinal tract and obesity. The Da Vinci Robotic Surgery and Single Incision Laparoscopic Surgery performed by the experienced medical team are the most chosen obesity procedures for their quick recovery time, minimal discomfort during the surgery and higher success rates.
"We are proud to be the only stand-alone specialty institute for bariatric surgery in India. Our goal is to offer the best in innovation, quality, care and technology to local and international patients. We have earned our place among the top obesity surgery centers in the world, and we are proud to be able give our patients a new chance to a healthy and happy life," says Dr. Sanjay Patolia, director at Asian Bariatrics and one of India's most acclaimed obesity surgeons.
Mexico - a bariatric surgery mecca for Americans and Canadians
Mexico is another top destination for obesity surgery. Taking advantage of its geographic positioning, Mexico is a safe and affordable option for patients coming from the U.S. and Canada. With surgeons trained in the U.S., medical equipment of the latest generation and procedures performed with professionalism, more patients are feeling confident in choosing this country.
Mexico Bariatric Team is among the top obesity surgery centers in the country. The experienced bariatric team at the center performs various procedures, including metabolic and revision surgeries.
"We are proud to be the only center in Mexico which performs revision and metabolic surgeries for patients suffering from obesity. We are committed to provide the highest quality in medical care and the fact that we have the JCI accreditation speaks for itself. We are dedicated to helping our patients, and we will continue to do so at the highest standards," says Dr. Juan Arellano, director of Mexico Bariatric Team and the only board-certified bariatric surgeon in Mexicali.
Turkey - an obesity surgery destination for Middle Easterners, Eastern Europeans and the U.K.
Patients from the Middle East, Europe and Asia looking for obesity surgery have another option: Turkey. This country has 51 JCI-accredited medical facilities, and solid proof of the high medial quality and professionalism. When it comes to bariatric surgery, Turkey differentiates itself as one of the few to offer laparoscopic sleeve gastrectomy with ileal transposition (SGIT) for diabetic obesity.
Ileal transposition is a bariatric surgery procedure that can be effective as gastric bypass bariatric surgery for weight control, and to help the body regulate glycemic control. Such surgery has been effective in some patients diagnosed with Type II diabetes mellitus. The procedure involves the stomach, duodenum and small intestine.
"Metabolic Surgery Clinic in Istanbul is the only healthcare facility in Turkey that is performing SGIT for diabetic obesity, and Turkey is among the six countries where this procedure is available. Thanks to the gastric bypass and the duodenum-jejunal bypass surgeries we are able to help patients get rid of two problems: diabetes and obesity. Also, all the other medical conditions related to them. I am proud to be among the few in the world to offer this revolutionary surgery, and I will continue to explain this process and its benefits as long as I live," said Dr. Alper Celik, founder of Metabolic Surgery, Turkey.
The thought of going into a foreign country may be scary, but with the appropriate help and thorough research it can become the best choice and the solution to deal with obesity once and for all. Medical tourism offers a multitude of options and advantages to patients, no matter their income or social status.
PlacidWay can answer your questions related to your medical tourism choices. Do not hesitate to contact us!
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On the heels of Health City Cayman Islands' first anniversary, the Caribbean hospital has earned the prestigious Gold Seal of Approval from Joint Commission International (JCI), the worldwide leader in accrediting the quality of healthcare, cementing its ability to compete with peers abroad in the medical tourism industry. Health City is only the second hospital in the Caribbean to receive JCI accreditation.
The accreditation commission's on-site evaluation of Health City Cayman Islands was carried out by a team of international healthcare specialists who visited the Cayman Islands last month.
Health City Cayman Islands is supported by two major healthcare organizations, Narayana Health Group of Hospitals and Ascension. Dr. Devi Shetty, Health City's founder and chairman of Narayana Health, said JCI's endorsement of Health City's state-of-the-art clinical facilities and of the medical treatment provided by the hospital provided expanded credibility around the world.
"We have spent a lot of time carefully selecting and attracting some of the best doctors and surgeons -- with world-class supporting services -- to our facility, so it is rewarding to see our efforts recognized with this accreditation by JCI," he said.
Health City's facility director and head of Medical Services Dr. Chandy Abraham described JCI's approval as a historic achievement for Health City.
"In receiving the Gold Seal of Approval from the Joint Commission International, Health City joins an elite club of top-class hospitals around the world that have opened up to a voluntary peer review and have achieved the stringent and exacting standards of the JCI," he said. "Health City Cayman Islands now operates on par with some of the most respected hospitals in the United States and around the world, considerably boosting our credibility and awareness among those people who live overseas looking to use our facilities. By increasing our visibility to overseas patients in this way, we have placed the Cayman Islands firmly on the global stage when it comes to medical tourism. Patients can be assured of the same high-class standard of care that they have come to expect in their home countries, but at far less cost to them."
Dr. Anthony R. Tersigni, president and CEO of Ascension, the largest faith-based and largest not-for-profit health system in the United States, said Health City Cayman Islands offered a tremendous opportunity for Ascension to collaborate with Dr. Shetty and his colleagues at Narayana Health on new ways of providing high-quality care at a lower overall cost.
"The partnership holds the promise of helping Ascension live our mission in a new and creative way by adapting what we learn to transform healthcare not just in the Cayman Islands, but also around the world. This Joint Commission International accreditation is an important milestone in our journey."
Dr. Abraham acknowledged that meeting the stringent accreditation standards set forth by JCI was attainable only with the coordination and cooperation of all staff members.
"Providing high quality, affordable healthcare is a team effort and one which gives all employees a feeling of pride and prestige to work in an accredited institution," he said.
"We opened ourselves up to JCI inspection teams because we are confident we have built a leading international medical facility staffed by world-class doctors attracted by the opportunities available at Health City to practice the best medicine of their lives," said Shomari Scott, marketing director of Health City Cayman Islands.
JCI is the international arm of The Joint Commission, the leading healthcare accreditor in the United States. Since 1994, JCI has been working with healthcare organizations, ministries of health, and global organizations in more than 90 countries. JCI has accredited and certified more than 410 public and private healthcare organizations in more than 45 countries since accrediting its first hospital in 1999.
The Joint Commission International Hospital Standards aim to stimulate continuous, systematic and organization-wide improvements in daily performance and in the outcomes of patient care.
About Health City Cayman Islands
Health City Cayman Islands, the vision of renowned heart surgeon and humanitarian Dr. Devi Shetty is supported by two major healthcare organizations, Narayana Health and the U.S.-based Ascension. Narayana Health is one of the leading healthcare chains in India with 32 hospitals, offering high-quality services which are affordable to all. Ascension, based in the United States, is that nation's largest faith-based and nonprofit health system, providing the highest quality care to all with special attention to those who are poor and vulnerable. Health City Cayman Islands provides compassionate, high-quality, affordable healthcare services for all in a world-class, comfortable, patient-centered environment. Offering healthcare to international, regional and local patients, Health City Cayman Islands delivers excellence in adult and pediatric cardiology, cardiac surgery, orthopedics, pulmonology, medical oncology and pediatric endocrinology.
For further information, visit www.healthcitycaymanislands.com.
About Ascension
Ascension (www.ascension.org) is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As the largest non-profit health system in the U.S. and the world's largest Catholic health system, Ascension is committed to delivering person-centered care to all with special attention to those who are poor and vulnerable. In FY2014, Ascension provided $1.8 billion in care to persons living in poverty and other community benefit programs. More than 150,000 associates and 35,000 affiliated providers serve in 1,900 sites of care - including 131 hospitals and more than 30 senior care facilities - in 23 states and the District of Columbia. In addition to healthcare delivery, Ascension subsidiaries provide a variety of services and solutions, including physician practice management, venture capital investing, treasury management, biomedical engineering, clinical care management, information services, risk management, and contracting through Ascension's own group purchasing organization.
Apollo White Dental Launches 'HOLI-DENT' Scheme to Embrace Travelers Seeking Dental Treatment in India
Pharmabiz.com-Apollo White Dental, India's largest chain of dental clinics, with over 70 centers across India having its presence in all major cities, has launched the HOLI-DENT scheme to embrace travelers seeking dental treatment in India. HOLI-DENT is equipped with the latest technology, and offers high-quality treatment on par with international standards.
V. S. Venkatesh, CEO, Apollo White Dental, says, "Indian dentists are among the best, and are very patient and friendly. Treatments are cost-effective and our dentists are also known to have the world's best consumables and instruments. Accessing the same quality in India at an affordable cost attracts many medical travelers to India. Patients from the Middle East account for 50 percent of total dental tourism cases. Apollo White Dental has patients from Southeast Asian and neighboring countries, reporting 30 percent inflow. The European Union is reported to have 20 percent of patients coming to India. Also patients from countries in the South Asian region prefer dental tourism in India due to lack of medical technology and infrastructure in their countries."
Dental tourism, like medical tourism is a trending concept (practice) amongst Westerners seeking dental treatment. The primary reason for seeking treatment outside one's own country is the mammoth cost of treatment packages with the local healthcare providers. These patients travel to countries such as India, Malaysia, Thailand, Turkey, South Korea, and Singapore, where the cost of dental care is relatively inexpensive. Amongst the countries popular for dental tourism, India has been an attractive choice amongst Westerners for a variety of reasons. India is a prime tourist destination for it is a nation of cultural diversity with many popular destinations to explore across the country.
Dentistry in India is governed by the Dental Council of India, which regulates the standards of dental education and the profession of dentistry throughout the country. The cost of dental treatment on an average is also relatively lesser in India than any other country. It is true that the total cost, including the travel expenses and the treatment available, is much cheaper in India than the cost of the treatment alone available in Europe or the Americas. Dental treatments done in India can save up to 90 percent on treatment expenses, which is less than any other country.
The HOLI-DENT traveler's scheme allows a patient to start with their treatment at any of Apollo White Dental's clinic and continue with their treatment at another clinic location of choice as per their travel itinerary. The patient can seamlessly integrate their treatment with the travel plan of exploring the riches of Indian tourism. Dentistry has grown to an all new level where people visit the dentist not merely for treatment purposes, but also for cosmetic or aesthetic reasons.
Cosmetic dentistry is one branch which has come up in a very big way in recent times. Bleaching or whitening of teeth, veneers, smile designing and tooth jewels are some of the very common cosmetic dental procedures that appeals to the younger generation. Implant dentistry is another major dental treatment option that is coming up. Gone are the days when people would go in for normal bridges to replace their missing teeth.
Newer advances and innovations in technology are encouraging people to opt for the best and most suitable option. Implants imported from European nations are the latest and finest available. When patients choose to go in for full mouth rehabilitation, we are more concerned in restoring the natural oral function that they once enjoyed. With the expertise that keeps us with international standards and with the help of high-end technology, we ensure that all our patients enjoy the best of quality of service.
NYU Researchers Examine Obesity Perceptions Among Chinese-American Adults in NYC
Study finds one-third of Chinese Americans did not perceive their body weight correctly.
Worldwide, obesity is becoming more prevalent. According to The World Health Organization, worldwide obesity has nearly doubled since 1980, and in 2008 25% of adults aged 20 and over were overweight, and another 11% were obese. Obesity has been identified as a major source of unsustainable health costs and numerous adverse outcomes, including morbidity and mortality due to hypertension, type 2 diabetes, cardiovascular diseases and certain types of cancer.
Accuracy of body weight perception is an individual's perception of their body weight (normal weight, overweight, or underweight) in comparison to their actual body weight. Research has shown accuracy of body weight perception to predict life style behaviors, efforts to lose weight and even medical visits.
Chinese Americans make up the largest subgroup of Asian Americans and represent 4% of the total U.S. population. However, when compared to their counterparts in China, Chinese Americans have an increased risk for obesity due to immigration and environmental changes they face in the United States. A recent study published in Obesity Research & Clinical Practice by researchers affiliated with NYU's College of Nursing (NYUCN) is the first to examine the accuracy of body weight perception in Chinese Americans.
The study, "Accuracy of body weight perception and obesity among Chinese Americans," explored the accuracy of body weight perception and its impact on obesity in Chinese Americans by examining the associations between 162 participants' accuracy of body weight perception in relation to obesity-related physical characteristics and indicators. To do so, researchers gauged participants' demographic information, and anthropometric measures in addition to weight, such as height, waist circumference (WC), hip circumference (HC) and body mass index (BMI).
"Among the 162 Chinese Americans recruited to this study, we found that 32 had underestimated their weight, 20 had overestimated, and 110 had accurate perceptions of their weight," said Mei R. Fu, PhD, RN, ACNS-BC, FAAN, associate professor of Chronic Disease Management at NYUCN.
Significant differences were found among participants in three groups of different accuracy of body weight perception in terms of gender, age, and education years. In the underestimation group, men were 2.34 times more likely to believe they were underweight, compared to women. In the overestimation group, women were 3.59 times more likely than men to think they were overweight. Participants in the overestimation group were on average, 14.7 years younger than participants in the underestimation group, and 13.6 years younger than participants who had accurately perceived their weight. On average, participants who had underestimated their weight had 3.2 fewer year of education, when compared to those who had overestimated their weight.
The results from this study also found accuracy of body weight perception significantly predicted waist circumference, hip circumference, weight to height ratio, BMI and weight, even after controlling for all demographic factors. Participants in the consistent estimation group and underestimation group had similar waist and hip circumferences and weight/height ratios, but much higher than the participants in the overestimation group. With regards to obesity-related physical characteristics and diseases, accuracy of body weight perception was found to not be related with HbA1C, hypertension and heart disease.
As the first to examine the accuracy of body weight perception in Chinese Americans, this study identified that approximately one-third of Chinese Americans incorrectly perceived their body weight. Having found that accuracy of bodyweight perception was associated with several demographic factors, this study lays a good foundation for future possible intervention studies for obesity management in Chinese Americans. The findings of this study also suggest that such intervention studies should address gender difference, target older subjects, and focus on educating Chinese Americans on normal values for waist and hip circumference and HbA1C.
Researcher Affiliations: Shan Liua1, Mei R. Fu2, Sophia H. Hu3, Vincent Y. Wang4, Robert Crupi5, Jeanna M. Qiu2, Chuck Cleland2, Gail D'Eramo Melkus6.
1. College of Nursing and Public Health, Adelphi University
2. College of Nursing, New York University
3. School of Nursing, Taipei Medical University
4. Internal Medicine Office
5. Department of Medicine, New York Hospital of Queens
6. Muriel and Virginia Pless Center for Nursing Research, College of Nursing, New York University
Declaration of Interest: All the authors have no financial interest or commercial association with information submitted in manuscript.
Acknowledgements: This research was supported by a research grant awarded by NYU Pless Center of Nursing Research, Association of Chinese American Physicians, and the National Institutes of Health (NIMHD Project# P60 MD000538-03). Its contents are solely the responsibility of the authors and do not necessarily represent the funders. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
About New York University College of Nursing
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master's Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit https://nursing.nyu.edu/
Christopher James
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6th Annual International Medical Travel
& Global Healthcare Business Summit
Tampa, Florida June 14th to 16th 2015
"Wellness Tourism, a growing opportunity"
Michael Tompkins,
International Spa Association Chairman
CEO of Hilton Head Health in Hilton Head, South Carolina.
Sunday, June 14th, 2015
About Mr. Michael Tompkins
Michael G. Tompkins has served in multiple capacities within the fields of health and wellness and luxury hospitality for more than 25 years.
Starting his career as a Registered Nurse, he progressed to the ranks of CEO of Miraval Resort & Spa in Tucson, Arizona. There, Tompkins' accomplishments included corporate development of new locations, facilities expansion, trend capitalization and lifestyle living residential developments.
Tompkins is currently the Chairman of ISPA (International Spa Association)
Global Healthcare Opportunities
International movement of patients and retirees
Medical Tourism and Retirement Living abroad
Establishment of operations abroad
Offshoring of Hospitals and Retirement Communities
International movement of students and healthcare professionals
Educational tourism and International Practice
Outsourcing of healthcare services and related services
Outsourcing in health (Corporate medical travel, imaging, medical transcription, medical billing, insurance reimbursement)
Clinical Trials and Medical Research abroad
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When June 14 - 16 2015
Where CAMLS, Tampa Florida
Main Topics
* International Medical Education
* Clinical Research Outsourcing
* Medical Services Outsourcing
* Medical Services Offshoring
* Human Resources on Health
* Public Policy on International Medical Travels
* Telemedicine
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June 14-16, 2015 - Tampa, Florida
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Destination: Health Canadian Medical Tourism Trade Show
August 13-15, 2015 - Montréal Convention Centre, Montréal, Québec, Canada
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Medical Travel Today: Opinions and Perspectives on an Industry in the Making
Medical Travel Today - the authoritative newsletter for the worldwide medical travel industry - is pleased to announce publication of a new book, "Medical Travel Today: Opinions and Perspectives on an Industry in the Making."
Featuring 40 of the newsletter's most compelling interviews from the first five years of publication, the volume chronicles the explosive growth of international medical tourism as witnessed and experienced by some of the key stakeholders and players. A must-read for anyone interested or involved in the industry.
Hurriyetdailynews.com-The Turkish Health Ministry will organize a health tourism summit in London between June 25 and 27, a ministry official said May 11.
Actionnewsjax.com-Jacksonville now has another reason to promote itself as being a destination city for those seeking medical help.
Wantchinatimes.com- As medical tourism is emerging as one of the fastest growing segments in the global tourism industry, certain destinations in China have also begun to attract international travelers seeking traditional Chinese medicine services, Shanghai's China Business News reports.
Businessreviewaustrailia.com-Medical tourism has become very popular for Australians in recent years, as a growing number of Aussies are deciding to travel overseas to countries including Thailand, India, South Korea and Malaysia for medical procedures such as plastic surgery or complex dental work.
Principal Solar, Inc. Announces Launch of Proposed Initial Public Offering
BusinessWire.com-Principal Solar, Inc. (PSI)(OTC Pink:PSWW) today announced that it intends, subject to market and other conditions, to offer its common stock in an underwritten public offering of 2,500,000 shares of its common stock pursuant to a registration statement filed on Form S-1 with the Securities and Exchange Commission.
Do you know of any available job openings relative to the medical travel industry? We encourage readers to submit any available, relevant job opportunities along with its descriptions and requirements for fellow readers and industry professionals to consider. All submissions are appreciated.
Editor's Note: The information in Medical Travel Today is believed to be accurate, but in some instances, may represent opinion or judgment. The newsletter's providers do not guarantee the accuracy or completeness of any of the information and shall not be liable for any loss or damage caused - directly or indirectly - by or from the information. All information should be considered a supplement to - and not a substitute for - the care provided by a licensed healthcare provider or other appropriate expert. The appearance of advertising in this newsletter should in no way be interpreted as a product or service endorsement by the newsletter's providers.


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A firefighter and two cops who worked at Ground Zero in the days and weeks after Sept. 11 have died of cancer in the past five days, the Daily News has learned.Family members and advocates are blaming their deaths on toxins released into the air after the twin towers collapsed - and they're urging Congress to act on a bill that would help pay for their medical care."Everybody is denying that this stuff is connected to 9/11, but it is," said Stephen Grossman, whose son Robert died of cancer on Friday at the age of 44.Robert Grossman was a police officer in Harlem who worked at Ground Zero for several weeks after Sept. 11.Read Full Story at NYDailyNews.com
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It's been 8 years since Metallica last released an album. Death Magnetic was a truly awesome album but then anything that followed St Anger really had to be.
When you have to wait a long time it is easy enough for an album to be over-hyped (Chinese Democracy anyone?) but this one does live up to the hype. My only criticism actually is that is it probably a bit too long. There are some cracking tracks on the album though, notably Moth into Flame and Atlas, Rise!
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text: Protagonists Category page Pages in category "Protagonists" The following 4 pages are in this category, out of 4 total. A Astrid HoffersonH Hiccup Horrendous Haddock III (Books)Hiccup Horrendous Haddock III (Franchise)S Snotlout Jorgenson Retrieved from "http://howtotrainyourdragon.wikia.com/wiki/Category:Protagonists" Ad blocker interference detected! Wikia is a free-to-use site that makes money from advertising. We have a modified experience for viewers using ad blockers Wikia is not accessible if you've made further modifications. Remove the custom ad blocker rule(s) and the page will load as expected.


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The battle of Gettysburg was not James Ewell Brown Stuart's finest hour. Many Civil War historians believe it was his most dismal. For the first two of the three days' battle, he simply wasn't there, and his whereabouts were unknown to his Commander, General Lee. Writers argue at length about who should shoulder the blame for that, the highly popular J.E.B. Stuart, or the even more popular Robert Edward Lee. It is true that Stuart's usual role was to use his cavalry to scout the enemy position and report it to Lee. He didn't do that during the Gettysburg campaign. Some say that Lee's orders to Stuart were ambiguous, leaving too much to Stuart's discretion, and not making clear what Lee desired. Others say that, by June/July 1863, Stuart well-knew what was expected of him. In looking for a goat, it is well to find an unpopular one, but in this debacle, there was none.
Stuart was the epitome of dashing cavalry officer. Dramatic in his appearance, Stuart always rode a grand horse, lined his gray coat with red material, wore his hat cocked to one side with a peacock's plume splaying from it, and always had a red flower or ribbon love-knot in the lapel of his jacket. He may have been vain and arrogant, but no Confederate supporter would be inclined to hold such things against him.
Stuart had a long record of remarkable achievement, a few failures, and the complete devotion of Southern citizenry. For the first half of the Civil War, Confederate cavalry was far superior to its Union counterpart. It took the Federal command structure a very long time to figure out how best to use its horse soldiers, and while they were muddling around that question, Stuart was riding around the entire Union Army. He did that more than once.
J.E.B. Stuart came close to being captured at 2nd Bull Run, so close in fact he left behind his beautiful plumed hat. The story of how he received a replacement concerns one of those lulls in the fighting, when both sides were able to sit down and act as if it was all just a game, or a movie where the actors were taking a break from battlefield scenes.
A battlefield was a strange place for the reunion of old friends. The contorted bodies of men who had fallen in combat two days earlier littered the ground around the small group of picnickers who, being soldiers, were able to enjoy their outing despite its macabre setting. The last time any of the men in the circle of friends had seen each other in peacetime, they had all been obscure, middling officers in the U.S. Army. Now, all wore stars--some on gray uniforms, others on blue. The most famous among them by far was James Ewell Brown Stuart, who little more than a year earlier had been a U.S. Army lieutenant. By the time of the meeting he was a Confederate major general and the most renowned cavalryman on American soil.
With Stuart that blistering afternoon were three Union brigadier generals: George Hartsuff, George Bayard, and Samuel Crawford. Availing themselves of the burial truce after the August 9, 1862, Battle of Cedar Mountain, they had crossed the battlefield to seek out their old army chum. Crawford and Bayard brought a basketful of lunch, a surgeon offered a bottle, and all the officers offered exaggerated descriptions of their wartime exploits (which for Stuart had been considerable, for the Yankees decidedly slim). Stuart proposed a toast to Hartsuff: "Here's hoping you may fall into our hands; we'll treat you well at Richmond!" Hartsuff laughed, "The same to you."
Inevitably talk turned to the late battle, in which the Federals had suffered a bloody defeat. Stuart suggested the incorrigible Northern press would find a way to contort Union defeat into glorious victory. Crawford exclaimed that not even the reckless New York Herald could find a way to construe this battle as a victory. Stuart offered a bet: Crawford would owe him a new hat if the Northern press proclaimed the Battle of Cedar Mountain a Union triumph.
A few days later a parcel arrived in Stuart's camp. It was from Crawford. In it were a copy of the New York Herald and a new plumed hat.
Cousins in the Civil War


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The death of three government employees following heart attacks during the six-week long budget session of the Legislature has forced the state to set up four dispensaries and a mobile health unit within the Vidhan Bhavan premises to treat employees.
The employees, Sopan Bhange, Suhas Salunkhe and P G Khandare, died of heart attack during the ongoing session. Many believe that the deaths have been due to excess workload during the session where employees have to complete 14 to 15-hour shifts.
"We have decided to have a mobile medical unit and four dispensaries within our premises," Council Chairman, Shivajirao Deshmukh, said adding that the government will take measures to reduce stress on employees.
Member of Legislative Council, Mohan Joshi, raised the issue in the House and demanded health facilities for the employees in Vidhan Bhavan.
"The employees work for 12 to 17 hours daily during the session. This affects their health. I request the government to have two shifts for them and also provide them with health facilities," Joshi said.


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THE largest Odeon cinema in the land is to be redeveloped as a banqueting hall. Bolton's Odeon was a giant, even bigger than London's Odeon Leicester Square.
Once a popular venue in the area, the former Mecca Bingo and Social Club has now been sold to Supreme Finance for an undisclosed sum. Berkeley Brown, the Manchester-based commercial property agent, has secured the disposal of the long leasehold of the 20,000-sq ft building on behalf of Rank Group Gaming Division.
Tim Westlake-Bryant, agent at Berkeley Brown commented: "We are delighted to have secured this sale on behalf of such a prestigious client.
"The site offers high-quality premises and is situated in the newly designated cultural quarter."


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New work by Zimoun as installed at the most recent edition of STRP Biennial in Eindhoven.
Motors, wood, rope, metal, polyethyleen, controlling system. Dimensions: 7m x 14m x 0.5m.
Installation view: STRP Biennial 2015, Eindhoven, the Netherlands. Curated by Angelique Spaninks. Project coordination on site by Jahn Darms. Studio production assisted by Jessica Bizzoni, Joris Stemmle, Matteo Taramelli, Elisa Tangheroni, Florian Buerki and Ulf Kallscheidt. Controlling system developed in collaboration with Jason Cook, Alexandre Saunier and Grégoire Lauvin, at the Digitalarti Laboratory in Paris. Photographies and video by Studio Zimoun
Project Page | Previously on CAN


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