India to capitalise on Singapore’ns Medical Tourism slowing Down

THE GROWTH of medical tourism in Singapore is expected to slow down amid stiffer regional competition, especially from the Malaysian healthcare market, according to investment bank UOB Kay Hian.

The softer outlook in Singapore comes amid a decline in growth of foreign-patient numbers. This, in turn, is expected to take a toll on growth in revenue. Foreigners made up 40 per cent of IHH Healthcare’s business in Singapore in 2013, but this fell to 30 per cent last year. Its quarterly revenue growth in the same period has also declined from an average of 5 per cent year on year between 2013 and 2014 to between 1 and 2 per cent year on year from 2015 to 2016.
With the sector’s stronger showing in Malaysia, UOB Kay Hian analysts singled out Health Management International (HMI) as a top pick with strong growth prospects. The firm is behind Regency Specialist Hospital in Johor and Mahkota Medical Centre in Melaka. The positive outlook in Malaysia has been “bolstered by favourable government initiatives, geographical proximity and cultural affinity to its largest market, Indonesia”, the analysts wrote.
Patients are flocking to Malaysia thanks to factors such as improvements in infrastructure and service quality, as well as the relatively lower hospital bills, they said. “Comparing private hospitals under our coverage, we note average bill sizes at HMI’s hospitals are approximately 15-30 per cent of Singapore’s. “Furthermore, a weak ringgit may also be a silver lining that can help Malaysia gain price advantage over its regional peers for medical tourism purposes.” A Maybank Kim Eng report this month noted that Singapore was the second-priciest medical-tourism destination in the world, and the most expensive in Asia. On the back of a rise in the number of medical tourists headed to Malaysia – from 643,000 in 2011 to 921,000 last year – UOB Kay Hian analysts expect Malaysian revenue intensity to climb as well. The sector is anticipated to hit its target revenue of 1.3 billion ringgit (Bt10.3 billion) this year. Meanwhile, UOB Kay Hian has reservations about near- to mid-term prospects for IHH and Raffles Medical Group (RMG), over the costs of their expansion into the Chinese market.China eyed “Besides diversifying the concentration of medical patients to include [the] Middle East as well as the Indochina regions, Singapore hospital operators have embarked on more aggressive expansion strategies, prominently in Greater China,” its analysts wrote. “While we view these expansions positively, we expect start-up costs to crimp earnings growth in the near- to mid-term.” The analysts added while IHH had “resilient operations” in Singapore, Malaysia and Turkey and new ventures in markets such as China and India, “the stock is fairly valued” and has been priced in. Similarly, a CIMB forecast for RMG last week said the cost of new hospital expansions might have been underestimated.

Iran Medical Tourism

About 105,000 tourists traveled to Iran in the last Iranian year (ended March 20) to receive medical care, the secretary of Health Tourism Strategic Council said.

Speaking to ISNA, Mohammad Ali Fayyazi added that the tourists had their paperwork processed by one of Iran’s 35 health tourism travel agencies licensed to operate in the sector.

The figure could be higher because many medical tourists either travel independently or are brought to Iran by unauthorized entities. In neither case do travelers obtain health tourism visas, which means they’re not registered as medical tourists.

“Most of the tourists came from Iraq, Azerbaijan, Armenia and the Persian Gulf littoral countries,” he said.

According to Mohammad Hossein Mirdehqan, director of Monitoring and Accreditation of Medical Services Office at the Health Ministry, a medical tourist spends between $3,600 and $7,600 on every trip.

So, by taking the average ($5,600), Iran’s revenue from medical tourism last year amounted to $588 million, slightly more than the previously reported figures.

Based on the sixth economic development plan (2017-22), Iran is projected to attract between 500,000 and 600,000 medical tourists every year. However, some officials have questioned whether this target is feasible.

Foreign Ministry officials have urged medical tourists traveling independently to Iran to apply for a visa online at http://e_visa.mfa.ir.

Iran issues visa on arrival at 10 international airports to citizens of over 180 countries. However, to develop its health tourism industry, it requires health tourists to apply for a “T Visa”, issued only to medical travelers.

Iran says it will help it with key statistics, such as where most health tourists come from and what type of service they need.

Uncooperative Hospitals

Along with halal tourism, medical tourism is a strategic focus area for Iran to develop its travel sector due to high quality yet affordable healthcare, particularly compared with that in regional countries.

Geographical proximity, hot and cold mineral springs in various parts of the country as well as low-cost and high quality health services in the fields of fertility treatment, stem cell treatment and dialysis, as well as heart, cosmetic and eye surgeries, have created new opportunities in Iran’s health tourism—a growth industry in many countries.

Some 400 hospitals are active in the field of health tourism, but only 170 have been granted permits to set up an International Patients Department.

“Unfortunately, many hospitals still admit health tourists brought to Iran by unauthorized middlemen; they seem to be more keen to work with them,” Fayyazi said, urging the Health Ministry to take measures against healthcare facilities that hurt the development of the sector.

Neglected for years, health tourism was thrust into the limelight following the election of President Hassan Rouhani in 2013.

Two years later, Health Tourism Strategic Council was formed with the representatives of health and foreign ministries, the Medical Council of the Islamic Republic of Iran and Iran’s Cultural Heritage, Handicrafts and Tourism Organization to organize the country’s health tourism sector.

The council has been able to instill discipline in the sector by regulating institutions operating in this field and pave the way from the establishment of healthcare hubs in Isfahan, Tabriz and Mashhad.

Iran’s ultimate goal is to earn around $25 billion a year through tourism by 2025, around $2.5 billion of which will come from medical tourism.

Thailand’s New Medical Tourism Visa Policy

Visitors to Thailand from China and the CLMV nations (Cambodia, Laos, Myanmar and Vietnam) seeking medical treatment are now allowed to stay for up to 90 days visa-free, Deputy Prime Ministers Tanasak Patimapragon and Admiral Narong Pipatanasai announced on Wednesday.

And visitors age 50 and up from 14 other countries can apply for long-stay visas valid for up to 10 years. Both measures are designed to fuel Thailand’s ambition to become a “medical and wellness” tourist destination and world-class medical hub. As part of the Strategic Plan to Become a Medical Hub (2017-2026), the Cabinet has approved in principle the extended permission-to-stay for citizens of 19 countries identified as potential sources of medical tourists.
The Interior Ministry announced that visa-exempt entry for hospital care for patients from the CLMV countries and China who meet certain criteria is extended to 90 days effective immediately. The same privilege – “meant to increase convenience of access to clinical care” – is also offered to as many as four people accompanying them.
Foreigners age 50 years or older from Britain, the United States, Germany, Switzerland, Japan, France, Australia, Norway, Sweden, the Netherlands, Italy, Finland, Denmark and Canada can apply for long-stay visas of up to 10 years. Permission will initially be extended for five years, and an additional five years can be added for people who meet stated criteria and conditions. The same privilege is offered to their spouse and children under 20. The ministry said the measure would “hopefully lead to the increase of country income”. The Public Health and Tourism and Sport ministries have been directed to work with relevant agencies in the public and private sectors to implement plans for developing the country’s medical-tourism capabilities.

Iran Medical Tourism

This industry provides new additional financial resources to health systems of the participating countries and also provides saving costs of health services since those countries are outsourcing in this area and present effective services to developing countries.
This study aims to define the challenges and opportunities of medical tourism industry in Iran and propose some mechanisms to make Iran prosper with this new Industry.
The potential opportunities and challenges of Iran medical tourism got through interview, this phase leaded to create the 5 point Likert scale questionnaire.
Data gathered from the questionnaires were answered by health services providers in private sector and was analyzed by MADM approach, TOPSIS method. The most important challenges Iran Medical Tourism faced by are:
– To create dual market structure in health services, non-portability of health insurances and lack of support of private sector by the government and main opportunities are increasing access to medical tourism market that resulted to increasing revenues,
– To grow private sector participation in health services and
– To decrease the number of patients who go abroad for treatment. The opportunities and challenges of this industry are different between countries and every country should enter this area with attention to its relative advantages.
Health systems are evolving and continuously faced by new challenges. Trade in health services is one of the most complex and important challenges that health systems have to respond to, and nowadays it seems to be one of the best mechanisms of financing and creating additional resources for health systems in developing countries.
In fact liberalization of trade in health services has the potential to create new challenges as well as creating new opportunities, particularly in low and middle income countries for the provision of efficient and sustainable health services.
Health services, in recent years, have become increasingly traded, because of advances in InformationTechnology, growing mobility of health services provider and customers and increased private sector participation in delivery of health services.
An increasing number of countries are competing to become key exporters of health services.
It was caused by the high cost of health care in developed countries, the steep rise in demand for health services as a result of the ageing of populations in those countries and the increasing availability of advanced health and medical services in developing countries with high quality and lower prices than in developed countries, in addition to long waiting lists for surgery in those countries.
The lack of health insurance is the most common factor for medical travel (health tourism statistics and facts).
A study indicates that key drivers for this new industry are: increased costs of health services, limited medical insurance coverage, affordable and high quality alternative options, increased facilities with international accreditation, increasing access to IT and linkages between key players of the industry and some of the geopolitical events such as incident of 11 September.
In a growing number of fields of treatment, the most cost effective option is traveling to a developing country.
Hence, the provision of world class health care services and facilities at competitive prices has opportunity for those developing countries that can do.
In fact globalization and liberalization of trade in health services has made health tourism possible and continues to flourish.
According to GATS, the most important multilateral agreement about trade in services, health tourism is the second mode of trade in health services.
In this mode customers (patients) leave their home country and go to the providers’ country to obtain health care services with high quality and affordable prices.
Health tourism according to Jabbari (2009) is divided to wellness tourism, curative tourism and medical tourism and medical tourism refers to modern medical treatment and complementary medicine.
Medical tourism is the abroad looking for available quality combined with cost effective and low price health services while offering a similar level of safety to the patient.
Medical tourism has become a US$60 billion a year business with growing rate about 20% by a year which could increase to $100 billion by 2012 (Herrick, 2007).
A projection estimates that only US patients will expend more than $40 billion for health services abroad by year 2017 (Deloitte, 2008a).
Nowadays many governments and insurance firms are to outsourcing medical services to low cost providers abroad.
Apart from the savings aspect from the patient’s perspective, medical tourism is a growing part of the global health market with countries taking on and favoring this activity as a part of their national industry and this attractive industry is open to all countries that can utilize their opportunity of outsourcing health services from developed countries with respect to their capabilities and competences. For a long time medical tourism was commonly the travel of rich patients from a less developed country to the health facilities in more developed countries that had advanced medical facilities to obtain better treatment.
But today the worldwide market place for health and medical care has changed and medical tourists go in both directions, from rich and poor countries in a similar way and developing countries became the main destinations where high quality combined with affordable healthcare is available (Smith, 2008). After Asian economics crisis in 1990, health and medical tourism has grown in some countries (Kazemi, 2007).
Asia has become the hub of medical tourism and successful Asian countries in this mode of supply of medical services are Thailand, Malaysia, Singapore, India and Jordan.
In Iran despite of its high potential for this industry focusing on low cost and high quality of healthcare services and access to Arab market (Jabbari, 2009) at present, medical tourism does not have grown well. Some hospitals and health care centers began to enter to this industry but they faced by so challenges.
Health system in Iran: The Islamic Republic of Iran is a low middle income and oil exporting country.
It is the 4th largest country of Asia and 17th largest country in the world with an area of 1,648,195 km2.
It is an ancient country located in the Middle East, a region between Asia, Europe and Africa (Mehrdad, 2009).
The country has 31 provinces, 293 districts, 885 cities and about 68000 villages and total population was estimated to be 70,000,000 in 2007 (EMRO, 2009).
The country is bordered on the East by Pakistan and Afghanistan, on the North by Turkmenistan, Armenia and Azerbaijan, as well as the Caspian Sea, on the west by Iraq and Turkey and on the south by the Persian Gulf and the sea of Oman. At present, 830 hospital provide health care services in the second and tertiary level of health system and more than 70% evaluated with first degree of health evaluation system of Iran (Jabbari, 2009).
According to last statistics of statistical center of Iran, about 120000 hospital beds and 4551 laboratories, 3042 rehabilitation centers, 2293 radiology and imaging centers and 7601 pharmacies are providing health services in Iran. Medical tourism in Iran: Medical tourism is not a new phenomenon in the world, as well as in Iran.
In the past, some people from neighbor countries especially from Arab countries of Persian Gulf came to Iran especially to Fars province to get health care services.
In this area in the country, there are no exact statistics about medical tourists who have come to the country, but some resources indicate that about 17500 patients have entered Iran in 2005.
The most popular and demanding procedures include advanced treatments in the field of cardiology and surgeries, cosmetic surgeries, fertility treatments and organ transplants (CHN news).
The main reasons of coming patients to Iran are:
– Quality of health services and low cost of treatments and drugs in comparison with other countries of the region (Middle East and Middle Asia),
– Access to advanced and new medical procedures, equipment and qualified professionals and medical staff,
– Similarity of culture and language in some regions of Iran with neighboring counties such as Iraq, Azerbaijan and lack of some medical procedures, equipment, medical professionals and health infrastructures in those countries combined with
– Natural attractions, ancient and historical buildings in famous cities of Iran (Jabbari, 2009).
Despite of these factors and existence of some legal factors such as the 4th and at present 5th program of economic, social, cultural development of Iran, medical tourism in Iran has not developed yet and some hospitals and medical and health centers individually are working in the area of importing patients from foreign countries and provide health services for them and some patients come to Iran in a traditional way. .
(Source: medwelljournals.com)
women in 40s have higher IVF success. IVF is done regularly in Iran, today.

Costa Rica promoting Medical Tourism

Private hospitals and medical services companies from Costa Rica showcased their services this week at the Society for Human Resource Management Annual Conference & Exposition (SHRM 2017) in New Orleans.

Costa Rica’s Foreign Trade Promotion Office (PROCOMER) coordinated the visit of the local companies to the international event. The mission’s main goal was to facilitate networking with potential business partners and also attract foreign patients to Costa Rica.

PROCOMER Exports Manager Álvaro Piedra said in a news release that SHRM 2017 was also a platform for the Costa Rican health sector to establish contacts with human resources representatives of large U.S. employers.

“It was an opportunity to showcase the quality and the talent of Costa Rica’s health services companies,” he said.

Costa Rican representatives at the event promoted the country’s offerings in dental treatments; bariatric and spine surgeries; orthopedic procedures, particularly knee and hip surgeries; and alternative treatments and minimally invasive surgeries, among other services.

A 2016 survey by the Medical Tourism Index ranked Costa Rica 4th in medical tourism services in the Americas, just behind Canada, Colombia and Panama. The country placed 14th in the global index.

Representatives from Costa Rican hospitals, insurance companies, research centers, medical and wellness tourism companies, among others, displayed the country’s services at the SHRM’s 2017, June 18-21. (Courtesy of PROCOMER)
Local organization

PROCOMER research has found that medical tourism is a niche with some of the best prospects for growth in the country.

Earlier this year, some 95 hospitals and health services providers that make up the Council for International Promotion of Costa Rican Medicine agreed to transform the organization into the Costa Rican Chamber of Health. The chamber, officially founded in February, brings together hospitals, clinics, doctors and specialists, universities, insurance companies, pharmaceuticals, clinical laboratories, research centers, medical and wellness tourism companies, among others.

Executive Director Massimo Manzi said at the time that the new organization aims not only to attract more international patients, but also to offer its associates solutions for training, technical assistance and international promotion. One of its main goals is to obtain updated figures and statistics about the medical tourism sector in Costa Rica, which were non-existent, he said.

Results of the PROCOMER study released in February found that tourists seeking medical services in Costa Rica were drawn to the country by various factors, including lower prices, the quality of professionals here, and the wide range of options ranging from preventive treatments to cosmetic and wellness procedures.

Costa Rica’s political and economic stability are also highly valued factors for medical tourists, PROCOMER found.

Chamber leaders expect the number of members to increase to at least 180 by the end of this year.

Mexico Dental Tourism to receive 56 Thousand patients this year

Dental tourism in Mexico will report this year an impact of about USD $372 million, seven percent more than in 2016, say experts from the sector.

This was highlighted by the announcement of the Dental Implant Week for Low Resources Patients, an event held in Mexico City from May 22 to 27, with the support of the Mexican Association of Oseointegration (COMO).

The president of the Mexican Association of Dental Industry and Trade (AMIC), Raquel Tirado Perez, said that “medical tourism with all procedures will generate in 2017, $3.69 billion dollars.”

She pointed out that the economic pledge for “dental medical tourism will be one thousand $1.37 million dollars.”

The specialist mentioned that this year is expected the arrival of about 56 thousand patients from the United States, Canada, as well as Central and South America.

In recent years this sector has reported an average growth of seven percent with the care offered to foreign patients, which is of great benefit to Mexico, she said.

She remarked that a foreign patient obtains savings of up to 90 percent in dental procedures performed in Mexico, compared to the costs of their home nations.

Tirado Perez mentioned that Nuevo Leon is the second entity in the country with the most important impact from dental medical tourism, which this year is expected to exceed $100 million.

For its part, the director of COMO, Diana Laura Bernal, reported that in the Week of the Implant fifty patients were attended with bone regenerations with equine bone and collagen membrane.

The patients were attended by specialists certified in dental implantology, she said.

Also she reamrked that in a private practice the cost of dental implant and bone regeneration ranges from $900 to $1,500 dollars, while under this program it only costs 3 thousand 180 pesos, about $150 dollars.

The technique that was used is the one applied in Italy, where the largest number of implants in the world is made with more than 200 thousand per year, while in Brazil and Argentina it is 100 thousand annually.

Indian Medical and Wellness Tourism Policy

The NDA government will roll out India’s first Medical Tourism and Wellness policies on June 21, National Yoga Day, this year. To incentivise medical tourism and traditional Indian wellness programmes, the government has decided to get hospitals and wellness centres to register with the ministry’s website and to also notify costs at which procedures or packages will be offered by them.
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Speaking to TOI, on the chief highlight of the policy to be unveiled on National Yoga Day , MoS tourism (independent charge), Mahesh Sharma, said, “India has the ability to be a world leader in offering health services at very competitive prices. To bring in greater transparency, our aim, through this policy, is to get hospitals and wellness centres to register with us. They can then put out their rate charts, the details of the procedures they offer, and their success rates to allow tourists to choose what suits them best.”