A major European medical travel conference will remind the world that every year, millions of medical tourists and health travelers go to, from or within Europe. The European Medical Travel Conference 2010 in Venice will focus on a sector of the medical tourism industry that is long established and highly significant in revenue terms.
Topics covered will include areas which many international medical tourism conferences have failed to address such as the implications of the European Union Directive on Patient Mobility, and the growth of spa and wellness tourism. Representatives of the twenty plus medical travel industry associations around the world have also been invited to attend and discuss the need for creation of an umbrella trade organisation for the medical tourism industry.
The agenda is evolving to respond to the issues and challenges that medical tourism needs to address for patients and providers. The conference accepts that the industry contains people with often conflicting views, so will seek to stimulate genuine discussion and be much more than just a shop window for products, services and destinations. Around 350 participants with a genuine involvement or interest in the business are expected, quality of participant being more important than just boosting numbers by any means.
The venue for EMTC 2010 is the Villa Fiorita Park Hotel, a 4 star hotel in Venice. The dates, 5th to 7th May 2010.There will be visits out to local spas and hospitals in the Venice region.
The conference has an advisory board with members who are assisting in the development of the conference and selection of speakers. Speakers are selected according to the quality and value of their contribution and expertise.
The advisory board includes;* Sabiha Al Aidroos, Ministry of Health, UAE* Professor  Ferruccio Bonino, University Pisa, Italy* Dr. Luigi Bertinato, Department of Health and Social Services, Venice * Dr. Constantin Constantinides, Symmetria, Greece* Dr. Maurizio D`Aquino, CdC San Giovanni XXIII* Professor Heinrich Fürst, MM Clinic, Munich* Dr. Prem Jagyasi, exHealth, Dubai* Keith Pollard, Treatment Abroad* Dr. Carlo Ramponi, EU office of the JCI* Dr. Abdulaziz Nasser, King Faisal Hospital, Riyadh
How conferences treat speakers has recently been a topic of quite heated debate in IMTJ and the medical tourism world. This conference feels that speakers are very important and the organizers follow a code of conduct for speakers, which fully respects and protects their intellectual property.
Speakers may: Use their contribution and knowledge for presentations on   other events before or after the congress. Publication of materials is undertaken only with the speaker’s consent and is free of charge. The organizers will not make use of the presentations for commercial purposes unless there is a specific agreement on shared profits, which regulates the business.
Dr. Uwe Klein, chairman and organizer is CEO of Health Care Strategy in Munich, chairman of the previous European Congresses in Germany and Hungary. Earlier this year, Dr.Klein resigned from the advisory board of the Medical Tourism Association.

Optimistic predictions of 23 million outbound US medical tourists by 2017 are unrealistic says a new report from the Deloitte Center for Health Solutions.
’Medical Tourism: Update and Implications’, says that outbound medical travel fell by nearly 14% between 2007 and 2009 largely because of the recession. The number of Americans traveling overseas for more cost-effective surgery and other medical care fell from an estimated 750,000 in 2007 to 540,000 in 2008. That number is projected to rebound a bit in 2009 with a projected 648,000 Americans seeking care abroad. Paul Keckley of the Deloitte Center for Health Solutions comments, The prolonged US recession has had a significant impact on patients ability to afford medical care, and by extension their use of medical tourism.
The study suggests that outbound medical travel is likely to pick up in 2010, growing an estimated 35% a year in coming years. If it grows by 35% a year, by 2017, the number could exceed 5 million. After dramatic backtracking on growth estimates made in 2007 and 2008, Keckley is understandably wary of long-term predictions. He estimates that at the very best, there could be 1.6 million outbound Americans by 2012, but then comes a long list of caveats, Barring any tempering factors, such as supply constraints, resistance from health plans, increased domestic competition or government policies.
The report says that medical tourism has transitioned from a cottage industry to an acceptable alternative for elective care that is safe and cost effective if coordinated by reputable health plans and providers. The emergent technologies of distance medicine combined with insurance coverage for certain low-risk procedures provide a backdrop for healthy growth in this sector.
Paul Keckley comments, In 2010, as quality is better defined, new business models emerge, insurers, legislators and employers explore pilots and programs, health care providers become increasingly involved in coordinating care and consumers continue to test it out to explore savings. Pent-up consumer demand for elective procedures, especially outpatient dental and cosmetic procedures, will help fuel increased demand for medical tourism again.  Health reform efforts in the near term will also likely contribute to medical tourism’s growth, though in the long run it is difficult to assess given uncertainty about the public option, employer and individual mandates."
Among the additional key findings highlighted in the report:* Inbound US medical tourism will see relatively slow growth to up to 561,000 travellers by 2017;although lack of reliable data means it does not attempt to put figures on intervening years* Although several health insurers have launched medical tourism pilots as part of health benefit plans, it is yet to be determined         if these pilots will be adopted on a broad scale and whether employers or patients will receive the benefits of cost savings via reduced premiums, co-payments or deductibles.* West Virginia and Colorado both failed to pass legislation that would either require or incentivize insurers to incorporate medical tourism within their health benefits plans.

TUV Rheinland has expanded its service portfolio for the hospitality and tourism industry to include new services for spa and wellness organizations, as recent international incidents have changed the attitude and expectations of those who travel and therefore the way the tourism sector operates. These new services help tourism operators and hotels distinguish their services from the competition and highlight excellence. TUV Rheinland is an independent international certification body based in Cologne, Germany.
Marius Stepien of TUV’s Asian office says, "Each of our services can be conducted independently, but can also be integrated and combined, eliminating the duplication of work, saving time and money. The audits are conducted by mystery guests combined with formal on-site assessments including back office document checks and employee interviews. The evaluation system is multidimensional with mandatory questions as well as supplementary bonus questions.
With more than 1000 certifications for hotels and tourism operators in 21 countries, TUV Rheinland offers a wide variety of services in the areas of tourism and health, ranging from training and staff qualification to the certification of quality management systems for wellness resorts, health spas, hotels, tourist offices, cruise ships and fitness studios.
Personalized care and comfort is expected to be worth a trillion US Dollars by 2010. Disappointed guests can endanger market image.  An assessment can show how much organisations care for guests by independently assessing service performance with a wellness quality evaluation program.
Quality standards vary widely in the international wellness industry, ranging from businesses offering genuine quality and a great experience for the guest, to companies, who just jumped the bandwagon and offer sub-par service and sometimes even life-threatening dangers. As there is no specific system existing to evaluate the quality of the wellness and spa business, the situation makes it increasingly difficult for the customer to make an informed decision. Therefore, TÜV Rheinland has developed a program for quality evaluations of spa hotels, resorts, and day spas, offering a guarantee of genuine quality with third-party certification, helping operators to demonstrate the quality of their service. Over 300 criteria are examined, ranging from the environment through the equipment in the spa area to the qualification of the staff, their attentiveness, and the level of service provided; Assessment of actual hardware and software Standardization and checking of treatments Qualification of employees Improvement of earnings Assured quality for the guest Competitive advantage Objective observation and analysis of quality Independent auditors
The wellness and spa programme can be combined with one or more of the other new offerings; eco-hotel, safety and security, and service quality. Eco-hotel allows businesses to demonstrate a commitment towards sustainability and ecological preservation with an independent verification and advice on saving costs by optimizing energy and resource management. Safety and security risk analysis includes physical security, and food safety. Service quality is where customers talk about their experiences – positive or negative. Openly assessed throughout the organization or discreetly checked by mystery guests.

After several years when the only promotion of medical tourism to the country was by small agencies and clinics, the Argentine government has launched a medical tourism initiative.
The government’s sudden interest in medical tourism is driven by a dramatic fall in tourism to the country because of the effects of the global recession and the swine flu epidemic. In August, the latest month where figures are available, the number of foreign visitors dropped by 31.8 percent compared with 2008, according to a recent government report. With income of $3.36 billion in 2008, tourism was the country’s third-largest source of foreign currency. Trying to make-up the lost $ billion with medical tourism is hugely optimistic, as most medical visits to the country are short-stay cosmetic surgery.
 The Argentine government plan to promote medical tourism hopes to attract visitors who divide their stays between getting medical treatment or operations and sightseeing. To get the initiative under way, the National Institute for the Tourist Promotion of Argentina, INPROTUR, has agreed to promote selected medical facilities that will offer lodging and tourist visits to patients from abroad.
Tourism Secretary Enrique Meyer says, We are also taking to the different fairs around the world a programme with prestigious medical professionals, latest-generation technology available in the country, personalized attention and comfort, added to unique tourist attractions. This work, that seeks to promote Argentine medicine abroad, will be adopted as a state policy that should remain in place over time, obtaining good income for our country.
The government is following on from local clinics who have began offering plans combining treatment with trips to the country’s main tourist locations, including Iguazu Falls and the gigantic Perito Moreno Glacier. These have attracted an unknown number of customers over the past few years who have taken advantage of the low prices in the South American country compared with the costs of European or US medical treatment, particularly following the devaluation of the peso in 2002.Most medical tourists come to Argentina to undergo cosmetic surgery, although there are also people who come for surgical operations, while many childless couples come seeking fertility treatments.
INPROTUR is public-private agency responsible for the promotion of Argentina as a tourist destination abroad. Medicina Argentina was organized as a result of the initiative sponsored by INPROTUR and Fundacion Exportar with the purposes of offering healthcare in Argentina: highly-specialized skills of physicians, scientists and technical staff and at the same time making Argentina a medical tourism destination.
The Medicine Argentina program includes stays in luxury hotels, as well as a variety of tourist and cultural attractions. At launch it promotes six hospitals, four specialist clinics and four local medical tourism agencies. The website is in English and Spanish, and plans to add more services soon.

With little official marketing or promotion of Dubai, a new private website seeks to fill the gap by showcasing Dubai’s healthcare resources online via a free online service Doctor-Dubai.com.
The Ministry of Health (MOH) UAE licensed portal is displaying detailed profiles of 1500 healthcare professionals from more than 280 medical facilities in Dubai to the world, attracting thousands of views every day. The portal lets doctors and companies create their profiles free of cost and display them to hundreds of thousands of visitors from across the globe, highlighting Dubai’s efforts in building excellence of service and value. It charges organisations for advertising.
Doctor-Dubai.com is a next-generation website dedicated to helping the people of Dubai find local medical professionals who accept their health insurance and ideally match their requirements. With nearly one and half thousand local providers listed, it has a profile for nearly every individual licensed to practice medicine in Dubai. The site combines detailed provider data with an easy to use search interface to enable users to take the guesswork out of finding the right doctor online.
It is an easy mistake to assume that the growing number of health facilities in Dubai are just after medical tourists. Demand for healthcare services in Dubai has increased quickly over a relatively short period of time thanks to rapid population growth and an increasingly unhealthy populace that, analysts believe, will make the demand for hospital beds double by 2025. In the face of this, the UAE government has overhauled the public health infrastructure at primary, secondary and tertiary levels and there are nine major hospital projects underway at a value of $596m. Dubai has invested heavily in specialist care units for the treatment of cardiovascular diseases and cancer over the past few years as its population starts to develop the healthcare woes associated with an affluent society.
At Dubai Healthcare City (DHCC), a $1.8bn public-private partnership with the Tatweer group, houses a collection of medical teaching institutions, private hospitals and clinics, pharmaceuticals offices, research facilities, spas and rehabilitation centres. In the future, the private sector is expected to play an increasingly crucial role, with healthcare providers from around the globe eyeing the Dubai market as a potentially lucrative option, and entering into partnerships with local companies.
Layla Moufid co-founder of Doctor-Dubai.com is extremely optimistic on the potential, Dubai is expected to be the favourite destination for most of the expected 11 million medical tourists to the UAE by 2010 and we are playing our part in establishing Dubai as the city that cares for your wellness.

Having experienced a poor summer season, with earnings and bookings down, Bulgaria’s tourism industry is using the winter months to review the situation and find a solution. While official sources try to play down the problem, private operators say the 2009 situation is bad and likely to get worse.
Figures issued by state agencies and the industry initially suggested problems, with official sources saying arrival numbers down by between 4 and 8%, compared to the 20% down that private organisations were reporting. The reality is worse, as Bulgarian tourism this year is expected to record a decrease in revenue of between 20 and 25 per cent, according to Rumen Draganov of the Institute for Analysis and Evaluation of Tourism.
Some Black Sea resort regions reported occupancy rates below 25% in the peak month of August, despite having slashed prices by as much as 50%. The poor season has prompted many in the industry to sell up, with 700 of Bulgaria’s 3000 hotels put up for sale on the market, according to figures from the Institute for Analysis and Evaluation of Tourism. The institute says the problem is a mixture of economic crisis, poor standards and increased competition from rivals Greece, Turkey, Italy, Spain, Portugal, and the Northern coast of Africa. To counter the recent downturn and the longer-term malaise predicted by some for the industry, tourism operators and officials are being advised to diversify their product and develop niche appeal rather than continue to promote Bulgaria’s mass-market sun-and-sea image. The EU is Bulgaria’s main source of tourism revenues, with around 75% of visitors coming from Europe. The tourism industry in Bulgaria is largely dependent on the country’s summer seaside resorts and mountain ski resorts.
One idea is to increase the profile and the quality of Bulgaria’s spa and wellness tourism segment. Spa and wellness tourism is expected to play an increasing role in the future, and it has been made a part of the state’s national strategy for sustainable development of the sector. Bulgaria has splendid opportunities for the development of a spa and wellness industry, said Anelya Krushkova of the State Agency for Tourism, She suggested that the 8000 mineral springs in Bulgaria are fresh stimulus for the development of that kind of tourism. Shortly after her statement at a Bulgarian conference on spa and wellness, the government abolished the organization, on the basis that the ex-communist state still works on the principle that if something goes wrong it must find someone to blame, and that the government has to find some money after the agency spent 140% of its 2009 budget.
A new Ministry of Economy, Energy and Tourism, will now be in charge of the tourism sector. How or even if, it will promote the local spa and wellness industry is too early to say.

Accreditation Canada International has been selected by the Ministry of Public Health in Lebanon to identify opportunities for improvement in the Lebanese health care system and ensure optimal use of Ministry resources. The six-month project, started in October, involves the review of current Lebanese primary health care standards and the pilot testing of the revised standards with three local health organizations.
This project is a key step in accomplishing the Ministry’s goal to upgrade health facilities including hospitals, primary health care centres, laboratories and other health institutions in Lebanon. The further development and enhancement of these standards will help ensure that the people of Lebanon have access to quality, safe and comprehensive health care services and will help to keep Lebanon’s population healthier.
Dr. Walid Ammar of the Ministry of Public Health in Lebanon says,Accreditation Canada International will help us in improving the quality of care and overall performance in primary health centres in Lebanon." Wendy Nicklin of Accreditation Canada adds, Accreditation Canada International is proud to be a part of this project and is eager to share its expertise in health care excellence through accreditation with Lebanon’s Ministry of Public Health. This initiative clearly demonstrates the Ministry’s commitment to improve the health and well-being of the Lebanese people by providing them with the best quality health care services possible."
This project further establishes Accreditation Canada International’s ongoing contribution to health care in Lebanon. Accreditation Canada International first became involved in the region in May 2009 when it was selected to provide technical support in the auditing of Lebanese acute care facilities. Regional partners in the Lebanon project include United Management Bureau, based in Beirut, Lebanon, and Al-Mashura Health Group, based in Riyadh, Saudi Arabia.
Accreditation Canada International specializes in exporting health accreditation expertise worldwide.  It is a not-for-profit, independent organization that provides national and international health and social service organizations with an external peer review to assess the quality of their services based on standards of excellence. Programmes and guidance have been helping thousands of organizations strive for excellence since 1958.
Although Accreditation Canada International has not yet accredited any hospitals in Lebanon, it has accredited individual hospitals in Bahrain, Kuwait, Saudi Arabia and the UAE.It is or has been involved in healthcare projects with the governments of Kuwait, Bahrain, Saudi Arabia and the UAE. Very few Lebanese hospitals have any international accreditation, the exceptions being American University of Beirut Medical Center and Clemenceau Medical Center (CMC), both in Beirut and both with JCI status.

Government ministers of the Cayman Islands and others are promoting medical tourism. Not to the island, as healthcare provision there is poor, but as opportunities in developing inbound medical tourism to the US and elsewhere. Patients from the Cayman Islands who need specialized medical treatment travel to the United States and within Latin America to receive high quality medical care.
Health insurance is handled by private insurers and a government-run company (CINICO). There is no universal health coverage. All employers are required under law to provide health insurance for their employees (although the employee may be required to contribute 50% of the premium).
The island is a British overseas territory and one of the world’s top tax havens. The territory comprises the islands of Grand Cayman, Cayman Brac, and Little Cayman, located south of Cuba and northwest of Jamaica. A new constitution giving the Cayman Islands greater autonomy from Britain takes effect this November The change will give the Caribbean territory its first premier: McKeeva Bush, one of the ministers promoting outbound medical tourism.
The Cayman Islands is the world’s most important hedge fund location and the world’s fifth-biggest banking centre. But it has suffered dramatically because of the financial crisis as its bank licence income slid. Public spending also got out of control, with blame particularly attached to an expensive school building programme. The Cayman Islands is desperate not to levy taxes on residents and financial institutions, fearing they will decamp to other tax havens. The Cayman Islands have endured a difficult year after being singled out specifically by Barack Obama in his presidential campaign last year for allowing aggressive tax avoidance.
The Cayman Islands has a limited health care system. There are two hospitals in George Town, the government run George Town Hospital and the smaller private Chrissie Tomlinson Memorial Hospital. Additionally, Faith Hospital is an eighteen-bed facility on Cayman Brac.All are limited in the treatment and surgery they can offer.
The government is very close to being broke. It has been negotiating with the UK’s Foreign Office a complex $279 million loan package that has conditions including higher taxes and significant cuts to its public expenditure programme. The deal is close to resolution, but not completed,  and should avert the embarrassment of the island authorities being unable to pay their staff; it is already unable to pay government suppliers. But local political resistance to raising taxes and a change in the UK minister that has to sign the deal off, means the deal is not a foregone conclusion.
Although the potential is being talked up, it is worth mentioning that the entire population, including children and pensioners, is at a mere 49,000, a quarter of the size of a London borough.

Numerous conferences have talked up the potential of medical tourism to India. Many hospitals were led to believe by organisations with a vested interest in painting a rosy picture, that Europeans and Americans would flock to India – Americans because of a non working health system and high prices, and Europeans wanting to escape long waiting lists.
The problem is that the rush of medical tourists from those areas is always tomorrow’.  Although Indian hospitals report signing deals with American and European medical tourism agencies, and ongoing discussions with US insurers, deals that actually produce mass business are nowhere to be seen. European health insurers and health authorities are slowly sending a few people abroad for surgery, but not to India or other Asian countries as they feel the long-haul flight is a medical risk for people needing surgery.
Indian medical tourism has often talked of 1 million or 2 million medical tourists. These figures sound good but have little relation to reality. Hospital groups now suggest that the figure at best is 300,000 a year, and could even be as low as 150,000. At the Association of Indian Chambers of Commerce’s medical tourism conference in January 2009, a presentation from India’s Institute for Clinical Research said India had treated 300,000 medical tourists back in 2006, but it had no newer figures.
India’s medical tourism industry is actually doing quite well and increasing the number of medical tourists. But Indian hospital groups accept that existing numbers and growth will be lower and slower than though in the heady days of 2007 and 2008. They are looking for deals and business, but will be more careful in dealing with entrepreneurs offering the next big deal, and wary of organisations and businesses predicting armies of American and European medical tourists.
 The Asian Heart Institute treats 400 international patients each year. Many are government ministers and senior businessmen from Africa and the Middle East .It has been accredited by JCI for three years, and is a modern building with state-of-the-art equipment. The top international surgeon who runs it can offer surgery at a fraction of US or EU prices, but Dr Panda reports that he sees only two or three American or European inpatients each month.
 Fortis Healthcare, India’s second-largest hospital chain is also still waiting for the long promised rush of American and European patients. The group hospitals are getting African and Middle East patients who used to go to London or the US. But patients from Canada, Australia, US and Europe are few.
 Another top Indian hospital group that welcomes medical tourists, Wockhardt, only treated 3,500 foreign patients in 2008,of which about half came from the US and Europe. Wockhardt expects the number of foreign patients to rise by 38 per cent this year. Apollo Hospitals and Wockhardt Hospitals have spent a lot of time and money seeking international business, and both believe that the effort is beginning to show positive results, but that growth will be slow and steady.

To compete with lower international pricing for lap-band weight loss surgery the Metabolic Surgery Center at Baptist Hospital has created a lap-band wellness stimulus package.
The cost has been reduced by 25 percent, from $16,100 to $12,000, only for self-pay patients who schedule lap-band weight loss before the end of January 2010. The package includes the surgical procedure with no overnight stay or complications, as well as three months of lap-band adjustments and consultations with the hospital’s dieticians and exercise physiologists.
Bernie Sherry of Baptist Hospital says, "The package is competitive with medical tourism travel rates. Medical tourism is gaining popularity as patients cross the border to Mexico where costs of surgery are lower. By receiving treatment at Baptist Hospital, self-pay patients receive both financial value and high quality care from an accredited centre of excellence."
Dr. Charles Morton, medical director of the Metabolic SurgeryCenter, says thousands of patients travel to Mexico each year for lap-band surgery, "In some places, medical qualification standards for physicians and health care facilities are very different than they are in the United States and there is no follow up care once the patient is back home."
The hospital expects the new package to draw patients from across the country and to help this has developed travel packages with special rates on hotel and air travel.
The Metabolic Surgery Center at Baptist Hospital offers one of the most comprehensive weight loss surgery programmes in the country. It is designated as a bariatric surgery centre of excellence by the American Society for Metabolic and Bariatric Surgery (ASMBS). Apart from in the USA, the only two international centres of excellence of bariatric surgery are both in London.
In Flint, Michigan, McLaren Health Care’s new proton therapy centre will open in 2012. The revolutionary treatment facility will encourage patients to come to the Flint area for cancer treatment at the Great Lakes Cancer Institute.
The facility will be Michigan’s first proton beam therapy centre. McLaren predicts an influx of medical tourists from neighbouring US states and Canada. The hospital is considering how best to serve patients and their families who would be staying in the Flint area for six to eight weeks at a time for a standard course of treatment. McLaren is open to considering options from contracts with existing hotels to partnering with someone to build a new extended-stay facility.
Cancer patients will be able to receive one of the most advanced forms of treatment available due to a partnership formed between McLaren Health Care and ProTom International, a Texas-based medical device company focused on proton therapy for cancer patients. ProTom’s proton therapy system, the Radiance 330, uses smaller machines so proton beam centres can be built for about one-third the cost and on a much smaller area than conventionally built centres that span the size of a football field. McLaren Health Care’s Philip A. Incarnati says, Proton beam therapy represents an innovation in cancer treatment, and we will bringing such an important advancement to patients across the Midwest."

National Heart Centre Singapore (NHC) is a tertiary referral centre within Singapore Health Services. This 185-bed facility is the national and regional referral centre for cardiovascular disease and cardiothoracic surgery, and a public hospital in Singapore. In 2005, NHC became the first heart hospital in Asia to be accredited by JCI and was re-accredited in 2008.
NHC’s mission is to provide excellence in health care and initially sought JCI accreditation to improve its patient care processes and outcomes. Dr Teing-Ee Tan, senior consultant surgeon, says NHC wanted to reinforce our commitment to quality care for patients as well as ensure a safe environment and continually work to reduce risks to patients and staff.
NHC decided to obtain accreditation from JCI because the JCI accreditation process is designed to accommodate specific legal, religious, and cultural factors within each country, an important consideration for a multicultural society like Singapore.
Post-accreditation, NHC has experienced numerous positive impacts: increased levels in patient comfort and satisfaction, a safer environment for patients and staff, and improved staff performance. More emphasis is placed on the quality of care for patients. And patients’ and families’ rights are given higher priority and respect. A systematic approach has been established for individually assessing the clinical quality of medical specialists. Professional policies and guidelines have also been established to standardize care and improve clinical outcomes.
The risk of medication errors has been reduced with improved storage and labeling of medications. Also, the risk of harm to patients, including the threat of patient falls, has been reduced, due to the implementation of new protocols. Better patient identification processes have helped ensure that patients receive the proper procedures and medications. Communication and patient education have also been enhanced and made more effective, helping to increase patient satisfaction.
Joanna Chia, NHGP’s quality manager, says her organization has a philosophy of continuous improvement, and sought JCI accreditation to gain a holistic review of the many facets of care delivery. Greater focus on analyzing data and tracking improvements was a direct result of the JCI accreditation process. Through this process, managers are more willing to look at data and to discuss problems and effective improvements based on data. Increased staff compliance with hand hygiene guidelines is another area in which NHGP sustained improvements. 
The preparation process helped NHGP to define the service it is delivering and the equipment necessary to deliver the care. It uncovered many areas for improvement, addressed them systematically, created policies and procedures and worked to embed these improvements in work processes.
Since accreditation NHC has experienced a gradual influx in foreign patients. National Heart Centre Singapore’s International Medical Services (IMS) team provides a wide spectrum of services to patients from overseas and their families.
A multi-disciplinary team from the NHC’s Heart and Lung Transplant Unit and SGH’s Liver Transplant Service successfully performed the first-ever combined heart and liver transplant in Asia in early April 2009. NHC is currently the only centre in Singapore that performs robot-assisted mitral valve repairs.

EU Health Commissioner Androulla Vassiliou has directed a serious warning to her fellow policymakers at the 12th European Health Forum Gastein (EHFG), There is now a risk that decision-makers are being tempted to think short term and to make cuts in the health budget. The crisis is causing increased psychosocial stress and in many cases an increase in hazardous behaviour such as alcohol abuse, smoking and unhealthy nutrition. For this reason the demand for health services will significantly rise as a result of the crisis.
The Commissioner’s warning that now is totally the wrong time for governments to cut health spending is against a background where several EU governments are using sleight of hand in their budgets. Even if what they spend is static or increased slightly, the demand for and cost of services is growing faster than even increased budgets can cope with. The UK is one of the first to reluctantly admit that over the next decade, the government will not be able to spend as much on the NHS as is really needed.
On cancer, patient safety and electronic records, the EU is making great strides. The Commission proposal on the issue of patient safety has made quality assurance a highly regarded healthcare issue throughout the EU. The European Partnership against Cancer initiated by the Commission facilitates coordinated cross-border measures
The European Network for Patient Safety (EUNetPaS) was officially launched in Utrecht, Netherlands in 2008. The project aims to establish an umbrella network of all EU member states to encourage and enhance collaboration in the field of patient safety. Patient safety is a global issue affecting countries at all levels of development. Understanding the magnitude of the problem and the main contributing factors is essential in order to devise appropriate solutions. An international expert working group set up by WHO Patient Safety produced a list of global research priorities that indicate areas with substantial knowledge gaps and where it is expected that further knowledge will significantly contribute to improving patient safety and reducing harm.
The WHO study ranks the priorities for patient safety in developing countries, transitional countries and developed nations and identifies the differences and similarities for each. One of the significant outcomes was that issues of effectiveness and cost effectiveness were most important for developing nations while issues of communication and safety culture were ranked most highly for developed nations. Patient safety is a fundamental principle of health care. Every point in the process of care giving contains a certain degree of inherent unsafety.
Patient safety is a serious global public health issue. Estimates show that in developed countries as many as one in 10 patients is harmed while receiving hospital care. In developing countries, the probability of patients being harmed in hospitals is higher. The risk of health care-associated infection in some developing countries is as much as 20 times higher than in developed countries.
Patient safety is an area that many agencies and hospitals targeting medical tourists have not yet taken seriously enough.

The Seoul International Medical Tourism Congress (SIMTC) in September gave local hospitals the chance to reflect on medical tourism’s expansion in Korea, discuss better business practices, and create connections with hospitals across the globe, including India, China, the USA, and Russia. Korea’s international medical tourism is seeing a 30 percent increase in overseas patients despite the ongoing global recession and the H1N1 influenza outbreak.
Serious help from government and other national bodies has made all the difference, and is a lesson to countries that think that inbound medical tourism can increase without such help. Kuwait’s Ministry of Health is considering sending patients to South Korean hospitals for treatment. Speaking after a tour of South Korean medical facilities, ministry official Qais Al-Dowairy said that hospitals in the country were advanced and included state-of-the-art equipment, as well as highly skilled staff. South Korea is aiming to become the number one destination for patients from oil-rich Arabian Gulf states.  277 South Korean hospitals and clinics have expressed interest in treating Kuwaiti patients in Korea. The number of foreign patients receiving treatment in South Korea is expected to reach nearly 50,000 by the end of 2009, compared to 40,000 in 2008, earning US$48 million.
The South Korean government has declared medical tourism as a next-generation growth engine. Local governments plan to build health care clusters for medical tourism to attract foreign patients. Daegu has launched Medi Citi as its own brand, arranging for 40 hospitals to prepare English, Japanese and Chinese brochures, opening websites in foreign languages and participating in international conferences and exhibitions. Osong and Daegu are both building medical complexes. Busan is a popular medical tourism destination among the Japanese for weekend cosmetic surgery. The local government runs a call center for translation services for foreign patients. Gangwon-do seeks to develop medical tourism in Gangwon province, targeting 10,000 foreign patients.
The Jeju Healthcare Town is a joint project of the South Korean Government and the private sector. Jeju hopes to attract medical travellers to Jeju Island’s clean and beautiful natural environment with cutting-edge health care. Jeju Healthcare Town will hold a groundbreaking ceremony around the year’s end and plans to open in early 2011. Projects in The Wellness Park, a medical relaxation complex for beauty, prevention, health and relaxation will open in 2011 and 2012.Those in The Medical Park, a high-tech medical complex for various high-quality specialized treatments; will open in 2013 and 2014. International companies wanting to invest will get local tax exemption, housing, special employment benefits for newly hired employees, corporate tax incentives, registration tax incentives, and property tax incentives for customs duties.

Medical tourism in Latin America needs to be regulated to protect consumers, according to Université de Montréal researchers. A new study published in the journal Developing World Bioethics argues that Argentinean fertility clinics are increasingly marketing themselves to international health care consumers: these clinics offer all-inclusive packages with fixed prices that feature airfare, accommodations, transfers, language interpreters and fertility treatment.
The appeal of such packages is obvious: healthcare consumers need not worry about any of the practical details of their trip budgeting, travel arrangements or language barriers and can instead focus on obtaining quality medical services combined with a vacation. Non-accredited clinics in Argentina offer much more competitive prices for services in comparison with clinics in North America or Europe. For example, in vitro fertilization in the United States runs upwards of $10,000 U.S. per cycle of treatment, says Bryn Williams-Jones, a bioethics professor in the Université de Montréal’s Department of Social and Preventive Medicine, who coauthored the paper with graduate students Elise Smith, Carolina Martin and Jason Behrmann.
An increasing number of private fertility clinics have opened in developing countries such as Argentina over the last decade and are attracting consumers through lower pricing. There are two subcategories of medical tourism clinics: accredited centres that are part of the broader healthcare industry and non-accredited clinics focused on medical tourism. India and Poland are actively involved in the fertility sector, so too now are Latin American countries such as Brazil, Chile, Mexico and Argentina.
Reproductive tourism clinics are targeting wealthy North American or European couples through the Internet. The main interest for these individuals to become medical tourists is the high cost, long waiting lists, or even the absence of access assisted reproductive technologies services at home.
Developed and developing nations have encouraged the practice of medical tourism, the authors argue, because of the economic spin-off. Legislation and professional guidelines both local and international are needed to regulate the conduct of private fertility clinics in order to ensure that services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices, says Dr. Williams-Jones.This study was supported by the Social Sciences and Humanities Research Council of Canada, the Fonds de la recherche en santé du Québec, COPSÉ and the Université de Montréal’s Faculty of Medicine.
The paper, Reproductive Tourism in Argentina: Accreditation and its Implications for Consumers and Policy Makers, published in Developing World Bioethics, was authored by Elise Smith, Carolina Martin, Jason Behrmann and Bryn Williams-Jones of the Université de Montréal.

The Seoul International Medical Tourism Congress (SIMTC) in September gave local hospitals the chance to reflect on medical tourism’s expansion in Korea, discuss better business practices, and create connections with hospitals across the globe, including India, China, the USA, and Russia. Korea’s international medical tourism is seeing a 30 percent increase in overseas patients despite the ongoing global recession and the H1N1 influenza.
Serious help from government and other national bodies has made all the difference, and is a lesson to countries that think that inbound medical tourism can increase without such help. Kuwait’s Ministry of Health is considering sending patients to South Korean hospitals for treatment. Speaking after a tour of South Korean medical facilities, ministry official Qais Al-Dowairy said that hospitals in the country were advanced and included state-of-the-art equipment, as well as highly skilled staff. South Korea is aiming to become the number one destination for patients from oil-rich Arabian Gulf states.  277 South Korean hospitals and clinics have expressed interest in treating Kuwaiti patients in Korea. The number of foreign patients receiving treatment in South Korea is expected to reach nearly 50,000 by the end of 2009, compared to 40,000 in 2008, earning US$48 million.
The South Korean government has declared medical tourism as a next-generation growth engine. Local governments plan to build health care clusters for medical tourism to attract foreign patients. Daegu has launched Medi Citi as its own brand, arranging for 40 hospitals to prepare English, Japanese and Chinese brochures, opening websites in foreign languages and participating in international conferences and exhibitions. Osong and Daegu are both building medical complexes. Busan is a popular medical tourism destination among the Japanese for weekend cosmetic surgery. The local government runs a call center for translation services for foreign patients. Gangwon-do seeks to develop medical tourism in Gangwon province, targeting of 10,000 foreign patients.
The Jeju Healthcare Town is a joint project of the South Korean Government and the private sector. Jeju hopes to attract medical travellers to Jeju Island’s clean and beautiful natural environment with cutting-edge health care. Jeju Healthcare Town will hold a groundbreaking ceremony around the year’s end and plans to open in early 2011. Projects in The Wellness Park, a medical relaxation complex for beauty, prevention, health and relaxation will open in 2011 and 2012.Those in The Medical Park, a high-tech medical complex for various high-quality specialized treatments; will open in 2013 and 2014.International companies wanting to invest will get local tax exemption, housing, special employment benefits for newly hired employees, corporate tax incentives, registration tax incentives, and property tax incentives for customs duties.

100 delegates from 16 countries representing ministries of health, sickness funds, healthcare providers and other parties committed at the European Healthcare Fraud and Corruption Network (EHFCN)’s Annual Conference to strengthen co-operation in their fight against healthcare fraud and corruption.
Centered on the theme of Cross-Border Healthcare in Europe, the conference discussed possible consequences of the draft EU directive 2005/36/EC-giving patients and practitioners the right to free movement throughout member states.
Paul Vincke, president of EHFCN said, Although EHFCN supports patients and healthcare providers mobility, we also warn decision makers of the risks of increased fraud and corruption in this sector. We call on them that provision is made to reduce losses to a minimum. We also look forward to implementing solutions that were advanced at the conference. An estimated 80 billion euro is lost to fraud and corruption in the healthcare sector every year. Let us eliminate fraud for the benefit of healthcare systems in Europe and the ultimate benefit of every patient".
Cooperation between member states and between healthcare parties is perceived a key to successfully tackling cross-border fraud and corruption. Sharing information is vital and can be started on a small scale between neighbour countries. An example is the bilateral cooperation agreement between the French health insurance fund for salaried employees (CNAMTS) and the Belgian National institute of disability and health insurance (INAMI/RIZIV). The purpose of this agreement is to facilitate the quick exchange of files and information in order to improve research and investigation. The agreement will take effect in 2010.
An important tool to assess risk and outline issues and contributing factors affecting fraud was presented by members of the EHFCN Cross-Border Fraud Working Group. The matrix is designed to identify the most important obstacles that member states are likely to encounter in their work of prevention, detection and sanctioning of fraud. It is particularly intended to be used in a cross-border context, taking into account that member states have different healthcare and legal systems.
The matrix helps to analyse the types of fraud that can derive from specific risk factors such as legal loopholes or lack of access to information or treatment, for every party involved (governments, practitioners, patients, insurers).
Representatives shared their experience and best practices in tackling fraud and corruption. EHFCN also conferred its first Excellence Award on Ewa Kopacz, Minister of Health for Poland, where tangible progress has been made towards an anti-fraud and anti-corruption culture within the Polish healthcare system, thanks to her continued efforts and determination.
The European Healthcare Fraud and Corruption Network (EHFCN) was established in 2005. EHFCN is the only European organisation dedicated to combating healthcare fraud and corruption across Europe in order to bring back money to healthcare services for the benefit of every patient. EHFCN provides information, tools, training and assistance in fighting fraud and corruption to its member associations. It also offers a platform for members to exchange information and ideas.
The matrix proposed by the Cross-Border Fraud Working Group is based on the Enterprise Risk Management-Integrated Framework (COSO ERM Framework). The framework provides a solid foundation that can be used by companies to enhance corporate governance and deliver greater stakeholder value.