The Korea Tourism Organization (KTO) has offered 40 travel agents and guides a lecture on Islamic culture and introduced a Halal food lunchbox and tour programs tailor-made for Muslims in a bid to attract more Muslim tourists. The biggest obstacle to attracting Muslim tourists is strict rules on food and prayer, and the KTO has found ways of dealing with both. Muslim interest in medical tourism in Korea is growing. Many from Southeast Asia are incentive traveler groups, and they prefer seasonal attractions, such as skiing in winter and flower festivals in spring, she said. Recognising that language difficulties is a real problem, the government has started a program to train medical interpreters to help hospitals avoid language barriers when providing services to foreign patients. The Korea Human Resource Development Institute (KHRDI), part of the Ministry for Health selected 65 trainees for its 200-hour program to develop medical interpreters in English, Chinese, Japanese, Russian and Arabic. Sessions for those selected will take place from July until December. According to the institute, all the interpreters are fluent in both Korean and their own respective languages. Some have graduated from graduate schools of interpretation, others have worked in the medical field before and some are already working as interpreters at hospitals. The curriculum consists of understanding communications in the medical field, methods of consulting specific patients; domestic and international medical laws; health insurance coverage and understanding of major diseases and their treatments among others. The trainees will go on field trips to major hospitals that attract medical tourism: Yonsei Severance Hospital; Seoul National University Hospital Healthcare System Gangnam Center and Cheongshim International Medical Center. Oh Hyun-bok of KHRDI explains, We are seeing a growing demand for professional interpreters to help understand exactly how patients are feeling and what could be their best treatment. Some hospitals say that language barriers exist because the medical coordinators are not language professionals. Some hospitals have been asking us to send trainees, even before they have finished their courses, to work part time. Some asked us for contact information for the people who failed to make it into the 65, so that they could hire them instead.’’ KHRDI expects the Council for Korea Medicine Overseas Promotion (CKMP), which includes 30 hospitals nationwide, to recruit them. Wang In-ju for the Seoul National University Hospital Health Care System in Gangnam admits that the hospital needs more professional translators. Russian patients sometimes bring their own interpreter because they like our services but sometimes communication is not satisfactory.’’ The Korea Health Industry Development Institute (KHIDI) and CKMP will hold the Korea Global Healthcare Conference, July 16 to 18, 2009,to attract American patients, in New York and San Francisco. Thirteen hospitals and clinics of CKMP and a medical tourism agency will attend.

Recession has affected the progress of medical tourism in Dubai.The banks have got cautious and stopped funding construction of healthcare projects in Dubai Healthcare City and elsewhere on hold. Healthcare businesses in the UAE have felt the impact of the recession and plans to become a major medical tourism destination have suffered a setback, although some argue that banks have panicked unnecessarily. Dr Azad Moopen of Dr Moopen’s Group, says, "In the UAE, economic downturn has not had a big impact on healthcare business. We are on track in terms of number of patients in our hospitals and clinics that cater to professionals and the well-to-do part of the population. Raza Siddiqui of ETA Star Healthcare adds, "By and large the healthcare business is recession proof, in the sense that whether the times are good or bad and whether you are rich or poor you will always need medical attention. Numbers did fall in February and March but now things are fine and we are witnessing normal volumes of patients in our hospitals. Dr Mohanakrishnan of Eurohealth Systems notes, The plan to become the healthcare tourism destination of the region has been affected by recession. Many of the projects in Dubai Healthcare City and other places are on hold. However, this is just a temporary thing and it will pass. Things will start moving again once the situation eases. The UAE needs to do a few things before it can fulfill its ambitions to becoming a medical tourism destination. They need to develop the infrastructure, they need to bring in more in-house experts in major procedures and they have to be more cost effective. The UAE has a lot of potential to become the medical tourism hub, especially where cosmetic surgery and infertility treatments are concerned. And the good news is that people from the United States, the United Kingdom and Middle East and North Africa are already travelling to the UAE for these procedure." Dr Moopen adds: "Some specialist hospitals were supposed to come on stream by the end of this year or early next year but these have been deferred. Many of the projects that would have provided advanced tertiary and cardiac care have been delayed or put on hold and this will impact the inflow of patients coming in for advanced treatment. Dubai Healthcare City has been set up with this purpose of bringing in advanced and specialized healthcare such as transplants, cancer treatment,and tertiary care, not easily available in the Middle East. But it is only a matter of time and things will look up. It will take a couple of years but the blueprint is there, only the plans have been slightly deferred. We will carve our niche in the medical tourism business. We might never be as cheap as India and might not be able to attract people from the US or UK for major procedures, but our major playing field will be the rest of the Middle East and North Africa.

There has been increased interest in recent weeks in health related investments in the Asbru health village near Keflavik International Airport in southwest Iceland.Among many investors who have been visiting the site and examining possibilities are Otto Nordhus of Swedish medical practice Nordhus Medical and representatives of investment firm Salt Investments, owned by serial entrepreneur Robert Wessman.Subsidiaries include Salt Health which owns health businesses, and Salt Properties, a property development company focused on investing in planned communities that offer a combination of residential properties and leisure amenities that embrace new solutions for promoting a better quality of life. Salt has Spanish deluxe residential spa and golf resort projects located in Los Nietos and La Primavera in Murcia, and in San Miguel de Salinas in Alicante. Nordhus and Salt Investments hope to encourage a growth in medical tourism to Iceland, by performing operations on Nordic visitors who are on long waiting lists in their home countries. Nordhus has already secured contracts with the Norwegian and Swedish authorities. Post and pre-operation care will be handled in the Asbru health village where there are plenty of apartments available for healthcare related developments. There are already several companies in the Asbru health village attracting health tourists. Detox Jonina Ben is a health therapy center specializing in Detox health therapies, opened in May 2009 by Icelandic entrepreneur Jonina Benediktsdottir. Detox therapy is a wellness method developed in Poland and aimed at enabling the body to heal itself. Since it opened it has been operating at full capacity. Another business is the Keilir IAK personal trainer program, which has been attracting a lot of attention. Recently nine members of the Icelandic handball national team that claimed silver in the last Olympic Games, signed up as students. There are opportunities tied to the development of health and relaxation in the Reykjanes area as the majority of tourists who come to Iceland travel through Keflavik Airport. A Reykjanes Health Association, Ice: Heilsufélag Reykjaness, has recently been founded to develop health opportunities in Reykjanes. The goals of the association are to market Iceland as the land of beauty and health. The Keflavik airport development corporation (Kadeco) the Blue Lagoon and the Keilir school of health are working with it to co-ordinate plans for the different parties in Asbru health village. Ásbrú is a former Nato military base near Keflavik airport. After Nato evacuation in 2006, the base was re-invented as a community of entrepreneurs, students and business. The US military had been there for 60 years. A new Icelandic government owned company, Keflavik Airport Development Company - Kadeco, leads the development and transformation of the former defence area, now known as Ásbrú. Ásbrú offers ambitious new academic programs at Keilir, has the largest university campus in Iceland, one of the largest business incubators in Iceland, as well as many other projects such as a green energy research center and Iceland’s first international data centre. Asbrú’s location close to Keflavik Airport and the large harbour at Helguvík offers a  central position between Europe, North America, and Asia.

With various benefits such as low cost, world-class facilities and comparatively less waiting period, the medical tourism market in Asia is expected to reach US$ 5.4 billion in income by 2012, says a new RNCOS report- Asian Medical Tourism Analysis (2008-2012).  Medical tourism is emerging as one of the fastest growing markets in Asia, with the rising number of foreign tourists going for treatment to the region. The report says that the medical tourism market has recorded a reasonable growth of around 11% since 2007 to reach US$ 3.8 billion income in 2008. Annual growth between 2009 and 2012 is predicted at 14%. The medical tourism industry in the region is growing at double-digit growth rate, outstripping the 4% to 6% growth in general travel bookings. The patients are ready to take up treatments in countries like Thailand, India, and Singapore despite the financial crisis that erodes the purchasing power of the foreign tourists, says a research analyst at RNCOS. Countries that are the most sought after destinations for the medical tourists arriving in Asia are - Malaysia, India, Thailand, Singapore, Philippines and South Korea. Thailand and Singapore are the leading destinations for medical tourism that together accounted for 64% of the total Asian medical tourism market in 2008. However the research says India will emerge as one of the fastest growing medical tourism countries, accounting for around 25% of the region’s medical tourism by 2012. These countries offer various complex treatments at affordable costs. The cost of some highly sophisticated treatments such as hip replacement or heart valve replacement is 8-10 times lower in India and Thailand than in the United States. Also, foreign tourists get their treatment done in the Asian countries like Thailand and India in a week or two, whereas it takes nearly a year to get treated in developed countries, says the report. The future prospect of the medical tourism industry seems encouraging. Asian countries will continue leveraging from their highly developed health infrastructure such as well-qualified medical professionals, internationally accredited healthcare institutions and hotspot destinations. The Asian region, mainly being India, Thailand, Singapore, Malaysia, Philippines and South Korea is expected to receive 6.1 million medical tourists by the end of 2012. The report provides a deep insight about the emerging medical tourism markets in Asia, the market trends responsible for the present performance of the industry and the future growth potential of the industry. It provides key information to clients looking ahead to venture into these markets as well as helps them to plan out strategies before going for an investment/partnership in the concerned markets. RNCOS is a specialist independent market research firm based in Delhi. The 110-page report costs from $ 1400 for an electronic PDF and $ 1700 for hard copy or CD-ROM.

Thailand’s’ Public Health Ministry has drawn up a five-year plan to double the revenue from medical service businesses by 2014 by making Thailand a medical hub and world-class spa destination. Last year, the revenue reached Bt200 billion. However, the government achieved only 80 per cent of the projected revenue because of the political chaos since 2007 and the closure of Suvarnabhumi Airport late last year. Dr Tangnapakorn of Health Service Support says, "Despite the global economic slump, medical service in Thailand continues to grow thanks to more choice of services, international-standard treatment, new medical sciences as well as new alternative treatments. These factors will enable Thailand to become a medical hub. What we are doing is to restore the confidence of foreigners to return to Thailand for world-class treatment." The ministry is trying to upgrade Thai spas to meet international standards for spa operators and therapists. Wichien Juthamongkol, of Phuket Spa Association (PSA), said the five-year plan is focused on world-class standards in both service and image. All Thai spa, massage and health services should be upgraded. In addition, total revenue from Thai spa and massage should account for a fifth of the total target of revenue by 2014.There are 200 spa operators in Phuket but only 70 spas have been licensed by the ministry. PSA will promote more hotel spas as now only 50 hotels out of a total of 400 hotels in Phuket operate hotel spas. Under the ministry’s five-year plan, spa operators will be graded in three categories - gold, silver and platinum. The healthcare sector has 1360 hospitals, of which two-thirds are in the public sector. In 2006 Thailand had an estimated 145,000 hospital beds, with 40,000 of these in the private sector. There has been an increase in the number of private hospitals in the past few years. In 2006 there were 471 private hospitals, most of which were concentrated in urban areas and 44 per cent of private hospitals were in Bangkok. Most private hospitals now have occupancy rates of only around 30 per cent, but some medical tourism ones are much higher. The Ministry of Public Health aims to make Thailand the centre for health services in Asia by 2010. The target is to increase the number of foreigners seeking medical treatment in Thailand’s hospitals from a total of 970,000 in 2003 to two million by 2010. As Thailand’s cost of living is much lower than in Japan, the US and Europe, it is much cheaper for foreigners to obtain medical care in Thailand than in their own countries. Realising that price needs to be coupled with excellent service, more private hospitals have started offering non-medical services, such as booking flights and arranging visas for patients. The government is backing a Hospital Accreditation (HA) scheme, whereby a hospital is accredited if it reaches international standards. HA is conducted by the Institute of Hospital Quality Improvement & Accreditation.

The UK government wants the best hospitals in the country to be awarded gold standard status in a system similar to the one that awards Michelin stars for restaurants. An accreditation scheme recognising the best clinical teams within the NHS, and showing how they compare with leading hospitals in the United States and Europe, is being drawn up to improve the quality of care. The concept is to set up an international panel as judges. But why re-invent the wheel when there are two UK based international accreditation organisations that already do this?  Lord Darzi, the Health Minister, says the scheme will introduce healthy competition, mark out best practice and encourage hospitals to aspire to world-class health services. It will apply to specific areas of care such as cancer, maternity or stroke cases. Doctors’ leaders welcome the initiative but want financial rewards for success in improving the quality of care. Speaking about the accreditation scheme, Darzi said it might compare to the Michelin system, although it would be a single stamp of approval rather than grades of excellence. It will be voluntary and involve assessment by an international panel and peer review, with input from the medical Royal Colleges and other professional, health service and regulatory bodies such as the Care Quality Commission and the National Quality Board, What we want to do is introduce a voluntary accreditation system which acknowledges whether the service is nationally and internationally recognised. I want to see how our best compares with the best in US and Europe, and learn from the best international examples. Details have yet to be fleshed out and will involve public consultation and involvement from think tanks such as the Health Foundation and the King’s Fund. Service accreditation is a highly complex area but is a logical extension of existing guidelines setting medical standards and improving services. The logistical problem of accreditation by a diverse international panel, which may or may not have any experience of UK hospitals, appears over complicated. A method where national and international patients could identify which UK hospitals is an excellent idea.  There are two UK organisations who already have extensive experience of assessing quality and safety, and accrediting, leading UK hospitals and hospitals in a range of overseas countries. Surely it would make more sense to get one or both of them involved rather than a panel who’s judgements could at best be arbitrary? CHKS has hospital accreditation programmes that put quality at the heart of everyday working practices. CHKS focuses on patients, their experiences and outcomes and already assesses hospitals implementing the Darzi vision of ’high quality care for all’ . An analysis of nationally available data sets has revealed Poole Hospital NHS Foundation Trust to be the safest hospital in the UK.The Trent Accreditation Scheme offers affordable accreditation based on NHS International Healthcare Accreditation standards that maximize patient safety. The Scheme has been developed by practitioners and managers from the NHS.

The American health industry has based opposition to outbound medical tourism on the inability to sue for any potential medical malpractice. When we make a mistake it is easier to sue your surgeon/hospital/doctor in the USA than anywhere else in the world is a poor defensive position when a key reason that US care is so expensive is the huge premiums that hospitals and doctors pay for medical malpractice insurance, as they get sued a lot. When you buy a car is your top concern the possibility that your family could sue the maker if a wheel comes off and kills you?  So the logic of stopping patients from going overseas on the basis that ’ we are so bad at home that we get sued a lot ’ is not good. Of course there may be clinics and hospitals that are incompetent and make mistakes. But the backstreet, under funded, under trained, professional can be a problem in all professions anywhere in the world, not just in the medical sphere. If you get your car fixed by a man with a shed and a hammer, you are unlikely to get the same result as if a garage with all the latest computer technology and equipment fixed it .The same principle applies to medical tourism. As a patient can choose to sue in the country they were treated or in their home country, sueing overseas is rarely allowed. The patient could sue in the US, but it is waste of time unless the hospital has US assets. Overseas governments will dismiss demands that overseas countries make laws on medical negligence, out of hand. Imagine undergoing surgery overseas. The doctors and hospital seem reputable. Now, imagine suffering post-surgical complications after returning home. You cannot easily return overseas. So you secure treatment locally, racking up unexpected, out-of-pocket costs. Afterwards, you consider suing. But who’s liable? Is it the surgeon or the hospital? Do you sue domestically or abroad? Did you deal direct with the hospital or were you guided by a US based medical tourism agency? These are the typical questions being considered by Nathan Cortez, an assistant professor of law at Southern Methodist University, who is examining what legal recourse U.S. patients have when problems arise; There’s legal uncertainty about everything, as well as a regulatory void. There’s a flood of ethical, policy, legal and moral issues. But he hasn’t found any court rulings involving disgruntled medical tourists, The lack of test cases illustrates the legal uncertainty, Cortez says. Cortez suggests the Department of Health and Human Services as a viable entity that could coordinate US regulatory controls over medical tourism. He proposes policymakers build on existing consumer protection laws and expand licensing systems. While the US government could not control overseas hospitals, it could demand that agencies based in the US need a licence, just as travel and estate agents do. As the agency is the most likely to be sued, professional indemnity insurance, as it is for many professions, would need to be a requirement of licensing. As Obama moves from state to national licensing systems, a compulsory US licensing system for medical tourism agencies becomes practical. Cortez is in the vanguard of those who feel that the days of unlicensed medical tourism agencies are numbered.

Taiwan’s medical tourism sector targets patients from Mainland China, Hong Kong and Macau with medical check ups and individual medical treatment. The check-up trade is just taking off, but the latter is being stifled by red tape, so the chances of reaching the government’s target of 100,000 medical tourists by 2010 are slim. Since 2007, only around 30 Chinese patients went to Taiwan for an operation say local hospitals, but Taiwan External Trade Development Council (TAITRA)’s Walter Yeh says from June 2008 to mid-June 2009, TAITRA assisted 698 Chinese people to go to Taiwan for medical treatment of which, 228 were for physical check-ups. Yeh says that the medical check-up market will grow mainly by organized groups and that more groups will come after the first 30-member medical tour group from China came for a six-day visit and praised local hospitality and treatment. At least six medical tour groups from China are already booked to in the latter part of the year. The first tour group members checked into four medical centers around the country for physical examinations. TAITRA helped the Guangzhou-based Zion Health Club to reach an agreement with 13 medical centers and hospitals in Taiwan to organize medical tourism groups from China for the purpose of medical care, spa treatment and sightseeing. Zion Health Club is a subsidiary of the Women’s World Spa Resort Group, a Taiwanese-financed company that has 600,000 members around China. The next group of 50 Zion members is scheduled to arrive in late August. A group of Chinese origin from the West Coast of the United States and two such groups from the East Coast are also booked in. With Chinese and American medical tourists coming from relatively high income brackets, TAITRA argues that they will spend several times more than a normal tourist. Apart from health checks, medical tourism between China and Taiwan is legally limited to live donor liver transplants, maxillofacial reconstruction, artificial insemination, joint replacement and cardiovascular treatment. Taiwan’s advanced medical facilities and high standard of medical professionals have attracted medical tourists, but officialdom is strangling the trade. Wu-Ming Yen of the Taiwan Non-Governmental Hospitals and Clinics Association (NHCA) says that a complicated time consuming application process is deterring very ill Chinese going to Taiwan for urgent medical attention. Chinese patients who wish to travel first have to obtain a medical certificate from a doctor in China to verify they need specialist care. Only then can they get accepted for treatment by a Taiwanese hospital that then has to apply to the Taiwan immigration authorities on behalf of the patient. After that, the patient still has to get permission from Chinese authorities, who are notoriously slow, to travel to Taiwan. The whole process can take up to 3 months. NCHA is urging the Taiwan and Chinese authorities to speed up the process. Some local doctors are more blunt, saying that as medical tourism is limited to very ill patients, with a three-month delay, they can be dead by the time they get everything sorted.