Highly collaborative annual surveys that don’t dictate policies and templates, but trigger the talent and know-how of hospital staff to find the absolute best way to do things is the message that a new rival to JCI is putting over, initially in the US. And it seems to be working. One problem is that many states only allow their own accreditation or JCI accreditation , but state laws are changing. While the hospitals the group picked up initially tended to be small and/or country ones, it is beginning to take major hospitals from JCI, the latest being Group Health Central Hospital in Seattle. So who is the newcomer? Houston based DNV Healthcare is part of the independent Norwegian foundation DNV that goes back to 1864. Their core competence is how to identify, assess, and advise on how to manage risk, with offices in a hundred countries. The initial focus is on the USA, but the longer-term aim is to make healthcare safer and more effective worldwide. Late last year, DNV’s innovative NIAHO accreditation program passed the rigorous evaluation process of the US Centers for Medicare & Medicaid Services (CMS); DNV Healthcare became the first new US hospital accreditation organization in more than 40 years. Underlying NIAHOSM standards are tightly coupled to the Medicare Conditions of Participation. DNV developed its NIAHO standards for hospital accreditation, building upon ISO 9001, a quality management standard that DNV says enables hospitals to most effectively address and avoid problem issues.  ISO 9001 is specifically designed to address service organizations and is proven as a basis for quality improvement. In essence, NIAHO requires hospitals to implement ISO 9001 as a means to achieving compliance. ISO 9001 is a vehicle to implement and maintain a quality management system that ensures compliance across all hospital processes. ISO 9001 is the "what," not the "how: giving hospitals much greater flexibility than the Joint Commission approach. In addition to the annual survey visits, each department in a hospital needs to be audited by another department on an annual basis. The worldwide potential is huge, as DNV has conducted ISO certifications of over 1200 health care facilities worldwide. DNV stresses that ISO 9001 compliance is not required on day one in order to obtain DNV accreditation, it can be completed later. It is a revolutionary approach that turns accreditation into a strategic business advantage by creating new standards of excellence from the skills, experience and ingenuity that already exist in a hospital. Yehuda Dror, president of DNV Healthcare says, The World Health Organization is actively promoting the concept of accreditation for all hospitals. The optimum solution will provide a clear foundation of best practices but also allow for local innovation. That is precisely the design of our NIAHOSM program. Now hospitals can choose to integrate proven quality systems into an annual accreditation process that is less complicated to administer. DNV offers risk-based certification as the standard way of conducting all management system certification, which evaluates how a management system handles risks, i.e. identifying strengths, weaknesses, and improvement opportunities.

A new report from Turkey’s top business association says the country should seek a bigger share of the fast developing medical tourism industry.  Doctor Erdal Karamercan of the Turkish Industrialists’ and Businessmen’s Association (TUSIAD), says Turkey should become a strong alternative for international medical tourism, one of the fastest developing sectors in the world. He argues that the Turkish private health sector is able to handle international competition in terms of hospital infrastructure, staff experience, and technology. Six authors wrote Medical Tourism-a new window of opportunity for Turkey, for TUSIAD. Private healthcare in Turkey is excellent, so much so that many people now visit purely for medical tourism; to take advantage of cosmetic, dental and major surgical treatments on offer at substantially lower costs. More than 30 Turkish hospitals and clinics have JCI accreditation. Karamercan adds, "In these times when the health sector is growing rapidly in our country, Turkey should become a strong alternative for international medical tourism. Transforming Turkey into a strong brand in medical tourism and receiving a maximum share from the global demand is essential. It is not only important in terms of economic gain but also for development of health services offered to our society. The state, private sector and civil society should prepare and act upon a realistic strategy toward this goal. We need a programme that can turn our qualities such as high technology, qualified health services, work force standards and accessibility into advantages in competition." The new report not only emphasises the importance of the subject but also offers suggestions on establishing collaborations and legal adjustments. Turkey is the 11th most visited tourism destination in the world. In 2008, 31 million foreigners visited Turkey and the number of tourists has increased 33 percent over the last two years. Meri Bahar, of Acibadem Healthcare, the head of the group that prepared the study says 30,000 to 40,000 people come to Turkey each year as medical tourists. This is a lot lower than previous guestimates of around 200,000. According to Bahar, Turkey’s goal should be 1 million patients by 2020. Investment has poured into Turkey’s private hospitals in recent years. But some groups see the best prospects for growth in tapping international markets. Russians account for about a third of leading health group Acibadem’s non-Turkish clients. Similar numbers come from the Middle East, Ukraine and Kazakhstan, and the group is actively marketing its services to doctors in Balkan and Central Asian countries that have cultural ties to Turkey, and easy flight connections. Foreign patients are expected eventually to fill 10 to 15 per cent of beds in Acibadem’s new hospital in Istanbul’s Maslak district. Between Europe and the Near East, Turkey has much to offer in terms of world-class health tourism treatment, state-of-the-art facilities, and highly skilled, western trained physicians. The cost of medical care in Turkey is competitive. One target market is the 5 million expatriate Turks living in the EU.

The Indian Medical Travel Association (IMTA), an association formed recently to promote India’s medical tourism industry is aggressively looking at this year promoting this high revenue-generating segment in the international markets of Middle East, Africa and Far East along with long haul markets Europe and USA. The association already has a membership of 40 hospitals, other service providers such as aruyveda, siddha and yoga clinics, wellness centres, and medical tourism agencies. It is targeting a membership of 100 in the coming months. It is also open to travel agents, tour operators and students. Most members are in India, but those who deal with it as a destination are also welcome. As a new association, IMTA’s immediate agenda is discussing with its members the best practices that can be adopted and bringing about uniformity by charting strategies to position India as a medical tourism destination. The association is a non-profit body and aims to be a unified voice for Indian healthcare (modern medicine as well as traditional Indian medicine) and travel industries. Pradeep Thukral, executive director, said, The medical tourism industry has a huge potential with state-of-the-art facilities, availability of doctors, technology, English speaking nation and the hospital capacity to cater to medical tourists. The fact is that prior to choosing a hospital, international patients first decide on the country. So we must join to aggressively promote India as a preferred global healthcare destination." IMTJ asked him about the possible confusion of the use of the initials IMTA, We might cooperate with IMTA Singapore or Israel and if tomorrow an IMTA comes up in Iceland or Indonesia. Our objective is India focused only, unlike others. The IMTA aims to Empower all the stakeholders in the Indian medical travel industry to work together to make India the leading global healthcare destination. Bring together the best providers in Indian healthcare and travel industries to help create a high quality, ethical and economically sustainable medical travel industry. Promote and provide a forum for communication on a regular basis for exchange of views, development of industry networks, creation and distribution of knowledge, establishment of standards and work on an agenda to make India the leading global healthcare destination. Promote and protect the safety and well-being of patients who choose India for their healthcare needs by creating channels for communication between patients, healthcare providers, overseas insurance and corporate referral groups, consultants and physicians from around the world. Serve as a strong voice of the medical travel industry to Indian and overseas media and raise awareness about the high level of quality healthcare and services available in India. Engage with the various arms of central and state government in India to influence public policy in national interest. Educate members on new technologies, marketing techniques and best practices to help participants to operate more efficiently. The original "IMTA" (the International Medical Travel Association) declined to comment on the potential for confusion now we have two IMTA’s both using IMTA on their websites and in their communications.

The Health Ministry of Malaysia has launched a "Malaysia Healthcare" logo and website as part of a concerted effort to promote medical tourism in Malaysia. Health Minister Datuk Seri Liow Tiong Lai who launched the branding exercise said the logo with its tagline ’Quality care for peace of mind’ was a part of collaborative efforts between the government and private sector, "The website will serve as a gateway for potential patients and visitors to explore what the Malaysian healthcare services sector has to offer in terms of medical treatment options, state-of-the-art health and medical facilities and general information on Malaysia. Thirty-six private hospitals in the country had been identified to promote the healthcare travel programme, and we hope more hospitals and dental clinics will participate. The ministry is proposing setting up the Malaysia Healthcare Travel Council to work with the economic planning unit, relevant government agencies and the Association of Private Hospitals of Malaysia, to promote the industry locally, champion the industry by consolidating the strengths of the government and private hospitals, and promote it overseas. According to the minister, the number of foreign patients has increased almost ten-fold from 39,114 patients in 1998 to 374,063 in 2008, while the revenue generated from their hospital bills had grown from RM14.1 million to RM299 million during the same period, which was a compound growth rate of 35.7%. The minister added, ""When the industry is gradually developed, we will be able to attract top medical practitioners from overseas to come to Malaysia, and this will be good for the healthcare industry. The multiplier effect of health tourism would be boost for other tourism-related industries such as hotel and transportation because foreign patients with accompanying family and friends would also use these services. Malaysia Healthcare promotes Malaysia as; Unprecedented value for money World-class practitioners Ease of entry Competitive prices Clinical competency Multi-ethnic, multi-cultural, multi-lingual The Health Ministry wants all hospitals in the country to be accredited by the Malaysian Society for Quality in Health (MSQH). Medical development division director, Datuk Dr Azmi Shapie said this was vital to ensure that the healthcare services offered by the hospitals nationwide would meet international standards, We will continue cooperating with the MSQH to ensure that each hospital and healthcare provider will meet the MSQH accreditation standard," MSQH is the national accreditation body for hospitals especially in terms of healthcare facilities, services and management. Of the total 137 government hospitals nationwide, 62 have been accreditation by the MSQH, while of 435 private hospitals, only 17 are MSQH-accredited, say the government. But that only totals 79, and the latest MSQH total is 82.As the MSQH accreditation is only valid between one and three years, MSQH-accredited hospitals need to continuously upgrade the standard and quality of their services.

Although rival JCI has accredited 2 hospitals in Lebanon, and they have accredited none in the country, Accreditation Canada International has been commissioned to carry out accreditation assessments for health care institutions in Lebanon on behalf of the Ministry of Public Health. The Lebanese Ministry has turned to Accreditation Canada for its expertise in assessing the quality and safety in health care facilities. Accreditation Canada has teamed up with a local firm, United Management Bureau (UMB) to meet the specialized needs of the Lebanese Health Care Accreditation Framework. The work will include the training of local surveyors and the assessing of hospitals that will lead to an understanding and plan for necessary improvements and recommendations. The partnership with UMB will maximize the benefit of shared extensive experience - UMB with their expertise in management systems coupled with Accreditation Canada’s excellent knowledge and understanding of principles of accreditation. The quality of hospital care in Lebanon has moved from a focus on physical structure and equipment to a multidimensional approach, emphasizing managerial processes, performance and output indicators. Mohamad Fawaz at UMB says "Quality improvement principles and hospital accreditation address issues of quality of care deficiencies and harmful or wasteful practices. Using Lebanese standards, the partnership between Accreditation Canada and UMB will play a key role in assisting in the objective of upgrading the quality and safety of care in Lebanon. Wendy Nicklin of Accreditation Canada adds, The breadth and reach of the focus on quality and safety in health care, continues to expand. Our experience and flexibility is a benefit which we bring to international markets with pride." Accreditation Canada International specializes in exporting health accreditation expertise to global frontiers. Accreditation Canada is a not-for-profit, independent organization that provides national and international health and social service organizations with a voluntary, external peer review to assess the quality of their services based on standards of excellence. It already works with The Bahrain Ministry of Health on an accreditation programme where local hospitals are in the process of international accreditation. In Kuwait it has accredited two hospitals, plus four in Saudi Arabia and one in the UAE. Recognizing that one standard approach does not work for everyone, Accreditation Canada International customizes its accreditation program to meet the client’s needs. Working collaboratively with clients, it provides continuous guidance without being prescriptive. The accreditation program is adaptable, culturally sensitive, and competitively priced. Accreditation Canada the institution and the accreditation program has been fully accredited three times since serving as a pilot for the International Society for Quality in Health Care (ISQua) in 1995. In 2007 a contract was signed between the Lebanese MOH and the Haute Autorité de Santé (HAS) to develop a hospital accreditation program. The new deal replaces this.

Canada has medical problems; there are long waiting lists, few Canadians can legally buy health insurance, the provision of private hospitals is poor, and many frustrated Canadians travel to the US or elsewhere for medical treatment. But some Canadian hospitals and agencies that send Canadians to the US or elsewhere, hope they can persuade Americans to go to Canada for treatment. Those seeing the potential in Canada say the corridor that includes Buffalo, Niagara, Hamilton and Toronto is the most likely destination as it has both hospitals and hotels. The trick will be convincing Americans that private healthcare is equal on quality to the US, and after taking accommodation and travel into account; the cost savings are worth the trip. Many US residents travel down to Central and Latin America for treatment due to close proximity. Although savings are much less for those near its border, private hospitals in Canada could become a lucrative market. Those promoting inbound medical tourism argue that in comparison to US health costs, medical tourism patients can save 30 to 60 percent on health costs in Canada. For Americans, a medical procedure done in Canada can be a good economical choice. There are no security concerns in travel to Canada, and no language barriers. Proponents point to Canada’s quality of health care as cited by the World Health Organization as equal to if not better than that of the US in most categories. The WHO does not differentiate between public and private care. A more recent survey says that the Canadian public health care system has flunked an international comparison test. According to Health Consumer Powerhouse (HCP), a research organization, Canada’s health care system ranks 23rd among 32 nations surveyed for quality, access and innovation. " Euro-Canada Health Consumer Index 2009," the second annual report, measures patients’ rights and information, waiting times for treatment, outcomes, the range and reach of services provided and access to pharmaceuticals.  Out of the 1000 points available, the Index ranked countries in the following manner: 1 The Netherlands  824 points 2 Austria                    813 points 3 Luxembourg          795 points 4 Denmark                794 points 5 Germany                769 points 23 Canada                549 points According to researchers, wait times to see a doctor and receive treatment dragged the Canadian ranking toward the bottom. Patients were waiting between 3-15 months for treatment, when they could have received the same quality of care in Germany, France or the Netherlands in two weeks. The Canadian system insures everyone, and all Canadians have access to basic and critical health care without ever seeing a doctor or hospital bill. But demands on the system have led to waiting lists for treatments such as MRI scans, cataract and artery bypass surgeries and hip replacements. Both American and Canadian health systems need urgent attention. How quickly one or both are fixed, will have a lot more influence on the medical tourism flows to and from Canada than anything else.

At a recent meeting in Phuket, Thailand, a new association was formed the Asian Association of Medical Tourism (AAMT). It has been formed because of the rapidly growing medical tourism industry in the Asia Pacific region. With the emerging trend of more people entering into the medical tourism industry in the region, the founders, SOS medical tourism, felt it important that the Asia-Pacific must have its own medical tourism association. Asian Medical Tourism Association (AAMT) was formed in mid 2009 as a non-profit trade body. At least for the first year, AAMT’s policy is to offer free membership for those involved in Asia-Pacific medical tourism. The association shall * Not show favouritism to any one member over another* Produce an information flow (online newsletter on a regular basis)* Network with other organizations with only the best interests of its members in mind.* Act as a database coordinator with research relevant to the medical tourism industry Aims and Goals- *To foster and grow the medical tourism industry in the Asia Pacific region*To act as an advocate for members to develop a better understanding of medical tourism* To help develop standards in line with the culture and economic needs of its members* To lend advice and provide information that may help our members further grow the interest in medical tourism industry* To provide a forum for our members to openly discuss issues relevant to all sectors of medical tourism industry* To act as a voice of medical tourism industry throughout all Asia AAMT will fully endorse and support the upcoming conference, The World Medical Health Tourism Conference to be held in Phuket in September 16-18, 2009. A 30% discount on the conference registration fee will be extended to certified members of the AAMT. All members are encouraged to attend the event, where the first ever meeting of members will take place to decide more detail on the future of the organisation. While rival bodies cover Asia, there is a mood in Asia-Pacific that they concentrate too much on potential American business, when countries see most growth from Asia, Pacific and Middle East regions.  A report on medical tourism by the Asian office of the Deloitte consulting group has had little attention.’ Medical Tourism-the Asian chapter compiled at the end of 2008, before the worst effects of the recession were known. While most others were still trotting out figures of up to 40% annual growth for individual Asian countries, the report suggested a more sober 20 percent annually across Asia. It highlights that the main fuel is the growing affluence of the middle class in Asia, allowing patients to travel for better quality medical care than in their own countries. Even before we knew that fewer patients from Europe and the US were travelling to Asia, it suggested that these areas were of much less importance to Asian medical tourism than many would like to admit.

With compulsory health insurance and offering probably the best healthcare in Europe, Germany is fast becoming a destination for specialist healthcare. Harley Street in London admits losing international business to Munich and other big German centres. German hospitals actively target Russians and the Middle East.So why will the number of Germans quitting the country for healthcare tourism rise dramatically? Germans are finding that dental treatment in former Eastern European countries is as much as 80% less expensive than at home, so it is cheaper to pay to go abroad than to have insured dental treatment at home and pay the self-insured portion of the bill, which can be up to 70% of the total. Germans also go abroad in large numbers for spa treatment. Although destination countries have talked about German patients, there has been no attempt to guess at numbers travelling for planned treatment, compared to those who have to get treatment when travelling.  A new survey suggests the number of outbound German healthcare tourists is already much higher than expected, and will increase. German health insurer Techniker Krankenkasse (TK) is pioneering insurance packages enabling its members to seek treatment abroad. A newly released survey done in 2008 found that around 1% of its members had care abroad in 2007, of whom 40% went for scheduled healthcare, rather than for acute and emergency care while travelling. It is the largest German health insurance fund with over five million members and 7.7 million insured persons. The insurer knows how many Germans have healthcare, so very conservatively, it has multiplied its sample to suggest that 272,000 booked ahead for care. This figure excludes spa visits and dental care not claimed back from insurers. TK leads the way in Germany in signing up foreign hospitals for members.TK European Service includes a special programme to use spas outside Germany - spa treatment is included in the list of benefits provided by statutory funds in the event of illness. The reason is that the survey found that, if ill, 33% of TK members surveyed said they would decisively take a service allowing them to use foreign spas, and a further 33% would probably make use of it. Dental treatment in Hungary, including hotel accommodation, is less than half the price of similar treatment in Germany.TK says that dental treatment is up to 80% cheaper in Eastern Europe. There are strong historic links that East Germans had before the fall of the wall with healthcare systems in Hungary and the Czech Republic. Other favoured destinations are Poland, and former Eastern European countries. Asian hospitals should note that neither the insurer nor members show any inclination or desire to go outside Europe for treatment. The health insurance reform of 2007 requires everyone living in Germany to be insured for at least hospital and outpatient medical treatment. 85% of the 70 million population are mandatory or voluntary members of one of the statutory health insurance schemes while the others have private health insurance.

The Pacific Asia Travel Association (PATA) has teamed up with the International Medical Travel Association (IMTA) to promote and develop healthcare travel and tourism across the region. The two associations have signed a memorandum of understanding that seeks to collaborate in such areas as data and trends analysis for the healthcare travel sector as well as exploring opportunities for joint membership. Medical tourism is recognised as one of the industry’s high value sectors, with medical tourists tending to stay for longer durations with the associated increase in local market spend. Ruben Toral of IMTA, says, "Asia is a well developed medical tourism region with excellent hospitals and tourism infrastructure. Working with PATA helps us to bring the healthcare and travel industries together in a more cohesive manner."IMTA is based in Singapore and the vast majority of members are based in Asia-Pacific. Formed 50 years ago with headquarters in Bangkok, PATA is a global organisation with 2500 members comprising 42 member destinations within the Asia-Pacific region, plus airlines, hotel groups, tour operators and travel agents. PATA is a membership association acting as a catalyst for the responsible development of the Asia Pacific travel and tourism industry. PATA member online booking service Agoda confirms the positive effect medical tourism has on the hotel industry. Michael Kenny of Agoda remarks, "We are definitely seeing a rise in medical tourism to Asia. For instance, our hotel partners in Bangkok such as the Ariyasomvilla and FuramaXclusive, which are both located very close to Bumrungrad Hospital, confirm that 30 - 40% of their guests are either medical tourists or their family members and friends. Following this trend, Agoda has made improvements to our site to make it easier to identify hotels which are near to popular hospitals, as well as negotiate long-stay discounts at a number of these hotels." Pomchai Chairungsinun of FuramaXclusive Sukhumvit adds, "Medical tourists make up about 30 to 35% of our clientele each year with June, July and August being our busiest months. The majority of patients usually have families visiting and will therefore request two to three rooms. Medical tourism is highly beneficial for us, as guests will generally stay for at least a week during their checkups and treatments. Our close proximity to Bumrungrad Hospital is a big bonus for visitors to the hospital." In Malaysia, G Hotel and Berjaya Georgetown Hotel in Penang have begun promoting themselves as medical tourist-friendly hotels, taking advantage of their close proximity to Gleneagles Medical Center and Penang Adventist Hospital.  In Singapore, many hospitals are located in districts with many nearby hotels. U.N. World Tourism Organisation (UNWTO) says the demand for international tourism has deteriorated, and continues to deteriorate, due to the economic recession. The impact is felt heavily in the Asia-Pacific region with tourist arrivals declining in Hong Kong, Japan, Thailand, Singapore, Macao and China. The only exception is South Korea, where tourism and medical tourism are both increasing. With tourism numbers expected to dip for the next three years, PATA and IMTA see medical tourism as one way of increasing visitor numbers.