A website that offers information mainly to UK and Ireland residents seeking treatment in the UK, Ireland, Europe and elsewhere, suggests that fewer people are going abroad for treatment. RevaHealth.com is a healthcare search engine with information about 60,000 clinics in the UK and Ireland and thousands more in 50 countries around the world. It suggests that the number of Britons looking for health treatment abroad has dropped by over 40 percent in the past six months. But it also says that numbers leaving the UK for treatment has fallen by almost 20 percent between February and March. So if the six-month drop is 40 percent and the monthly drop under 20 percent, then this can either be read as a sign of a continuing fall, or that the fall has dropped by half, which suggests there is a recovery. A truer comparison would be March 2009 compared to March 2008. It is important to factor in that medical tourism does have seasons, that the site traffic for March is over 30 percent higher than February, and that half the site’s business is in domestic health care not medical tourism, so there is no way of knowing if the extra traffic is predominantly people seeking domestic healthcare or the same mix as before. Caelen King of RevaHealth comments, While putting off cosmetic dental and plastic surgery procedures might seem like the prudent thing to do in a bad economy, there are still lots of money saving options open to savvy customers. Due to the downturn in the economy, many clinics abroad are lowering their prices, making the potential savings even greater. Countries like Hungary, Turkey and even Thailand offer UK patients high-quality treatments like tooth whitening, breast implants and liposuction for less. Before getting carried away in an excess of gloom and doom or excitement about a recovery, it is vital to appreciate that the figures are purely the number of people looking for information on a website, not real figures of the numbers of people who are or have been or will actually go overseas for treatment Philip Boyle of RevaHealth adds: The number of enquiries we are getting for cosmetic surgery continues to grow faster than our traffic, with the number of enquiries from the UK jumping by over 58 percent from February to March.   Company figures for March 2009 are different from what other medical tourism sites may show as a large proportion of general searches and enquiries passed on to clinics are for people in the UK and Ireland looking for treatment at home The number of people in the Republic looking for dental treatment in Northern Ireland increased by nearly 75 percent in February. Tax relief in Ireland was recently lowered from the higher rate of 41 percent to the standard rate of 20 percent, making expensive work even more costly for many patients. Caelen King said: "Our research clearly shows that Irish patients are choosing to shop around for dental treatment, and going across the border to Northern Ireland is an increasingly popular option.’’

At the first Latin American Medical Tourism Congress in Monterrey, Mexico, the opening address to the audience was to announce its cancellation as a preventative measure to minimise the spread of swine flu.

Rigid rules on medical advertising have placed Malaysian doctors and hospitals at a disadvantage in global medical tourism. This is a stark contrast to doctors and medical institutions overseas, whose websites include virtual tours of hospitals or clinics and testimonials from their patients. Conservative local doctors argue that advertisements have nothing to do with medical skills or treatment but, in the real world, branding and promotion are inevitable. Health Minister Datuk Seri Liow Tiong Lai wants it both ways. While he claims his ministry will do its best to help promote medical tourism, he is firm that any form of advertisement should not breach the medical code of ethics. Less than three years ago, the Malaysian Medical Council (MMC) lifted the advertising ban imposed on registered medical practitioners. Unlike doctors in some foreign countries who can pose on their websites to promote their services, Malaysian doctors are only allowed to put up tiny photos with their names, qualifications, job titles, telephone numbers and places of practice in any form of advertisement. The Health Ministry’s Medicine Advertisements Board (MAB) must approve all medical advertisements, including websites, in advance. Over the years, there have been many complaints over the rigid guidelines on such advertisements. Advertising agencies too, are controlled, actual copies of advertisements must be submitted to the board for approval and no changes are allowed to the copy after approval. MAB’s control has also stopped the advertising industry offering foreign advertisements. Even healthcare facilities and medical tourism agencies wanting to advertise in the media in Malaysia, or use advertorials, are not allowed to actually name the healthcare facilities. No one will pay to advertise if they cannot name the hospitals, the types of treatment available or the list of medical specialists. Even advertisements on medical tourism in other countries must get approval, and only general information is allowed, not specific promotion on healthcare facilities or hospitals. Overseas healthcare facilities and tourism organisations are now advertising in foreign magazines which are on sale in Malaysia, and untouchable by the MAB, but Malaysian doctors and hospitals fear that if they advertise in these magazines, the MAB could bring charges of breaching the medical code of ethics. Malaysian Medical Association (MMA) president Dr Khoo Kah Lin would rather be a little conservative than over-advertise. He feels that the Malaysian Medical Council (MMC) and the healthcare industry can always discuss ways to make medical tourism more attractive, and that some doctors have a tendency to make excessive claims to boost medical tourism. Malaysia is not the only country to impose strict guidelines on medical advertisements. In China, advertisements on hospitals and doctors also need prior approval from the Ministry of Health and the State Administration of Industry and Commerce. Hospitals are discouraged from advertising and applications rarely get approved. Dental and cosmetic surgeries do openly advertise, while private hospitals opt for advertising on public transport such as buses and metro trains. The law in China has been tightened so only basic information on medical organisations like the name of the hospital, address, type of treatments and business hours are allowed. Many private hospitals want to highlight the types of treatment they offer, rate of success and rate of complications for each and every type of treatment. Putting up such information is a form of transparency that allows patients to choose. In Thailand, private hospitals advertise their range of services but avoid naming their doctors or specialists. To avoid any violations of rules, some even present their advertisements to the Thai medical council for review and approval. Like in Malaysia, medical practitioners are not allowed to stake claims, using superlatives like world-class, world-renowned or best in their advertisements. They can only list the types of services available. Syed Hussien of The National Chamber of Commerce and Industry of Malaysia (NCCIM) wants the Ministry of Health to set up a health tourism promotion council to promote and market Malaysia as a premier medical tourism destination. He argues that there are overlapping roles in promoting medical tourism by three ministries; health, international trade and industry and tourism. He argues that lack of effective marketing strategy means Malaysia has lagged behind Thailand and Singapore in this sector. A Medical Tourism Board will be set up in Penang to help promote its hospitals overseas, said Health Minister Datuk Seri Liow Tiong Lai.He added that hospitals in the state would contribute to support the board that would then run campaigns abroad to attract medical tourists. By avoiding detail on how this would work, he was saved from trying to explain how a campaign with rigid advertising restrictions would work. It appears that you can only advertise Malaysian medical tourism with adverts that are so bland as to be ineffective. The message from Malaysia is a clear warning to other countries. If you want a strong medical tourism industry, the various government bodies must work together, not against each other. With ever more countries and hospitals competing for foreign patients in a much tougher market than 2008, don’t blame the recession or hospitals if advertising controls, poor marketing, or other factors which governments have control over, cause your country to get fewer medical tourists than you expect.

With the growth in the number of medical tourism providers, quality standards become all the more important. To demonstrate their commitment towards quality some international healthcare organiSations choose to be accredited by the US based Joint Commission International (JCI). JCI accreditation has gained worldwide attention as an effective quality evaluation and management tool. A JCI hospital is an international hospital outside of the United States that has been accredited by the Joint Commission International. The year 2008 was another dynamic one for JCI accreditation. At the end of 2008, there were 242 JCIaccredited organisations in 35 countries, and some have already been added in 2009. JCI surveys were conducted in 24 different countries in 2008, including Austria, Brazil, China, Costa Rica, Czech Republic, Denmark, Egypt, Germany, India, Ireland, Italy, Israel, Jordan, Malaysia, Mexico, Portugal, Saudi Arabia, Singapore, Spain, Switzerland, Taiwan, Thailand, Turkey and the United Arab Emirates (UAE). Israel, Portugal, and Switzerland are new to JCI accreditation. The following organisations were awarded the status of accredited or certified following an initial or triennial survey during 2008: Al Essra Hospital, Amman, Jordan Al Noor Hospital, Khalifa Street, Abu Dhabi, UAE Alexandra Hospital, Singapore American British Cowdray Medical Center IAP Observatorio Campus, Mexico City, Mexico American British Cowdray Medical Center IAP Santa Fe, Campus, Mexico City, Mexico Antalya Hospital - Medical Park Healthcare Group, Antalya, Turkey Apollo International Hospital Bangalore, Bangalore, India Apollo Hospital Dhaka, Dhaka, Bangladesh Aut Even Hospital, Kilkenny, Kilkenny, Ireland Bahçelievler Hospital - Medical Park Heathcare Group, Istanbul, Turkey   Bangkok Hospital Medical Center, Bangkok, Thailand   Beacon Hospital Cancer Center, Sandyford/Dublin, Ireland   Bursa Hospital - Medical Park Healthcare Group, Bursa, Turkey   Centro Hospitalar do Alto Ave, EPE Unidade de Guimarães, Guimarães, Portugal   E-DA Hospital, Jiau-Shu Village, Taiwan   Göztepe Hospital - Medical Park Heathcare Group, Göztepe, Istanbul, Turkey   Ha EMEK Medical Center, Clalit Health Services, Afula, Israel   Hospital CIMA Hermosillo, Hermosillo, Sonora, Mexico   Hospital CIMA Monterrey, San Pedro Garza Garcia, Mexico   Hospital de Câncer II INCA, Rio de Janeiro, Brazil   Indraprastha Apollo Hospital, New Delhi, India   Institut für Medizinische und Chemische Labordiagnostik, Villach, Austria   International Medical Center, Jeddah, Saudi Arabia   King Faisal Specialist Hospital, Jeddah, Saudi Arabia   King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia   King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia   KK Women’s and Children’s Hospital Pte. Ltd, Singapore   Magrabi Eye and Ear Center, Dammam, Saudi Arabia   Mater Private Healthcare, Dublin, Ireland   Meir Medical Center, Clalit Health Services, Kefir-Saba, Israel   Min-Sheng General Hospital, Tao-Yuan, Taiwan   Mount Carmel Hospital, Dublin, Ireland   Mouwasat Hospital Qatif, Saudi Arabia   Prince Court Medical Centre, Kuala Lumpur, Malaysia   Raffles Private Hospital, Limited, Singapore   RAK Hospital, Ras Al Khaima, UAE   Riyadh Care Hospital, Riyadh, Saudi Arabia   Saad Specialist Hospital, Al Khobar, Saudi Arabia   Samitivej Sriracha Hospital, Sriracha/Chonburi, Thailand   Samitivej Sukhumvit Hospital, Bangkok, Thailand   Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia   Sema Hastanesi, Dragos/Maltepe, Istanbul, Turkey   Sheikh Khalifa Medical City, Abu Dhabi, UAE   Sonderkrankenanstalt für Rehabilitation, Thermenhof GmbH, Villach, Austria   Soroka University Medical Center, Clalit Health Services, Beer Sheva, Israel   Sports Surgery Clinic, Dublin, Ireland   Sultan bin Abdulaziz Humanitarian Center, Riyadh, Saudi Arabia   The Specialty Hospital, Amman, Jordan   Total Care AMIL Berrini, São Paulo, Brazil   Total Care AMIL Unidade Barra da Tijuca, Rio de Janeiro, Brazil   Tungs’ Taichung MetroHarbor Hospital Wuchi Campus, Taichung, Taiwan   UPMC Whitfield Cancer Centers, Waterford, Ireland   Wockhardt Hospital Bangalore, Bangalore, India JCI hosted two Executive Briefings in 2008. The first was held in Singapore, and the other in Berlin, Germany. Ninety-nine participants representing both accredited and non-accredited healthcare organisations attended. A new optional hospital tour activity was offered the day following each briefing at an accredited organization. The two participating organizations were Tan Tock Seng Hospital, Singapore and DRK Kliniken, Berlin. Each tour highlighted activities the hospital has used to implement the third edition of the International Accreditation Standards for Hospitals. The focus of the tour was patient safety as it pertains to medication use and infection prevention and control.

The International Association of Medical Tourism (IAMT) is a new non-profit organisation, based in New Jersey, USA, committed to offering wellness services to healthcare seekers worldwide. It is a coalition of hospitals, doctors, healthcare service providers and volunteers. It arranges care for patients, who are association members, but takes no fee as the patient pays the hospital direct. IAMT aims to offer a range of benefits to member healthcare providers, insurance companies and agencies. The founders have been long time volunteers in various international humanitarian activities. Volunteerism is the base of the organisation. A number of IAMT professionals and associates provide honorary services as volunteers. There are membership fees, a minimal part of which will go towards administrative expenses and the rest will be used for a ’Donate a Surgery’ programme. IAMT seeks to provide an unbiased source of information for patients, insurance companies and employers about top hospitals and their quality of care. The organization aims to offer medical guidance, treatment, and assistance to the uninsured, under-insured and anyone within the US in need of additional resources. A key aim is to offer international patients the power to choose by providing information about doctors and hospitals, enabling them to make informed decisions. Founder and president Naresh Jadeja said: We can help them. We will provide information about these facilities and detailed avenues from whom to seek help. No one should have to compromise with their health. You meet so many people and you hear so many stories about somebody who couldn’t pay for that knee-replacement surgery or a cancer patient who was denied treatment for some reason or the other. But there are several reputed hospitals even within the US and overseas which offer affordable treatment options to the uninsured and the under-insured. Jadeja told IMTJ: Our healthcare awareness campaign will provide information for all destinations including US, Europe, Canada, Latin America, and Asia-Pacific. There are medical tourism associations other than IAMT but every organisation has its own set of goals, values and mission. Our initial focus is Americans but we want to be worldwide.   It has already opened a regional office for the Asia Pacific region to provide information about US and Europe hospitals to patients in Asia Pacific countries. It will also oversee all logistic operations of IAMT in India, Singapore, Malaysia, Korea, Thailand, China, Hong Kong, UAE, and the Philippines. Businessman N.D Rana is the regional president. It plans to run conferences in 2010 in Mumbai, India and Newark, USA, both with a focus on Asia.

The Indian tourism ministry is finalising a scheme where a medical tourist visiting India will be offered an additional treatment free. It aims to launch in April and continue through the rest of 2009. The scheme will be part of the schemes implemented by the government to increase foreign tourist arrivals in the backdrop of the global slowdown, and the drop in visitor numbers following the terrorist attacks of 2008. The ministry is in advance discussion with major hospital chains including Apollo, Manipal, Moolchand, Fortis and Wockhardt to offer the complementary treatment. Now, foreign medical tourists will be offered one additional treatment for free. Almost all major hospitals have expressed their interest in partnering with us, said tourism secretary Sujit Banerjee. A patient coming for a bypass surgery could be offered a complementary skin treatment or something similar according to the patient’s preference. Foreign tourist and medical tourist numbers visiting India has been dropping since November. Arrivals picked up slightly in February, thanks to various promotional schemes launched by the government along with airlines, tour operators and hoteliers. Under the existing promotional scheme, a companion of a foreign tourist gets free air passage provided they fly with Jet Airways, Kingfisher or Air India. The tour package also provides extended stay in spas and hotels across the country. The measures are part of the government’s ’Visit India 2009’ plan. The bookings under the proposed scheme beginning this month will continue till the end of the year. The tourism ministry has set a target of doubling the number of foreign tourists arrivals to the country by the end of 2010. It has launched road shows in various source countries including US, UK, Canada and Australia to increase the number of visitors. Whether the measures will work is debatable. If having a heart operation, you are unlikely to care about a free cosmetic treatment. At a recent major health conference, Dr Naresh Trehan highlighted the importance of medical tourism, and India’s potential for it. He also mentioned problem areas that are more vital than a two-for-one promotion. Areas that restrict the growth of medical tourism to India include hygiene, visa procedures, pollution, medical regulation and political unrest. Dr Trehan painted a picture of the potential, but warned that India had a long way to go to achieve success.

Alpine Center and healthCare cybernetics (hCc) in Greece have joined forces to introduce a health-tourism study course to students from 30 different countries at the campus of this Swiss Business School for Hotel & Tourism Management Education. It groups medical tourism into eight segments: medical, dental, spa and thalassotherapy), wellness, sports, culinary, accessible, and assisted residential tourism. Dr. Constantine Constantinides, hCc’s owner, will teach the course. Constantine Constantinides informs us that a health tourism-related MBA will soon be launched. The school launched a new two-year course in spa management in 2008. Alpine Center has for two decades been a leading hotel and tourism management school in Europe and a leader in developing and offering quality, cutting-edge programmes of study. It will also host the International Health Tourism Research Institute whose mission includes conducting industry and market research by academic staff members and supervised students. Research results and findings will be published in both academic and industry journals. healthCare cybernetics (hCc) provides knowledge, analysis and strategic thought on healthcare.  Based in Athens, it plans to move to Dubai, but retain an Athens base for projects.

In July, American publisher Healthy Travel Media and the Association of Private Hospitals of Malaysia (APHM) will launch Patients Beyond Borders: Malaysia Edition, published in English for international distribution. Produced in collaboration with Malaysia’s Tourism Ministry and supported by hospitals and related private organisations, the 240-page guidebook will feature Malaysia’s 20 plus international hospitals, selected health travel agents, nearby recovery and guest accommodations, and area travel information. The majority of medical tourists come from Indonesia, Singapore and Bangladesh, but Malaysia also attracts medical travellers from the US, Canada, UK, and Australia. APHM members in the book include: Gleneagles Intan Medical Center Gleneagles Medical Center Penang National Heart Institute KPJ Healthcare Group NCI Cancer Hospital and Specialist Clinics Pantai Hospital Group. Penang Adventist Hospital Prince Court Medical Center Sime Darby Medical Center Subang Jaya Sunway Medical Center. APHM represents more than 100 private hospitals and medical clinics approved and licensed by Malaysia’s Ministry of Health. Of those, only around 30 private hospitals are directly involved in medical tourism. Healthy Travel Media and the Accredited Hospitals Association of Turkey (AHAT) will launch Patients Beyond Borders: Turkey Edition, to be published in English in late 2009. Supported by Turkey’s leading healthcare facilities, the 280-page guidebook will offer an in-depth overview of Turkey’s leading American-accredited hospitals, selected health travel agents, accommodation, and essential medical travel information. The book will include details of fully accredited Turkish hospitals catering to the international patient. The main nationalities going to Turkey are German, American, Dutch, British and Japanese. Turkey increasingly gets patients from Belgium, Azerbaijan, Russia, Bulgaria, Romania, Kosovo and Syria. Turkey also specialises in long-term care for elderly patients from Norway, Sweden and Denmark. The Accredited Hospitals Association of Turkey was established in January 2008 to coordinate the activities of hospitals throughout Turkey and deliver world-standard healthcare by creating collaboration among hospitals, patients, universities, and related organisations. It also encourages hospitals to maintain the highest standards of quality and attain international accreditations. AHAT members in the book include: Acibadem Healthcare Group Anadolu Medical Center Bayindir Hospital Florence Nightingale Hospitals Güven Hospital Hisar Intercontinental Hospital International Hospital Kent Hospital Memorial Hospital Mesa Hospital Yeditepe University Hospital Print and electronic versions will be available through retail outlets worldwide, Amazon and other online retailers, and through the relevant associations.

Polish private medical institutions have joined forces to jointly promote the medical services provided in Poland on the international market. Dozens of clinics have set up a medical organization called Medical Tourism Chamber of Commerce(IGTM), based in Gdansk. It seeks the support of the government and local governments, the tourism industry, the representatives of Poland abroad and foreign countries in Poland. IGTM seeks to target German, Scandinavian and British patients as dentistry and cosmetic surgery in Poland cost far less than in many older EU countries, around half the price. According to IGTM’s data there are dozens of Polish clinics specializing in services for foreigners and Polish clinics not only compete with their western counterparts in terms of prices, but also the quality of services, which has improved vastly in the past decade.

Taiwan has begun promoting its medical tourism industry to potential visitors from Mainland China. Taiwan Health, a high-end clinic funded by a Mainland China-based Taiwanese entrepreneur, will open an office in Guangzhou in June. It will serve as a centre for Mainland patients seeking health checkups or cosmetic surgery in Taiwan. The clinic has signed cooperation agreements with 10 private Taiwanese hospitals to act as a medical tourism agency to refer patients to them. Taiwan Health is working closely with the Taiwan External Trade Development Council (TAITRA). TAITRA has been tasked by the government with promoting Taiwan’s medical tourism industry. TAITRA wants Mainland Chinese travel agents to arrange for Mainland Chinese patients to see parts of Taiwan during their stay. Two market appraisal groups, each consisting of between 30 and 50 potential clients, will arrive in Taiwan before June. Compared to other Asian countries, TAITRA argues that Taiwan is geographically closer to China and enjoys several other advantages, including a common language and highly skilled medical personnel. Medical tourism is seen in Taiwan as more recession-proof than regular tourism, and it generates more revenue per visitor. So far, Taiwan’s efforts to attract medical tourists have focused on nearby markets, such as Japan, where the population is rapidly aging, and mainland China.

Texas-based US Risk Underwriters has launched a new professional liability product for the medical tourism industry called MedTour Pro for Employers. This and related MedTour products only cover treatment outside the US for US-based travellers, agencies and employers. MedTour Pro for Employers is designed for US companies that provide freedom of choice to their employees, including an option to obtain medical services abroad. The coverage is for damages caused by any actual or alleged negligent act, error or omission by the insured while providing options for medical tourism services. MedTour Pro for Employers is written by reputable insurance companies on a claims-made basis, with limits offered at US$1M, and a minimum premium of US$5,000. While MedTour for US-based medical tourism agencies offers a range of limits and a minimum premium of US$2,200. The cover is designed to respond to employers’ needs whenever they are sued for any wrong-doing that is involved with administration of medical travel benefits. MedTour Travel and Medical Complications is a travel policy plus non-negligent trigger coverage that pays out when there is a complication without having to assess negligence. This is not available for individual purchase and can only be bought by an employer or a medical tourism agency. The travel and medical complications package can either be automatically included in the agency fees, or offered as an option to customers. The first-known sale is to an American who went to Trinidad for cancer surgery, arranged by Mobile Surgery International (MSI).

Plans have been agreed to upgrade and develop health facilities in Ghana and make it the medical centre of excellence in the West Africa Sub Region. New equipment is being bought to refurbish all health facilities to help ensure quality healthcare delivery for people in the country and beyond. Dr George Sipa Yankey, Ghana Minister of Health, said the Central Regional Hospital on the Cape Coast will be developed into a medical tourism centre and further extend its quality services to neighbouring countries. Central Regional Hospital will soon be upgraded into a teaching hospital for the University of Cape Coast (UCC) Medical School to ensure excellent and quality healthcare is accessible for all people in the region. Meanwhile, Vision3, a strategic alliance formed between Gulf Finance House, Ithmaar Bank and Abu Dhabi Investment House, has signed a deal with the Moroccan government to develop a US$1.8 billion mixed-use health resort over a massive 270-hectare area in Essaouira. Mohammed Boussaid, Moroccan minister of tourism, said: The project will not only help develop the health and wellness sector in the Kingdom of Morocco, but also help promote health tourism.

In its second annual study on healthcare trends, Deloitte finds a favourable shift towards intra-bound medical tourism among Americans who would consider seeking treatment in another US city than going abroad. The results of the 2009 Deloitte Survey of Healthcare Consumers are vastly different from the previous year’s, which showed that Americans would consider travelling overseas for treatment - particularly if they can achieve 50 percent savings on international-standard healthcare. In this year’s results, 43 percent of the 4,000 Americans aged 18 and above say they are prepared to travel out of their local area to undergo a test, procedure, or treatment if it would cost 50 percent or less than when done in their home city. In fact, eight percent have travelled for care outside of their local community as medical tourists. However, out of local area does not automatically mean going overseas. Only one percent say they have gone abroad for treatment, a similar result to 2008. But while last year’s study said 40 percent would consider treatment abroad, the figure plummets to 10 percent for the 2009 survey. The results for 2009 also vary by category. Among uninsured patients, 20 percent would consider medical tourism. Receptivity to medical tourism is highest among younger adults at 10 percent to 12 percent, compared to only six percent for seniors. The most surprising low figure is from baby boomers at only seven percent, a figure that will disturb hospitals, agencies and self-appointed experts who have long argued that this generation is the key target American market for medical tourism. Other useful data from the Deloitte study are:     As healthcare reform heats up in the White House, nearly 40 percent of US consumers have expressed discontent with the status quo.     In addition to skipping or delaying care, the high cost of healthcare is prompting many consumers to switch physicians, prescriptions or health plans to save money.     Fifty-three percent would like employers to be required to provide health insurance for employees     Thirty-seven percent favour a mandate requiring every American to obtain health insurance either through direct purchase or through an employer or government programme. The findings suggest that a growing number of consumers wants to be actively engaged. They see variance in service, quality and costs. They are comparing doctors, hospitals, medications, devices, health plans and self remedies. They are exploring alternatives to conventional approaches and spending money to achieve their health goals. Paul Keckley, who oversaw the report for Deloitte Center for Health Solutions, said: The current economic climate is taking a toll on American consumers prompting them to increasingly make decisions about healthcare that are married to their pocketbooks. Consumers want a bigger say in their healthcare decisions. More than half believe that 50 percent or more of the dollars spent on healthcare in the US are wasted. The time for healthcare reform could not be more pressing. For the medical tourism industry there are clear messages. For every American who has gone overseas for treatment, eight have already become medical tourists within the US. The promise of healthcare reform has cut in half the number of patients who would consider going overseas. The key target market is not the baby-boomers with time on their hands who can combine overseas medical treatment with a holiday, but younger generations who are time and cost pressed by work and family commitments. Although one report is not conclusive in itself, it suggests what IMTJ has long-argued: that medical tourism combining holidays with treatment is only a small part of the global medical and health travel business - where people go abroad for a vast range of reasons from complex surgery down to spa treatment. Countries, agencies and hospitals promoting the beaches, safaris and tourism as equal to the medical treatment, may have to rethink their advertising and marketing if they want business. As cash gets tighter, people go for the treatment, not the tourism.