Iowa-based China Connection Global Healthcare (CCGH) is spearheading the new Fitness and Culture Experience for Teens, an eight-week summer camp in China for overweight American teenagers. Organised in coordination with China’s Aimin Weight Reduction Hospital, the programme will offer 40 US high school students and 10 of their Chinese peers an international wellness experience integrating diet, exercise and traditional Chinese medicine to achieve significant weight loss. The camp will be held in Tianjin, China from June 10 to August 10. The obesity-intervention plan designed to address the social, environmental and individual determinants of the disease. Based on reports from the Centers for Disease Control, one in six American children is overweight or obese, a rate that has tripled during the last 20 years. Children and adolescents are developing obesity-related diseases, such as type 2 diabetes, that were once only seen in adults. A new study by the World Cancer Research Fund also reports that 34 percent of all cancer cases in America can be prevented simply by eating better, exercising more and maintaining healthier weights. CCGH founder Ruth Lycke said: We are passionate about the Fitness and Culture Experience being a catalyst in changing the lives of these young people. This group will reshape their bodies and expand their awareness of the world and its people in a unique way." CCGH is a medical tourism agency specialises in sending American health tourists to China and the only company focused on addressing obesity in teens. Lycke herself went to the First Teaching Hospital in Tianjin years ago for traditional Chinese medicine treatment following a stroke. Organisers of the Fitness and Culture Experience for Teens hope to simulate the encouraging experience by teenager Alonzo Bland who last year lost over 300 pounds without the use of bariatric surgery during his nine-month stay in China. Teen participants in the programme this summer can expect to lose between 20 and 25 pounds per month under strict, medical supervision. CCGH has an office in China and is growing its teenage weight loss programme through a grassroots approach to local sponsorships and is hiring from the ranks of the highly skilled, unemployed in each city. Thirty field representatives in 30 cities across the US will assist CCGH in selecting participants and sponsors from the communities in which they live. The goal is to reach kids who need help the most and ensure no deserving teen is left behind as a result of his or her family’s financial situation. China Connection Global Healthcare enables its clients to receive Western and traditional Chinese medical care through a network of Chinese hospitals and clinics at rates far less than those charged in America. Since 2006, CCGH has assisted hundreds of people from the US, Canada, the UK, India, Australia and Japan in finding the care they needed.

The University of Pittsburgh Medical Center (UPMC) and Leptos Group, a leading property and hotel conglomerate in Cyprus, are developing a world-class hospital that will offer a wide range of medical services to both local residents and foreign visitors in the Mediterranean island. Under the 23-year partnership, UPMC will manage a new 100-bed hospital and the existing 36-bed Iasis Hospital in Paphos. With its global expertise in providing clinical, technological and hospital management services, UPMC will assist the new health complex in developing centres of excellence in the areas of oncology, transplantation, aesthetics, cardiology, orthopaedics and minimally invasive surgery. The new hospital called Neapolis, which will be completed in three to four years, is an integral part of a mixed-use development project that includes a university, research centre, office park and luxury lifestyle housing, as well as retail, entertainment, cultural and leisure facilities. The project is one of the largest landscaped parks on the island. Michael Leptos, chairman of the Leptos Group, said: Despite the economic climate, we are confident that the new Neapolis health centre will be a success, filling the need for more health care options in Cyprus and alleviating long-wait times for many patients seeking specialised care. In addition, these facilities will be well positioned to attract patients from throughout the Middle East and Europe as medical tourism grows throughout the region." UPMC’s services in Cyprus will include on-the-ground senior management for the hospitals, staff training, equipment procurement and implementation of sophisticated information systems. UPMC expects to develop medical services that are now in short supply on the island, including comprehensive cancer services at Iasis Hospital. UPMC already manages of two cancer centres in Ireland and it plans to develop at least 25 more cancer centres throughout Europe and the Middle East with partner General Electric Company. In addition to the Neapolis project, UPMC’s international portfolio includes management of the independent Beacon Hospital in Dublin, Ireland, and a leading transplant hospital in Palermo, Italy.

A 100-bed multispeciality hospital staffed by German doctors and nurses is being built in Khalifa City and is expected to be finished by the end of 2010. Its operator, German General Hospital, has also built a medical centre in Al Rowdah and brought in 80 percent of its staff from Germany and Western Europe. The US$50-million facility will focus on three main areas: cardiology, orthopaedics and vascular diseases. Markus Eulig, chief financial officer of the group, estimates that about 100,000 people travel from the UAE each year to receive medical treatment in Germany. For the first time in the Gulf, qualified German healthcare run by a team of medical experts from Germany will be available to the UAE and GCC residents. The hospital in Khalifa City will provide a service for those who feel an affinity for German medical care so they do not have to travel overseas, he explained. The Al Rowdah German Medical Centre is scheduled to open next month and will offer a broad range of services, with specialities in internal medicine, paediatrics, orthopaedics and radiology. Both facilities are being funded by Shedlin Middle East Health Care, which is regulated by the German financial authorities. The design and planning for both the medical centre and general hospital have also been carried out by German architects, Woernerundpartner, who specialise in hospital and health-care projects. The hospital and clinic will be operated by Klinikum Offenbach, whose main hospital in Germany has around 1,000 beds and treats 33,500 patients each year. The project’s UAE partner, Abdulla Abdul al Fahim, said the team did not want to close the market to Germany but simply give people in the UAE, and further afield, the option to receive treatment closer to home. He noted: If people prefer to receive German treatment and be cared for in the same way as they would be in Germany, they will be able to do that here. German medicine has an outstanding reputation worldwide. Quality of care, cleanliness, medical technology and innovation are all unsurpassed anywhere in the world. But there are three problems: high cost, need for a visa, and language difficulties. Some in Germany see inbound medical tourism from the Middle East as a short-term business only, and that longer-term it is better to invest in hospitals and clinics in the Middle East.

Local healthcare leaders are urging the government to give medical tourism more than a cursory glance. "Proper handling of medical tourism will bring to Israel much income and foreign currency, improve our status in the world, and especially in the region, contribute to the creation of new jobs, increase the satisfaction of doctors and contribute to their remaining in Israel. All this will raise the level of medicine in Israel," said Professor Shlomo Mor-Yosef, director-general of the Hadassah Medical Organization (HMO). Income from medical tourism will help finance hospitals, imaging institutes, labs and research. It would be a win-win situation, but no government, health or finance ministry has done anything significant to promote medical tourism to Israel. With a little investment in medical infrastructure, it could reduce the temptation among the most experienced and promising doctors to leave the country, boost the quality of "hotel services" in hospitals and help the tourist trade. The professor and his colleague Amitai Rotem, HMO marketing director, outlined the challenges of Israel’s medical tourism industry:     Without urgent state initiatives, Israel is leaving the field to other countries. In the meantime, a handful of Israeli hospitals are trying to develop their own medical tourism facilities.     Existing infrastructures in most local hospitals can’t compare with those now in the East. For Israeli hospitals to compete, the level of hotel services must be improved and the number of beds increased.     Current marketing and administrative systems, not built for the speedy responses needed for competition, must be upgraded. Prices are not flexible enough, and the quality of service offered today in most cases is suited to local needs rather than meeting international tourist standards. The government, Mor-Yosef and Rotem urge, must take an active role in promoting the field. Of the 16,000 foreign patients who came for treatment in 2006, public hospitals like Jerusalem’s Hadassah University Medical Centers cared for 7,000, and private hospitals for 3,500, with only a few going to government and health fund-owned facilities. Estimated annual revenue for these services total US$40 million. Mor-Yosef and Rotem said that major treatments such as surgery, organ transplants, dental care and plastic surgery are sought by medical tourists. Unlike ecotourism, in which the traveller chooses a destination and only then selects the elements of the vacation, Rotem noted that medical tourism begins with a defined medical need. To this is matched an appropriate destination in terms of medical specialisation, cost, service (such as a suitable language and culture) and in certain cases cultural availability (such as a Saudi Arabian tourist who wants to visit Jerusalem’s Dome of the Rock). From a desire to minimise cost and waiting time, the modern patient turns into a tourist, and tourism experts and health industry people supply the "merchandise." Mor-Yosef said while foreign tourists receive the same level of treatment as Israeli patients, profitability from foreigners is much greater. The Health Ministry’s rates for tourists are much higher than those for Israelis, and discounts for tourists are lower. Payment is made in advance, unlike the local market that pays with credit. He also stresses the need to upgrade facilities to meet the expectations of medical tourists by improving "hotel services" in hospitals.  The strong message from the pair is that government ministries need to work together; The Health Ministry must set a supportive policy, both in setting prices and allocating additional beds to hospitals that cater to medical tourists. The Interior Ministry needs to establish speedy and friendly processes for providing tourist visas to patients. The Tourism and Foreign ministries must market the State of Israel as a destination for medical tourism. The Finance Ministry has to allocate funds, both for marketing and for improving the infrastructure that will be needed as medical tourism increases.

The fate of a high profile international project indicates troubled times for Dubai’s healthcare building projects. Dubai’s third-largest property firm may cancel a proposed Formula 1 theme park if it fails to receive government cash or tap debt markets. The project timeline for the proposed theme park has already been postponed. The plan was to fund the park with the sale of houses, but UAE property markets have collapsed and banks are unwilling to lend to the property sector. Marriott International’s global expansion plans over the next five years of 30 new hotels in the Gulf region, including 17 new hotels in the UAE, nine in Saudi Arabia, three in Qatar and one in Bahrain. But construction is not going to be soon as the global economic slowdown hits, with the UAE’s hotel trade is suffering more than other Gulf countries. UAE hotels have slashed room rates in a bid to stimulate business. The medical tourism industry in UAE is not immune to the global financial crisis either. Indeed, Dubai’s attempt to take business from Asian medical destinations such as India by creating local brands to attract international patients maybe in jeopardy. DeveloperTatweer has apparently put some projects in its major project Dubai Healthcare City  (DHCC) on hold. The most well-known medical tourism project in the Middle East, DHCC is designed not only to attract medical tourists but also to reduce the need for residents to travel abroad to receive high quality treatment. Although the government-owned business is keeping quiet about what it is or is not doing, details of some future projects have vanished from the DHCC website, and the sole survivor no longer gives expected completion dates. The current debate is whether in tough times, medical tourism will accelerate in countries offering lower cost, or a lack of cash will reduce the demand for non life-threatening surgeries like cosmetic surgery, dentistry, and Lasik/laser procedures. Dubai’s problem is that by selling itself as a high-cost, high-quality destination, it loses out whichever argument is true. Healthcare tourism isn’t recession proof, and new destinations will find it harder than ever to break into the market.

Most Americans seeking medical services abroad are either uninsured or under-insured, so pay for treatment out of their own pocket. Most estimates of future demand by analysts, agencies and hospitals, assume that private and state healthcare insurance systems will follow the tiny handful now, where the insurers pay for medical tourism. Healthcare reform has been promised for the last two decades, but President Obama has pledged to cure Americans from "the crushing cost of health costs," saying the country cannot afford to put healthcare reform on hold.  This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes," Obama said in his speech to Congress. Obama’s plans include root-andbranch reform of healthcare. Hospitals, doctors and insurers have all done well in recent years, and have managed to prevent any serious healthcare reform. Now they are all seriously worried that Obama may actually succeed. His reforms would include lower prices from hospitals, salary cuts for doctors, payment to hospitals by government insurance schemes linked to quality of care not quantity of care, giving Americans a choice of a public health insurance plan to compete with private insurance, and forcing insurers and health plans to guarantee coverage with no exclusions for pre-existing conditions, accepting all comers and not price sections of the community out of the insurance market. Which of these are realistic and which are being used to scare hospitals, doctors and insurers into backing reform is unknown. Compulsory government health insurance for everyone with the government dictating the price that hospitals charge for healthcare is still a possibility. The medical and insurance establishment used lobbying and political allies to stop earlier attempts at reform. But Obama is in a much stronger political position than his predecessors. 45.7 million Americans are uninsured, and for those with insurance coverage health-care costs have been rising four times faster than wages. There is general agreement that healthcare has to be drastically reformed now. Anyone targeting American medical tourists could be affected by reform as it could change everything. The state cannot stop Americans going overseas for treatment, but by compulsory insurance and price-controls it could remove many of the reasons people go abroad. Health insurers that offer a private alternative to traditional Medicare will be affected by plans to make sharp cuts in their payments and open the programme to competitive bidding. The new administration plans to expand healthcare coverage for the uninsured. The expected cuts in budgets for programmes such as Medicare and Medicaid will reduce the amount doctors and hospitals get for treating patients whose care is paid for by the government; threats to stop accepting such patients could rebound harshly on hospitals. Central to the reform debate is whether healthcare providers should be able to set their own rates or whether the government should tell them who to treat and how much they will be paid. Hospitals and doctors are resigned to the fact that they will have to accept change. Insurers are threatening to fight the reforms, but with recent figures showing dramatic price increases for the ever-decreasing number of Americans who can afford private health insurance, they have no alternative solution to offer.  Obama wants the main features of healthcare reform to be in place by the end of 2009, which considering other changes he has pushed through in a few weeks, may not be as impossible as it sounds. Whatever the outcome, three things are clear. Americans have less money to spend on healthcare; major insurers will not rush into medical tourism deals until they know how drastically they may have to reform what they offer to patients and at what price; and the price-differential between US and other countries will fall. In these uncertain times, many American employers will wait to see how they are affected by healthcare reform, before changing their employee benefit packages to embrace employer-paid medical tourism. If Americans are a target market, you need to keep a very close eye on US healthcare reform as it could quickly impact your business. You may even have to change from marketing on price to marketing on quality alone.

The UK’s House of Lords EU Committee has published a report on the European Commission’s proposal for a Directive on Cross Border healthcare entitled Healthcare across EU borders: a safe framework. The commission’s directive aims to clarify EU citizens’ rights to seek medical treatment in member states other than their own, and have the costs reimbursed by their own national healthcare systems. These rights have been confirmed in numerous European Court of Justice Rulings but the proposed directive represents the first efforts by the EU to codify these rights in a single document. The directive not only covers in- and out-patient treatment, but also extends to dentistry. The report welcomes the European Commission for a Directive on patients’ rights to cross-border healthcare, but calls for improvements and warns that it must be carefully monitored upon implementation, suggesting a three-year review. The Committee agree with the Commission that, as the right of EU citizens to travel to another Member State to receive healthcare has been confirmed by the European Court of Justice over the last ten years, it is essential to put in place a legal framework to replace the current ad hoc arrangements. The Committee consider whether patients seeking healthcare in other Member States should pay the costs themselves in advance of treatment and then claim reimbursement later. They raise concerns that this would prevent those without adequate financial means from taking advantage of their right to cross-border healthcare. The report recommends that a patient’s own healthcare provider should pay the fees directly to the provider in the other member state, and suggests that this could be linked with the process of securing authorisation prior to travel, which the committee considers necessary to enable patients to make informed decisions about their treatment. The report also calls on member states to ensure that patients are aware of their rights under the directive and are informed about the quality of care that they can expect, and any potential language barriers. Member states should finance information for its own citizens about healthcare abroad and should draw up a description of its own health system to guide other member states. It accepts that in practice it will fall to medical practitioners, such as GPs and dentists, to actually provide the information to patients. The directive distinguishes between hospital care and non-hospital care. It defines hospital care as any treatment requiring an overnight stay. Non-hospital care is everything else. In the light of ECJ case law, the Directive provides that reimbursement for non-hospital care shall not be subject to prior authorisation, provided that if this care were carried out in the home member state, it would have been paid for by its social security system. However, the directive permits member states to implement a system of prior authorisation for reimbursement of the cost of hospital care provided in another member state. The directive proposes that patients pay for their cross-border treatment upfront and seek reimbursement at a later date. This would fit in with how several EU health systems already work for domestic care, where the hospital provider and social insurance are separate organisations. In the UK, the care and insurance are both provided by the NHS, so the patient gets free treatment. The House of Lords wants to replace the pay and reclaim system with one where the hospital is paid direct. Most EU countries favour a pay and reclaim basis. The Commission itself is prepared to consider direct payments, but only after treatment has been completed. This issue illustrates that most UK organisations that gave evidence have little understanding on how health systems work outside the UK.     The EU plan has an implementation target date of 2011.

US group Global Solutions, a leader in strategic and software consulting services, has acquired a majority holding in e-Medsol, based in India. Buying e-Medsol enables Global Solutions to expand into medical tourism. e-Medsol has a platform and a process to create an integrated solution for medical tourism. Anuja Agrawal of Global Solutions said: We feel e-Medsol has created an offering which is truly unique and has the potential to provide a cohesive structure to the medical tourism industry. We are firmly committed to enhancing e-Medsol’s offering to create a single point of service for any player in the medical tourism industry. Global has appointed a new chief executive and e-Medsol will continue to operate under the same name. Dr Benosh Haris, founder of e-Medsol, who will continue as chief operating officer, said: Global’s strong financial backing, global infrastructure, strategic consulting and product development expertise will bring the stimulus needed to grow our medical tourism offering. e-Medsol, based in Kochi, India, has a network of 50 hospitals and healthcare providers and healthcare facilitators across the globe. Over the next few months, e-Medsol wants to significantly grow that number and seeks to add insurance companies and corporate destination managers to the network. e-Medsol will be launching its consolidated platform for medical tourism in India, IndiaCares, in the next few months. Its global platform will be launched shortly under the iGlobal brand. There are more than 70 US medical tourism agencies that arrange medical travel for patients to Indian hospitals, and many more elsewhere in the world. Indiacares is an online platform so medical tourism agencies can tie up with hospitals in India and process everything online. Fifteen Indian hospitals are signed up as are 16 agencies; five in the US, three in Canada, three from UK, two from Middle East and three in Africa. e-Medsol is a software and service company focused on development of products and services for the medical tourism industry. Since its inception in 2004, it has focused on developing online models that can effectively connect hospitals to medical tourism agencies. It enables hospitals and agencies to network online and refer patients directly to these hospitals. Hospitals and agencies with existing working relationships often remain unconvinced that paying to add a third party into the mix will either increase their business or make their processes more efficient. Few agencies send more than a handful of patients to each particular hospital. New owners Global will need to add value to the offering to make it attractive to agencies and hospitals.

A Singapore company has launched a web-based medical service aimed at raising the number of visitors seeking medical care in the region. The FlyFreeForHealth platform is a medical concierge network, providing visitors medical advice via its portal. Nurses trained in hospitality, IT and tourism, dubbed iMedical Butlers, will offer medical advice through the site. The agency, which was established in August 2008, provides services designed for foreigners looking to receive medical care in the region. The new service is for treatment in Singapore and Thailand. The company hopes to add India and Malaysia soon. FlyFreeForHealth has just completed a review on hospitals in Korea and health packages in Korea are currently being developed. FlyFreeForHealth also has two new partners; the Tourism Authority of Thailand and Singapore travel agency, CTC Holidays. The new e-service aims to help patients make travel arrangements into the region, in addition to pairing them with the appropriate hospitals. FlyFreeForHealth currently employs six iMedical Butlers, and is looking to recruit more in the Philippines and India. The company is also looking at nurses fluent in Russian, to encourage visitors from Central Asia. Porntip Makornpan, a director at Tourism Authority of Thailand, said the country saw an inflow of some 1.5 million tourists seeking medical care last year, a decrease on earlier estimates of 1.69 million. Dr Wei Siang Yu, founder of FlyFreeForHealth said: The new business to consumer shift is seeing the behavioural pattern of medical travellers changing. They look for more options. They also want more interaction before selecting the doctor. Merely looking for information on the internet is no longer sufficient

East African country Uganda is planning to grab a market share of the medical tourism sector by attracting private investors to develop medical facilities. Medical tourism is a relatively new concept in Uganda and indeed the East Africa region, but has potential. Investment by both the private and public sectors in recent years have seen the establishment of specialist clinics, spas, improved hospital facilities, traditional medicine and better HIV/AIDS management. This has contributed to growth in the niche market. Professor Maggie Kigozi, executive director at the Uganda Investment Authority says, Medical tourism is opening a new frontier for revenue generation in the country. We are working to ensure Uganda is well positioned with facilities that meet the chief drivers of the growing medical tourism market: affordability, high quality and excellent service. Medical tourism, though still young in Uganda, is promising to drive forward both the health care and tourism sectors thanks to the partnership approach of both the private and public sectors. "The main attraction for clients visiting the country are the hot springs such as those at Ihimba, Sempaya, Kitagata, Buranga and Nyamasizi, that are said to have high mineral content. These are suitable locations for investors looking to build rehabilitation clinics and spas. The availability of women’s fertility services and advanced HIV/AIDS research and management programmes are other factors drawing patients to the country. But as the country only gets 70,000 visitors a year, the current number of medical tourists is tiny. Herbal medicine has also become an attractive option to patients who prefer to take the natural healing route. Uganda’s forests are a granary of herbal medicinal plants. The government plans to regulate the herbal medicine sub-sector to maintain quality and best practice." According to Bradford Ochieng of the Uganda Investment Authority, Uganda’s medical tourism sector offers the following: Internationally accredited medical facilities using the latest technologies (e.g. open heart surgery and fertility centre). The largest group of dedicated gynaecology and fertility specialists in East and Central Africa, supported by a team of experienced scientists, nurses and counsellors through its Women Hospital International. The fertility centre specializes in In-Vitro Fertilisation, intracytoplasmic sperm injection, laparoscopic surgery, and myomectomy operations. Medical treatment costs are lower than other countries in the region. Fluent English speaking staff. Options for private room, translator, private chef, dedicated staff during your stay and many other tailor made services. An international reference centre for AIDS research, prevention, care and treatment. Foreign investors require a minimum of US$100,000 in planned investment in order to secure an investment license from the Uganda Investment Authority, whereas for local investors, the minimum planned investment requirement is US$50,000. Local investors may proceed with their investment without licensing with the Uganda Investment Authority. The license is crucial to foreign investors as it is the instrument that legalizes their investment in Uganda.

Specialist research company Intelligent Spas has published the first-ever Global Spa Benchmark Report that presents a plethora of financial statistics for the global spa industry and includes breakdowns of key performance indicators by region for the Americas, Europe, Middle East/Africa and Asia Pacific. This statistical report contains over 1850 spa industry benchmarks relating to revenue, expenses, visits and employment, with many topics showing historical data available from 2005 to 2008, plus forecast data for 2009 and 2010. The benchmarks are comparable across the entire spa industry due to the consistent methodology implemented and the some of statistics and benchmark ratios featured in the report include: treatment room occupancy average treatment rate average revenue per visit revenue per available minute therapist productivity rate repeat visitation rate capture rate of hotel guests breakdown of total revenue including retail revenue breakdown of total expenses Of particular interest to medical tourism businesses is the comparison of visitor profiles by gender, age and residence The comprehensive report also presents a collection of other spa industry intelligence including: Spa business models describing ownership, business structure, management structures. Spa infrastructure covering spa size, space breakdown, treatment rooms and stations, standard support facilities versus water-based support facilities. Spa menus such as variety of hydrotherapy and water-based treatments offered and the range of treatments practised. Spa industry trends relating to clients and products. Other findings include: The average spa treatment rate achieved by spas globally in 2008 was $90. Europe achieved the highest rate of $111 and Asia-Pacific received the lowest average rate of U$77. The average size of a spa facility is 788 metres and spas contain nine treatment rooms on average. Employees per spa average 22.9, with the Americas averaging the most (33.8) and Europe the fewest (13.6). Across the globe, the day spa guest has become a critical target market for hotel and resort spas with 38% of total spa visits at hotel spas coming from local residents and other tourists not staying at that hotel. In Europe and the Middle East/Africa, just 53% percent of hotel spa visits are from in-house guests. All regions are expecting decreases in average annual revenue per spa during 2009, however the outlook for 2010 is brighter with all regions expecting growth between 8% and 32%. Julie Garrow of Intelligent Spas states, "After eight years conducting spa industry research within the greater Asia Pacific region, we are thrilled to provide global statistics for this very essential industry. This type of business intelligence is ideal for anyone interested to learn more about the spa industry and is a vital reference for those responsible for the operational or financial performance of their spa or spa-related organisation." The Global Spa Benchmark Report incorporates a selection of results from Intelligent Spas’ Global Spa Benchmark Program. An unprecedented response of over 1270 validated spa businesses contributed to this report. Intelligent Spas is the only independent researcher specialising in spas, and the Global Spa Benchmark Report is for sale.