A documentary on Taiwan’s medical achievements will be aired around the world early next year, says the Taiwan Department of Health (DOH). The 60-minute film will showcase the healthcare system and give insights into its potential for developing medical tourism. National Geographic Channel will broadcast the show. The film will be completed by Fox International Channels in December ready for showing next spring in more than 30 countries, drawing an expected viewership of 0.2 billion households.
’Taiwan’s Medical Miracles’ will discuss the nation’s moves to develop medical tourism. According to statistics, more than 15,000 foreigners, including people from China, visited Taiwan for health checks, cosmetic treatment and surgery in 2010, creating an output value of US$11,875,000. These figures are much lower than figures released in 2010 when the Taiwan Institute of Economic Research (TIER) Taiwan reported 40,000 medical tourists in 2009, and in early 2011 the Department of Health estimated that 2010 saw 85,000 medical tourists.

Kaohsiung Medical University has signed a memorandum of understanding with a private medical center in Malaysia as a first step toward developing Kaohsiung into a hub for medical tourism in southern Taiwan. The cooperation can pave the way for the university to attract Southeast Asian clients to Kaohsiung. The Mahkota Medical Center (MMC) in Malacca is a medical tourism destination. The reason for the deal is that there is a shortfall of specialists in Malaysia, and the university will assist in the training of MMC paramedics and improve the center’s clinical research into acute and severe diseases. In return, the university hopes that MMC will set up an office in Kaohsiung to further help Kaohsiung’s medical sector tap the Southeast Asian market.
Taiwan hopes to emulate Hong Kong and the Republic of Korea to become a medical service provider for wealthy mainlanders as cross-Straits individual travel has began. Many mainland residents have gone to Hong Kong or the Republic of Korea for medical and cosmetic treatment, but the cost of medical checks in Taiwan is half to two thirds of that in Hong Kong and Singapore. And they will not have a language problem in Taiwan as in Korea.
Taiwan hospitals have often hoped to attract more clients from the mainland, but it was limited as mainlanders going for medical services in Taiwan could only travel in tour packages to the island. Shin Kong Medical Club, the health check division of Taipei-based Shin Kong Hospital, has received about 700 mainland clients since 2009. Many of them came to take the PET/CT examination, which checks for cancer. The three-and-half-hour examination is often part of their travel schedule. According to a survey by the hospital, 90 % of their mainland clients are satisfied with the service.
The two governments lifted the ban on mainland tourists to Taiwan in June 2008, but they could only travel in tour packages. Individual travel began in June 2011, but the permit only covers residents in Beijing, Shanghai and Xiamen. As mainland travelers are free to design their own travel schedule in Taiwan, local hospitals expect more of them will come for medical purposes only.
According to Taiwan’s health department, early indications are that one in ten mainland travelers will come for a health check or medical treatment. Medical treatment is limited as there is a 15-day legal stay limit. But Chao Yuen-chuan of the Taiwan External Trade Development Council (TAITRA) says the potential is limited by restrictions. He wants the government to revise medical visa screening laws and paperwork requirements, especially for Chinese nationals, so international tourists can come to Taiwan more easily, "A simplified document processing system is crucial, especially if we want to reach the Chinese market."

More foreigners are travelling to the Czech Republic for breast enlargements and facelifts as the economic crisis drives the search for cheaper cosmetic surgery, says Tomio Okamura of the Association of Czech Tourism Agencies, “We have witnessed a big increase in the number of medical tourists, from about 6,000 in 2008 to 9,000 last year in 2010. Foreigners now account for a fifth of the total number of cosmetic surgery clients in the country. The economic crisis helps us as people want cosmetic surgery that is less expensive but of a quality comparable to that in the West."
Most of the clients are German, followed by Brits and Austrians, but Poles and Slovaks have also gone to the country for cosmetic surgery. Czech prices are about three or four times lower than in the West.
Meanwhile, spa tourism is even more popular than medical tourism. Czech tourism highlights what is happening at top local spas – the top ten Prague spas- • Teplice is the oldest spa in the Czech Republic having opened its 857th spa season this year. People fancying luxurious amenities could visit a newly refurbished Imperial suite in the Emperor’s Spa. A new treat is the speciality spa coffee prepared exclusively for Teplice visitors who can enjoy the drink with traditional spa wafers.• The most famous spa in the Czech Republic is Karlovy Vary and there visitors can check the Elizabeth Bath named after the Austrian empress Sisi and celebrating its 105th anniversary this year. People can try Elizabeth’s bath with mineral water, an Indian anti-stress head massage or a Hawaiian relaxation massage. • Mariánské Lázně sees the reopening of a renovated spa house Nová Marie that offers comfortable accommodation and wide range of services and spa treatment including natural Mary’s gas CO2 and peat.• The spa hotel Royal Spa offers special spa and wellness packages and stays for high-end customers. The guests can enjoy wholesome baths at Balbín’s Spring or massages with herbal sachets.• The first radon spa in the world with a detoxication wellness package is in the Radium Palace hotel while Běhounek hotel organises fit weekends – two-day programmes full of physical activities.• Lázně Mšené is just under one hour from Prague and celebrates its 205th season this year with opening of a newly refurbished original interior of the spa restaurant Dvorana from 1905. Additionally the small family spa has diversified its treatment and wellness procedures and includes aerobic or zumba programmes as well as special physiotherapeutic packages for older guests.• *The Luhačovice spa offers a new traditional spa treatment package that includes various procedures of local mineral springs, traditional hydrotherapy and outdoor exercise signaling a return to a traditional type of wholesome exercise dating back to the beginning of the 20th century. Newly renovated luxurious four-star interwar-style Spa&Wellness Hotel Alexandria was opened at the end of the last year.• Mcely Spa is a chateau and English park as part of the spa. Private therapeutic suites offer a relaxing and inspiring environment. The English park also includes an outdoor jacuzzi, a small sauna building, natural swimming lake, multifunctional sports ground and a specially designed natural course for cardiovascular and muscular fitness.• The Spa at Mandarin Oriental, Prague is a former Renaissance chapel. Guests are greeted in a vast light-filled lobby, the former nave. The glass flooring encases illuminated remnants of a onetime Gothic church uncovered during the site’s reconstruction. Spread over two floors, the spa features seven treatment rooms including two couples’ suites. An underground passageway links it to the hotel.• Offering well-being massages for relaxation of the body and soul and luxury procedures, the spa in Le Palais Hotel offers an upmarket spa experience.

Romanian Health Minister Attila Cseke is planning a new law to grant spa resort status to ten localities, which have therapeutic springs, as Romania has the highest medical tourism potential in Europe and must take advantage of it by further developing resorts that provide therapeutic baths.
The ten places that have therapeutic springs – Baile Olanesti, Covasna, Baile Felix, Sovata, Techirghiol, Amara, Baile Herculane, Baile Govora, Calimanesti-Caciulata and Ocna Sibiului – will be granted spa resort status.
Romania’s 70 natural spas provide relief for many medical disorders and illnesses including rheumatism, endocrine, kidney, liver, respiratory, heart, stomach and nervous diseases as well as nutrition, metabolism and gynecological disorders. Romania is home to more than one third of Europe’s mineral and thermal springs. Natural factors are complemented under medical care by physiotherapy, acupuncture, electrotherapy and medicines produced from plants.
The Tourism Ministry says medical tourism brought the country EUR 250 million in 2010, according to the association of tourism agencies in Romania. Around 3 % of the tourists who visited Romania last year went for medical services –60,000 people. Of these, 70% went for spa tourism, the rest being dental tourism, cosmetic surgery and anti-aging therapies. Although the country’s state medical care system has serious problems, private operators are opening clinics and hospitals, to fill the gaps in the domestic and international markets. The government believes that spa tourism has huge potential, much bigger than medical travel. Romania could generate up to EUR 500 million to the state budget by 2015 from medical tourism.
Medical tourism has developed slowly in Romania. Three ministries in Romania, Tourism, Healthcare and Education have recently signed a partnership to collaborate in promoting medical tourism in Romania.
Medical travel is also outbound, particularly to Turkey, Austria and Germany. Earlier this year, medical tourism agency Medical Insight launched the first Romanian website containing information about foreign hospitals. The website targets those who want to travel abroad for medical services. It now offers 17 countries and now plans to add information on spas in Romania for people wishing to visit the country.
The number of foreign tourists to Romania could double in the next two to three years, according to the World Tourism Organization. 8 million people are crossing Romania’s borders each year, including 1.3 million tourists. The Romanian authorities are keen to increase the number of tourists, and get them to spend more money in the country by increasing their average stay in Romania. This is why spa and medical tourism is attractive as visitors both stay longer and spend more than the average tourist. The tourism ministry seeks to double tourist numbers by 2015. According to official statistics from the National Statistics Institute – 95% of foreign visitors come from European countries, while 56.4% come from EU member states. Hungary accounts for the highest number of tourists who entered Romania, with 32.2%, followed by Bulgaria with 15.9%, Poland – 10.2%, Germany – 9.7%, Italy – 7.4% and Austria – 3.8%.

Wellness Tourism Worldwide has issued the phase one report of the 4WR: Wellness for Whom, Where and What? project.
The 4WR: Wellness Travel 2020 is a research project aimed at forecasting the state of wellness tourism by 2020 in three categories: • who (consumers• where (countries offering wellness tourism products)• what (types of wellness tourism products).
4WR collected information from 140 stakeholders from wellness, tourism, spa and healthcare industries in over 50 countries worldwide.
The report is divided into two sections: Part one describes the current status of wellness tourism, and Part two offers industry perceptions and trends shaping wellness tourism by 2020 (Part two will be published in mid-August).
The top 11 areas of wellness tourism are-• Beauty treatment• Sport and fitness• Leisure and recreational baths• Spa and wellness hotels• Yoga and meditation• Rituals• Nutrition and detox • Spiritual and wellness festivals• Occupational wellness• Spa cruises• New age
Within wellness tourism are many cultural and geographic differences both of the people and destination countries. Traditions such as yoga and the availability of natural assets such as thermal water help determine who goes where. Services offered vary greatly from region to region. Natural healing is to the fore in Central and Eastern Europe, and the Middle East. In the USA and Canada the emphasis is on medical travel for treatment. Traditional and complementary treatment is the most important in the Far East while spiritual tourism dominates in Asia. There is a section of the report that offers pie charts for 12 regions. For each what it shows is what resources are available within very broad sections such as spa/ wellness and hospitals/hotels.
Medical and wellness tourism has a tendency to exist in a vacuum, distancing itself from world events and normal tourism. Where the report does hit an important note is in stressing that both are just element of global tourism and that there is no simple division between medical/wellness tourism and other tourism as they are so inter-related that many elements are impossible to untangle.
The World Tourism Organization’s latest UNWTO World Tourism Barometer says that international tourist arrivals grew by 4.5% in the first four months of 2011, with growth in all regions with the exception of the Middle East. Global tourism continues to consolidate the recovery of 2010 despite the impact of recent developments in the Middle East and North Africa, as well as the tragic events in Japan, which are temporarily affecting travel flows to these regions.
Between January and April 2011 destinations worldwide recorded 268 million international tourist arrivals, some 12 million more compared to the 256 million registered in the same period in 2010. Europe exceeded expectations and posted the highest growth in the first four months of 2011. Destinations in Northern, Eastern and Southern Europe performed particularly well. Growth in Asia and the Pacific was in line with the world average, but slightly below previous prospects. Asia, and in particular North-East Asia, suffered the impact of the earthquake and tsunami in Japan which affected both its inbound and outbound travel as well as intra-regional travel from other markets. In the Americas, international tourist arrivals increased by 5%, driven by the strong results of South America, which contrasted with the below average growth of North and Central American destinations. The Middle East and North Africa have been considerably affected by recent developments.
UNWTO maintains its forecast for an increase in international tourist arrivals in 2011 at between 4% and 5%, slightly above the long-term average and in line with previous assessments. The developments in the Middle East, North Africa and Japan are not expected to significantly alter the global forecast.

Wellness Tourism Worldwide (WTW), a new global trade body based in the USA and Hungary, has been launched. It was founded by health and wellness consultants Camille Holheb and Laszlo Puczko.
WTW is an international trade alliance for wellness and tourism related businesses, organizations and institutions concerned with health, well being, leisure, tourism and sustainability. It argues that wellness tourism offers a larger market than medical tourism.
The organization seeks to promote the importance of wellness tourism as an economic growth and social well-being generator, to encourage public-private partnerships, and to assist governments in developing policies that allow wellness tourism to thrive worldwide. It hopes to attract members across countries, regions and sectors that share the collective goal of accelerating wellness tourism growth.
Wellness travel consumers have a wide range of needs and interests and WTW aims to attract and protect consumer interests by increasing awareness and acceptance of travel as a key activity for improving wellbeing and improving the delivery of wellness travel products through quality standards.
Research shows the wellness industry will increase due to growing interest in staying healthy, the aging world population, fragmented healthcare systems, increased globalization and an increased interest in integrative health/complementary medicine. The wellness industry includes spas but also extends to organic, anti-aging and beauty, fitness, nutrition and supplements and human performance technology. Wellness motivated travel is a vague concept so the trade body seeks to include manufacturers, distributors, insurance companies, and others who service and support the operation of wellness service providers.
It seeks as members-• Government agencies (ministries of tourism, ministries of economic development)• Tourism organizations and related businesses (destination management organizations, associations, travel agents, hotels, airlines, spas)• Corporate entities focused on employee wellbeing (corporations, insurance groups)• Healthy food and fitness related businesses,• Companies and organizations focused on sustainability,• Higher educational institutions offering wellness and wellbeing programmes.
WTW aims to offer the usual range of services that the many existing medical/health/wellness organizations offer –• Webinars, workshops, and conferences.• Educational curriculum development.• Industry research.• A range of services to members and others. • Participation at industry events, trade shows, meeting and conferences.• Newsletter.• Familiarisation trips.
There have been many global trade associations launched in the medical/health/wellness sector but most have folded or faded into obscurity. It mentions the need for quality standards in the wellness sector, which suggests that it ultimately seeks to offer accreditation; if so it will be entering an overcrowded market where most businesses that are not hospitals have yet to be convinced of the need for quality standards unless they are official government or medical authority requirements.

Mainland Chinese can now apply for solo visits to Taiwan under an agreement concluded by the Taipei-based Straits Exchange Foundation and its Beijing counterpart the Association for Relations Across the Taiwan Straits. The new free independent traveler scheme allows Chinese tourists to go to Taiwan independently instead of as part of group tours.
The first stage will see up to 500 mainland Chinese enter Taiwan each day for trips of up to 15 days. Initially, it will only apply to residents of the three Chinese cities of Beijing, Shanghai and Xiamen while residents of the coastal province of Fujian, where Xiamen is located, will be allowed to travel individually to the Taiwan-controlled islands of Kinmen, Matsu and Penghu.
Travellers may be accompanied by spouses, parents or dependents, must be at least 20, possess a verifiable yearly income of US$17,300 or have substantial savings in a bank. Those who overstay will be banned from entering Taiwan for three years. Students age 18 and over will be considered as long as they can provide proof of full-time enrolment in a recognized educational institution. Independent travel permits Mainland Chinese visitors to experience Taiwan. The initiative will benefit Taiwan’s tourism industries.
The Taiwan government expects medical tourism to attract between 2000 and 9000 Chinese every year. Wang Chih-kang of the Institute for Biotechnology and Medicine Industry (IBMI) commented,” With Taiwan’s medical professionals, medical services on a par with those in Europe and the United States, and comparatively lower fees, medical tourism will become a major industry for the country. Taiwan can attract independent Chinese tourists for physical checkups or cosmetic surgery. Taiwan should relax the restrictions on the length of time Chinese tourists are allowed to stay in Taiwan to allow them time to convalesce after major surgery. According to Wang Chih-kang 3700 foreign nationals arrived in Taiwan for medical treatment over the past two years, most of who were Chinese. Language is Taiwan’s edge in developing medical tourism, Taiwanese medical professionals can communicate with overseas Chinese and they can also speak English well and can communicate with non-Mandarin speaking foreign patients."
Taiwan’s tourism industry has performed well in 2011. Official statistics indicate that the island welcomed an all-time high of 5.57 million visitors in 2010 and is poised to exceed the goal of six million this year. Travel between the island and mainland stopped at the end of the civil war in 1949, and since 2008 Mainland Chinese travel to Taiwan was only allowed in groups due to official concerns they might otherwise overstay their visas and work illegally. Last year, more than 1.63 million Chinese visited Taiwan – most of them on organised group tours, the rest on business, family and study trips – a rise of 67 % from a year before, making China the biggest source of visitors to the island.
Chen Hung-chi of the International Medical Service Center at China Medical University Hospital argues that Taiwan should first increase market presence in China’s medical industry in order to develop the island’s medical tourism. He argues that as China continues to lack medical services for the well off, it is best that Taiwan establishes a niche market as soon as possible to cater to this sector. Only after Taiwan builds up a comprehensive hospital chain and referral system in China can cross-strait medical resources be integrated, which in turn will boost medical tourism to Taiwan.

The future direction of outbound and domestic medical tourism for Americans is partly dependent on the effect of US healthcare reform; on who pays for insurance and whether or not the insurance will pay for medical tourism. Evidence given to politicians at an official hearing has to be read with care, as some of those offering views on what will happen in 2014 tend to spin information to bolster their own arguments.

The Congressional Budget Office (CBO) estimates that only 7% of Americans now covered by employer-sponsored insurance will have to switch to federally subsidized policies through exchanges in 2014. But employee benefits consultant Lockton asserts that CBO has significantly underestimated a figure that may be closer to 20 million or 30 million of the 150 million Americans now with employer-sponsored coverage. The counter argument is put in a survey by the International Foundation of Employee Benefit Plans that finds that employers anticipate rising costs under reform, and many intend to increase employee cost sharing as a result, but few will cancel cover.
According to consultants McKinsey, 30% of employers will definitely or probably stop offering health coverage in the years after 2014. 45% of employers say they will definitely or probably pursue alternatives in the years after 2014. Those alternatives include dropping coverage, offering it through a defined-contribution model, or in effect offering it only to certain employees. After criticism, McKinsey hastily backtracked with a long press release arguing, “The survey was not intended as a predictive economic analysis and was not an economic forecast, but a measure of attitudes of employers. It is an opinion survey so not comparable to the healthcare research and analysis conducted by others such as the Congressional Budget Office, RAND and the Urban Institute. Each of those studies employed economic modeling, not opinion surveys.”
Putting the predictions in perspective, the number of Americans with health insurance through employers has already declined, due to millions losing their jobs. Most employees will continue to get coverage through their jobs after the new healthcare law takes full effect, says a new study sponsored by Robert Wood Johnson Foundation. It says that low and moderate-income families employed by small firms were the most likely to be affected by a loss of employer-sponsored coverage, as it may be cheaper for employers to help such individuals buy cover from the heavily regulated state health insurance. Another study by the Urban Institute said it expects the healthcare overhaul to help small businesses with 50 or fewer employees provide medical coverage to employees due to the tax incentives for small employers.
Starting in 2014, the Affordable Care Act (ACA) will require mid- and large-sized companies to make payments to the federal government if they do not offer health insurance to their employees and dependents. Employers with at least 50 full-time employees will have to provide qualified health insurance coverage to their full-time employees and their dependents. Qualified coverage is defined as comprehensive (paying at least 60 % of health care expenses) and affordable (costing less than 9.5 % of employees’ household incomes). If they do not and if their employees purchase coverage instead through a new state insurance exchange with the assistance of federal subsidies, companies will have to make a tax payment of up to $2000 for every full-time employee beyond the first 30. The Affordable Care Act requires states and the federal government to review premium increases that appear excessive. The act provides for the operation of health insurance exchanges by states. Health insurance exchanges are organized marketplaces for the purpose of providing coordination and guidance to individuals and insurers. Individual policies can continue to be sold through the individual market outside the exchange. States will also establish exchanges for small-group health insurance coverage. States will have the option of merging their individual and small-group markets and may opt to have one exchange to serve both, while states can co-operate on joint exchanges.
The varying estimates provoked an intense political and media debate, but it is a new situation for everyone, so asking business leaders to second guess now what will happen in three years time is a very poor predictor of what businesses will actually do in 2014.

Eight private healthcare companies, clinics and hospitals on the Costa Blanca have formed an alliance to try and attract more foreign patients. The Mediterranean Health Care Association says the objective is to make Alicante province a destination for European health tourism.
The eight are: Vistahermosa Clinic, Medimar International Hospital, San Jaime USP Hospital in Torrevieja, Hospital Clínico in Benidorm, Vissum Ophthalmologist Corporación, Sha Wellness Clinic in El Albir, the Davó maxillofacial and the Casaverde neurological rehabilitation centre. Together they aim to internationalize their services through co-operation and a programme of marketing and joint promotion. €400,000 has been invested in the idea, and the plan is to find patients online, and via insurance companies, travel agents and public health bodies in other countries. The main target markets are Europe, United States, Russia and North Africa.
President of the association, Alberto Giménez Artés explains, “Given the demographics of the health market it is hoped this Mediterranean part of Spain, with its sophisticated medical facilities, easy proximity to northern Europe and the other target areas, and its reasonable pricing, will prove a popular destination, for the older patient especially. The availability of cheap flights into El Altet’s expanded airport is also an essential factor in attracting health tourists. In addition to medical care the association also aims to provide accommodation and travel advice and arrange both for patients and accompanying friends and relatives as part of an all inclusive and holistic approach to this expanding service.”

MajesticSpa Essential Moments, a boutique spa in the Hotel Majestic in Barcelona, Spain, part of the Catalan group Majestic Hotel Group, is the first spa in Europe to achieve SpaExcellenceSM certification. This certification is the culmination of months of organizing and documenting the spa’s quality system in accordance with the international standards of spa excellence from SpaQuality. The standards provide a framework for everything a spa does including planning, day-to-day operations, behind-the-scenes processes, leadership, teamwork, training, system evaluation, continual improvement and more.
Spa director Eva Crespi says, "Implementing these standards have helped us to have a clear and concise management system. This translates into being able to be fully devoted to customer satisfaction. We developed protocols in order to improve our efficiency, which also makes it easy to train staff and incorporate changes and innovations.” Assessors conducted an assessment of the spa quality system for compliance The spa’s processes were assessed in several categories: intention and strategy, leadership, guest experience, operations support and improvement, as well as how well they worked together as a quality system. The spa can expect an unscheduled anonymous guest assessment to evaluate the spa from a guest’s perspective before the next annual assessment.
MajesticSpa is on the 10th floor of Hotel Majestic and offers facial treatments, body treatments, massages, manicures, pedicures, waxing and make-up. The facilities include a reception area, four treatment rooms, two pedicure rooms, two manicure rooms, a make-up area, and a hydrotherapy circuit, which includes a dry sauna, an ice fountain, a steam room and a sensations shower with relaxing essential oils. SpaQuality is an independent organization specializing in evaluating quality systems in the spa industry. Julie Register and Linda Bankoski created it in 2003.

While other areas of the Philippines are still talking about developing medical tourism, Cebu is making rapid progress. Seeing Cebu’s potential for medical tourism, a group of dentists and entrepreneurs have set up Dentaland, a dental clinic within a local shopping complex, the Ayala Center Cebu.It will offer high quality dental services at a low cost to medical tourists. The company will be opening another clinic next year and is also working on its accreditation.
Dentaland Inc. was formed by nine friends, seven of whom are dentists. The other two co-owners are Gino and Carmel de Pio-Salvador of Global Carrier Philippines, who handle the company’s marketing and management. The clinic is equipped with the latest state-of-the-art and modern hygienic facilities. It has created a room designed for children. The plan is to link up with hotels and with the wellness sector. Dentaland plans to work with the Cebu Health and Wellness Coalition as well as spas and other health and wellness destinations in Cebu.
After working with four hospitals in the Philippines, Accreditation Canada International is also hoping to work with two Cebu hospitals to get them international accreditation that would give foreign patients more confidence in their services. In the Philippines, the Manila Doctors’ Hospital has achieved accreditation from Accreditation Canada International, and the organization is working with the Philippine Heart Center, Asian Eye Institute and Clinica Manila.
Accreditation Canada works with hospitals in a step-by-step approach without overloading them with things that they need to do to get accredited. Hospitals believe that international accreditation will help them attract medical tourists. The accreditor does not have a fixed price, as it customises a programme to meet global health care standards to promote quality and safety in medical tourism. A well-prepared hospital can get accredited in 12 months, but the normal period is two years. Accreditation lasts for three years before it has to be renewed.
Medical tourism is one of seven growing economic sectors in the country identified by the Joint Foreign Chambers (JFC) to help bring in foreign direct investments and create jobs. Among the core health care services identified by the Department of Tourism as in high demand among foreigners are executive checkups, cardiovascular care, cancer care, stem cell therapy, joint replacement surgery, weight management, eye care, dental care, cosmetic surgery, spa wellness treatments and long-term care and retirement.
But for the country to attract more foreign patients, the JFC is recommending that the government promotes medical travel packages, and finally develop and implement the long promised national policy on wellness and medical travel.

The world’s first online portal dedicated to the medical evidence that exists for 22 spa and wellness therapies, Spaevidence.com, was launched at the Global Spa Summit in Bali, Indonesia. The new portal consolidates clinical evidence about 22 key spa therapies, including yoga, reflexology and aromatherapy, from four existing databases: Natural Standards, the Cochrane Library, Pub Med and the Trip Database. The portal has been developed with support from Dr. Ken Pelletier, Dr. Daniel Friedland, Dr. Marc Cohen and Nader Vasseghi. Among the therapies are lesser known ones such as ear candling, qi gong and music therapy. For each therapy it gives links to databases, research and ongoing trials.
Under the 2011 banner of “Engage the Change: The Customer. The Money. The Future,” delegates attended dozens of presentations and panels exploring smart new ways to engage with consumers; enter new markets; embrace new technologies; implement new business, tourism and wellness concepts; and pursue new investments.
There are at least 75,000 spas across the world, the number being difficult to determine as where a hotel with health leisure facilities ends and a spa/wellness centre begins is a matter of debate. Spas are seen as a leader in promoting both medical tourism and wellness tourism.
The release of new industry research is a hallmark of every summit, and the ten research reports available online include:• GSS: “Wellness Tourism and Medical Tourism – Where Do Spas Fit?”• Coyle Hospitality Group: “Priorities of Today’s Spa Consumers”
Each year a poll of the 500 plus attendees provides a window into current industry performance and the future. The 2011 delegate survey highlights include:• The economic turnaround is directly, positively impacting the spa and wellness industries: 82% predict an increase in gross revenues for 2011.• China ranks as the top country that spa groups would most like to expand their business, followed by other countries in Southeast Asia.• 57% report that social media campaigns are currently driving an improvement in customers/sales, but 26% still do not engage in any social media initiatives.• 37% report that group buying/online deal sites have driven an improvement in customers/sales, but 58% don’t participate in group buying/online deal sites, the fastest-growing online category.
The spa industry in Indonesia has become the third fastest developing and third biggest in Asia after those in India and China, according to Indonesia’s tourism minister Jero Wacik, "in 2010 the spa industry in Indonesia grew 7% or almost as fast as that in China which grew 8% and that in India which developed 11 %. The spa industry cannot be separated from tourism and so it is contributing economically to Indonesia. We do not know the exact number of spas in the country, which is why we plan to make an inventory of spas. It is vital to improve the quality of the spa industry in this country so that it can attract more tourists. We will work with regional governments and produce an ethics code for the industry."

Taking advantage of the publicity that US domestic and overseas medical tourism is getting, an increasing number of agencies are promoting hospitals and clinics in South and Central America as cheaper than the USA, and with an eye on the ever increasing costs of air travel, a much shorter flight time than Asian destinations.
Connecticut agency, Weltrek, is launching medical tourism and healthcare destination guides providing exclusive highlights of a destination, country or city with detailed information about the quality of healthcare found in that region. The agency only offers treatment at four locations in Ecuador and Costa Rica.
Weltrek also offer Wel-pass for patients at a reduced cost for a limited period of time. Acquiring the Wel-pass allows patients to talk to their prospective surgeon via phone or web conference to answer any questions about their procedure. Patients can also transfer their medical transcripts to their chosen surgeon, safely and securely.
Medical tourism agency, Gorgeous Getaways, has entered into a partnership with Costamed Hospital and Dental (CMC) to promote Cozumel in Mexico to Canadian and American patients seeking affordable high quality medical treatment in a safe and relaxing environment. US medical tourism agency, MedToGo International is helping an increasing number of Canadians get surgery in Mexico.
US agency, Medical Tourism Company (MTC), is offering weight loss surgery in Mexico, 60-70% cheaper than in the USA. Mexico has emerged as a cost saving option even after considering travel, accommodation and other expenditures. MTC offers affordable weight loss surgery in Puerto Vallarta, Guadalajara, Tijuana, Hermosillo, Cuidad Juarez, Monterey, and Mexicali. MTC has also added cosmetic surgery in Costa Rica as Costa Rica is close to the United States and Canada and presents minimal problems in travel planning or budgeting. Costa Rica cosmetic surgery prices are very affordable.
The Fundacion de Santa Fe de Bogota hospital in Colombia’s capital is one of few hospitals in Latin America that is able to treat advanced abdominal cancers. It offers specialist treatment that is only available in a very small number of places globally, and only three sites in Latin America. Currently, the outlook for people with these conditions treated with conventional therapy is poor; for patients with peritoneal carcinomatosis from colorectal cancer median survival time is six to eight months, with no five-year survivors. The HIPEC treatment shows promising results; research documents five-year survival rates varying from 25 to 70%. The treatment is helping the burgeoning Colombian medical tourism industry, attracting patients from other countries who would be unable to afford or otherwise access this life-saving treatment.

An EU funded project, ’The Role of Health Tourism in Improving the Competitive Strength of the Rural Areas in Hungary and Croatia’ is a trans-border project that aims to define factors necessary for the improvement of the competitive strength of the rural trans-border area through health tourism. The research results will be available soon.
In cooperation with experts from the Institute for Tourism, REDEA is in charge of implementing the research that aims to present the situation and potential for the development of health tourism in Croatian and Hungarian regions near the border. On the Croatian side, the project relates to Medimurska, Viroviticko-Podravska and Koprivnicko-Krizevacka counties. In Hungary the three border counties are Zala, Somogy and Baranya. The Regional Development Agency (REDEA) aids the development of Međimurska County through activities related to small and medium-sized entrepreneurship.
Health tourism is one of the oldest types of tourism in Croatia. It is the use of comparative natural and healing advantages arising out of the climate, with the purpose of maintaining and improving health and quality of life. The basis of health tourism is the use of natural healing factors that can come from the sea, spa, or climate. Geothermal sources are an extremely important resource in Hungary, so health tourism is also important there. The social impact of health tourism on the standard of living, employment and education will be determined.
The general aim is to determine the importance of health tourism in the competitive strength of the rural areas in the border area, and to identify key success factors. Specific aims include- investigating investments, subsidies and support in the health tourism of the border area; evaluating the role of companies in health tourism and health institutions in the region. It also seeks to create an IT platform and trans-border network of Croatian and Hungarian health tourism institutions with an exchange of ideas, and a debate on development plans.
Expected results include:• Research on the local authorities, companies, medical staff, tourists and the local population in health tourism.• Research on best practices.• IT platforms with presentations and interactive maps.• A new network of Croatian and Hungarian experts in health tourism on the border area.• Conferences and workshops.• Identification of success factors, needs and capacity of health tourism in the border area.• Impact of investments in the border area on the population.• Creation of a transborder network of health tourism.• Identifying investments into the development of health tourism; entrepreneurs, companies and institutions (hotels, spas, regional and local administration, hospitals) that are in some way connected to health tourism.
As well as health tourism, the two countries are well established in dental tourism. Dental tourism is crucial for Hungary’s economy, generating 227million Euros in revenue each year according to Viktor Orban, Hungarian prime minister. Health tourism, especially spa and dental tourism is to receive special attention with the Hungarian government planning support worth 117 million Euros.
Many dental surgeries across Hungary welcome the news of governmental support. Hungarian Dental Travel, a long-established UK based independent dental trip organiser only works with surgeries, which pass their on-going quality controls and live up to British dental patients long-term expectations. The company has just added Dr Salman, whose dental surgery is in the center of Budapest, and who speaks Arabic and English.
The proprietor of Harley Street’s Milo Clinic, Dr Nick Milojevic, has opened a new surgery in his home country, Croatia, which will offer safe, expert cosmetic procedures at a fraction of the cost of equivalent treatment in the UK. Dr Milojevic is now offering a Harley Street standard service in Croatia, taking the worry out of seeking procedures outside Britain.

The outbound medical tourism industry has grown rapidly in recent years in Canada and two new reports throw some light on what is happening and why, but do little to solve the question asking how many Canadians go abroad for healthcare?
An analysis of 12 phone interviews conducted with 10 Canadian medical agencies to understand Canadian patients’ involvement in medical tourism provides a snapshot. Questions in the research for the feature in BMC Public Health focused on the information provided, how medical tourists make decisions and what agencies do for their money.
The ten agencies sent Canadians to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Most medical tourists are between 40 and 60, from a variety of socio-economic backgrounds. Potential customers were put off by fear of the unknown, and antagonism of most Canadian doctors to the concept of medical tourism. The report concludes that medical tourists are not similar to each other and have different reasons for going where they go; while those who consider it and fail to travel, all have different reasons too. The authors speculated that people with a historic family or ethnic link to a country considered as a medical tourism destination may not need an agency. Another conclusion was that the research provided no clues on how public healthcare could help, hinder or mesh with medical tourism.
According to a report from Deloitte Canada – ’Medical Tourism in Canada – exploring a new frontier in healthcare’, 2% of the adult population travel between countries to receive treatment, and that figure is expected to grow each year. It suggests that 525,000 Canadians travel each year; a figure that is not supported by anecdotal evidence from hospitals and agencies – and previous Deloite estimates of travelling numbers have been much higher than reality.
Over the past five years, Canadian governments have reduced the volume of insured medical services purchased out-of-country, but the costs of these services have more than doubled. At the same time, anecdotal reports suggest that Canadians are privately purchasing cosmetic and elective services at an increasing rate, though little data is available, admits the report.
Many factors are influencing the growth and surrounding regulations of patients travelling for medical care:• Evolving medical tourism guidelines and international accreditation.• Expanding and increasing sophistication of foreign medical tourism operations.• Increasing provincial and local provider interest in supporting medical tourism through legislation and policy.• Increasing demand for outpatient surgery and a drive to reduce wait times.• Emerging consumer interest in medical tourism options.• Economic constraints and changing financial incentives.
Adding to the emerging state of medical tourism in Canada is growing policy and public attention to waiting lists for key services, increasing consumer willingness to travel for health care services, and renewed direct-to-consumer marketing by medical tourism companies and foreign destinations. This growth presents opportunities for increased medical tourism in Canada – both for Canadians seeking care abroad and for establishing Canada as a medical tourism destination – and sets the stage for renewed focus on this health care trend by Canadian governments, providers and consumers.
The Canadian Medical Association argues that there should be no need for a private medical-tourism industry and that policymakers should focus on improving Canada’s health-care system, so that there will be no need for a Canadian to go across any border to receive health care. It also argues that timely access and availability of treatments at home would entice Canadians to receive treatment at home rather than abroad.

ArticleAuthors: Rory Johnston/Valorie Crooks/Krystyna AdamsJeremy Snyder and Paul KingsburyCredits/Source: BMC Public Health 2011, 11:416