A sale on heart valves

For a limited time, Thailand has a deal on heart valve replacements.

At the (relatively) low price of 590,000 Thailand Baht, or about $18,000 Canadian, the Bangkok Hospital Medical Center will replace your damaged heart valves — a procedure that sometimes become necessary in middle aged patients for reasons ranging from infection to rheumatic heart disease to congenital heart defect to valve disease or even just normal aging and wear.

The $18,000 gets you use of the operating room, critical care unit accommodation for two nights, a standard single room for five nights (including nurses, meals and room service), treatment by a team of cardiologists, surgeons, anesthesiologists and rehabilitators, medications, laboratory and diagnostic services and blood transfusions. The valves themselves are not included.

The price is billed as about 20 per cent of the cost of having the procedure done in the U.S., the target market for the offer. It's not immediately clear, however, how much of a savings the price is from the hospital's regular charge. But a chart in a recent edition of US News and World Report would place the rate somewhere between what a patient could expect to pay in Singapore (considered the high-end destination for medical tourists) and notoriously value-priced India.

But act soon, the offer ends Sept. 30.

Home shows for medical care

The folks behind the medical tourism conference I covered in Las Vegas last May have launched a travelling consumer show for patients to visit and comparison shop for their overeas medical treatment.

The shows start in Texas in October.

Where past such conferences have been strictly geeared toward the business side of things, these shows will be like home shows for medical care -- with overseas hospitals, medical tourism brokers and toruism boards setting up booths to sell their wares.

The idea is to make it easier for those interested to dip a toe into the world of medical tourism, a fast-growing industry in which first world patients fly to third world countires for cheap medical treatments -- and no waiting lists.

So far, only American dates have been set, but the man behind the shows, Skip Brickley, told me in May he hopes to bring the shows to Canada one day. Two of the dates, however, are in Florida in February and March, which should attract a few snowbirds.

Here's a complete list of dates, so far.

-- Oct. 25-26, 2008, Hilton DFW Lakes, Dallas, Texas

-- Nov. 1-2, 2008, Renaissance Hotel, Austin, Texas

-- Dec. 6-7, 2008 Hyatt Regency Crystal City, Arlington, VA

-- Feb. 21-22, 2009 Sheraton Mart Airport, Miami, FL

-- Feb. 28-March 1, 2009 Orlando, FL, location TBD

-- May 8-9, 2009 Marriott Hotel & Marina, San Diego, CA

New Zealand opens door to medical tourists

It seems New Zealand is doing what Brian Day, president of the Canadian Medical Association, would have this country do.

It's entering the world of medical tourism. Already home to several private hospitals, the country now has its first medical tourism company, Medtral, aimed at getting North Americans into the country for cheap and fast surgery. Company founder Edward Watson is now touring North America drumming up business.

The company is positioning itself in the market as more upscale than India or Thailand, which offer some of the cheapest overseas medical care, but cheaper than Singapore -- the designation of choice for those willing to pay for truly upscale care. The target market, Watson says, are patients who want cheap foreign surgery, but amid a more familiar culture. "It's not a foreign experience," he told the Washington Post. "Yeah, it's different, but you still have Starbucks, you have McDonald's."

According to pricing charts on the company web site, a hip replacement will cost $28,457.95 (CA), including airfare for two, surgery, five or six days in a hospital, accommodations at a luxury hotel afterward (where a nurse will visit you regularly) and physiotherapy. So far, 29 Americans and one Canadian have signed up, according to the Post. The company expects to treat its first patient in late August, 69-year-old Eugene Horn, an Episcopal priest in Oregon.

Horn told the Post he wanted cheaper surgery than he could get in the U.S., and likes the idea of going to a developed country with an established public health system. Another patient, 54-year-old Marc Shaw of California, is also considering Medtral for his knee-replacement surgery.

That is exactly the type of patient, Day has told me, that Canada could attract if it got into the medical tourism market. There are a lot of Americans who want cheaper surgery, and would feel more comfortable getting the procedure done in a country similar to their own.

But the first step, Day says, is to get rid of the waiting lists here for surgery -- the primary reason Canadians go abroad for treatment.

It seems, however, that Canada has nothing to learn from New Zealanders on that score. As the Washington Post points out:

"The kind of timely response that Horn and Shaw describe is something many New Zealanders themselves have trouble accessing. The country has one of the world's oldest and most comprehensive public health systems, and few New Zealanders have private health insurance. They rely on a sometimes swamped public health system to deal with their complaints, and there are waiting lists for many procedures, including hip replacements and radiotherapy."

To many that sounds like Canada.

Health Care Globalization, Part 2

Where this blog began, it now returns.

Canadians have always had a theoretical ability to jump the queue and get faster health care by simply going to a hospital in the United States. But the fact that the care would cost tens of thousands - even hundreds of thousands - of dollars kept most people from doing so.

Only the rich could afford it.

But as Leigh Turner, a medical ethicist at McGill University told me, international queue jumping is now a viable option for the middle class because places like India and Singapore offer surgery at prices as low as one-tenth those in the US. That's a potential threat to medicare, he says, because it could lead to pressure to let people spend the money to queue jump at home, keeping the money and jobs here.

It's an issue I examine today in a package of stories in the Saturday Star.

Queue jumpers, mainly from Canada and the UK, make up a big part of the medical tourism industry - about 15 per cent of the worldwide market. Most are still rich people from the Third World looking to get better care or access to better technology outside their own countries. But the focus is expected to shift as North Americans catch on to the idea.

And there's a burgeoning industry on the continent to help them do it. One of those companies, Healthbase Online Inc., helped Jill Misangyi of Hamilton go to India for back surgery she had waited for in Canada for 16 years. The company handled everything - even arranging for her to be picked up at the airport. It was as easy, she says, as booking a trip through a travel agent, and cost about the same as a family vacation.

The medical tourism industry is not huge, but it's growing fast. And as long as there are waiting lists in Canada, there may well be a market for it.

Dr. Brian Day, president of the Canadian Medical Association, says the solution is simple: get rid of the waiting lists. He would like to do this by changing the way hospitals are funded, giving them a financial incentive to do more surgeries. He is also comfortable with letting people pay for faster service at home. Once the waiting lists are gone, he says, Canada could even become a medical tourism destination.

Read all about it in the Saturday Star. It's a big issue that isn't likely to go away any time soon.

Summit wrap

This will likely be the last blog from the Health Care Globalization Summit. Cards have been exchanged, hands shook and business deals among the delegates begun -- if not complete.

It's been fascinating for me to immerse myself into the business side of health care. It's something we don't see that often in Canada. This being a business conference, there was was no discussion of whether for-profit medical care is a good thing, or whether higher profits are a measure of quality of care -- topics that always come up when business and health care are discussed in Canada.

The question all week was not should profits be made from health care, but how can more money be made.

But Canada and the U.S. do share at least one major health-care concern — accessibility — though for very different reasons. In the U.S., access to health care is denied due to cost. In Canada, it's due to wait lists. The solution offered for both here has been the same: get more people to go abroad for care. And hospitals from India to Singapore to Malaysia to Latin America have been on hand to drum up business.

There's little doubt medical tourism is taking off. In fact, health systems in many developing countries are betting their livelihood on their ability to attract out of country patients. A representative from Singapore told me the population of the island is too small to support a good health-care system, so foreigners are needed.

With U.S. health care not getting any cheaper and aging baby boomers in Canada about to add their names to waiting lists for new hips, new knees and cardiac surgery, Singapore may have little to worry about.

Dr. Wal-Mart

Today at the Health Care Globalization Summit in Las Vegas kicked off with a much-anticipated presentation by John Agwunobi, president of health and wellness at Wal-Mart.

The world's largest retailer, he said, is moving into health care, setting up clinics in its U.S. stores that "co-brand" with local hospitals to provide basic care for customers -- mostly simple tests, shots and treatments for colds and ear infections. The first three opened in February in Atlanta, Little Rock and Dallas, with another 76 opening since. The company expects to have 400 clinics by 2010.

Agwunobi, a pediatrician and former top official with the US Department of Health, said no appointments are needed and wait times are no more than 15 minutes. He says Wal-Mart's move into health care will shake up the medical industry by forcing doctors and hospitals to be more "consumer friendly." The old model for health care, he said, "is being pushed aside."

Agwunobi said part of the incentive for Wal-Mart to get into the business, including selling cheap generic medicine, was the boom in Americans filling their prescriptions in Canada, where prices are lower, and the millions of Americans with no health insurance who need cheap care.

The clinics, he said, also take stress off local emergency rooms.

Agwunobi was mobbed in the hall after his keynote by conference delegates, all strong advocates of consumer-driving health care. That's where he confirmed Wal-Mart hopes to bring the concept to Canada one day, as well as Brazil and Mexico.

But there are limitations, he said.

"There will never be a day when we are delivering babies in Aisle 5," he said.

Health called a commodity

As the Health Care Globalization Summit wraps up, I'd like to relate a coupe of e-mails I received from readers.

One worries that medical care is becoming commodified, and that the advancement of medical tourism will lead to two-tier medicine in Canada. Some people will be able to afford to spend thousands of dollars to get procedures done abroad, while those who can't afford it will have to wait.

Only a few years ago, arranging overseas care required dozens of long-distance calls, endless e-mails and hours of web surfing to put it together. Patients would have to fight their own way through the bureaucracy of arranging medical tests and getting needed travel documents. Today, brokers in Canada and the U.S. do all the legwork, and hospitals in India have call centres staffed 24-hours a day to help patients make their arrangements. Anyone with a cheque book can do it.

Vishal Bali, chief executive of Wockhardt Hospitals in India told me yesterday afternoon that he expects  the number of Canadians coming to his hospitals to grow as Baby Boomers age. The main procedures Canadians seek in foreign hospitals are orthopedic and cardiac -- and both conditions become more prevalent with age, and have long waiting lists in Canada. Increased demand will lead to longer waiting lists, and more business for Bali's hospitals.

But while one reader said that means two-tier medicine, another e-mailed to suggest that it would be better to get Canada in on the medical tourism game and use the added revenue to get rid of Canadian wait lists.

The second reader also sent me a link to a Thai consulate web site advertise their country as a place for Canadians to get surgery done. The site includes a price list.

Coming up, today is the last day of the summit, and features Wal-Mart describing its move into medical care.

Waiting lists top cost, part 2

The McKinsey report on the medical tourism industry was just presented at the Health Care Globalization Summit in Las Vegas, so I have a bit more information.

The definition for "medical tourist" in the report excludes anyone getting out-patient care, and anyone who is mixing travel with medicine.

In other words, if patients combined their medical travel with  sightseeing or lying on a beach, or did not spend a night in hospital, they were cut from the report's stats.

One medical travel broker here told me the exclusion of out-patients would drop from the stats some 90 per cent of plastic surgery and dentistry procedures done -- two big reasons people go abroad for medical care.

By its own estimates, McKinsey has excluded up to two-thirds of the travel that many in the industry include in their stats -- meaning the industry could be much larger than the company is estimating.

Singapore hospital representatives here claim they to serve up to 400,000 medical tourists a year on their own.

The other health care globalization

If you have a problem with your computer and call the manufacturer's help line, there's a good chance you will end up talking to someone in India.

Well, talking to your doctor might soon be the much the same experience.

Bill Crounse, a medical doctor and worldwide health director for Microsoft Corp., told the Health Care Globalization Summit in Las Vegas this morning that much of our interaction with doctors is "cognitive." That is, it involves little in the way of physical examination, but is mostly an exchange of questions and answers.

As such, he says, there's no reason the patient and the doctor need to be in the same room.

"It makes no difference if my doctor is across the street or half way across the globe," he said.

His branch of Microsoft is developing technologies for doctors to consult with one another and with patients by computer -- especially handheld devices, in hopes of reducing response times.

"What can be done virtually, should be done virtually," Crounce, who has his own blog, told the conference.

Crounce also touched on medical tourism, laying the blame for the industry's growth  at the feet of government.

"Ultimately, this is about failure by government, failure to provide care," he said.

"Let's face it, no one would get on an airplane and fly somewhere for medical care if they could get it at home."

Let the commenting begin

It seems there was a problem with the comment function of this blog, that I am told has now been fixed.

So if you have tried and failed to leave a comment, or want to start commenting, you can now do so.

Sorry for the inconvenience.