Health and Medical Tourism

Presentation to NW Tourism Lekgotla

Dr Tshepo P. MaakaSerokolo Health Tourism (Pty) Ltd

10 Sept 2009

Presentation Layout

• What is medical tourism?– Segments of Health Tourism

– Who are health and medical tourists

– Why do they travel and where do they travel from?

• How big is Medical tourism internationally and locally?

• Why SA as a medical tourism destination?

• Serokolo Health Tourism– Case Study- Creating a medical tourism experience

• Summary:– Who is in the value chain of medical tourism

– Benefits of medical tourism

– Growth and Development Challenges

What is medical tourism?

What is Medical Tourism?

Industry where people from all around the world are travelling to other countries to obtain medical, dental and surgical care while at the same time touring, vacationing and fully experiencing the attractions of the country they are visiting”

It is all about the experience!!!!

Medical tourism began primarily with elective and cosmetic surgery generally not covered by medical insurance, but growing numbers now travel for life-saving and

medically-necessary procedures such as cardiac surgery.

Furthermore people combine medical check-ups with travel both internationally and locally

Segments of Health Tourism

• Medical Tourism • Dental Tourism• Spa Tourism• Wellness Tourism (health tourism)• Culinary Tourism• Sports Tourism• Accessible Tourism• Assisted Residential Tourism (Ambient Assisted

Living Abroad)

Who are these tourists?

MEDICAL TOURIST• Life-saving procedures• Elective and necessary

procedures• Stay longer, min 10 days• Minimal tourism activities• Travel with companion• International (can be local)• Quoted on medical history

HEALTH TOURIST• Health seekers• Dental and cosmetic surgeries• Medical check-ups/Screening• Packages: Spa therapy and

revitalization/wellness• Short-stay < 1/52• Combine health travel with lots

of tourism activities, golf, safari, shopping, food

• Travel alone• Local and international• Pre-packaged

Traditional medical tourists are residents of industrialised countries…

Note: according to the UK Patient Association in the UK more than 1 million UK citizens are waiting for hospital treatment and the maximum waiting time for an NHS operation is set

at 6 months in 2005.

…but these are being joined by people from other countries including from developing countries.

RESEARCH FINDINGS

• USA, Canada, Great Britain, Western Europe, Australia and Middle East

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• Rise in life expectancy and surging demand for healthcare services in own country

• Rise in non-communicable diseases that require specialised services

• Increasing burden on healthcare services leading to long waiting periods*

• High costs of medical and health services

• Exclusions and non-coverage of services by medical insurance companies

• High malpractice insurance fees

• Generally able to pay

• Disposable income

• Usual services purchased are elective procedures especially cosmetic surgery

• Combine medical service with a vacation

Traditional medical tourists

• Indonesia, Africa,

• Unavailability of required medical services in

own country

• Quality and safety concerns of medical services

in own country

• Relatively high costs of medical and health

services

• Exclusions and non-coverage of services by medical insurance companies

• May be able or unable to pay

• Usual services purchased are life-saving and medically-necessary procedures

• May purchase elective procedures

• Tourism aspect of offering may not be important

Emerging medical tourists

Medical tourism is a rapidly growing industry with various factors contributing to its increasing popularity

• High health care costs in industrialised countries

• Decreasing levels of medical insurance coverage

• Ease and affordability of international travel

• Advancement in telecommunications

• International/bilateral trade agreements

• Proven safety of healthcare in select foreign countries

• Rapidly improving technology and standards of care in may countries of the world

• High standards and quality of care in developing countries that now offer world-class medical services

• Lower costs

• Rapid access and privacy

• Favourable currency exchange rates in the global economy

Medical tourism presents an affordable, enjoyable and safe alternative to having medical, dental and surgical procedures done in the home country.

Medical tourism is a result of customer driven demands for healthcare services

Medical tourism is a product of the

globalisation of medical and health

care services

Cost comparison

SA Costs

Summary of countries participating in medical tourism

Source: Mckinsey Study summary

Where do medical tourists go?

Just how big is this industry?

Medical Medical Traveler Traveler

Convergence Convergence PointPoint

Medical Medical Traveler Traveler

Convergence Convergence PointPoint

Airlines

Health and Medical Services

Hotel

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Medical Travel GDP

Growth

$ 60bn in 2006 and $100bn

global industry by 2012

(???Recession figures)

Converging forces in medical Tourism

Adapted from Globalysis 2006

What about SA??

– Total visitors to SA in 2007/ 8 = Approximately 10 million– 4.5% are medical visitors (Monitor, 2001 report) = 450,000– 50% treated in Joburg (conservative assumption) = 200,000– Each accompanied by one companion– Ave length of stay is 10 days (5 in hospital, 5 days out)– Ave medical procedure R25,000 (i.e. 5 days in hospital)– Ave out of hospital spend is R1,250 x 5 days = R6,250– 1 private health group sees 200 per month in 5 hospitals– Estimated total revenue per annum R9.8 billion

Adapted from City of Joburg 2009

Why should we promote SA as a medical tourism destination?

1/…medical facts

• SA is a medical pioneer:– The world’s first heart transplant was done in SA on the 3rd of December 1967– CAT was co-developed by a South African born Physicist Allan Cormack in 1972– SA has the world’s first surrogate grandmother, who gave birth in October 1987– The world’s oldest surviving sextuplets were born in SA on Jan 11, 1974

• SA has the medical infrastructure– Our private healthcare systems was ranked 4th in the world in 2004– We have the largest ARV programme in the world

• Part of a global HIV Vaccine Initiative– Our medical institutions have international accreditation– World renowned medical and surgical specialists– Single digits infection rates– Clinical outcomes comparable to USA and UK, and even better– Most of our private wards sit at 65% occupancy rates

• Centres of excellence (excellence drived medical tourism– The Endometriosis Institute of Southern Africa – iThemba Labs Medical Radiation Group - only hadron therapy centre in Africa– The Walter Sisulu Paediatric Heart Institute– Fertility Clinics– Sports Institutes

2/…

• Medical tourism improves health delivery systems – strengthens public health delivery systems

• We have the only 64-slice CT scan in Africa

• We have most MRI and CT scans in Africa

• SA is seen as a hub for international travel for Africa

• SA seen as a hub for medical care in sub-Saharan Africa

– Reverses the brain drain

– Keeps medical resources within the African continent

– Improves healthcare delivery systems for locals

– NEPAD

– Proximal to most African countries South of the Sahara

– Medical tourism allows for “Africans to do sth for themselves”

Serokolo Health Tourism (Pty) Ltd

The History....

2004Serokolo Health South Africa foundedwww.serokolo.co.za

20051st medical tourist (Canada)

2006 Registration Serokolo Health Nigeria1st foreign Government contract for services1st medical tourism conference SA

2007 Partnership with all hospital groups in SAPartnership with laboratory and radiology groupsPartnership with GTA

2008 to dateInternational membershipGlobal client baseDiversified product offering- consulting, trainingDiversified client baseSolid operationsSolid local tourism partnerships

Our services

TREATMENT PLANNING

CLIENTHANDHOLDING

CASE MANAGEMENT

AFTERCARE & REVITALIZATION

COMPREHENSIVEHEALTHSCREENING

Medical Visas

Pre-travel medical screening

Global quotations

Medical Dataexchange

Allocation of service providers

Accommodation

Accompaniedspecialist Appointments

Drop- and- fetch

Personal andNursing support

Local transport

Personalizedmeals

Medical evacuation

Specialist referral

Hospital visits

Treatment facilitation

Bills collation and cost management

Customizedpost-careaccommodation

Nurse Visits

Body Therapy

Lifestyle Modification

Retail Therapy

Allied medical services

Medi-spa

Tours

All systems bodyhealth assessment

Health advisory services

Preventative care

Health Maintenance

Health packagesand health tours

Creating the Medical Tourism experience.....

A Case Study(1)• Nigerian:

– “Lost confidence in own national healthcare

delivery system” Prof Babatunde Oshotimehin , Minister of Health

– Previously looked to the US and UK for medical care• Seasoned traveller

• Medically aware

• Affluent

– Knows the “perception” SA has about Nigerians

– Perceives SA to be like the “rest of Africa”

– Does not know you!!!!!

– Heard about the good steaks at the “Meat and Co”

– Loves shopping and the “glitz and glamour” of Sandton City

– Was told about Sun City

– Church activities “part and parcel” of his weekly routines

– Carries no credit cards or medical aid card

– Has two to three cell phones- poor internet connectivity

Where am I going?

Contact from doctor or patient Patient information form completed and sent to SHT

Quote is sent to patient (global estimate quote)

Final arrangements are made upon receipt of payment and reflection in our bank account (within

72 hours of receipt of payment)

SHT representative meets the patient at the airport

Patient is transported to hospital and handed over to

treating specialist

Accommodation for recuperation is arranged prior

to patient’s discharge from hospital

Arrangements are made for patient to leave South Africa

Patient in hospital - SHT visit and case management

Medical records, report and service review

Patient arrives in South Africa

Accommodation for family memberTours for family /spouse

Specialist sourced and quote finalized

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©Step-by- Step Process

• Establish rapport– Prompt response- within 4 hours ideal, 24 hours sufficient (call centre)– Use local contact as you are a “faceless person” in SA– Provide a medical tourism itinerary upfront– Provide CVs of Drs if requested– Aesthetics– Speak the same language:

• Medical aid, medical insurance-• Discovery, Bonitas, Hygeia HMO, BUPA, Aetna

– Have a medical services welcome gift!!

• Seamless process– Done through medical tourism facilitators or service providers– Simplify the process– Forex– Negotiate convenient appointments with surgeons upfront – Full integration of all service providers in the value chain– Reduce time spend between clinical service providers

• Consistent in Pricing– Provide Pricing upfront and in USD (with a rand equivalent)– Be very transparent

Which currency????

• Provide an All in one experience(Two many hands spoil the broth)– Vitalab Clinic– Concierge desks in hospitals– “Medical tourism precincts, zones”

• Provide more information– Invest in doctor-patient relationship in a short space of time– Spend time with the patient daily (Drs be visible)– Explain concepts thoroughly– Keep the referring Doctor and family updated

• Provide comprehensive clinical services– Hip surgery+ comprehensive check-up

• Be culturally sensitive• Provide interpreters if no Portuguese, French, Spanish or Russian

Dr to send patient to• KEEP THEM SAFE!!

– Indemnity & Insurance– Post-op care– Processes for complaints– Structured Tours!!– Recuperate in an accommodation not too far from medical services

Who creates the experience?

In closing.....

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Medical tourism value chain services

Courtesy of City of JHB 2009

Benefits of Medical tourism Medical visitors

tend to stay longer – 5X longer Combine hospital stay with convalescence, plus leisure & shopping Often accompanied by one or more persons More likely to be higher-income individuals - higher per capita spend

Hospitals & clinics Increased capacity & demand contributes toward retention of medical staff and

procurement of state of the art technology Reinvestment in SA rather than offshore Improvement public health care facilities e.g. Folateng units in Academic

Institutions

Accommodation, Retail, Entertainment , transport Medical tourists spend more time in metropoles and spend more per capita Employment opportunities for semi-skilled sector, esp. women and young

people SMME Sector

Low barriers to entry in tourism sector (guided tours, taxi services, B&Bs, etc)

Growth and Development Challenges

– Negative perceptions of the some parts of the country both internationally and locally (crime, energy, HIV)

– Lack of information from a visitor perspective of world-class medical expertise, facilities

– Air accessibility is currently priced at the higher end of the spectrum.– RSA long haul destination for visitors from UK, USA & Europe– Visa and immigration issues are a disincentive for the African market. – Restrictions on medical practitioners promoting themselves– SAMA regulations prohibit commercial brokers from recommending patients

to any doctor– SA Tourism currently under-estimates the significance and potential

ROI of medical tourism– Cottage industry mentality among existing players in the sector– High priced intl. insurance products / lack of local products– Dept of Health legislation on private health care pricing

Thank you for the opportunity!!!!!!!

Dr Tshepo P. Maakawww.serokolo.co.za

healthtours@serokolo.co.za“We’ll treat you well”