A father left with a £25,000 bill after his son was injured in Vietnam has issued a warning to other gap-year travellers, and their parents, to make sure they go through the small print of travel policy to make sure of the cover it offers. Mandy Aitchison has the details

James Pinnington, 19, from London, was badly injured when he hit an electricity pylon while riding a scooter in a remote area of Nha Tranf in Vietnam, four months into his Gap year trip. As a result of the accident, James suffered two broken legs, a fractured

Worrying statistics from a recent Canadian poll show that the message to the public about the important of travel insurance just isn’t penetrating. Milan Korcok reports

According to a new national poll, most Canadians travelling for leisure do not buy travel insurance when they venture into the US, the majority believing they are sufficiently well protected through their work or credit card insurance. Furthermore, despite persistent warnings about the high and rising costs of healthcare in the US, and the urging by federal and provincial government agencies that out-of-country travel insurance is a necessity, 42.7 per cent of Canadians travelling to the US for leisure ‘rarely’ or ‘never’ buy travel insurance. Only 49.2 per cent say they ‘always’ or ‘usually’ buy it, and 7.2 per cent do so only ‘occasionally’. These numbers show little change from a similar Ipsos Reid poll done for RBC Insurance in 2004, which showed that 48 per cent said they rarely or never bought insurance for US travel, while 47 per cent said they always or usually bought such insurance. The margin of error in the most recent poll was +/-2.19 percentage points.In a statement accompanying release of the poll data, Stan Seggie, president and CEO of the travel insurance division of

Canadians shun US trip cover

Milan Korcok describes the latest moves by some American hospitals to claw back some of the money they believe they are owed by foreign insurers

Canadian travel insurers are reporting increased use of international collection companies to harvest not only overdue bills rendered by US hospitals for

treating foreign travellers, but current accounts that hospitals say are too problematic to chase.The intrusion of such collectors into the initial stages of the payment process is seen by many travel insurers as short-circuiting existing preferred provider network contracts between insurers and hospitals, ultimately raising health costs and patients’ premiums,

damaging relationships between insurers and hospitals, and undercutting client trust.Dr Colin Plotkin, a Canadian consultant who assists international travel insurers in settling catastrophic claims, reports a rapid expansion of collection agency activity particularly among hospitals in high tourism locations – California,

ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS AUGUST 2008 • ISSUE 91

NOW INSIDE: privatehealthcarenews GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS

continued on page 12

continued on page 7continued on page 6

Here come the collectors

Page 38

Page 18

Page 20

Page 28

Page 26

Insurance gaps

International Travel Insurance Journal

IN THIS ISSUE

REGULARSNews continued 4Company brief 8Insurance matters 9Health matters 12Editorial comment 12Air ambulance news 14Travel matters 16Profile 38Private Healthcare News 33Service directory 40Grapevine 46Diary dates 46On the move 47

FEATURES

News analysis: The collectors are coming 18Milan Korcok has the latest analysis from all sides of the fence on the contentious issue of international collection firms targeting foreign patients

Feature: Getting onboard 22Policy wording is something that many travel insurers are continually striving to improve. But are they making progress, and what should they be aiming for? Marie Clair from the Plain English Campaign puts pen to paper

Feature: An epidemic problem 26Frightening new diseases and the return of old killers focuses the negative side of increased global travel. Roger St Pierre warns insurers on new and emerging threats

Assistance world markets: Denmark 28SOS International gives ITIJ the lowdown on the country’s provision of healthcare and assistance infrastructure

PHN feature: Hospital safety: is it out of reach? 38Going into hospital sick and coming out sicker is not the result any of us expect in this age of medical marvels.

Miles Clarke is a Sydney-based writer and has a degree in Journalism. He has some 27 years’ media experience in newspapers, radio and for the past 14 years as a freelance contributor to print and online publications on business and travel matters around the world

David Craik been working as a freelance journalist for the past six years and write for national newspapers and magazines. This includes shifts on the Daily Express City and Business desk where I cover market reports including the insurance sector. I have experience writing news and features on a wide range of subjects including insurance, aviation, transport, recruitment, IT, personal fi nance and small business.

David Ing is a freelance journalist covering mainly travel and tourism issues in Spain. He writes on air transport for a leading international news agency, as well as contributing special features to Newsweek and writing in-fl ight magazine articles and guidebooks.

Milan Korcok is an award-winning freelance health poli-cy and economics writer who covers travel insurance, public health, and medical education issues in Canada and the US. He has been writing about health fi nancing and policy issues in these countries since the 1960s and is a frequent contribu-tor to leading North American professional journals and consumer media. He lives in Fort Lauderdale, Florida.

Roger St Pierre is an avid traveller who has visited 119 countries and rising. He writes and broadcasts extensively on the tourism industry, motoring, cycling and music. He is also fascinated by how the global economy works. At 15, he already had fi ve regular newspaper columns covering sport but also happens to be a qualifi ed associate of the Chartered Insurance Institute and writes regularly on business and fi nancial matters for a number of prestigious publications.

ITIJ CONTRIBUTORS

2

International Travel Insurance Journal

Published on behalf of Voyageur Publishing & Events Ltd, Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or fi rm mentioned is hereby excluded.

Printed by Pensord Press, South Wales, United Kingdom

Copyright © Voyageur Publishing 2008. Materials in this publication may not be reproduced in any form without permission INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522

Editor-in-chief: Ian CameronEditor: Sarah LeeAssistant editor: Mandy AitchisonCopy editor: James WallisDesigners: Eli Butler Steve Annette Julie Wiles US correspondent: Milan KorcokConference manager: Denise ClementsProduction: Helen Watts

Kirsty DiclaudioAdvertising sales: David Fitzpatrick James MillerFinance: Cathy Knott

Louise GoddardIllustrations: Chris Duggan

ITIJVoyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK

editorial: +44 (0)117 929 4636

advertising: +44 (0)117 925 5151

fax editorial: +44 (0)117 925 2040

fax advertising: +44 (0)117 929 2023

email: mail@itij.co.uk

web: www.itij.co.uk

design: V Creative Design

WOULD YOU LIKE TO SUBSCRIBE? VISIT www.itij.co.uk

International Travel Insurance Journal ■ www.itij.co.uk

ITIJ TEAM

International Travel Insurance Journal

4 NEWS

Country-specific advicePatrick Chong, managing director of Journey’s Travel, has contributed to the education of consumers with regards to travel insurance, giving advice to travellers about the countries where the most claims happen.Chong pointed out in his advice to the public: “With cheap travel insurance now so widely and easily available, there’s really no excuse to travel uninsured, especially given how common insurance claims are for certain destinations.” He went on to give details of five countries that have some of the highest numbers of insurance claims, the first of which is Thailand. He told people that although it is one of the most popular destinations in the world, it is also one of the places that is most likely to see a visitor claim on their insurance. There is no single cause for claiming that is dominant, although there were large numbers of claims for theft, illness, traffic accidents and lost items. Patrick conceded that ‘just what it is about Thailand that makes it such a common place to claim isn’t known’, but recommended that anyone travelling there should take out comprehensive travel insurance.The next country on the list where travellers should definitely take out travel insurance is Mexico, where the highest number of travel insurance claims stemmed from overexposure to the sun leading to medical treatment. Patrick warned holidaymakers that they should pack a high-factor sun cream as well as a comprehensive insurance policy.The Czech Republic is also highlighted, thanks in part to the huge numbers of hen and stag parties that decide to head to Eastern Europe for the cheap beer. Claims in the country mostly relate to pickpocketing, so consumers are advised to ‘keep your wallet out of sight and go easy on the Staropramen’ by Patrick.In South Africa, meanwhile, a country that has achieved astounding tourist numbers thanks to its safari offerings, there is a high prevalence of crime

and tourists should be aware that the danger is pretty much constant, no matter where they are in the country. Most travel insurance claims from South Africa are for muggings and armed robbery, although it is mentioned that most muggings are non-violent, so claiming should merely be a matter of filling out a form, rather than a hospital stay.The Caribbean islands are another very popular destination for British tourists – beautiful and idyllic they may be, but one danger in particular awaits tourists: insect bites. While most will only be a minor inconvenience to the traveller, allergic reactions or infected bites can often require professional medical attention and bills from private hospitals in the Caribbean can add up quickly. As Patrick pointed out: “Nothing runs up a bill like uninsured medical expenses abroad.”Just in case the travellers had been put off with all the warnings, Patrick finished by saying that the safest place to visit is Ireland, as it has the smallest number of travel insurance claims from visitors. As a final word of warning, he told consumers that no matter where they are going, their baggage can go astray at any point, so a good travel insurance policy with decent baggage cover is a must.

Tesco reveals top claims

Travellers warned … again!

Spain’s Foreign Ministry has launched a new ‘travellers’ register,’ aimed at speeding up support and contact between its consulates, citizens and their families in the case of an emergency occurring abroad. David Ing takes a look

Spain’s new Travellers’ Register, or Registro de Viajeros as it is called in Spanish, will allow all Spaniards travelling overseas to input personal details such as next of kin contacts and to post their journey plans, including the names of companions and hotels, on the ministry web site.At an official presentation at the beginning of July, Foreign Minister Miguel Angel Moratinos made a personal plea for anyone who might be visiting destinations ‘off the conventional routes or in risk zones’ to check out government advisories on www.maec.es. By registering their travel plans on the site, they stand to help both themselves and the work of the Ministry’s Consular Emergency Unit. By feeding information to the unit, with entry via a personal password, the unit’s work will be ‘faster and more efficient, given that it will have up-to-date lists of people to be found in a country or region affected by a natural catastrophe, political or social conflict, an accident or a war or terrorist threat, and can maintain contacts with the travellers and their families in Spain’.The new register was launched at the beginning of Spain’s peak holiday season as part of a third annual ministry campaign called ‘Your Embassy can help you’, in the presence of representatives of both the country’s major travel agent associations, FEEAV and AEDAVE and tour operators. Providing information on the services and assistance offered by consulates will enable ‘citizens to face foreign trips with more security’, said the minister. Leaflets explaining what the consulates can and cannot do for travellers are being distributed through travel agencies and at airports, while street posters are being used to spread the message. Around 15 million Spaniards travel abroad each summer according to the Ministry.

In an effort to educate the raft of consumers out there with little or no understanding of why they need travel insurance, UK-based Tesco Travel Insurance has come up with a number of hints and tips for avoiding common pitfalls on holiday, as well as showing what people claimed for last year. It has shown that the top three claims made by Tesco’s customers in 2007 were for baggage loss, medical treatment and cancellations.The insurer has told customers that if their bags are stolen, it must be reported as soon as physically possible to the authorities and has also said that in the event of a delay, customers should obtain written confirmation from the airline, train operator or ferry owner about the length and reason for the delay. And for those in need of serious medical intervention while abroad, they have been told to ring the emergency helpline immediately, to make sure appropriate treatment is given, although for more minor injuries the insured should pay the bill themselves and keep the paperwork to claim back the charges.

A new survey from charity Age Concern has revealed that 75 per cent of British holidaymakers fail to check the terms and conditions of the policy when purchasing travel insurance, and 56 per cent of those surveyed failed to buy cover altogether, prompting a warning from the charity that consumers must take more care over the policies they buy. Age Concern is urging everyone going overseas this summer to make sure they are familiar with the terms, conditions and exclusions of their travel insurance policies to ensure they do not end up out of pocket for something they assumed they had cover for. Antony Osborne of Age Concern commented: “Our research shows just how many people don’t think to check the details of their travel policy before going on holiday and highlights the very good reasons why everyone should do so. Having comprehensive travel cover is so important for holidaymakers – it provides financial security in case the holiday doesn’t go to plan for whatever reason.”The charity has also released some ‘top tips’ for consumers, which give information and suggestions about what people should check on the policy before they make a purchase.

Holidaymakers feel the crunchBad news for insurers – holidaymakers in Britain could be pushing travel insurance to the bottom of the list of priorities as a result of the credit crunch. More than half of those surveyed by Norwich Union admitted that travel insurance could fall off their list when planning a holiday this year. The insurer conducted the research to see how the economy’s turndown is affecting summer holiday plans, and it produced some significant results: fifty-eight per cent of people will take fewer holidays this year, putting a stop to a trend of multiple, smaller holiday breaks, while 75 per cent are planning to go on holiday within the UK rather than head abroad in order to keep costs low. A further revelation was that 65 per cent of people are intending to dip into their savings to pay for their holiday this year, instead of the more common option of using a credit card.Following the results of the survey, Norwich Union is urging holidaymakers to ensure they keep their travel cover on the holiday checklist, and not to forego cover in a bid to save a few pounds, as it could cost them so much more in the long run. Data from the company shows that the average medical claim costs around £1,200, with the average baggage claim resulting in an average payment of £220.Suzi Fenn, travel product manager at Norwich Union, said of the issue: “Understandably, people are looking to make saving on their holidays this year given the economic climate. However, with more than £60 million paid out in 2007 in insurance claims for everything from medical emergencies to damaged baggage, scrimping on this essential travel cost really isn’t worth the risk.”

Spain launches Travellers’ Register

International Travel Insurance Journal

6 NEWS

NEWSWIRE

Detail is ‘no bad thing’The Association of British Insurers has reassured consumers that travellers should provide their insurers with ‘as much information as possible’ when making a claim. The ABI has spoken out after recent reports that an insurer questioned the validity of a claim that had ‘too much detail’, making the insurer think it could be fraudulent (ITIJ 90, The devil is in the detail’). Malcolm Tarling, spokesman for the ABI, made his position clear: “Insurers do not automatically assume that a neat, detailed informative claim form means the claim is in any way fraudulent.” He added, however, that insurers have a right to be vigilant and a duty to investigate any claims they deem suspicious, but holidaymakers should not be put off from putting as much detail as they have on the claims form. “This [case] should not dissuade people from supplying the insurer with as much information as they have because, providing the claim is genuine, it will ensure that the claim is handled as quickly as possible.”

Nevada, Arizona and Florida. Especially notable, he says, is that most of the agencies are from Europe, the UK and the Middle East, although American companies are now edging into the action.Patrick Hrusa, director of Provider Relations, Assured Assistance Inc, an operating entity of RBC Insurance Company of Canada (RICC) confirms an increased number of calls from clients who have been contacted by collection agencies. He notes also that some of these calls are for bills not yet submitted and others are for bill balances i.e. additional payments for bills already thought to be settled.

Udi Ben-Gal, director of operations for BDM Ltd, an international collection services company headquartered in Israel, confirms that there has been a considerable increase in demand by US hospitals for his company’s services, and attributes much of that to the difficulty hospitals are encountering in tracking foreign patients after they return home, and unrelenting pressures from travel insurers to get unrealistically large discounts on their hospital bills – something the hospitals are simply no longer prepared to offer.For more information, please see the News Analysis on Page 18

Here come the collectors continued from page 1

A new survey has shown that 85 per cent of British travellers buy insurance, compared with 73 per cent worldwide. Only 11 per cent of Brits accepted the first quote, and 69 per cent said they would buy an annual policy in the next year.

Healix Risk Rating Ltd has received the Queen’s Award for Enterprise in the Innovation category for the company’s medical risk assessment products. The key to success is their medical algorithms, which accurately predict and score the underwriting risk following a series of carefully worded questions.

At Go Travel Insurance, 23 per cent of all claims last year were related to luggage, prompting Christian Young, chief executive, to advise travellers to check their policies to make sure all their belongings are covered.

A British tourist has died of suspected food poisoning at a luxury hotel at Lake Garda, northern Italy. About 30 other holidaymakers also fell ill, 16 of whom required hospital treatment.

Consumers have been warned to check their policies to make sure their kids are covered if they are on holiday with someone other than a parent, as some policies do not allow children unaccompanied by a parent to remain on a parent’s policy.

Karma doesn’t rate cover

Drivers hit down under

Brian Wright, managing director of online provider Karma Insurance, has warned that students or professionals looking to take time off with a gap year could altogether spend £59 million more than is necessary. Karma sourced worldwide travel insurance costs for a 19-year-old for a year’s holiday and found that there were significant disparities in cost, but not level of cover, between its own policy and that offered by student friendly travel operator STA. Brian said of the issue: “It’s predicted that around 200,000 post-A level students and graduates will pack their bags this year and government statistics reveal around a quarter will have no insurance. Given the sky-high premiums being offered by the majority of gap year insurers, I’m not surprised.”He gave a damning opinion of such insurers, accusing them of profiteering at the expense of the already cash-strapped students. As he pointed out, the average cost of a gap year is around £12,000, with most students saving frantically to contribute some or this entire sum. What they don’t budget for, however, is insurance, which often gets left to the parents to sort out.Traditional gap year cover offers insurance for cancellation, missed departure, curtailment, medical expenses, personal liability, cash and baggage, but these policies are outdated and not enough, according to Brian, who said: “Policies should reflect the growth in popularity of sports termed as extreme or hazardous and cover accordingly. Equally, they should recognise that people may be visiting from remote regions and provide search and rescue cover, plus protect the cost of trips that are independently arranged.”He also pointed out that online insurers do not have to deal with traditional overheads, so there is no excuse for those companies not to pass on such savings to the customer, and continued: “Also, they should be broadening their horizons and offering more substantial cover. South America is a popular destination, yet it’s one of the most dangerous, so why do so few providers offer search and rescue?”

Tourists hiring cars in Australia are being hit by the largest excess charges compared to any other country in the world, according to online excess cover provider Insurance4carhire. The firm has cited a recent underwriter’s claims report that shows motorists in Australia incur the highest excess charge in the event of damage to their vehicle, with some figures reaching as high as £2,000.There are always hazards on any road, but Australia has one problem that is not found anywhere else – kangaroos. The likelihood of colliding with a kangaroo on an Australia road is high and can cause serious damage to a car. Recent figures from a national motoring authority have shown that of 9,000 claims

made for animal-related collisions in 2007 in New South Wales, 7,000 involved kangaroos. Other contributing factors to accidents in the country include fatigue caused by driving the exceptionally long distances between Australia’s main towns and cities, as well as the temptation to drive very quickly down long, straight desert roads.Simon Vella, spokesman for Insurance4carehire, said: “When hiring a car abroad, many people sign up for the car rental company’s own insurance policy, but don’t realise that this will not cover them for the excess for damage to certain areas [such as tyres and windows]. But if you get hit by a large animal, it’s pretty likely that these places will sustain damage.”

Students could suffer from Endsleigh closuresThe news that Endsleigh is to close down its university campus branches has been met with disappointment from the insurance industry, especially because the company built its business and reputation in the student sector.Brian Wright, managing director of Karma Insurance, commented: “Endsleigh was established to provide insurance for students – this was its raison d’etre. It enjoyed support from the National Union of Students (NUS) and warning bells should have rung when the NUS sold its shares in the business 18 months ago.”The worry is that the timing of the closures, which coincides with the start of the academic year in the UK, could mean that more students will simply not think about insurance at all, whereas if they are wandering around the student union and catch sight of an insurance office, it at least prompts them to consider it.ITIJ spoke to Stuart Wartalski, head of corporate communications for Endsleigh Insurance

Services Ltd, who responded to Karma’s comments: “Some competitors of Endsleigh may choose to conduct selective price comparisons against our products from time to time, which may not be generally representative of the overall position. Equally some companies may replicate our product innovations and undercut our premiums in certain areas for the purpose of self-promotion. We remain the only insurance provider recommended by the NUS, and the NUS president and treasurer also continue to sit on our board.”

TripAdvisor, the world’s largest online travel community, has released the results of its survey of more than 3,700 travellers worldwide, and has found that two-thirds of worldwide respondents and 60 per cent of US respondents have purchased travel insurance. Fifty-one per cent of those surveyed said the number one reason for buying the insurance is for peace of mind when they are away from home.The survey also showed that 47 per cent of world travellers and 35 per cent of US respondents plan to buy travel insurance in the next 12 months. The most popular type of policy was single trip insurance, with 65 per cent of global travellers and 50 per cent of US travellers likely to purchase this sort of policy. The current economic turndown was also mentioned as a factor by some 15 per cent of respondents to the survey, who said the credit crunch had forced them to think more carefully about financial protection.For many customers, the most important aspect of a travel insurance policy is trip cancellation, with 53 per cent saying the cover was vital, while for 19 per cent the most integral aspect of a policy is the medical and health coverage. Ten per cent chose travel delay/interruption as the most important clause.With regards to claims statistics, the survey found that 20 per cent of insured US respondents have made a claim on a policy, of which 25 per cent found the process ‘simple’, 23 per cent dubbed it ‘time consuming’, 19 per cent thought the process was ‘frustrating’, while just 18 per cent though the system was ‘efficient’. It was also revealed that 18 per cent of those US respondents have had a claim denied, 36 per cent of whom did not know why.The poll also showed that 53 per cent of Americans verify quotes on travel insurance comparison sites. Chris Harvey, CEO of Squaremouth, one such comparison site, called the survey ‘significant and comprehensive’. The results of the poll, he said, were mirrored by the company’s own research, which revealed a growing awareness by consumers that they can use vast research and comparison information available online to source the best deals. Harvey also issued a word of warning to consumers who fail to check the Internet, saying they could end up paying more for less cover. The TripAdvisor poll revealed 66 per cent of travellers buy insurance at the same time as booking the trip, at which point Harvey pointed out that insurers should know they have ample time to shop around: “Customers don’t need to feel pressured by the tour operator or cruise line pushing their own insurance.”

Travellers buy for peace of mind

www.itij.co.uk

NEWS 7

Insurance gaps

Final FSA rules releasedThe UK Financial Services Authority (FSA) has now published the final rules on which types of travel insurance sellers will need authorisation to continue sales from January next year. The final details include specific information on those who could be exempted from the regulation, where six conditions must be met before it is agreed a firm would not need FSA-authorisation. It also clears up any confusion that firms may be feeling about becoming an Appointed Representative, gives detailed cost breakdowns for the different levels of regulation and information about the standards firms would be expected to adhere to once they were regulated.It is reiterated that the regulation of connected travel insurance (CTI) has been given ‘a lighter touch’ than for some other types of insurance sales, so firms selling CTI will only have to maintain certain parts of regulation, including the FSA’s Principles for Business. Nor will firms have to comply with every part of the Insurance Conduct for Business rules, although examples given of rules they must abide by include ‘taking reasonable steps to ensure customers only buy policies on which they are eligible to claim’, and ‘giving appropriate product disclosure to the customer and telling the customer about their cancellation rights’.So, with regulation now less than six months away, the industry can only wait and see if its dire predictions about the effect of regulation will come to pass.

continued from page 1

vertebrae and internal bleeding. His father, Chris, flew out to be with him straight away but, upon arrival, was not happy with the treatment offered by the local hospitals, so organised for his son to be transferred by air ambulance to Ho Chi Minh City and then on to Bangkok. After treatment, James was flown home on a commercial flight accompanied by a doctor and nurse. The total cost for the care and flights – £25,000.Did James have travel insurance? Yes. Chris had purchased a comprehensive policy from high street retailer Boots, which offered up to £10 million for medical claims and repatriation expenses. However, when he tried to claim on the policy, Boots said that James was not covered because, although he was wearing a helmet (most scooter riders do in Vietnam), he did not hold a full, valid UK motorcycle licence. This exclusion was contained in the policy document, but was in very small print on page 14 of a 50-page booklet. It should be mentioned, however, that Boots did offer help with the repatriation back to the UK, but at a cost of £85,000 – an offer that was declined by Mr Pinnington, who subsequently made a complaint to the company regarding the claim. The firm said in a statement: “Boots has investigated Mr Pinnington’s claim. Our Gap Year Insurance policy wording clearly states that a claim will not be paid ‘arising from a two-wheeled motor vehicle as a driver or passenger if you are not wearing a crash helmet and the driver is not a holder of a full UK category A motorcycle licence’. Boots and the insurance underwriters of the policy, AIG UK, will continue to liaise with Mr Pinnington about his complaint.” It added that it was also investigating the cost discrepancy between the two repatriation quotes.Speaking to a British newspaper, Chris said: “I even read a copy of the policy before I bought it because I am very careful, and I thought it was very comprehensive. But, of course, when disaster strikes,

they happily find a small-print loophole.” He also pointed out: “Most children on Gap years in Asia and at some point rent a moped, because that’s how they get around. But I bet only a tiny percentage of them have a full UK motorcycle licence.” He added that he was not seeking his money back from Boots, but wants to raise awareness of the issue of small print in policies tripping up consumers – even savvy ones who read the policy.Tom Griffiths, the founder of Gapyear.com, a website that offers both travelling advice and social networking, said: “Our research shows that 25 per cent of [Gap year] students are either not insured or

under-insured. It’s no exaggeration to say they are putting their parents’ homes at risk.” He has heard tales from travellers of medical bills running up to £100,000 and some people having to remortgage or sell their house in order to settle the bill.As a result of the Pinnington case, British customer watchdog the Consumer Action Group (CAG) has said that British standards are being applied unfairly overseas, and that insurers must be clearer with customers when insurance is sold. The CAG pointed out that, officially, any class of UK or international driving licence would not apply in Vietnam anyway, and local moped and car users are required to

have separate licenses, although these laws are not strictly applied in practice. The watchdog is also of the opinion that the exclusion should have been contained in a ‘key facts’ booklet, instead of buried in the rest of the small print. Marc Gander from the CAG told the BBC: “We consider that it was unwise and probably unfair that this important requirement was omitted from the ‘key facts’ booklet (in the terms and conditions) and we believe that Mr Pinnington may have suffered as a result. We consider that the provision of a ‘key facts’ booklet and then the omission of important key facts amounts to misinformation.”

International Travel Insurance Journal

8 COMPANYBRIEF

NEWSWIRE

British Airways (BA) has appointed Mondial Assistance to supply online travel insurance and assistance to its customers across 18 countries. The contract allows passengers to purchase travel insurance through BA’s website, with an additional ‘opt-in’ step in the online buying tickets process. The three-year deal will include policy sales and claims administration, and is a ground-breaking move for countries such as Bulgaria, Romania and Cyprus, where traditionally such assistance

services are lacking.Keith Vipan, contracts manager for BA, said:

“We are very excited to work with the leading innovator in Europe and across the world of online travel insurance

solutions. Through this partnership, we will be able to enhance British Airways’

passenger experience and, in addition, open up a new revenue stream for the airline.”

Europ Assistance (EA), in an effort to adapt to the changing needs of the market, has become the first international assistance company in the UK to purchase an oxygen concentrator for use when repatriating customers on commercial flights. Ordinarily, it is necessary to ask the airline to provide onboard oxygen, which is not always an easy process and one that can cause delays to the repatriation process. In order to overcome these and other issues, EA has purchased a unit that works by removing nitrogen from the air and returning nearly pure oxygen. Initially, the device was developed for use by chronic respiratory patients in their homes, as it gives them the freedom to move around. The highly portable unit is easy to travel with as hand luggage, and is powered by two internal

rechargeable batteries giving six to eight hours of use. This can be extended, however, by plugging into an ‘at-seat’ power outlet. The device is quiet, so minimises interruption for other passengers, and is certified for use on aircraft by the Federal Aviation Administration.Paul Everett, director of sales and client services for Europ Assistance, said: “The oxygen concentrator has proved indispensable as it now means that as we are not reliant on the airlines for oxygen and we have

an increased choice, meaning shorter flight times can be selected as well as better timings. In addition, in certain parts of the world, such as the Caribbean, we can use small airlines, avoiding the need to use an air ambulance, which is a significant saving in time.” Not to mention money!

Canadian travellers with RBC travel insurance have immediate access to quality acute medical care, thanks to InRoomMD, a healthcare concierge scheme that provides in-room hotel visits to travellers that have become ill in the US. The company was the first Canadian travel insurer to sign up to the scheme, and over the past two years, estimates that over 980 of its policyholders have used the service. Stan Seggie, president and CEO of the travel insurance division at RBC, said of the scheme: “The ‘wow’ factor of on-the-road house call services consistently brings compliments from our policyholders. They really appreciate the convenience and security of not having to leave the hotel in search of urgent local healthcare within an unfamiliar city, let alone within an unfamiliar healthcare system.”InRoomMD CEO Andrew Jacobson noted: “Going forward, our commitment remains steadfast to provide services that support RBC Insurance in anticipating and surpassing their clients’ expectations.”

Europäische Reiseversicherung has improved its corporate travel product RundumSorlgos Business – an insurance policy aimed at companies that employ up to 250 people, with a maximum of 1,500 travelling days a year. The policy now claims to offer an unlimited sum for its health insurance aspect, although covered sums for such payments as medical emergency assistance, accident insurance, liability insurance and optional baggage insurance are still limited. The RundumSorglos Business product is an insurance package for the entire company, including the management board, meaning corporate travellers do not have to be individually named. The product is open to the general broker

market in Germany and can be booked online via a special booking tool. An integration of this tool can be put into brokers’ homepages.Meanwhile, Air Berlin has chosen Europäische as its partner for all its travel insurance offerings. From 1 July this year, such insurance may be reserved for any flight offered by the Air Berlin group. On the Internet, products are already integrated into the flight reservation procedure and offer a variety of cover that includes re-booking protection and trip cancellation insurance.In related news, the company celebrated its 100th anniversary this year, along with positive earnings for 2007, with a €1.4-million profit after tax.

US-based AirMed International has received the endorsement of and become the official air ambulance provider for the industry-leading African safari company, Safari Legacy. Jennifer Kunath, North American director of sales and marketing for the travel firm, said: “Due to its world-class service and incredible reputation, we are especially pleased to promote AirMed membership to our customers. We know that medical emergencies happen – even on dream vacations – and we encourage our guests to be prepared with medical evacuation coverage.” Travellers with Safari Legacy will receive substantial discounts off annual retail rates.

Al Alhi Bank of Kuwait, in association with AIG Kuwait, has launched its new product, ABK-AIG Travel Insurance, to provide additional value to customers. The insurance can be purchased at any ABK branch or by calling the call centre.

Squaremouth, the US-based travel insurance comparison site, has recently unveiled three new plans from Travel Insured International. The new plans have stronger benefits and several new options for consumers to tailor their plans.

Online insurer Cheaptravelinsurance has recently been included on the panel for a leading price comparison site, Moneysupermarket.com.

Thomas Cook (India) Ltd has tied up with Bajaj Allianz to offer life insurance solutions through its distribution network of 160 retail branches across India. Thomas Cook decided to sell its first non-travel product in order to offer a variety of services to its clients.

Genesis Travel Benefits has opened a new division of the company that is dedicated to providing travel incentives and group travel to client companies, insurance carriers and brokers.

Seven Corners has introduced a comprehensive travel insurance package created for the more than 500,000 expected attendees of the Olympic Games, with a daily rate that starts at just $1.50.

Drakefield Insurance has rebranded its aggregator site, whichpolicy, to appeal more widely to consumers. It is now called QuoteBanana.co.uk.

Medical Information Anywhere has added a policy to its offerings that covers people with pre-existing illnesses.

SmartWings, Prague’s low-cost carrier, has teamed up with AXA Assistance to deliver travel insurance as an ancillary offering.

Mondial Assistance Group is to enter the e-commerce travel insurance sector in India. The firm has signed a global deal with a leading Indian airline and is also in final talks with a number of international and local online travel agents.

AXA has launched its Independent Travellers insurance in order to cater to the growing number of holidaymakers who organise their own trips.

SelectCare Worldwide, a Canadian and expatriate travel assistance company, has now expanded its reach of services to the international marketplace. Jacque LeTual, director of business development for the company, said he was pleased with the move, and added that the firm’s travel exports provide such services as cost containment, claims management, recovery and subrogation. He went on to explain that SelectCare has both the resources and expertise to offer assistance services to organisations in North America, South America, Europe and Asia: “We have a 24-hour 1-800 emergency assistance call centre, a proprietary claims database system and a network of over 5,500 acute care hospitals and over 500,000 physicians around the world.”

BA signs three-year deal

EA enhances services

Doctor service a success

New corporate product from Europäische

Safari company endorses AA operator

SelectCare Worldwide expansion

www.itij.co.uk

INSURANCEMATTERS 9

The Confederation of British Industry (CBI), an employers’ organisation, has found that more than 10,000 jobs will disappear from the British financial services sector over the summer, as the credit crunch erodes profits and pressure mounts on companies to protect earnings from previous years. The CBI says that the stormy outlook for jobs among insurers and banks is part of a long-term trend that will ‘play out for some time’ as the UK economy continues to slow.According to the most recent CBI survey, carried out with PricewaterhouseCoopers (PwC), the impact of the credit crunch has worsened considerably over the past quarter, with profits falling at a record pace and business volumes declining at the fastest rate for 17 years. The same survey found that hopes of an earlier recovery have been dashed as nine out of 10 firms said it would take at least another six months before the markets started to recover. Ian McCafferty, chief economic advisor for the CBI, said: “Profitability in the sector is being badly hit, so firms are trying hard to trim costs by planning to cut back on training and marketing for the first time in a number of years. The problems of the financial sector will echo throughout the wider economy and will drag economic growth down this year and next.”John Hitchins, banking spokesman for PwC, said most banks were waiting with bated breath to see if the US insurers involved in underwriting much of their mortgage debts faced a cut in credit rating, adding that monoline insurers could be further undermined by downgraded rates, which would then cut the ratings of bank debt.

Lord Levene, chairman of Lloyd’s of London, has told the Financial Times that the firm has plans to significantly expand its operations in the Middle East and Asia, including a possible onshore presence in the Gulf, in order to reduce its exposure to the US and tap into the emerging markets’ success. Speaking about a venture in the Gulf, Lord Levene said that Lloyd’s was still working out ‘the extent to which we can source new business there with an onshore platform that we cannot currently get externally out of London’. He added: “It is a very hot topic … because there is a lot of competition between different locations and I don’t want to pre-empt the discussions that we are having.” At the moment, Lloyd’s has 40 per cent of its business in the US, while Europe accounts for

between 20 and 25 per cent. Asia represents six per cent of business, while the Middle East, at the moment at least, is responsible for only a ‘tiny’ amount of business, according to Levene. He continued: “We are pleased to have much business [in the US], but in absolute terms, its overweight. In five years’ time, we will get a significantly greater part in both Asia and the Middle Easy than we have today, but I wouldn’t want to put a number on it.”Elsewhere, Lloyd’s has received approval to operate as a reinsurer in Brazil and China, both emerging markets where consumers are gradually becoming wealthy enough to consider insurance as a ‘must-have’ product. Levene, speaking at the World Economic Forum in Kuala Lumpur recently, stressed

the potential of China as one of the Asian countries where ‘we can develop the notion of insurance being something that people want’. “We want to reinsure Chinese insurers in local currency for the sort of risks that we insure in the rest of the world,” he said. “That is a big job and we just launched ourselves on it. This is a very, very new market.”

Lloyd’s expansion

According to the Chinese cabinet, Chinese insurance companies could be instructed and co-ordinated to invest large amounts of money in key reconstruction projects in and around areas affected by the Sichuan earthquake. The State Council declined to release details of how much support the insurers would be expected to give, but did unveil a number of other fiscal measures to support rebuilding efforts, including the exemption of corporate income taxes this year for firms that suffered heavy losses as a result of the disaster. The latest data shows that insurers have so far paid out ¥370 million (US$48.1 million) in claims linked to the earthquake, made up of ¥196 million for life insurance and ¥174 million for property insurance.In related news, life insurers have been told they must pay out half the amount of the sums insured to the beneficiaries of policyholders confirmed by the local authorities to be missing after the quake. Mr Wu Dingfu, chairman of the Chinese Insurance Regulatory Commission, told insurers they will have to pay the full amount to beneficiaries once the missing policyholder is confirmed dead. As of 30 June, 18,403 people were still reported to be missing as a result of the disaster, while a total of just over 69,000 have already been reported dead, with 374,177 injured.

Insurers could fund quake reconstruction

Jobs sacrificed to protect profits

International Travel Insurance Journal

10 INSURANCEMATTERS

Regulators in China have revealed plans to further liberalise the reinsurance market in the country, removing the current preferential treatment for domestic companies, according to local papers. The change is set to be made with proposed amendments to the Insurance Law, according to Financial News. Industry observers say the company that will most strongly feel the effect of the change is state-owned China Reinsurance Group, which currently has an 80-per-cent share of the marketplace. The proposed alterations to the law include removing an arrangement that encourages direct insurers to give preference to China Re when they cede premiums.The move to free up the reinsurance market was not a huge surprise, as in line with its commitment to the World Trade Organisation, China has slowly but surely been liberalising other financial services sectors as well, including ending compulsory reinsurance through China Re. Industry analysts say that the incredible economic growth experienced in the country has meant that greater underwriting capacity and technical improvements were inevitable, and recognising this pattern authorities have already granted reinsurance licenses to Munich Re, Swiss Re, Hannover Re and General Re.In related news, China Life has launched the country’s first disaster insurance policy, in part to address the increase in demand for such insurance following the earthquake. It will cover six types of natural disaster, including earthquakes, floods, tsunamis, typhoons, mudslides and landslides. Shirley Shao, chief actuary for China Life, said: “We will first launch the policy in some catastrophe-hit areas such as Sichuan, Zhejiang and Hainan.” She added that the company is looking to tie up with reinsurance companies in order to spread the risk prevalent in certain regions.

New data from Deloitte has shown that cutbacks in consumer spending habits could cost the UK’s insurance industry up to £1.5 billion. Its research found that more than 25 per cent of those surveyed who buy insurance from price comparison sites are seeking to reduce their insurance spend. At the same time, less than 40 per cent of respondents said they definitely wouldn’t cut back on the insurance products they buy in the next year in order to reduce the cost of their policies. Of the people who said they would curtail insurance spending, 20 per cent said they would stop their payment protection insurance, 18 per cent said they would consider changing from comprehensive to third-party insurance for their car, 12 per cent said they would cut spending on travel insurance, and nine per cent would

cut spending on pet and health insurance. Matt Perkins, partner and head of financial services in the Midlands for Deloitte, commented: “At a time when households have less disposable income, it is understandable that many will look at how they can reduce their spending. However, consumers should think carefully about which types of insurance they need most in a down-turn. A short-term saving could cost a lot should an accident occur, and adequate insurance cover isn’t maintained.”

Based on the results of the survey, Deloitte has estimated that insurers could miss out on a total of £1.5 billion in insurance premium revenue. So, some tough decisions are ahead for insurers if they want to continue the success of previous years, according to Perkins: “Insurers will need to decide whether they are happy to cede volume, or become more competitive on price to protect market

share. A better deal may be in store for consumers, particularly on non-compulsory purchases if insurers become keener on price to mitigate loss of volume.”

The new chief executive of Insurance Australia Group, Mike Wilkings, is slashing jobs in a major shake-up of the embattled company. Miles Clarke reports

The 600 job losses announced by IAG will be primarily targeted at the company’s Australian operations rather than its underperforming British division. It is also understood that the focus of the cuts will be in the areas of senior management and backroom staff. However, IAG is likely to avoid any impact on its front-line retail business such as its NRMA Insurance outlets and the call centres which deal with its several million customers.IAG is one of Australia’s biggest players in the travel insurance market. The UK brands include Equity Red Star, Equity Insurance Brokers, Hastings Direct, Advantage Insurance and Open & Direct. Hastings Direct and Open & Direct both offer travel insurance products. The moves are part of a wide-ranging review of IAG’s business ordered by Mr Wilkins after his elevation to the job in May when his predecessor, Michael Hawker, resigned in the wake of continuing investor disquiet at the company’s performance.IAG employs about 16,000 people, the bulk of them in the Australian division, which contributed nearly £2.6 billion of the group’s overall £3.6 billion of gross written premium or revenue last year. The company is the largest insurer of property and vehicles in the country through its NRMA, CGU, SGIO, SGIC and Swann Insurance brands.However, that has not been enough to protect the group from abnormally high claims from the storms that have battered NSW and Queensland in the past two years or the slump in the sharemarket, which has hit its investment portfolio.It has also faced criticism from investors from an ill-timed £1-billion expansion into British insurance just as that market faltered. The new division continues to drag on IAG’s earnings which are no longer high enough to sustain its generous dividend policy. The combination of these events and the uneasy shareholder response to the IAG board’s recent dismissal of an opportunistic $AU4.60-a-share takeover offer from the rival insurer QBE prompted Mr Hawker’s resignation after nearly seven years as chief executive.Merrill Lynch’s Andrew Kearnan criticised the fact that no one at board level was taking accountability for the issues that have driven four successive years of earnings and share-price underperformance. “We believe acceptance of accountability by the board is a necessary step toward restored credibility in the marketplace,” he said.Mr Wilkins, a former boss of IAG’s domestic challenger Promina who Mr Hawker appointed as his deputy last November, has used his elevation to prepare a detailed plan aimed at returning IAG to financial health after two successive years of falling earnings. However, the present financial year is expected to make it three bad ones in a row after another poor first half in which profits fell to as low as £55 million. That was a drop of £115 million on the corresponding period last year.

Indonesia’s insurance industry enjoyed a profitable 2007, according to the Jakarta Post, which cited a study carried out by the Insurance Media Research Institute (IMRI). The study found that last year, the life insurance sector in the country registered overall growth in profits of 20 per cent to IDR2.83 trillion (US$304.2 million), while the general insurance industry saw profits rising by an impressive 47 per cent to IDR60.41 billion. IMRI’s study was based on the financial results of 135 local companies, 88 of which are in the general insurance business, 43 in life insurance and four of whom are reinsurers.However, despite these undeniably positive

results, Hotbar Sinaga, president and director of government-owned insurer Jamsostek, has predicted that the industry will face harder times next year. In particular, he said, the life sector, which has seen the rising popularity of unit-linked products, could be put under pressure by higher bank rates and uncertainty in the world’s stock markets. He added that for smaller companies, there would be additional pressure this year as a result of a newly introduced presidential decree that requires all insurance companies to have a minimum capital reserve of IDR40 billion by the end of this year, and 100 billion by 2010.

Chinese market to liberalise

Consumer cutbacks could cost insurers New broom at IAG

Indonesian insurers enjoy increases

Fundación Mapfre, through its Insurance Sciences Institute, has for the fourth consecutive year published its ranking of the 15 largest European non-life insurers by premiums. Once again, the list shows that Mapfre is the only Spanish insurer in the top 15, in 11th place, with premium volume of €9,293 million, a 9.9-per-cent increase on 2006. It is worth noting that during 2007, there were no significant moves in the rankings when compared to 2006, with the exception of the advancement of AXA, which now ranks as the second-largest insurer above Zurich. Maintaining its hold on the top spot is Allianz,

followed by AXA, then Zurich, Generali and Aviva.Regarding general revenues of the first 15 non-life European insurers, the list has demonstrated that the growth in emerging markets has offset the performance of more mature markets, where there has been a progressive increase in competition. Furthermore, said Mapfre, most of the companies in the list have felt some effect in 2007 from several natural catastrophes, including winter storm Kyrill and the floods in the UK. Overall, the 15 biggest insurers in Europe achieved combined premiums of €224,269 million, an increase of 4.3 per cent on the previous year.

Mapfre releases non-life rankings

www.itij.co.uk

INSURANCEMATTERS 11

NEWSWIREJohn Bell, head of claims for Aon Risk Services, has spoken out about the emerging trend of insurers being tougher on claims in an effort to help margins in today’s softening marketplace, and the move by the Association of Insurers and Risk Managers (Airmic) to reduce insurers’ use of reservation of rights. His concerns stem from the fact that while claims frequency is falling, the levels of liability settlement are increasing above inflation and are not being matched by equal rate rises. “As a consequence,” he said, “insurers are scrutinising claims much more thoroughly and are seeking to apply policy conditions more strictly than before.” This has lead to some high-value claims being potentially compromised and other claims being delayed, so clients and policyholders need to be aware that attitudes in claims departments are changing.Bell also noted a trend for insurers to immediately reserve their rights upon notification of certain losses, which he said underlined his concerns that the trend could increase further as the credit crunch continues to have knock-on effects. However, this is not the way to solve the problem, according to Bell: “Reserving rights sends completely the wrong message to our clients and undermines insurers’ reputation in the world of commerce. As such, we support Airmic’s plans to ensure our clients are treated fairly.” He also said that Aon has come across various instances of ‘underwriting at the point of claim’ in place of a full investigation into material facts before the risk is underwritten.Bell also expressed his worry over insurers’ lack of commercial empathy when recoveries are sought from Aon’s clients’ customers, saying: “Although this may be the correct course of action when applying the principles of indemnity, we would expect insurers, as partners in the risk transfer environment, to consult with the broker and their clients before taking actions that could damage trading relationships.”Despite these worrisome trends, Bell did finish by saying that by working as a team, insurers and brokers could bring about ‘speedy settlements at a reasonable level of indemnity’.

The announcement by the British government to publish an Equality Bill that would include provisions to outlaw unjustifiable discrimination on the grounds of age has been met with mixed responses from consumers and the insurance industry. The Bill does state, however, that ‘it will not affect the differential provision of products or services for older people where this is justified’.Nick Starling, the Association of British Insurers’ director of general insurance and health, said of the legislation: “Insurers agree that unfair discrimination on the basis of age is wrong. That is why they do not practise it.” He continued: “Legislation, no matter how well-intentioned, could have the unintended consequence of forcing some insurers to withdraw certain products altogether, reducing competition and availability and pushing up prices for all age groups.” He also said that the ABI is working with the government on the proposed bill, which it is hoped will endorse the principle of premiums reflecting the risks presented by individual consumers.

Hannover Re has signed a five-year exclusive co-operation agreement with state-owned Indian insurer GIC Re to develop life reinsurance in the nation. The two companies are equal partners in the venture, which came into effect retroactively on 1 April this year, according to a statement released by the German reinsurer. It added that given India’s 1.1-billion-strong population and rapidly growing middle class, the country offers ‘immense business potential in the medium term, especially in life insurance’.Wolf Becke, chief executive of Hannover Re Life, said that as a result of the venture, the company would be able to gain faster and better access to the market and in turn, GIC Re will benefit from Hannover’s international network and long-standing experience in the marketplace. He added that in order to properly support the venture, Hannover Re is planning to establish a service company in Mumbai in the autumn, although Indian business will be underwritten from the company’s home in Hanover.

Zurich has revealed it will be making a number of redundancies after unveiling plans to cut its cost base by 10 per cent by the end of the year. It has entered into a period of consultation with the Union of Finance Staff and employee representative bodies.

MAPFRE has reached an agreement to acquire 60 per cent of the share capital of Atlas Compania de Seguros, the 10th largest insurer in Ecuador. The purchase, with a value of €3.8 million, is subject to the relevant regulatory authorisations.

AEGON Religaire Life Insurance Co., a joint venture between Religaire and Aegon, has received approval from the Insurance Regulatory and Development Authority in India to operate in the life insurance market.

Detica Group has signed an agreement with Lloyd’s of London to support the insurer’s upgrading of its capital modelling infrastructure as part of its capital systems upgrade programme.

The Saudi Arabian insurance market witnessed growth of 24 per cent to SAR8.6 billion at the end of last year, according to the Saudi Arabian Monetary Agency.

AXA has completed the acquisition of 36.7 per cent of the share capital of Reso Garantia, Russia’ second largest property and casualty insurer.

Canara HSBC Oriental Bank of Commerce Life Insurance Co., a joint venture between two state-run banks and HSBC, will be capitalised at 3.25 billion rupees and will have access to 40 million customers, according to the firms.

Aon Middle East has announced the opening of its regional headquarters in the Dubai International Finance Centre, following news that the company had been granted a full licence to operate there.

Plans by UK insurers to siphon billions of pounds from inherited assets and split them with shareholders were dealt a blow when MPs said the FSA had failed to establish clear rules to protect policyholders.

A new Ernst & Young report has found that the London insurance market expects its rate monitoring processes to underestimate true underlying rate reductions, despite more technical and actuarial input.

According to data contained in the latest study from Swiss Re, world insurance premium income grew 3.3 per cent in 2007, reaching US$4,061 billion, which was driven primarily by the life business in industrialised and emerging markets. In the life sector, premiums increased by 5.4 per cent, which is higher than the previous ten-year average. Non-life premium growth was healthy in the emerging markets, but significantly decreased in industrialised countries. Swiss Re has found that both industry sectors are financially sound, however, despite the credit crunch.Daniel Staib, one of the study’s authors, said: “Despite a macroeconomic inflation environment characterised by marginally slower economic growth and rising inflation, life insurance continued to expand in 2007, with world life insurance premiums increasing.” He attributed this growth to a trend in the industry towards single-premium business and pension and annuities products, which drove sales up in countries where an ageing population and reductions in social security benefits were causing a

shift in buying patterns. Another growth driver is the fast-developing economies of today’s emerging markets, where a relatively young populations and expanding middle classes are pushing sales numbers up in all insurance sectors.Swiss Re’s study showed that non-life premium growth slowed to 0.7 per cent in real terms

over 2007, totalling $1,668 billion. It was noted that although downward pressure on premium rates continued in some countries, overall technical results were favourable and profitability remained sound. Staib added: “As the economic environment and capital markets stabilise, life insurance is projected to resume its strong performance in the medium term, both in terms of growth and profitability.” With regards to non-life insurance, however, the picture is more mixed: “Non-life insurance premiums are expected to fall in industrialised economies. However, non-life premiums will continue to grow in the emerging economies, albeit at a slight slower rate than in the recent past.” He also voiced his concern over rising global inflation, which he said would probably increase claims costs in liability insurance and other long-tail business lines, as well as hamper profitability.

Claims trends revealed by Aon

Mixed response to Equality Bill

Indian adventure for Hannover Re

Swiss Re study released

John Bell

International Travel Insurance Journal

12 HEALTHMATTERS

Editoral commentThis is my last column as Sarah Lee! As of next issue, I shall be Mrs Watson, so wish me luck and let’s hope I have no need to use my travel insurance as a result of my honeymoon to Sardinia!This issue, we explore the increasing trend of US hospitals employing global debt collectors to recoup funds from travel insurers. Many see this as an intrusion that leads to higher healthcare costs and higher premiums, while also undermining the insurer-hospital relationship; but hospitals say that with huge discounts already given to international travel insurers, they can’t afford not to track down outstanding monies. There are several other issues at play here, with companies chasing outstanding debts and bill balances in countries from the UK to Israel – all of which is discussed in our News Analysis on p18.Elsewhere in this issue, we continue our exploration of assistance and healthcare markets and practices around the world – focussing this issue on Denmark. And we have other features and news covering all aspects of the travel insurance spectrum, as well as a private healthcare round-up in PHN. Please also note that ITIJ is currently putting together its third annual cost containment supplement, so do get in touch if you’d like to be involved either editorially or otherwise. Thank you, and happy reading!

MDR-TB problem faced

Dengue warning in Yemen

Yellow fever strikes PeruThe World Health Organization (WHO) has

announced a new drive that will be backed by ‘substantial funds’ to tackle the increasing number of people suffering from multi-drug-resistant tuberculosis (MDR-TB) around the world. According to the WHO, diagnostic tests that take just two days – instead of the normal three months – will be introduced into some developing countries where the problem of MDR-TB is most prevalent. Funding will also be made available to those countries to cover the cost of antibiotics, which are currently far more expensive than the basic TB treatment, and are essential for people suffering from the drug-resistant strain of the disease.Statistics have shown that more than five per cent of worldwide TB cases are MDR, and the latest estimate from the WHO states that there are now 490,000 MDR-TB cases every year, contributing to more than 110,000 deaths. The countries where

the problem is most obvious are the former Soviet Union, where over 22 per cent of cases are MDR,

and many countries in Africa, although data on the ground there is too patchy to determine exactly where the problem is worst. It is known that it was in South Africa, however, where an even more dangerous form of the disease was first found – extensively drug resistant (XDR) TB was identified there two years ago.The main problem is that there are so few drugs to treat XDR-TB, and those that do are very expensive, placing them out of reach of many of the worst affected countries. There have been cases of XDR-TB, though, in 45 countries, including Britain, which the

WHO says threatens to ‘derail 10 years of progress of TB control’. The new drive to curb the reach of the disease is the joint achievement of the WHO, the Stop TB Partnership and UNITAID, an international drugs purchasing facility set up to help developing countries, and the Foundation for Innovative New Diagnostics.

The Middle East is a hotbed for expatriates and holidaymakers alike, and although there are sporadic reports of polio and malaria outbreaks in the region, most of the time it is relatively free from disease. However, there are now reports that an outbreak of dengue fever has occurred in the Arabian Gulf coast, in the western coastal town of al-Hodeidah and Mokha and the hill area of al-Dali’. And another recent

outbreak is currently raging in the Shabwa province in southern Yemen, where nearly 1,000 people have become infected with dengue fever since the middle of May this year. Three of the province’s 17 districts have now reported cases – Mayfaa, Hotaib and al-Saeed. Tourists and workers alike have been told to seek medical advice before travelling to the region, and to ensure that all appropriate vaccinations are in place.

Peru is now a staple destination for the increasing number of gap-year travellers that trawl through South America searching for inspiration, but several tourist accidents there recently have highlighted the lack of infrastructure in the country, and the health risks that come with visiting a developing nation. Although it is known that there is a risk of yellow fever in the country, it is not usually high. However, as of 7 June, the Peruvian Ministry of Health had reported at least six confirmed cases of yellow fever, including four deaths and eight probable causes. It has now been identified that there is a risk of yellow fever transmission in the areas east of the Andes Mountains. The warning, however, does not include the popular city of Cusco or the must-see deserted city of Machu Picchu. The UK Foreign and Commonwealth Office has issued a warning to tourists that if they plan to travel from Peru to other countries in South America, they may need to show evidence of a valid yellow fever vaccination.

RBC insurance, said that before they leave on vacation “Canadians need to ask themselves if they could afford to pay out thousands (of dollars) in hospital bills or lose the cost of their vacation. If they can’t, they need to consider purchasing travel insurance.”The statement also noted that employment and credit card plans often are not as comprehensive as dedicated single or annual trip plans in that they often don’t cover up-front payments to foreign providers, air ambulance repatriation, or case management, and they often have limitations on coverage amounts, number of travel days allowable and medical service coverages.Though Canadians have publicly-funded, universal healthcare insurance administered by provincial government agencies, their out-of-country coverage is limited to medical emergencies, and payments for those services are restricted to small, arbitrary amounts – as low as $75 a day for residents or British Columbia, $400 for residents of Ontario, and similar varying amounts for other provinces – highest in the eastern, Maritime provinces. In no case, however, do they cover anything but a fraction of the typical US hospital bill, which can run to several thousand dollars per day.These considerable reimbursement discrepancies may account for the fact that 60 per cent of all British Columbians polled said they ‘always’ or ‘usually’ buy travel insurance for travel to the United States, while only 40.7 per cent of Maritimers do. However, the poll also showed that almost 68 per cent of Canadian leisure travellers 65 and older ‘always’ or ‘usually’ purchase travel insurance when going to the US, somewhat substantiating other surveys done by the Conference Board of Canada showing that over 80 per cent of snowbirds – those who frequently winter in the US for at least 31 consecutive days – buy travel insurance, and are well aware of the need for this coverage.

It appears, therefore, that among non-snowbirds, or those who travel to the US for shorter trips of just a few days or on weekends, there is less sense of need for US coverage. The poll also surveyed respondents about their experiences and attitudes toward buying insurance for travel within Canada but out of their own province. Though Canada’s ‘medicare’ is an amalgam of separate provincial and territorial plans administered by the individual jurisdictions, federal cost sharing requires all plans to conform to certain national principles, one of which is that benefits are portable from province to province – that is, that travellers from one province are covered for medically-necessary services if they travel to another. The portability factor is not totally consistent however, and some services such as ambulance coverage or services of auxiliary medical personnel – chiropractors or therapists – might not be covered to the same extent in all provinces. Thus travel health insurers urge Canadians to buy their products also for inter-provincial travel.In that respect, only 29.6 per cent of respondents to the poll said they ‘always’ or ‘usually’ bought travel insurance for inter-provincial travel and 61.8 per cent said they ‘rarely’ or ‘never’ bought insurance for inter provincial travel. Here too, the highest rates of purchase were among the older age groups, but still only peaking at of 47.4 per cent among travellers 65 and older. The poll also shows that a majority (55.1 per cent) of 55 to 64-year old Canadian leisure travellers ‘always’ or ‘usually’ buy travel insurance. Contrarily, only about one third of younger travellers (18 to 34) said they ‘always’ or ‘usually’ bought coverage for US travel.The RBC Insurance/Ipsos Reid survey was conducted between 27 March and 10 April, 2008 and was based on responses from a randomly selected sample of 2,251 adults interviewed by telephone.

Canadians shun US trip cover continued from page 1

Sarah LeeEditor

sarah@itij.co.uk

www.itij.co.uk

HEALTHMATTERS 13

Clean air at 50,000 feet

Vaccine available again

Australia’s Transport Safety Bureau has scotched the commonly held notion that crowded aircraft are incubators for disease. Miles Clarke reports from Sydney

A thorough review of the data from epidemiological studies and microbial assays indicate that the risk of transmission of infectious diseases within an aircraft cabin is low, especially in modern aircraft. “Despite the popular view that the risk of contracting an infectious disease during air travel is high, the available evidence suggests otherwise,” says the report by Australia’s Transport Safety Bureau.Almost any destination on earth is now only one or two flights away, and the duration of many long haul flights has increased, with non-stop international flights of 12 to 14 hours now commonplace, with some taking over 20 hours. During this time, people of varying states of health sit in close proximity to each other. The number of passengers onboard a single aircraft is also increasing with the introduction into service of the Airbus A380, which can typically carry up to 555 passengers.“Many passengers might be concerned that the high recirculation rates of cabin air on modern aircraft pose a particular risk for infection. However, outside air entering an aircraft cabin at altitude is essentially sterile, and the high airflow rates, laminar airflow pattern and frequent air exchanges of an aircraft cabin ventilation system minimises the spread of infection onboard aircraft,” claims the report. The report found filtration systems on modern aircraft should remove the possibility of the transmission of infection that would otherwise exist in aircraft cabins using recirculatory ventilation systems. “Considering the large number of flights that occur each day, reported cases of transmission of infection in an aircraft cabin have occurred relatively infrequently,” the report states. “The evidence suggests that passengers’ health is not greatly at risk through air travel, and widespread infections are unlikely.” Where infection transmission was reported to have occurred in an aircraft cabin, it had required close contact with an infected passenger, suggesting that the risk of transmission within an aircraft cabin is no greater than in other crowded and confined spaces, ‘provided circulation and filtration systems are working properly’. Another aspect of the report found that, although the increase in international air travel could facilitate the spread of a future influenza pandemic, the aviation industry would also play a critical role in easing the impact of one. “Australia will prevent or minimise the spread of an emerging pandemic through border control measures and also possibly through travel restrictions,” the concludes the report.

The US Centres for Disease Control and Prevention (CDC) has announced that drugmaker Sanofi Pasteur has resumed production of single-dose vials of YF-VAX®, the yellow fever vaccine, after they had experienced a temporary halt in production. As of June 2008, the pharmaceutical firm notified the CDC that they have now increased their inventory and ordering limits for the product.Sanofi Pasteur has indicated that the five-dose vials of the vaccine are also available, although limits remain on the number of orders a clinic can make. It added through, that ‘the supply of the single-dose presentation should be able to accommodate travellers in need of a yellow fever vaccine’.

International Travel Insurance Journal

14 AIRAMBULANCENEWS

Spotlight on HAL Dhruv

The HAL Dhruv is a multi-role helicopter that is developed and manufactured by Indian company Hindustan Aeronautics

Limited (HAL). It is currently being supplied to the Indian armed forces, while a civilian variant is also available. It has already been exported to Peru – where the Health Ministry has ordered two – Nepal and Israel, and is being considered by Bolivian authorities. The Dhruv is part of the company’s Advanced Light Helicopter programme, which was fi rst announced in 1984, but hit problems not long afterwards. Even after the fi rst prototype fl ew in 1992, problems remained due to the changing demands of the Indian military, funding and contractual issues with Messerschmitt-Bölklow-Blohm, which was the consultant for the design. The Indian National Disaster Management Authority has placed orders

for 12 of the aircraft, and the chief test pilot in the programme said the helicopters will have top-of-the-line medical infrastructure, including ventilators and two stretchers.

Specifi cations

Capacity: Flight crew 1/2 Stretchers 2Length: 15.87 metresRotor diameter: 13.20 metresHeight: 4.05 metresMax take-off weight: 5,500 kgMax speed: 280 km/hourService ceiling: 6,500 metresRate of climb: 8.9 metres/sec.

New long-range jet for CareFlight

New King Air joins RFDS fl eet

A new jet ambulance service launched in Perth, Western Australia, in June creates a national network for the Australian CareFlight medical evacuation charity. It also enables the charity to provide emergency evacuation to patients in South East Asia.The Westwind II plane is provided through a partnership with Pel-Air Aviation. The new aircraft will halve the service’s air response time as compared to a propeller driven aircraft, and doubles the range. The Perth-based jet joins existing CareFlight services based in Darwin, Gold Coast and Sydney to create Australia’s fi rst national network of jet air ambulances.Dr Andrew Refshauge, CareFlight’s New South Wales chairman, commented: “The achievement of a national jet air ambulance network means a single phone call could activate up to fi ve jets to converge on the scene of a major disaster.” He added that all fl ights will be staffed with one critical care doctor, from anaesthesia or emergency medicine, and one intensive care nurse with aviation training. The medical team is jointly supplied by the Ramsay Joondalup Health Campus and CareFlight Australia.An agreement is in place between the CareFlight charity and Western Australia Health. WA Health Minister, Jim McGinty, who presided over the offi cial launch of the new CareFlight air ambulance said: “The CareFlight Air Ambulance will complement the State’s existing aeromedical services, such as the Royal Flying Doctor Service, and boost the State’s capacity to deal with disaster situations.”The CareFlight jet and medical teams will also be available to mining companies, assistance

services and others who need to retrieve patients quickly from remote locations. Mr McGinty explained that the new jet would also increase the scope of the service: “Having this jet air ambulance service means that for the fi rst time Western Australia will have access to a rapid response medical team that could retrieve seriously ill patients from as far as South-East Asia.”He also said that the new service would assist with the preparation of disaster management plans. In the past CareFlight medical teams have provided medical and disaster support to victims of the Bali bombings, the 2004 South-East Asian tsunami and the 2006 Jogyakarta earthquake.The new Perth-based service has already carried out an international mission, fl ying to Bali in early June at the request of an assistance company to collect a 53-year-old Perth man who had suffered multiple injuries in a motor cycle crash and needed urgent specialist surgery at Royal Perth Hospital.

The latest aircraft to join the fl eet of the Royal Flying Doctor Service (South East Section) has now entered into service; Mike Victor Whisky (MVW) has joined the fl eet operating out of Broken Hill. Radical modifi cations to the fi tout of this Beechcraft King Air B200C promise long-term, lasting benefi ts for the RFDS, its staff and the patients it serves, says the charity.“Modifying an aircraft to make it suitable for use as a fl ying intensive care unit has always been a long and complex process,” explains business manager Alan Tippett. “Traditionally, that work has involved signifi cant structural changes to the airframe. This new design is far less invasive and introduces a modular design, much of which can be pre-manufactured and installed once the aircraft arrives from the factory. This dramatically cuts down installation time and has the added advantage that it is easily removed when it comes time to sell the aircraft. The equipment is also reusable.”The company responsible for the redesign is Total Aerospace Solutions (TAS), a company specialising in the development and design of aircraft equipment. TAS director Mark Buick commented: “RFDS aircraft operate under unique conditions, often in exceptional circumstances. They need an unprecedented level of fl exibility and adaptability. We developed a prototype design to respond to that need.”There are obvious economic advantages to the new design. The module can be pre-manufactured, so aircraft spend less time on the ground before they go into service. At the end of their usable life span with the RFDS, the retrofi t before resale will be easier, faster and therefore less expensive.Operational benefi ts are also signifi cant. For the fi rst

time, there is a hydraulically operated cargo door, overcoming the need for doctors and fl ight nurses (who often travel alone) to manually operate the heavy cargo door fi tted to the aircraft. The new stretcher lifter has increased load bearing capability

and provides a very stable patient loading platform. In addition, the new stretcher litters have been designed for greater fl exibility to respond to different situations, including, where necessary, transporting a patient to the aircraft from an inaccessible

location in the back of a utility vehicle. Seats are designed for greater ergonomic comfort and stretcher pods can quickly and easily be converted into additional sideways facing seating. Intercom facilities built into the medical attendant’s seat armrests will allow them to communicate with the pilot and also ground services such as ambulances and hospitals.“These advances will make a real difference to our work,” says senior medical offi cer Dr Mike Hill. “Patients will benefi t from safer, more comfortable transfers and staff will enjoy greatly improved working conditions.”The new design will also assist the RFDS in coping with the challenging conditions it encounters in its everyday work, delivering emergency medicine and primary health care to remote parts of rural and regional Australia. In aeromedical confi guration, the new plane can carry two patients and a medical team.RFDS is a charity and although it receives some government funding it relies largely on donations from members of public to keep the service going. The service is free of charge to anyone who lives, works or travels in outback Australia.

Adam Sèbire / Royal Flying Doctor Service Southeast SectionSanjay Simha

www.itij.co.uk

AIRAMBULANCENEWS 15

US air ambulance operator AirTrek has come out fighting against the revocation of its operating license by the Federal Aviation Authority (FAA) on 10 June. The company, which is based in Florida, believes that the FAA acted contrary to its own policy in making the decision describing its behaviour as a ‘witch-hunt.’ David Craik spoke to Dana Carr and the FAA about the situation

“Thirty years without any violation demonstrates that Air Trek respects the regulations and provides quality service,” said owner Dana Carr. “The FAA action is unfounded. Air Trek had compiled an annual FAA base inspection in February this year with all satisfactory marks. The FAA has certainly been inconsistent with this.”An appeal against the order, which was made for air safety violations, has already been filed and a hearing before a National Transportation Safety Board (NTSB) administration law judge in Tampa, Florida was scheduled for 8-10 July. However, this has now been postponed until 2 September, after Air Trek waived its right to an emergency hearing. It is understood that Air Trek and the FAA are discussing the case with the potential of reaching a settlement agreement.So how has it come this far and which issues need to be resolved?

The caseThe FAA suspended Air Trek’s license on 23 May after an inspection at the company’s headquarters at Charlotte County Airport. Following the suspension, the FAA carried out further inspections at the HQ which led to more serious problems emerging. “Our findings as part of that investigation indicated that revocation was in order as opposed to the suspension,” said Kathleen Bergen, a spokeswoman for the FAA’s southern region.The revocation letter cited 14 air traffic safety regulation violations. These included flying aircraft that had not been deemed safe, failure to follow weight guidelines, deceptively recording maintenance shortfalls, allowing pilots to make international flights without proper training or certification and letting pilots fly after they had failed required tests. The FAA letter stated that ‘Air Trek’s systemic noncompliance with regulatory requirements is unacceptable and a danger to the flying public’.

The defenceCarr had blamed the suspension on allegations from a competitor and a few disgruntled employees. His position has not changed with the revocation. “All of the FAA concerns are paperwork related and we will be able to show the NTSB that we were in compliance at all times,” he said.However, there have been press reports that Air Trek was not compliant with the FAA inspections, denying inspectors access to the company’s planes on 5 June. “The FAA acted in disregard to a legal order that all contact should be through our attorney,” stated Carr. “It was our council not to allow the FAA to continue their witch-hunt. We were willing to allow the FAA inspector to complete conformity inspections on all aircraft in preparation to reissuing our certificate.” The FAA has indicated that it has been monitoring Air Trek since one of its planes crashed in Panama in July 2004, killing six people on board. The company has had two non-fatal crashes since then on US soil.The question arises therefore why the FAA waited so long to revoke Air Trek’s licence if it saw the company as such a danger? Does this reflect a failing in how the FAA manages its regulation of accredited air

ambulances? Bergen told ITIJ: “As the case is pending it would be inappropriate to respond to these questions.”One body also pushing for answers from the FAA is the National Air Transportation Association (NATA), which believes that its members cannot now rely on the work of local FAA inspectors. This

is because, as in the Air Trek case, national FAA inspection teams carry out their own checks determining some local decisions as deficient. The NATA is calling for a ‘reliable mechanism’ so operators know they are truly being compliant. It seems that there is enough uncertainty over this case to lead Air Trek and the FAA to sit around the table to find an answer, but if the hearing does go ahead in September, Carr is keen to make his case. “The hearing will reveal that the FAA acted contrary to FAA policy. We regret that the FAA acted impulsively to their concerns rather than allowing us to demonstrate our willingness to comply as we have for 30 years. The real concern is how these unfounded actions have impacted on Air Trek’s devoted employees during a difficult time in the US economy.” Even if Air Trek’s appeal is unsuccessful it is likely that the company will reapply for a licence in the future. “Air Trek plans to continue providing quality service to our clients,” Carr states.

Air Trek vs. the FAA

Boeing offers 737 air ambulance

LifeFlight flies debut mission

Raisbeck increases global network

Boeing engineers in Sweden have started an innovative project that will enable the conversion of 737 jets from normal commercial airliner to air ambulance in just a few hours. The company has a certified modular system of stretchers and self-contained intensive care beds that can be used in the mass evacuation of casualties from disaster zones. Boeing engineer Sven Stein said the conversion of ‘a standard airliner or business aircraft [could be completed] in less than six hours’. A 727-800 is able to carry six intensive care beds and the staff needed to care for the patients, along with up to 24 less seriously injured people.

Sweden keeps a full planeload of equipment on standby, but it has only been used in a real emergency on one occasion, when it helped out in the evacuation of people injured in the Asian Tsunami of 2004. Although, says Boeing, the conversion is a powerful tool to offer aid in emergencies, there must be a basic infrastructure in place in the destination country that can handle large aircraft, which is why the plane was not used in Burma or China during the recent natural disasters there. The Swedish government, though, holds regular disaster response exercises where the system is employed to great success.

LifeFlight Panama has reported its first mission was flown 10 June. LifeFlight 1, flown by pilot Joseph Rios, accompanied by senior flight doctor Javier Bernard and senior rescue specialist Danilo Bernal, made its first life-saving flight in the Republic of Panama.The not-for-profit flight was carried out so that the patient could be transported immediately, to Panama City’s Centro Patilla Hospital, for a life-saving procedure, said the company. The patient had suffered a heart attack and was taken to the Chicho Fabrega Hospital in Santiago, where he was stabilised. It was determined that the patient needed immediate transfer to a hospital in Panama City. As ground transport would have meant sending an ambulance from Panama City, a round trip of approximately seven hours, the LifeFlight 1 helicopter was called, reducing this time to two hours. The aircraft flew from Albrook Airport to Santiago (1 hour) and then returned to the Mirimar Hotel Heli-Pad, Santiago, where the remainder of the transport was completed by a ground ambulance.LifeFlight is currently awaiting completion of its operational paperwork.

Raisbeck Engineering has recently signed a deal with Líder Aviação, headquartered in Belo Horizonte, Brazil, making it an authorised installation centre to support sales of performance packages. The Brazilian firm will also be responsible for promoting, selling

and installing the ZR Lite and Aft Fuselage Lockers for the Learjet 30 series to both current and prospective customers in the South American marketplace.Líder Aviação began as an executive charter operation, offering a Cessna 170-A in 1958 and expanding its fleet over the years. Today, the

company offers a complete integration of customised solutions in corporate aviation, including helicopter operations, aircraft chartering and management, sales, maintenance, ground handling, insurance, training for pilots and air ambulance support.Nick Nicholson, Raisbeck’s sales manager for Learjet performance systems, anticipates rising international sales for the company’s products, forecasting that the new Brazilian partner will play an integral role in the process: “ZR Lite international sales have steadily increased this year, with our 100th sale quickly approaching. Líder provides our customers with top-of-the-line service and expertise, which mirrors Raisbeck’s philosophy.”

International Travel Insurance Journal

16 TRAVELMATTERS

Emerging markets booming

Quake lake could become an attraction

Caribbean tourism faces hard times

Where to this summer?

Europe exceeds expectations

The United Nations World Tourism Organization (UNWTO) has found that tourism in emerging markets has grown by between six and eight per cent over the last 10 years, which is significant because it is twice the growth rate of industrialised countries. Speaking to the UK Tourism Society conference, assistant secretary general of the UNWTO Geoffrey Lipman said that tourism contributes up to 70 per cent of the income of the world’s poorest countries, and with statistics showing that the number of international travellers will double by 2020, areas such as China, India, South East Asia, Eastern Europe and the Gulf states stand to make more money than ever before. Many of these industrialising countries have either already become, or stand ready to become, important outbound markets thanks to burgeoning middle classes and increasingly liberalised travel policies. In particular, Lipman highlighted China, where there are increasing numbers of people who have the means to travel, with tourists from the country spending US$30 billion abroad in 2007. When focusing on domestic travel, China was again brought to the forefront of the issue, as in 2006, the country registered 1.6 billion domestic trips.Lipman added: “It is fair to assume that this growth scenario will suffer from the economic downturn and more than fair to say that massive prolonged increases in fuel prices, with few short-term options (at least for airlines), as well as other ‘mega crises’, will have a fundamental depressant effect. But the numbers of potential travellers are so huge and the logic of targeting tourism for development so pervasive that the long-term growth prospects will remain substantial by any measure.”

Authorities in China have given new meaning to the words ‘disaster tourism’, following the announcement of the plan to turn the Tangjiashan ‘quake lake’ into a scenic tourist hotspot. Experts are said to be studying the lake and how to develop it in a ‘comprehensive’ and ‘scientific’ way.Local party official Chen Xingchun said: “It will be an important part of rebuilding Beichuan county.”

The recent earthquake in China triggered massive landslides in Sichuan, blocking the flow of rivers and thus creating around 30 unstable lakes that threaten to burst their banks and cause devastation to millions more Chinese people caught in its path. Xingchun told reporters that it could take up to three years to rebuild Beichuan, which would feature the distinctive Qiang culture, industry and culture.

Industry experts and commentators have said that the future of tourism in the Caribbean is being threatened by increasingly high airline ticket prices and a stumbling US economy.Allen Chastanet, chairman of the Caribbean Tourism Organization, was dire in his predictions: “Billions of dollars of investment are being exposed and thousands of jobs are being exposed.” He added that the Caribbean was feeling particularly vulnerable because one airline, American, controls such as large portion of the market, carrying more than 60 per cent of the passengers that end up in the region. Now, however, the airline has said it expects to cut its daily flights out of Puerto Rico from 93 to 51 in September, while there will be no more flights to Santo Domingo, Antigua, St Maarten, Aruba and Samana in the Dominican Republic.

It has been suggested that cutting down the number of flights to Puerto Rico could also have knock-on effects for the cruise industry – last year, 10 cruise ships used Puerto Rico as their home port, but if cruisers cannot get there, that trend will quickly come to an end.Spokeswoman for American Minnette Velez said that rather than raise ticket prices so high that they are out of consumers’ reach, the decision has been taken to cut flights and reduce capacity: “Travelling would be completely inaccessible if we increase fares as oil prices rise.”American is not the only airline, however, to reduce its flights to the Caribbean regions – Spirit Airlines announced recently that it is to close its San Juan hub, while Continental Airlines is also expected to declare destination and flight cutbacks soon.

Mondial Assistance has unveiled figures showing the preferred 2008 summer destinations for Europeans who are travelling by plane – the rankings are based on an analysis of over 418,000 travel insurance contracts subscribed to until May this year. From the figures, it is clear that Europeans travelling abroad this summer are choosing Spain as the most favoured destination, with 25.3 per cent of planned flights heading to the Iberian peninsula. Italy was next with 14.1 per cent of the flights, while the UK followed with 13.8 per cent. France was the next popular destination, followed by Ireland and Portugal; the figures also revealed that although France remains the leading tourist destination in the world, it appears among the top three preferred destinations only for the French themselves, the Portuguese, the Swiss and the British.The results of the survey showed that French people prefer to holiday at home, or close by in Southern Europe, which is also the most popular destination for German holidaymakers. The majority of Brits will head to Spain; the Irish, Swiss and Dutch also appear to have a continuing love affair with Spain, with most visitors from those countries heading for some sun and sangria. Most Polish people, however, would appear to be travelling to the UK, with Spain coming second in their preferred destinations, followed by France. The average length of holiday will be 10 days, although the Polish will travel for longer, as will the French, Dutch, Germans and Irish.Erick Morazin, international sales director at Mondial Assistance, said the analysis could be performed due to the company’s e-Magin platform, which has ties to most European airlines. “As a result,” he continued, “we can follow the most frequent destinations, booking behaviours, holiday durations and other information about air travel in real time.”

The performance of European tourism was more successful than expected last year, despite the pressures of higher fuel prices, tighter security rules at airports and distinctly un-summery weather across the continent, according to the findings of the European Travel Commission’s latest report. European Tourism Insights 2007 concluded that international arrivals and overnight volume both rose by between four and five per cent compared to 2006, beating forecasts made by the World Tourism Organization.The figures contained in the report demonstrate that a sizeable portion of the increase is due to more people going on short city breaks. However, it is not, as expected, the leading market travellers who are opting for more weekends away; it is, in fact, travellers from secondary markets that are increasing

their travel plans.In terms of destinations, the big winners in Europe were Serbia, Montenegro, Iceland and Turkey, which all saw increases in tourist numbers of around 20 per cent. Greece, Lithuania and Malta enjoyed smaller, though still double-digit growth in arrivals, but not in the number of nights stayed.Despite these undeniable increases, the Commission has warned the industry that although Europe was a strong performer and still good at attracting tourists, there may be ‘rough seas ahead’, thanks to the strong euro against the low dollar deterring visitors, tough

European Union visa policies, the Olympic Games ‘stay at home’ factor and ailing worldwide economies. It went on to accuse governments in Europe of not taking tourism seriously, instead leaving promotion and investment to the travel industry. The Commission’s executive director Rob Franklin noted: “By

contrast, governments of many emerging economies have earmarked tourism as a means of diversification and, as a result, are making huge investments in tourism infrastructure development and marketing to support the sector, as well as facilitating and stimulating private sector investment in tourism.”

International Travel Insurance Journal

18 NEWSANALYSIS

Though international travel insurance companies are accustomed to spectacular payment demands by American hospitals,

they are now facing new battles as these same hospitals mobilise collection companies – some of them in Europe or the Middle East – to boost their receivables and mine sources of untapped revenue.

Whether this turn to collectors is a matter of efficiency, opportunism or avarice depends on just who is speaking.

Insurers fear interventionInternational insurers, who normally deal with hospitals through networks of preferred provider

contracts, fear that the intervention of tough, professional collectors will lead to higher costs and patient premiums, erosion of relationships with hospitals, and deterioration of client trust.On the other hand, collectors and their hospital clients say that international travel insurers have forced the issue by demanding unrealistic discounts

far out of proportion to the fragmentary business they provide, and that American hospitals don’t have the same capacity to handle foreign accounts as they do domestic ones or the same leverage over them once the patients have left the country. This conflict, say insurers, has led to the bizarre situation of clients in Canada being harassed by

The collectors are coming

Milan Korcok has the latest analysis from all sides of the fence on the contentious issue of international collection firms targeting foreign patients

www.itij.co.uk

NEWSANALYSIS 19

collectors in Switzerland calling in unpaid bills from hospitals in the United States. “Hospitals have discovered that if they put pressure on the consumer, the underwriter will pay because it becomes a public relations issue,” says Magdi Riad, vice president, Product & Claims, for TIC Travel Insurance Coordinators. “And this is not a fair game … the consumer is not aware that this hospital is charging four times what it would have accepted from an American Medicare patient.” Or, for that matter, adds Riad, what it would have accepted only yesterday through a pre-existing contractual arrangement negotiated by a preferred provider network. “The last thing an insurer wants is to have his policyholder deal with intimidation from a collector, whether it’s a collector from the UK or a collector from the US. This is a no, no,” says Riad.Yet intimidation in its rawest forms is exactly what Canadian travel insurers, who have a much greater share of their client base exposed to US hospital cost pressures than insurers from other nations, say they are increasingly experiencing. And this clearly has ominous overtones for insurers from all nations who have patients admitted to American hospitals.Though collection agencies have always been part of the US healthcare landscape, they have generally been used as vehicles of last resort, going after the insurer or client after all other attempts at settlement had failed.Now, however, some Canadian insurers say hospitals are turning to collectors as front-line troops, circumventing existing PPO contracts, dumping

patient collection, credit and financial information into collectors’ bins and letting them go at it – especially for foreign accounts, which they fear may be tougher to bring to ground.Dr Colin Plotkin, a British Columbia-based consultant who assists international travel insurers in dealing with catastrophic claims, cites a ‘spawning’ of collection agency involvement, especially among hospitals in areas of heavy tourist density such as the American West or Florida. Accounting clerks are taught, he says, to quickly spot foreigners and differentiate them from domestic patients by watching their reactions when asking for a permanent address, drivers’ licence, or social security number. “Any American can tell you their social security number off by heart. Canadians can’t.” It is becoming commonplace, says Plotkin, for collection agencies ‘to simply institute a system into the business office of a hospital whereby every case that is international gets automatically sent to the collection agency’. “And that collection agency is now in control of the bill. They make a percentage on how much they collect and it stands to reason they will do everything they can to get as close to the full bill amount as possible.”As others have noted, collectors may offer insurers discounts of five to 10 per cent off a bill in their grasp, but this is a long way from the 40 or 50 per cent insurers may have achieved via negotiated PPO discounts. And that, says Plotkin, can only lead ultimately to the consumer paying higher premiums. “It is another layer in the process that needs to be funded.”

International insurers… fear that the intervention of tough, professional collectors will lead to higher

costs and patient premiums

International Travel Insurance Journal

20 NEWSANALYSIS

Patrick Hrusa, director of Provider Relations, Assured Assistance Inc., an operating entity of RBC Insurance Company of Canada (RICC), concurs that calls from individual clients who have been contacted by collection agencies are increasing. Some of these are for bills not yet submitted, while others are for bill balances – additional payments for bills already thought to be settled. Some of these collection intermediaries seem to have no idea of the normal contractual agreements that exist between hospitals, PPOs and insurers, says Hrusa. They simply call the client, ‘tell them how much is to be paid, give them a reference number and a lock box address in Austin, Texas to which they are told to send a cheque’. They are given no information about the services provided, a statement of benefits, or anything else, he adds. “When we get such a call from a client, and we look at these accounts, we look at all the bills and cheques that have been issued and see that everything has been paid in accordance with the contract between payer and provider. There have been no notice disputes, just clean payments. We then have to try to explain to the client that this is the reality of the US healthcare delivery billing system today.”Hrusa says there is nothing cost effective in US hospitals simply circumventing the normal third party handling of foreign bills by routing them to collection agencies: “I don’t see physicians or hospitals receiving more funds. It is simply an additional layer of administration, with more people involved, more commissions paid, but not with additional revenues for hospitals or doctors.” Ken Vorvis, vice president, Strategic Planning for Medipac International, one of Canada’s largest providers of snowbird insurance, confirms that ‘these types of companies are creeping in’ and adding another layer of cost to claims administration, but some are also seriously disrupting existing provider relationships. He cited one example of a major cardiac centre on the east coast of Florida that has dispensed with all of its PPO contracts and is now simply offering small 10-per-cent reductions on a

more or less take it or leave it basis. “This hurts,” he says; “When I can negotiate a contract for $40,000 for a cardiac case and now I have to go to $100,000 that hurts. This can only have one result;” he continued, “rates going up.”Mila Pejovic, associate director of Travel Assistance and Medical Case Management at World Travel Protection Assist, concurs also that the intrusion of collection agencies into the claims payment process ‘is indeed a growing problem’. And she too notes that most of the collection companies involved are from Switzerland, England, and Israel. The use of European collection services to pursue international bills makes logistical sense for many countries in Europe or Asia, but when it includes Canada, just across the border from the US, it becomes somewhat baffling. But they are ones that initially, have staked out this turf.

The European connectionThough American collection companies have long been a part of hospital billing procedures domestically, much of the foreign collections business being handled for American hospitals is channeled through European or Middle East firms.Ovag International A.G., headquartered in Switzerland, is reputed by some sources to have an impressive client list of America’s top hospitals, among them such institutions as Columbia Presbyterian, Johns Hopkins, Tenet Healthcare Group, Cedars-Sinai Medical Center (Los Angeles), Massachusetts General, Orlando Regional Healthcare System (Florida).Global Recovery Alliance AG, also headquartered in Switzerland, states on its website that ‘11 of the top 30 North American hospitals have already enjoyed the benefits of using the international collection services of Global Recovery Alliance’. These ‘Top’ hospitals are among the US News and World Report catalogue of the top 100 hospitals in the US.BDM Ltd. International Collection Services, headquartered in Tel Aviv, Israel, states on its website: “Pursuing non-payment for services rendered is tough enough with patients residing in the US; for patients who reside outside the country, it’s a whole new world.” BDM cites itself as the US healthcare industry’s ‘number one choice for international collections, with many years of experience pursuing foreign medical claims, travel insurance and collections for US healthcare providers’.Gallagher Associates Ltd., headquartered in Kent,

Hospitals auction off their debt online

With American hospitals experiencing mounting un-payable debt – up to six per cent of their expenses, on average – many are getting so desperate to recoup what they can, that some are auctioning off their debt online, e-Bay style.Certainly the foreign trade accounts for only an infinitesimal portion of these debts, which are for the most part generated by expanding numbers of uninsured, underinsured patients, and even insured people who can’t pay all of their growing share of deductibles and co-payments – a legacy of the massive shift of healthcare costs from employers to their workers. The result is that some hospitals are now so desperate to improve their revenues that some are beginning to auction off their debt via online sites to collection agencies for pennies on the dollar. According to the Wall Street Journal, collection agencies bid for the debt through online sites such as ARxChange.com (owned by TriCap Technology Group) or medipent.com (run by Medipent LLC). Collection companies that win the bids are then free to go after the hospitals’ debtors, using whatever weapons they have in their arsenal, and go after them they do.According to the Wall Street Journal, the two systems together have auctioned off approximately $460 million of hospital debt so far, but they admit the game is just in its first innings.These auctions, and other forms of collecting on domestic bills differ from the collections of foreign patient bills in that they have had a relatively long shelf life and hospitals have pretty well given up on them.

Hospitals have discovered that if they put pressure on the consumer, the underwriter will pay because it becomes a public relations issue

www.itij.co.uk

NEWSANALYSIS 21

Dear ITIJ,

I’m writing to you in reference of your article Canadian hospitals deny repatriations, June 2008 - Issue 89.Even though you mention some key issues, I don’t think you have all the information, and the article seems to mislead your readers.We have been in the assistance business for over 20 years and repatriations to and from Canada is one of our fields of expertise. We work very closely with BC Bedline and other government agencies, and as long as you know what you are doing, securing a bed for a Canadian out of the country patient is not difficult nor does it take a long time.I know every case is unique, but again, when you have the knowledge and professionalism required to do the job, the results are good and patients and family members are happy with their insurance company.We enjoy reading your magazine and find your articles very interesting and helpful. Unfortunately, this time I have to disagree with you and felt necessary to send you this letter.

Warmest regards,

Jaime PerezBusiness Development ManagerMega Assistance Services Inc.

Dear Mr Perez,

It is heartening that you have had no problems. We did not say all repatriations to Canada were problematic, but that many were, and were becoming more so. As you will see in the analysis in issue 90, we acknowledge that there are highly competent professionals in various Canadian provinces who have also been in the assistance business for many years, who do know what they are doing, who are encountering problems of bed repatriation and trying to correct them. We feel their views are pertinent.

Regards,

Milan Korcok Tell us your viewsITIJ would like to hear from you regarding your experience of

repatriations to Canada – whether you have only positive stories

to report, or whether you have had trouble securing a bed for a

patient. Please email sarah@itij.co.uk.

Thank you and we look forward to hearing from you.

England, is another major player that Canadian insurers say is showing up frequently as a collector of foreign accounts for US hospitals. And possibly because of the successful beachhead launched by the Europeans, American firms such as MedFi, CollectRx and Fort Lauderdale, Florida-based Sunbelt Medical Billings are expanding their base in the burgeoning foreign account collection business. According to several Canadian insurers interviewed, some collectors tend to pounce on new claims that have not even been submitted to the insurer for payment. Says RICC’s Hrusa: “Many times we have notices coming from Switzerland before we have even received a statement from the hospital. And many times that notice is sitting in the patient’s mailbox … before it has been received by the insurance company. Let’s not get into the issue of discounts; we don’t even have a notice of the claim to begin with, and the collectors may only be offering a discount of between three and seven per cent.”Udi Ben-Gal, director of operations for BDM Ltd., in Israel, disputes the contention that his collection firm moves prematurely or that insurers are denied the opportunity to make reasonable payments. He says that ‘all US hospitals will gladly accept payments that are based on PPO rates’ but many foreign insurers want better than that. “They try to play it both ways,” he says, demanding the Medicare rate offered to domestic insurers but without offering the great volumes the Medicare system provides. “The insurer says ‘if the hospital is not losing money on Medicare and the Medicare rate for a procedure is $10,000, how come you charge me $100,000?’” On the other hand, says Ben-Gal, they don’t take into consideration that American hospitals treat many millions of uninsured or underinsured patients from whom ‘they will not receive a dime’.He says there are also the realities that US hospital computer systems are not set up to capture foreign information such as different address formats or personal identifiers, and this makes recording of information on such patients fragmentary and sometimes unreliable. Then there are the differences in time zones and language that impede follow-up communication. Sometimes the patient returns home ‘and doesn’t even inform his insurer that he was in hospital’: “The

hospital can’t do anything because it can’t find the patient, and it loses leverage over the patient and therefore leverage over the insurance company. Other times the patient is not even aware the insurer has not paid,” he says. “Some (hospitals) outsource the account a week after the bill drops,” he continues. “Some of them try their best for 60 or 90 days and when they get no response or payment, only then will they send their accounts to us.”

Changing relationshipsTIC’s Riad echoes the concern that insurers are not being given the chance to make a fair assessment of the claim before they are sent out for collection. “It looks like hospitals now are turning inward and basically ignoring any contractual obligations that they may have with a PPO network when it comes to foreign patients,” he says.Ben-Gal confirms that many hospital/PPO relationships are changing: “I know most of my clients have changed their PPO contracts and have reduced the rates of discounts they were prepared to give.” He notes also that insurers who may have received 40 per cent discounts now may get 25 per cent and if the bill is $1,000, ‘then insurer’s say it’s OK, but if the bill is $200,000 the insurance company will say its not good enough, they want to negotiate a better discount’. “That is not right,” he says. “You cannot one day pay according to the contract and another day say you’re not happy with the discount.” Though the intrusion of collection agencies into the claims settlement process still appears to be in its early stages, with some Canadian insurers not having been impacted yet, those who have see it as a deeply disturbing, ominous omen for all foreign insurers dealing in the turbulent US healthcare market.It is something to be dealt with early, and to be stopped, they feel. But how?Plotkin believes much of the sense of frustration hospitals feel in dealing with foreign insurers has been precipitated by their ‘greed’ in pursuing demands for unrealistically deep discounts hospitals can not accept. “Hospitals have become aware that international cases are being funneled through domestic (PPO) networks (such as those provided by Aetna or United Healthcare) and are being reimbursed as though the patient were a domestic patient, an American citizen,

paying taxes toward healthcare and belonging to a legitimate PPO network working for a legitimate American employer.” Expecting foreigners to qualify for the same discounts that people on Medicare get, whose subsidies are paid for by American taxes is not fair, he adds. “Hospitals have picked this up. They say ‘we’re not having any of it … give this to collectors. Let them deal with it’.”Plotkin’s solution is for payers to ‘simply dig their heels in and refuse to deal with collection agencies and deal directly with the hospital’. “That will cause their demise. And that’s what I do. I refuse to deal with collection agencies. I say ‘sorry, I’m not permitted to discuss anything with you. Please supply me with a letter from the patient authorising discussion with you’.”That appears to be one way to stop dealing with collectors. But perhaps the more fundamental problem for the entire travel insurance industry is to figure out how to stop American hospitals getting into the position that they need to hire collectors to deal with foreign insurers. And that may take more than saying ‘NO’.

‘these types of companies are creeping in’ and adding another layer of cost to claims administration Letter to the editor

International Travel Insurance Journal

22 FEATURE

Some years ago, ITIJ invited the Plain English Campaign (PEC) to write a piece on policy document wording. That feature was written

by John Wild, an experienced member of the PEC; but when ITIJ asked him for an update, his reaction was mixed: “As with other areas of industry and commerce where there is heavy legal or financial involvement, we struggle to make quick or revolutionary changes,” explained Wild, now the campaign’s senior trainer. “However, we are seeing an increase in the number of travel insurance companies who have realised that communicating clearly with customers generates consumer trust, and ultimately leads to more business.” So, frustrated UK consumers, in particular, can take heart in knowing that improvements are being made, but the question is – why so slow and so painful? We tried to get an idea of the answer by gathering a review panel of PEC editors and a range of travellers for an afternoon of travel insurance policy perusal with promises of a free holiday for their troubles. We

reveal our findings below, and explain the concept and importance of clear and concise policy wording.

Clear benefitsLegal bodies continue to argue that the use of plain English in documents diminishes and generalises their legal implications, but there are increasing examples of court hearings or press coverage that show the real problem lies with jargon and lack of clarity. The same goes for travel insurance policies. So, how big a crisis is needed before these excuses are shown for what they are? Encouragingly, our counterparts on other continents are seeing the clear benefits of authoritative decisions and government guidance over the use of plain language – for both insurers and consumers. But in the UK and most of Europe there is a lack of definitive law regulating the industry’s documentation. The EU directive for the Unfair Terms in Consumer Contracts Regulations (UTCCRs) goes some way to dealing with plain language issues in favour of the consumer, while organisations like the

Association of British Insurers (ABI) or the Financial Services Authority (FSA) have an interest in the issues of travel insurance. But there is not yet a singular body that has full responsibility for legislation that sets out the essentials for policy wording. While researching this article, some of the recognised UK bodies mentioned confirmed their support for plain language. They claimed that they practice the use of plain language themselves, but admitted they had no responsibility for checking or enforcing it elsewhere.The absence of universally-accepted standards in plain language means consumers usually end up attempting to cope with vast amounts of insurance documentation. Even relatively simpler policies, such as single-trip travel insurance, can often look like a ten-page examination paper. Bodies such as the Travel Health Insurance Association of Canada, however, are advising their members to adopt the use of uniform definitions for clarity and consistency. They have clearly recognised a need for such standardisation, and have formed a solution that

provides a solid base for others to follow.The United States, meanwhile, has had its Plain Language in Government Communications Act for some time now. And although it is aimed specifically at government language use, this act has had a positive impact on the wording of other official documentation such as insurance policies. Clearly, US officials are beginning to appreciate that long held concerns about plain language losing the weight or the meaning of a document are unfounded. In a country that is often criticised for its ‘claims culture’, plain language is a tool that reduces the opportunity for either party to hide or get lost in the policy wording maze. Processing is faster, sales are higher and claims could potentially decrease. We have also seen the evidence of these benefits in the UK, with a number of plain English supporters. One UK insurance company realised the sales of their ‘Home cover’ policy were low and that they were losing their customer base. They asked us for help and by applying plain English principles the company saw a sales increase by 600 per cent in just 16 months. However, the consumer remains reliant on the goodwill of the insurer to provide plain language. The UK’s parliamentary decision to replace archaic Latin terms with plain English in civil courts is a major step forward. And in the UK the ABI, the Financial Ombudsman Service and the FSA have encouraging views about the mutual good that comes from using plain English. But without specific law, consumers are faced with a slow and uphill climb. Nick Palmer, a British MP is in the throes of pushing through the much needed Small Print Bill in the UK, which would contribute to improving various consumers’ documentation, including travel insurance policies. Furthermore, events like the recent baggage handling crisis at Heathrow’s new Terminal 5, and the press coverage regarding subsequent travel insurance claims also highlighted the need for insurers to use clearer language.

All changeSo, what has changed since our original article for ITIJ, if anything? Recent PEC edits of travel insurance policies in the UK reveal that the same problems continue to frustrate consumers. Some of the most frequent are:

• policy documents written in coloured inks that challenge people with visual impairment or dyslexia;

• font sizes well below the recommended limit; • lengthy documentation of up to 40 pages; • differing terminology from one provider to the

next; and • many combinations, permutations and exceptions within one policy.

Most noticeable was the change in the sheer size of travel insurance policy documents, which seem to grow year by year. One recently reviewed travel policy has grown from 14 pages in 2005 to 38 pages this year. The danger here for policyholders is that they become intimidated by page after page of text, even if it is well written. This often means they skim through the policy and trust that it is suitable, which can be risky. On the other hand, wording can be so

Getting on boardPolicy wording is something that many travel insurers are continually striving to improve. But are they making

progress, and what should they be aiming for? Marie Clair from the Plain English Campaign puts pen to paper

we are seeing an increase in the number of travel insurance companies who have realised that communicating clearly with customers

generates consumer trust, and ultimately leads to more business

www.itij.co.uk

FEATURE 23

complicated that customers cannot decide what type of cover is most suitable, which can mean they end up with inadequate insurance. For example, we recently heard from an elderly couple who went on holiday to Portugal. They had taken out travel cover and thought they were well-protected. On the second day of their holiday, the wife tripped and fell awkwardly and was rushed to hospital in Portimao for an operation. The treatment was superb, but then the bombshell came with the hospital’s bill: the operation and hospital stay had to be paid for then and there. The policy was valid, but would only refund the policyholders later. The couple had no credit cards and not much currency so became desperate. Fortunately, the day was saved by a relative who paid the bill for them. But what would have happened if they had not had someone to turn to? By their own admission, the reason they were in this mess was because they had not read their policy properly because it was too long, full of jargon and they could not read the small print.Insurance brokers can get it wrong too. One man we spoke to went to his insurance broker to buy a travel policy for a holiday in Europe with his wife. The broker advised him which policy would be suitable so he paid the premium and went home. Luckily, that night he read through the policy document and realised that it was only suitable for his wife. He was excluded because of his age. Needless to say, he had a few words with the broker the following day.

One vital aspect of insurance is there must be ‘utmost good faith’ by the policyholder. This means that everything that may be relevant must be disclosed to the insurance company, including pre-existing medical conditions, to prevent rendering the policy invalid. Insurance companies are striving to get this message across to policyholders, but this can have the unfortunate side effect of making the policies longer.

Journeying onThe Plain English Campaign has been trying since 1979 to promote the use of plain language in all sorts of communications, and over that time we have had great success not just with improvements to the language, but also with changes to design and presentation. But what exactly do we mean by plain English? It is not ‘cat sat on the mat’ language, and it doesn’t talk down or patronise. Plain English means using everyday language, active verbs, short sentences and so on. It also includes good design principles, typography, signposting, use of white space and many other techniques.In our experience, a plain English insurance policy benefits the insurer as much as the policyholder. In one case, our legal experts worked with an insurance company on their motoring policy, and only when the policy was translated into plain English did it become obvious that the policyholder would not be covered if they went driving in Scotland. The company was horrified and embarrassed. The old

policy wording was so obscure that they did not even realise that travel in Scotland was not covered. This experience is by no means unusual. A spokesman for the Insurance Ombudsman stated that in disputes where they were asked to adjudicate, 90 per cent of the cases were due to the company not understanding the contents of its own policy. The main reason for this is a failure to use plain English and to review policies regularly to make sure that policies still mean what the company thinks they mean. In too many cases, policies change over time with extra clauses being ‘bolted on’ to cover particular situations, while at the same time the original meaning of the policy becomes more and more obscure.Competition between insurance companies continues to be fierce. The companies that survive will be those that provide clear, unambiguous policy wording. Plain English Campaign’s mark of clarity, the Crystal Mark, appears on nearly 17,000 documents worldwide, including many insurance documents. When the public see the Crystal Mark, they know that they will be able to understand their rights and duties. The campaign also promotes an Honesty Crystal Mark, which assures consumers that the company will stand behind every detail contained within a document. A major Irish insurance company has taken this step and reports positive feedback

from its clients, and an increased sense of pride and confidence from its employees. It would be heartening to see an increase in Honesty Crystal Marks on travel insurance policies, if only to prove to consumers that insurers do not make their policy documents deliberately difficult. In a society that has become more challenging for government, business and the individual, consumers do have more information, but whether it is in a form that gives more knowledge is still dubious. Perhaps our basic package holidays could come with some basic package travel insurance – in basic plain English – and leave the more adventurous traveller to machete their way through the jungle of insurance exclusions – or is that too easy?No wonder that John Wild’s reaction to selecting a travel insurance policy for his free holiday was also mixed: “It’s a slow boat to China, a hike up the Himalayas, a journey to the jungles of Borneo,” he said wistfully. A sense of pleasure at the cost of great pain then? In the end, our review panel were just too exhausted comparing policy details to consider what to pack, and decided not to take their holidays after all. Needless to say, the boss was happy.

> worldwide AIR AMBULANCE OPERATOR> worldwide REPATRIATION & MEDEVAC> worldwide AIRLINE STRETCHER SERVICE> worldwide MEDICAL AIRLINE ESCORTS> worldwide BED-2-BED TRANSPORTS> PERSONAL MEDICAL CONSULTANCY

24 / 7 available for those in need!Tel: + 43 1 600 1212based in: VIENNA (LOWW/VIE), AUSTRIA

www. medicaljetservice.com

THERE IS LIGHT ON THE HORIZON

MJSlightonhoriz76.indd 1 24/4/07 16:01:04

Most noticeable was the change in the sheer size of travel insurance policy documents,

which seem to grow year by year

in the UK and most of Europe there is a lack of definitive

law regulating the industry’s

documentation

Marie Clair is Press Officer for the Plain English Campaign (PEC), where a hands-on approach keeps her in touch with the grass roots of the campaign. She is committed to using every opportunity to raise the global profile of the PEC in every sector of activity where plain English brings direct benefits.

• International

Travel Insurance Conference

•International

Private Healthcare Conference

• International Air

Ambulance Forum•

International Pet Insurance Conference

•Assistance Medicine

•

conference sponsors

International Travel Insurance Journal Awards Evening

After yet another successful year of the 2007 Venice ITIJ Awards, we are proud to announce that this year’s ceremony will even better last year’s event to once again provide the industry with an outstanding occasion that celebrates excellence and achievement in the global Travel Insurance and Private Healthcare industries.

ITIJ is read by the top players in Travel Insurance today and it is this readership that allows us to compile the most comprehensive vote available. Each individual that subscribes to ITIJ will have the opportunity to vote for their top-rated company in each of the nominations categories.

Once all the votes are in, a shortlist of the top three to fi ve companies in each category will be drawn up (based on the number of votes received). Each of these fi nalists will then be asked to create a presentation that will be considered by an independent judging panel, which will decide the ultimate winners on the night.

The fi nalists’ presentations will be screened at the ITIC Gala Dinner awards evening in Budapest on Friday 14th Nov.

The categories:• Air Ambulance provider of the year• Assistance/Claims Handler of the year• Cost Containment company and provider of the year (to include PPOs and general services)

• Insurer/Underwriter of the year• Intermediary of the year (to include all retailers of travel insurance)

• ITIJ marketing campaign of the year (judged independently)

• Best International Healthcare Insurer

ITIJ AWARDS 2008

The rules:

• One vote per category per subscriber to ITIJ

• Votes/nominations must be received by 28th August 2008 to: www.itij.co.uk/awards

• Only registered company domain names will be accepted. Hotmail, Yahoo and other Web-based emails will not be accepted

• The fi nalists within each catergory will be contacted on Monday 1st September and provided with the criteria and deadline for submitting their presentation

: : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : :

visit www.itij.co.uk/awards for more information

ONE READER – ONE VOTE!

Award sponsors

sponsors of the Air Ambulance of the Year Award

sponsors of the ITIJ Marketing Award

sponsors of the Intermediary of the Year Award

sponsors of the Insurer of the Year Award

sponsors of the Cost Containment Company of the Year Award

sponsors of the Assistance Company of the Year Award

International Travel Insurance Journal

26 FEATURE

Global warming, ever-bigger natural disasters, premium wars – how about the following to give underwriters something

more to worry about? The world is shrinking. More and bigger planes, added routes, ever growing travel – both business and leisure – with whole new markets opening up, are all factors that are making humanity more mobile and, if it’s easier for more and more of us to take to the skies, the same applies to infectious diseases. There are several ways the global travel insurance and assistance industries can prepare for a pandemic or deal with minor outbreaks. Here, ITIJ looks at what threats might be round the corner, and steps the industry can take to mitigate the risk associated with the often frighteningly quick spread of silent killers such as flu epidemics in today’s ever more mobile and adventurous society.

Waging warHere’s a sobering fact. The so-called ‘Indian’ flu epidemic of 1919 killed more people around the world than died in battle during the entire First World War, with many towns and villages decimated, not just in Asia

but in Europe and beyond too. That particular virus travelled by sea and took months on its lethal journey. In chilling contrast, the SARS epidemic had the potential to leapfrog from nation to nation just as quickly as a jet plane could fly between them.According to the experts, pandemics work on a cyclical basis and we are about due for the next big flu epidemic following those of 1919 and 1968. Says Bonnie Arquilla, director of disaster preparedness for Central Brooklyn and a member of the New York City Department of Health disaster committee: “The critical period of a major pandemic will last for six to eight weeks. During that period, around 35 per cent of the employed population will be off work; schools and many businesses will be forced to close and the knock-on effect will be colossal. You could almost call it viral terrorism.” Many hospitals and other facilities around the world stage exercises once or twice a year to make sure everything is in place to deal with such a crisis, but Arquilla is concerned by the number of communities that will still be caught on the wrong foot. “The big concern with flu is over how quickly it strikes: it takes 24 hours for the symptoms to

manifest themselves but during that time the infected person is highly contagious.”

Of course, the World Health Organization (WHO) and national governments around the globe have measures in place to give early warning and to

hopefully eliminate epidemics before they spread, but there are flaws in the

system. Moreover, several major killers that were once believed to be all but eradicated

have rebounded strongly. Just recently, a visitor to Glasgow

brought TB – an illness we once thought to have

been banished for good – back into the

Scottish city. Years of development

and fine-tuning brought the WHO’s International Health Regulations to a point where many battles seemed

to have been won, but winning

a battle is not winning a war.

Crossing bordersWith the ever increasing reduction of

international trade

barriers and the demand for easier

movement of goods, livestock and people, there has arisen a situation where a better balance needs to be struck between protecting our health and avoiding undue constraints on the global economy. What’s more, countries, especially developing ones, sometimes resist giving early warnings about disease outbreaks for fear of the damage that bad publicity will wreak on their tourism industries and their economy in general.

Moreover, according to the WHO’s recently published ‘A Safer Future’ report, there is major concern over the emergence of new, ever more virulent diseases that are now potentially able to span the world in days rather than months. Recently, 2003’s SARS outbreak rightly caused great alarm. Here was something highly contagious, with a very high death rate, but whose symptoms take a week to emerge. A 72-year-old Chinese victim took at least one airplane trip in the days before he fell ill and doctors feared he may have infected more than 20 others before being diagnosed. Tracking down and quarantining those possible victims was a logistical nightmare. Soon after, cases popped up not only across China but as far away as Canada. In the following months, several hundred people died but, fortunately, the survival rate proved better than expected and the virus was contained within a year.In countries like the UK, every winter, seasonal influenza kills very old and very young people and others already weakened by illness, but current fears among the world’s medical experts are of a new and potentially deadly version – like that of 1919 – jumping from animals to humans, and governments internationally are already planning for its hoped for containment.More recent, and indeed current, focus has been on so-called avian flu, a pandemic disease that could possibly become a mass murderer. At present, this virulent strain attacks and kills only people who have been in close contact with infected poultry, because it is unable to spread from person to person, but the fear is of a mutation that will be able to do just that. This could cause a death rate running into thousands if not millions.In worse case scenarios, nine out of 10 people diagnosed with the Ebola or Marburg viruses in tropical Africa have died within days. The ever-growing fear is that, given the growth of modern day travel – with a year-on-year increase of seven per cent, and a volume now well exceeding 600 million international flights a year – such nightmare outbreaks of various killer viruses could soon become pandemics.

The big comebackAlong with the emergence of fresh enemies, new,

more resistant strains of old illnesses are making a return, so much so that there is already serious talk of reintroducing the toxic DDT as a means of containing malaria, which still kills more than a million people every year and is becoming more resistant to treatment. Likewise, all but eradicated in the developed world, polio has rebounded in India where WHO statistics point to 249 cases in 2006 compared to 35 the previous year. Says Jay Wenger, of the country’s National Polio Surveillance Project: “What started in the north of Uttar Pradesh has now spread into neighbouring states and beyond.”Measles, too, had seemed to be defeated but has returned to haunt anxious parents in the US. Other comeback killers include cholera – with an estimated 50,000 dying in the first month of an outbreak in the Congo – and tuberculosis. Says Bonnie Arquilla: “In normal times, cholera is easily contained. It is simply a matter of following good practice in terms of hygiene and sanitation, but when a disaster such as a flood, an earthquake or the destruction of a war takes place, these things fall down and cholera is quick to step in. I was frankly amazed that we did not experience a major outbreak in the aftermath of the tsunami. Certainly, the recent increase in natural disaster occurrences gives cause for worry over potential cholera outbreaks.”Furthermore, TB now kills around 1.5 million people annually around the world, and is the terminal illness that finally kills many AIDS victims. Worryingly, the TB bacterium is proving increasingly resistant to antibiotics.

Then there is the plague, that traditional, much-feared ally of the Grim Reaper. Down the millennia, outbreaks have killed as much as 40 to 50 per cent of some nations’ populations as the so-called Black Death has struck people down and killed them within days. Untreated, the mortality rate for bubonic plague victims is 75 per cent; for septicemic plague it is 100 per cent. The current worry is that the next big outbreak will prove resistant to treatment.Comments Carolyn Walker, of Healix International, a UK-based medical case monitoring and evacuation services company: “Diseases are now able to spread far more rapidly than in the past,” and explains: “There are two major types of infectious diseases that can develop into epidemics. These are common source epidemics that arise from a contaminated source, such as food or water, and host-to-host infections, which are transmitted from one infected individual to another via various, perhaps indirect,

An epidemic problemFrightening new diseases and the return of old killers focuses the negative side of

increased global travel. Roger St Pierre warns insurers on new and emerging threats

the SARS epidemic had the potential to

leapfrog from nation to nation just as quickly

as a jet plane could fly between them

developing countries urgently need outside

assistance to help them control epidemic

outbreaks, with the provision of an incentive for early

notification

www.itij.co.uk

FEATURE 27

these measures arose not so much in response to the concerns and demands of the medical profession and public health authorities but from the commercial requirements of the open market demanding an end to the knee-jerk reaction to shut the gates and pull up the national drawbridge whenever an outbreak or epidemic occurred in a neighbouring country. Helpfully, there have already been a number of instances when this reporting system has helped prevent the cross-border spread of infectious disease within the Community.

Global reachIn a wider sphere, things aren’t quite so good. The current WHO International Health Regulations only contain reporting requirements for cholera, plague and yellow fever and do not address such already well-known highly contagious and killer diseases as Ebola, other haemorrhagic fevers and meningococcal meningitis, or new threats such as avian flu or Nipah virus. What’s more, there is no incentive provided for reporting an outbreak, while the WHO can only act on information given by an official government source in the country concerned and can do nothing to prevent over-protectionist reaction to outbreaks.Perhaps the most pressing requirement of any revision of the status quo is for the WHO to involve the World Trade Organization (WTO) in improving the regime. The risk of the international spread of disease through trade is now being debated and assessed within the WTO, but what is really needed is a dialogue between the two organisations, in the spirit of the International Sanitary Conferences of the Victorian era.Revised International Health Regulations should require the WHO to provide a world alert system about potentially dangerous outbreaks of all communicable diseases; coordinated international action for early containment and the authority to restrain over-reaction in the form of over-zealous quarantine rules or the erection of trade barriers in

cases that lack a scientifically proven public health justification. Furthermore, developing countries urgently need outside assistance to help them control epidemic outbreaks, with the provision of an incentive for early notification. There is a real cost benefit to donor countries through such a process, as early containment is far more effective, both on a cost and a humanitarian basis, than waiting for an outbreak to spread into the developed world.With any such measures, there is also an urgent need to involve charities such as Oxfam and Médecins Sans Frontières, other NGOs and commercial organisations working in the health sphere and that, of course, involves travel and health insurers and assistance providers. The latter, of course, have a vested interest in improved containment. An outbreak of food poisoning or flu rampaging through a cruise ship can produce a rash of costly claims. Not to mention the choices they need to make regarding the level of coverage to offer to today’s intrepid traveller when it comes to underwriting for covered ailments. Where future risks seem likely to prove extremely high, insurers can of course opt to include specific diseases in their terms and conditions, just as they exclude coverage of injuries arising from high risk sports, but this could be unpopular with travellers, so too would be the exclusion of coverage of travel to areas where infectious diseases are known to be rampant. Insurers can, however, inject a measure of risk management by insisting, as many a host government does, on comprehensive inoculation for those policyholders travelling to certain regions of the globe.Today’s epidemics strike fast and hard; the medical profession, health organisations and health insurers all now have their eye on the ball and the mood is to react just as rapidly. “The concerted efforts we are putting into conserving the ecology need to be reflected in the vigilance and action we take when it comes to looking after our own health,” says a WHO spokesman.

routes. The ultimate scourge of mankind has, of course, been the deservedly much feared Plague, which also affects more than 300 species of animal, but there are lots of other highly contagious killers to worry about.”

Prior planningEpidemics of contagious diseases are a concern not just for governments but for companies that, in an era of ever growing international commerce, need to send their representatives scouring the globe for business opportunities. iJET is an American-based organisation that runs a World Pandemic Monitoring Service, providing real-time alerting, authoritative analysis and best practice tools to help business organisations address a wide number of global health concerns. The business started with a unique piece of software that links into corporate travel systems and allows executive travellers to be automatically re-routed around terrorists, hurricanes, riots and whatever else comes along. It now extends its surveillance to take care of infectious disease concerns, and recently published an extremely detailed Avian Influenza and Pandemic Planning report.Based in Maryland, US, iJET’s intelligence operations’ centre monitors more than 150 countries on a round-the-clock basis, analyzing and verifying information from well over 3,000 sources. Health is one of 10 categories of information featured, with others including security, transportation, entry and exit rules and communications. The searchable service delivers intelligence in a brief, need-to-know format that is frequently updated to reflect changing conditions. The ‘at a glance’ screen provides

information on health warnings and immunisation needs along with current visa conditions, currency conversion rates and weather forecasts. Besides reaching end-users, the service targets such travel advisors as travel agents, corporate travel managers, and travel health specialists, as well a providing useful data for travel insurers and assistance companies.Fast-flowing, detailed and accurate information is key to the war against epidemics. The first-time appearance or resurgence of an infectious disease requires timely and coordinated action across the international community. For example, when it comes to infectious disease control, member states of the European Union have effectively become one country, an essential requirement in the creation of an internal market that requires the free movement of people and animals, as well as goods. Under the 1993-8 Maastricht and Amsterdam treaties, the EU was given over-riding competency in the field of public health. This has led to the detailed setting up of a network to ensure surveillance and to control outbreaks of contagious diseases that have extended to more than one member country; deal with the spatial or temporal clustering of cases of disease of a similar type, if pathogenic agents are a suspected cause and there is a risk of the outbreak spreading to other member countries; spatial or temporal clustering of cases of a disease of a similar type outside the community, if pathogenic agents are a possible cause and there is a risk of propagation into the community; and monitoring the appearance or resurgence of a communicable disease or infectious agent that may require timely and coordinated community action for containment.Under the treaties, member states are required to coordinate both prevention and control and to inform the EU Commission about the control measures that have been adopted. Interestingly,

Insurers can, however, inject a measure of risk management by insisting, as many a

host government does, on comprehensive

inoculation for those policyholders travelling to certain regions of the globe

International Travel Insurance Journal

28 ASSISTANCE&HEALTHCAREWORLDMARKETS

Denmark is a small country with just fi ve and a half million inhabitants, but the population is internationally oriented and very keen on

travelling. Danish citizens are also used to a relatively high standard of healthcare, and are well provided for by the country’s publicly fi nanced health system. They likewise expect a good standard of medical treatment when travelling within or outside of the EU, and have come to rely on an excellent assistance industry to help them in such situations. Travellers to Denmark enjoy the same high standards of medical care if they fall ill or are injured during their stay, which is paid for by the state up to the point when the patient is fi t to fl y. Here, we take a look at the structure of the healthcare market, and look at the developing assistance industry.

A public serviceWith more than 50 public hospitals in Denmark, the nearest medical facility is never far away, and the public health service is proud of its high standards and quality of care. It is based on the principle of equal and free access to treatment for everyone irrespective of social or fi nancial situation, and is, to a large extent, fi nanced by taxes. Acute help is always free, whereas medicines, dentistry, physiotherapy and psychological services are subject to partial self payment. In the 1970s, the Danish health service was among the best in the world, but since then its position has been taken over by other Western countries. The main reason for this is the diffi culty for the tax-fi nanced system to keep abreast of the increasing consumption of health services and new, expensive methods of treatment. However, both public and private hospitals, as well as individual specialists, live up to the population’s demand for quality care, they adhere to international standards, and are among the most effi cient in the Western hemisphere. Denmark also has very good and reliable emergency services in case of accident or acute illness. There

are waiting lists for certain non-acute treatments and surgery, but for a number of years work has been going on to reduce wait times, and a guarantee of treatment has been introduced which means that treatment or examinations are carried out at a private facility if the patient’s wait time exceeds a month. In spite of the tax-fi nanced health service, private insurance has gained a strong foothold in the country over the last fi ve to 10 years, with approximately 15 per cent of the population now taking out insurance covering treatment in private hospitals; while even more people have taken out insurance to cover the excess on such items as dentistry, glasses and medicines. There are only two private hospitals in Denmark, and several small private clinics. None of the private hospitals or clinics have emergency rooms, but the standard of care is very good – as in the public sector – and you receive a better range of hotel services and your own room. The two private hospitals cover a broad range of treatments, and are based in Denmark’s capital city Copenhagen (Hamlet Hospital) and Vejle in Jutland (Mølholm Hospital).

Everyone who stays temporarily in Denmark is entitled to free treatment in case of sudden illness, sudden deterioration of a chronic illness, or accident. And most visitors – both European and others – are treated in state hospitals due to their accessibility, or in the university hospitals of Copenhagen, Odense, or Århus, which are considered the best of their kind. In an emergency, a ground ambulance will automatically take a patient to the nearest and best hospital for treatment.

Bringing in the baconDespite its small geographical size, Denmark has a big heart when it comes to assistance and healthcare provision. Dorte Vesterholm Jensen tells us what to expect from the Danes

there are only two private hospitals in

Denmark, and several small private clinics

www.itij.co.uk

ASSISTANCE&HEALTHCAREWORLDMARKETS 29

The right to free treatment expires when the patient is fit to be repatriated to his country of residence. Regarding non-acute treatment, visitors from the EU and the Nordic countries are provided with medical care on equal terms to Danes, and expatriates residing in Denmark are similarly covered after their first six weeks’ stay. The biggest challenge for assistance companies when working with Danish hospitals is that they have very strict rules on patient confidentiality. Thus, a doctor needs approval from the patient before any cooperation with assistance companies. In need of assistancePersonal assistance is quite an old phenomenon in Denmark. At the end of the 1950s, SOS International, Denmark’s oldest assistance organisation, was established to provide breakdown and recovery (technical) assistance to motorists, and later medical assistance to travellers. The decision to focus on technical assistance was a response to the popularity of the car as the preferred means of transport for Danes, both for domestic trips and for short international trips. The Danes are well travelled and have been for many years. At the end of the 1950s, the first package trips to the sun of Southern Europe were sold in the country, and since then this industry

has grown steadily. In recent years, however, as in many other developed countries, individual trips where holidaymakers plan their itinerary and travel details themselves have become more popular, and the travel insurance and assistance markets have developed in line with changing traveller needs. In the EU, of which Denmark is a member, the European Health Insurance Card (EHIC) agreement applies, entitling any EU citizen the right to emergency medical treatment on the same financial terms as a resident of the country they are visiting. In addition, a special agreement exists between the Nordic countries and between Denmark and England, entitling residents of those countries who fall ill or are injured in one of the other countries in question to the same treatment as he or she would be in their own country. Free emergency medical treatment for Danes travelling in Europe is no new thing, however. Since the 1970s, Denmark’s public health insurance scheme has covered the cost of such treatment for its citizens up to the point where they are fit to fly. This scheme is administered by an outsourced company, which since 1 January has been SOS International. The company won this contract through a public tender process in which four other companies were competing, taking over the role from Europæsiske Rejseforsikring.

Until 31 December 2007, the public health insurance scheme also covered repatriation costs for those Danish citizens injured abroad but this cover has now been removed from the arrangement. Thus, Danes must now to take out their own private travel insurance if they want to be certain to have their repatriation expenses covered in case of illness or injury during a trip. So, where do Danes tend to travel to when venturing abroad?

Acute treatment Free for everybody until repatriation is possible

Non-acute treatment, which is medically necessary during stay in Denmark

Free – however, with partial self payment of e.g. medicine, dental treatment and physiotherapy for:

People residing in the Nordic countries • (Norway, Sweden, Finland, Iceland)

Citizens of EU/EEA countries or Switzerland • when the EU medical card is brought along

British citizens with UK passports• Expatriates residing in Denmark are covered •

after 6 weeks’ stay in Denmark

All these groups rank as Danes residing in Denmark and they are comprised by the Public Health Insurance scheme.

Approximate prices at private clinics and hospitals:

Consultation at general practitioner From DKK 180

Dental check up DKK 225- 466

CT Scan DKK 3,400 – 5,500

MR Scan DKK 4,000 – 4,500

Exchange of hip DKK 90,000

Heart bypass surgery DKK 123,000

PTCA procedure DKK 35,000

International Travel Insurance Journal

30 ASSISTANCE&HEALTHCAREWORLDMARKETS

Southern Europe, especially Spain, remains popular, as do France and Italy. After Southern Europe, the most commonly visited countries are neighbouring countries, while a quarter of all long-stay (four nights or more) trips abroad are to either Sweden, Norway, Germany or Great Britain. Even though destinations have become more exotic with increasing globalisation, European countries are still the preferred travel destination of the Danes. Therefore, medical assistance and treatment that is necessary abroad is, for Danes, to a very large extent covered by public compensation schemes.

Assistance growthWith such a small population, there are relatively few Danish speaking people in the world, making Denmark a fairly difficult place for foreign assistance organisations to operate in, as language capabilities are an essential requirement in this field. Also, with such a small population, there is a limit to how many assistance operators the market can bear. And it’s not like an assistance operator can simply set up a smaller base in a smaller country, as large costs are involved in the establishment of a 24-7 emergency operations centre no matter what its physical size. Consequently, there are relatively few assistance organisations specialising in travel assistance in Denmark: a few insurance companies such as Tryg, Gouda and IHI have their own emergency centres that assist their policyholders if they find themselves in an emergency situation abroad. But most insurance companies, such as Topdanmark, Codan, Fair and Alka, choose to outsource their assistance services due to the high operating costs, special requirements and competencies needed for such work. On the whole, SOS International is the only independent assistance organisation and emergency

centre based in Denmark, even though other international assistance companies such as Europ Assistance have Nordic bases, and others such as Mondial work with commercial partners to provide services in the region. SOS is by far the largest player in this region – not only in Denmark but all the other Nordic countries as well – but it is still small compared to other international assistance companies. The reason it is, nevertheless, able to compete successfully in the international market is to a large extent due to the fact that the Nordic market is a niche market, and one it knows well. In addition, SOS is an independent player, placing its assistance requirements with a large global network of partners rather than insourcing service providers. This provides a flexible and cost-effective structure. At the same time, cooperation with far larger international organisations takes place when assistance is needed in countries where these organisations are based, while SOS and other Danish assistance organisations also undertake tasks for international organisations when assistance is needed in Denmark. The country is a base for assistance organisations acting in the common Nordic market due to its advantageous geographical location being physically connected to the rest of Europe, and its large population size compared to the other Nordic countries. Generally, cooperation with Danish organisations is fairly simple: in many international surveys, for instance, Denmark is ranked as one of the least corrupt countries in the world, while Danes are perceived as extremely trusting people. Regarding insurance, Danish companies tend to outsource travel claims handling more so than their Nordic neighbours. The reason being that travel claims are a relatively specialised area requiring specific competencies, and such skills have so

with such a small population, there is a limit to how many assistance operators the market can bear

www.itij.co.uk

ASSISTANCE&HEALTHCAREWORLDMARKETS 31

Dorte Vesterholm Jensen works as healthcare specialist at SOS International in Copenhagen. She is also involved with the development of new health services for the private health market in the country. Dorte has a Master of Science degree in public health and has, through her studies, travelled and worked around the world in countries such as Vietnam and Slovakia.

ITIJ AHWM rATIngHeAltHcARe coSt HHHH

AcceSS to emeRgency cARe HHHH

oveRAll quAlIty of cARe HHHH

emS (AIR AmbulAnceS) HHH

Please note: These ratings are an overview of what ITIJ believes to be a fair reflection of the general standards in the country, and do not represent any one hospital or service. ITIJ recognises that some individual facilities and services would receive different ratings than others, and to those shown in our chart, should ratings of each be done separately.

far not been taught at the Insurance Institute – probably because travel insurance is such a small part of insurers’ business. As a result, travel claims in Denmark are handled by a number of companies who specialise in this field.

Take me homeAs a nation of avid travellers, especially as so many of its population travel out of the region in the winter season to escape the harsh winter climate, Denmark has had plenty of experience repatriating injured citizens home from abroad. SOS International, for example, annually repatriates around 5,000 Scandinavians, predominantly from the Canary Islands, Spain and Thailand. The majority of its medical transports are carried out by scheduled or charter flights, however, as the largest scheduled and charter airlines in the Nordic countries fortunately still carry stretchers. Approximately 180 stretcher repatriations are carried out from the Canary Islands during the winter season from October to April. Many elderly people travel to this area in the winter period, so at this time of year there are a higher than normal number of stretcher repatriations out of the island group. As this workload is pretty much guaranteed, SOS International pre-buys a number of stretcher spaces on this route each season. Not only warm destinations are attractive, though: skiing holidays are also very popular. But contrary to their Nordic neighbours, Danes are not very good at skiing. This is probably due to the fact that Denmark doesn’t have any mountains – the highest ‘mountain’ is 170 metres above sea level. Nevertheless, during the 2008 ski season, SOS repatriated more than 2,000 tourists from the Alps with broken arms and legs. Again, in order to ensure seats and stretcher space for repatriating patients, SOS pre-bought a fixed number of reservations from various ski destinations. As mentioned, most repatriations are carried out by scheduled or charter flights, but in order to ensure quality of service and price, SOS categorises airlines into A, B, C or D providers. Furthermore, with some of the airlines, SOS’s own physicians can approve a medical transport and give medical clearance, which means that the transport is authorised immediately if there is space on the flight. This quick turnaround could save a great deal of money if the patient waiting to be repatriated is in an expensive private hospital.There are, naturally, always going to be some patients whose state of health is so critical that repatriation must be carried out by air ambulance, but air ambulances are also often used to repatriate clients from Copenhagen – a flight hub for the region – to other Nordic countries, as larger flights cannot access smaller airports in the region. Within the borders of Denmark, though, most transports from Copenhagen are carried out by ground ambulance, as the country is so small that it is often less stressful for the patient to be transferred in this way than to be transferred from one flight to another.

A happy endingIn summary, the Danish public health system is based on the principle of free medical treatment for everybody, and includes a high standard of accident and emergency treatment for foreigners who are temporarily staying in the country. Likewise, since the 1970s, emergency medical treatment required by Danes abroad has been covered by the public health insurance scheme. As Denmark is a small geographic area, and as travel insurance is a niche market, many insurance companies outsource their assistance services relating to such insurance to assistance organisations operating in the entire Nordic market. The assistance market is highly developed, however, and offers a world-class standard of service to Danish and other Nordic citizens travelling abroad.

International Travel Insurance Journal

32 PROFILE

ITIJ: How did you come to work in the travel insurance industry, and how did you come to your present role? LM: I moved back to Gibraltar (my home town) after graduating with a BA Honours Degree in Insurance Studies at London Guildhall University, applied to PTI and was offered a job a few weeks later. I started off as assistant manager in 1998, was promoted to underwriting manager in 2004, and then underwriting director in 2005.

ITIJ: What has been your greatest achievement – both professionally and personally? LM: Personally, achieving my degree; and professionally, getting a job in my chosen career and becoming a company director. I have also just passed my ACII so am now an Associate member of the Chartered Insurance Institute.

ITIJ: What motivates you? LM: Both money and working in a friendly environment.

ITIJ: If you could work in any other profession, what would it be? LM: Working with animals.

ITIJ: PTI’s parent company, the Collinson Group, recently purchased London-based Columbus Direct, which now sells the majority of PTI policies. This seems to have been a successful purchase …LM: Yes, since Columbus became part of the Collinson Group, underwriting has been reviewed thoroughly and this has allowed us to transform our policy wording by giving maximum benefit without jeopardising underwriting. The emphasis is to ensure that we have developed the right products for the right customer groups, so careful analysis is undertaken between PTI and the

Columbus marketing team to ensure the correct balance is found and policies are sold successfully. ITIJ: Columbus only sells travel insurance directly to the public. Why do you think this model is so successful, and what are its advantages over selling through brokers? LM: Columbus provides a low-cost distribution channel by cutting out the middleman, and sells mainly online through developed search engines that make policy fulfilment quick and efficient, and some aggregator sites. The policies are also price competitive. The company has a high level of brand loyalty, helping it to regularly rank within the top three insurers in the UK. Other PTI distribution channels include broker networks and some tour operators and travel agents.

ITIJ: How can underwriting travel insurance be improved? What systems does PTI have in place to ensure the risk fits the client? How is this attributed to the over-65 market? LM: Underwriting could be improved by understanding the risk to the insured a little better, but there is only so much information that can be captured at the point of sale. We have full medical screening on the majority of our policies, regardless of age, using MediQuote Expert. The over-65s market – being a higher risk segment – is always screened, although other factors besides age are taken into account when rating risks.

ITIJ: Do you have any interesting hobbies? LM: Nothing seriously interesting: aerobics, travelling, listening to music and often taking part in fundraising for local charities.

ITIJ: What are the advantages and disadvantages – as an insurer – of being based in Gibraltar? LM: Being based in Gibraltar, we have lower operating costs because the island has no central funds levy like Lloyd’s of London. We are regulated by the Financial Services Commission (FSC) of Gibraltar, with a supervisory regime that is intended to match UK standards. Subject to FSC approval, we have exactly the same ability to write business in any EU state as a UK insurer. We also have the flexibility to respond quickly to market changes by outsourcing our sales, marketing, claims and assistance processes, therefore allowing us to concentrate on managing the underwriting operation. A disadvantage of being Gibraltar-based could be consumer misperception of an overseas insurer not meeting the same stringent regulations as the UK’s FSA.

ITIJ: Where do you see the future of underwriting for the global travel insurance industry? LM: Policies seem to be getting more similar and more standardised, particularly in UK, which does create a standard for insurers to adhere to whilst meeting consumer expectations on cover, but as the market is led by competition new ideas are copied by others, even if low-return or high-risk. In some low-return scenarios, therefore, it might be necessary to avoid standardising policies to ‘fit in’, and thus steer away from writing for premium or market share as opposed to writing for profit. Other countries, meanwhile, are becoming better educated with regards to the benefits of insurance, and travel insurance specifically is now being seen as a necessity.

Lunch with LorraineITIJ recently caught up with Lorraine Moberley, underwriting director for Professional Travel Insurance Company Limited (PTI), to find out how business is going in Gibraltar

www.itij.co.uk

GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS 33

privatehealthcarenewsGLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS

Healthy outlook for Spanish private providersTie-ups between regional governments and private hospitals have led to a positive outlook for the industry in Spain, as James Wallis reports

Spain, along with almost every other country in the world, is finding it harder and harder to cope with the healthcare needs of an increasing and ageing population, which has put so much pressure on public infrastructure that regional governments have been left with little choice but to involve private healthcare companies. In Valencia at least, public-private partnerships are now the standard, and many other Spanish regions are now following suit.As demand for medical care continues to far outweigh supply, these regional governments have become important clients of private healthcare operators. Gabriel Masfurroll, chief executive of USP Hospitales, the second-largest hospital provider in Spain, has estimated that government money accounts for between 10 and 15 per cent of USP’s business. At the same time, more people have more disposable cash than before in Spain, prompting a surge towards private health insurance and allowing them to pay for specialist treatment when publicly funded facilities are inadequate or too busy. The latest statistics suggest that 20 per cent of the population now has some form of private health cover. The government cash and more Spaniards being able to afford insurance, coupled with the continuing

Regulators in California, US, have moved to stop one of the state’s biggest hospital operators, Prime Healthcare Services Inc., from billing privately insured patients for unpaid medical services received at its facilities. Mandy Aitchison has the latest developments

The Department of Managed Healthcare (DMHC) director Cindy Ehnes told The Los Angeles Times: “Prime Healthcare’s ongoing practice of putting consumers in the middle of billing disputes between providers and health plans is the largest example of this egregious practice we’ve seen to date, and it must be stopped. Consumers who have purchased

health coverage in good faith deserve to know that it will cover them in a medical emergency and not result in crushing medical debt.”In response, Prime Healthcare’s general counsel Mike Sarrao said the company ‘is disappointed that DMHC … has resorted to punitive actions against the very providers, physicians and hospitals that are essential to maintaining the healthcare safety net relied upon by thousands of patients every day’, adding that Prime Healthcare ‘does not believe the DMHC has the requisite legal or equitable standing to bring the suit forward’.The insurers at the centre of the row contend that Prime Healthcare purposefully inflates its bills when

it charges them for patients treated in its hospitals, and as a result of this practice, the insurers, including Kaiser Permanente, said they have had to send Prime only partial payments. The insurers also intimated that Prime often cancels most private insurance contracts when it buys a new hospital, meaning many of the patients treated in such emergency rooms are then ‘out of network’, allowing the hospital to charge higher fees for the care they receive.As a result of the part payments by the insurers, Prime admits it has been sending thousands of patients the unpaid portions of their healthcare bills – some reportedly reached as much as $50,000 – causing a flurry of complaints from patients, insurers

and regulators. According to a 2006 survey, more than 1.75 million people in California who visited emergency rooms in the previous two years received $758 million in bills for unpaid balances on top of their co-payments and deductibles. Nearly 60 per cent of the 1.75 million paid the bill.Earlier this year, Kaiser Permanente sued Prime to block the firm from billing more than 5,000 of its patients for unpaid medical bills and in May, the insurer won a temporary restraining order from the Los Angeles County Superior Court, barring Prime from collecting money from former patients or reporting bills to national credit collection agencies. The insurer is also now involved in a

The end of balance billing?continued on page 39

continued on page 39

International Travel Insurance Journal

34 privatehealthcarenews

2008 market report released

Accreditation in India

Bupa wins Irish battle

Companies cut staff cover

Dublin-based Research and Markets has recently produced its Private Healthcare Market Report 2008, which includes a SWOT (strengths, weaknesses, opportunities and threats) analysis and company profiles. The report found that in total, the UK market for private healthcare was worth £24.77 billion in 2007, a rise of 8.1 per cent on 2006 and an impressive increase of nearly 32 per cent since 2003.According to the report authors: “The market is currently thriving, with sectors such as mental health, elderly care homes, and, to some extent, acute care benefiting from increased levels of public funding and a shift from public to private provision.” However, a cautious note was sounded in the report as it points out that National Health Service (NHS) waiting lists had been cut in recent times, and standards improved, both of which could challenge the private sector’s involvement in healthcare delivery. It was also noted that in the area of acute care in particular, which has seen substantial benefits from NHS commissioning, might not see such fruitful times in the future as ‘a clear and secure path to revenue growth is not evident’.The report also found that the independent hospital sector has had to become more competitive and deliver greater cost efficiency in order to comply with NHS-controlled tariffs. In addition, it states, the acute care industry will have to improve its efficiency as pressure mounts from the private medical insurance (PMI) industry as it seeks to deliver cheaper and

more attractive propositions to customers. The PMI industry itself is, continues the report, already very mature, and falling membership numbers over the past five years have encouraged providers to get more creative and competitive in their plan designs.Through the research done for the report, it was discovered that British consumers are somewhat ambivalent in their attitude to the private healthcare market: Key Note’s findings showed that more than 80 per cent of those surveyed are loyal to the NHS and would prefer to use it if quality of care could be guaranteed. However, at the same time, almost 50 per cent admitted they aspired to the privileged treatment enjoyed by private patients. This ambivalence could be an opportunity, say the authors: “The future for the private healthcare industry may be one offering cheaper forms of healthcare and insurance packages which really give patients benefits that the state system is unable to provide.”In related news, Norwich Union Healthcare (NUH) has welcomed the publication of research by the Institute of Public Policy Research that shows the private sector plays ‘a vital role’ in the UK healthcare system. Commenting on the research, Dr Doug Wright, head of clinical governance at NUH, said: “This research shows how valuable the private sector is to the UK’s healthcare system. NUH believes that the best interests of all patients come first and that building greater flexibility into the system will help provide this.”

Wockhardt Hospital in Bangalore has received accreditation from the Joint Commission International (JCI), signifying the second accreditation for the group of hospitals. The facility only recently opened, with 400 beds, and offers multispecialty care.Dr Paul Chang, managing director of the Asia Pacific region for the JCI, told reporters that seven other organisations in India are also in various stages of the accreditation process and that the JCI is planning an increased focus on the whole Asia Pacific region. He explained: “We believe that there is great demand for meeting international standards of performance, [due to] the growing stratum of Indian society that places emphasis on the quality of all services it receives, including healthcare. Whereas this group will pay attention to the ‘award’ of accreditation now, eventually, it will actually demand the kind of organisational transformation that only a seasoned leader in international accreditation, such as JCI, can assist a hospital in accomplishing.”Undeniably, the JCI has an excellent, world-recognised reputation, but its costs are high, which is why some hospitals in Asia have opted for recognition through such organisations as the Trent Accreditation Scheme, Accreditation Canada International and ACHS International.Meanwhile, in related news, the Al Ain branch of the Al Noor Hospital in Abu Dhabi has achieved JCI status – the 14th hospital in the region to do so.

Ireland’s Supreme Court has overturned an earlier legal verdict that stated Bupa was wrong to challenge the country’s controversial risk equalisation scheme. The Supreme Court has now ruled that the High Court should not have rejected the British insurer’s challenge to the scheme, by which system insurers must pay into a fund that effectively compensates Vhi Healthcare for its large proportion of older customers. The most recent turnaround comes after Bupa lost a similar appeal in the European courts earlier this year.Fergus Kee, Bupa Health Insurance managing director, said that although the legal team had yet to study the ruling in detail, he was ‘pleased with it’, adding: “Bupa left Ireland with great regret. We have developed wonderful relationships with our customers and we had a world-class team. We had no option but to leave at that time, given the scale of the mounting risk equalisation liabilities.”Jimmy Tolan, chief executive of Vhi Healthcare, was understandably less positive about the development:

“Today’s decision may have serious consequences for older and chronically ill members of society and it is our goal to try and ensure that private health

insurance can continue to be purchased on acceptable terms by our medically vulnerable customers.”Hibernian Health, meanwhile, has said it ‘strongly welcomes’ the ruling by the Supreme Court. Dick O’Driscoll, managing director, said: “[The] ruling is great news for the health insurance market and consumers. Our message to all health insurance consumers remains the same – Hibernian Health is committed to driving innovation and value in the market for all consumers.” He added that the firm will continue to develop products and benefits that suit people of all ages, but also said ‘there is a clear need to now review the other single largest hindrance to competition in the market, which is the dominance and regulation of Vhi’.

Corporate companies in India are said to be cutting, and in some cases removing completely, health insurance cover for their employees after sharp rises in premiums, which have pushed up costs. In particular, it has been noted that IT companies, which traditionally offer excellent health cover as an incentive, are now cutting costs through either the introduction of co-payment schemes, the removal of cover for some family members of the employed person, or by simply stopping cover altogether.VG Dhanasekaran, vice-president and regional head of India Insure Risk Management & Insurance Broking Services Ltd, said of the issue: “IT companies are reacting to the twin but unrelated threats of business recession and increases in health insurance premium rates by tweaking benefits and coverage. BPOs, for instance, where traditionally attrition has been high, are cutting down on coverage for parents. Some have either reduced overall limits or brought in sub-limits within the overall floater limit for patients.”The restrictions on claims by patients have been made after a surge in the number and average cost of such claims. Girish Rao, managing director of Swiss Re Healthcare Services, commented: “The overall claims ratio in the corporate group health portfolio is high – up to 150 per cent. Around 60 per cent of the claims in this segment come from parents of employees. So, the cover is either being spun out of the scope of coverage or co-payment has been put in.”Since free pricing was introduced in India, insurance companies have raised rates on their group health policies regularly as they are no longer required to cross-subsidise it against more profitable corporate property insurance policies. However, in the last six months, premiums for group health insurance have risen by between 25 and 40 per cent, yet the cost of claims continues to outrun the premiums charged. Despite these figures, it seems some Indian insurers will insure corporate accounts, if it’s the right name, whatever the cost. One insurer accepted a renewal of health cover by a leading IT company for Rs250 million, in spite of it paying out claims of around Rs350 million the previous year.

Emergency talks for Southern CrossBritain’s largest care home operator Southern Cross has been forced to start emergency talks with its banks after failing to meet a £46-million loan repayment deadline. The heavily indebted group says that is has been unable to pay back loans that have funded a rash of purchases in recent months, following its failure to sell a number of other properties.Eyebrows have been raised in the industry about the group’s pursuit of a debt-fuelled acquisition programme in the current economic climate, and many wondered how long it would last. Indeed, so it seems, did the management of Southern Cross, who shared personal windfalls to the tune of £36.3 million from share sales last December. Chief

executive Philip Scott and then finance director Graham Sizer were the biggest beneficiaries, both of whom left the group just weeks afterwards.In July, Southern Cross issued a profits warning, blaming tighter local authority spending for a period of disappointing occupancy rates, although it also admitted the levels could have been affected by a number

of unexpected deaths in its homes for the elderly. As a result of such falling levels, top-line operating profit for the year to 30 September is ‘unlikely to exceed £80 million’, according to new finance director Richard Midmer, which fails to reach city forecasts of £88 million. Between September last year and March this year, the group borrowed £82 million to fund a series of acquisitions, planning to repay the debt by selling and leasing back the underlying property assets. Chief executive Bill Colvin said: “We have been caught by the credit market situation and the commercial property market situation. Yes, I made a mistake by buying Portland [a £42-million buyout of seven care homes in north-east England] earlier this year.”

Consumers seek more help from insurersA recent article by consulting firm McKinsey states that most consumers stick to health insurance products that they know, preferring not to shop around for cover due to the fact that they find most of the available information too confusing and difficult to navigate. The portrait painted of a confused consumer emerged from a survey in 2007 of around 3,000 Americans who had the option of choosing a health insurer. The survey sought to learn about consumer concerns, perceptions and purchasing behaviour with regards to health insurance. In the study, it was discovered that 74 per cent of respondents would consider purchasing an individual plan from their current health insurer in the future. However, recommendations from other people, as well as brand recognition, were also significant in driving people’s choices. One-third of those who took part in the survey said they would only consider familiar health insurers when they made a recent health insurance decision, and 38 per cent compared just two plans.The survey also found that in general, consumers were interested not only in stand-alone, traditional health insurance, but also in a range of other financial add-ons, such as health-focused savings accounts or annuities. However, it was highlighted that when choosing between such products, consumers need more information, advice and guidance to help them to understand which one is the most appropriate for them. It is also worth noting that individual consumers are of equal, if not more, importance than groups, says McKinsey; individual customers represent a market where revenue growth and profit margins are 2.5 and 1.5 times higher, respectively, than those of the more traditional, group plans. Insurers are advised, therefore, that in order to win the business of these retail consumers, they must listen to them carefully and provide better support in the buying process.

UK-based Chartwell Group, the independent financial advisor and brokerage firm, has launched Chartwell Healthcare, a service that will advise both individuals and companies how to protect their most valuable asset – their health. Gary Noble has been chosen to head the 10-strong team of healthcare advisers, although it is predicted by the firm that the team will grow to around 30 members by the end of this year.Noble said of the new business: “Our proposition is based on top-level service. We will take the time to understand our clients’ needs and budgets to create a tailored plan, reviewed regularly to take changing

circumstances into account. Being part of the Chartwell Group means that we can service the well-being of clients as part of their holistic financial planning and I am thrilled to be establishing Chartwell Healthcare.”

Chartwell Group launches initiative

www.itij.co.uk

GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS 35

Aetna establishes Shanghai officeEU Directive to boost medical tourismAetna has announced it has taken the first steps towards entering the health insurance market in China after the establishment of its first office in

Shanghai – the first step in a two-year process required before foreign insurers can apply for a licence in the country. It has been four months since Aetna Global Benefits (AGB), Aetna’s international division, received approval from the

China Insurance Regulatory Commission to establish the office. As the next two years pass, Aetna says it will conduct increasingly detailed research into the marketplace and explore ‘strategic development options’ in order to determine what the Chinese market is currently lacking, and move to fill the gaps it finds.Martha Temple, president of AGB, said: “Aetna’s exploration of the Chinese market represents our commitment to follow our customers and their employees into critical markets around the globe and across all borders. We believe we can help multi-national employers expanding to the Far East, as well as Chinese-based companies, by leveraging our local knowledge and our global approach to effectively manage healthcare quality and cost.”

The European Union (EU) proposal for a directive on patients’ rights in cross-border healthcare provides an added stimulus to the already growing number of medical tourists who seek hospital treatment elsewhere in the EU, according to Treatment Abroad, an online provider of medical tourism information services. The directive will create a formal framework for the cross-border system, removing obstacles for patients that wish to travel to other European countries for treatment. Under the new rules and in certain circumstances, British patients will be able to travel to other EU countries for treatment and reclaim the basic cost from the National Health Service, although they will have to pay for their own travel and accommodation arrangements, plus any top-up fees if the foreign hospital costs more than the NHS would have.The directive also proposes common principles in terms of guaranteeing patient safety, ensuring quality and continuity of care; stimulating greater European cooperation on healthcare, including the establishment of ‘European Reference Networks’, which would create a concentration of expertise, training and resources for

specific diseases and health issues; the establishment of a European network for the assessment of new technologies and the establishment of standards for e-health, in particular the transfer of patient data.Treatment Abroad’s Keith Pollard was fulsome in his praise of the proposal: “This directive is the first stop to creating a truly European market in healthcare; it could revolutionise the way we experience healthcare in [the UK] and throughout the rest of Europe. It’s very good news for the fast-developing medical tourism industry.”

IBM puts onus on providersIT firm IBM recently released its latest study, entitled Healthcare 2015 and care delivery: Delivery models refined, competencies defined. In the research, the firm has called on US and international healthcare systems to collaborate in achieving milestones such as defining, measuring and delivering healthcare value. The report details the issues that are driving up the cost of healthcare – including globalisation, changing demographics and lifestyles, diseases that are more expensive to treat and an absence of information systems – and states that the only cure for sorting out the world’s healthcare delivery model is a ‘fundamental transformation of healthcare’. In the near term, the report was fairly damning in reference to small changes that are already taking place, saying that such adjustments are hindering long-term alterations.Jim Adams, executive director of the IBM Centre for Healthcare Management, said in the study: “Historically, care delivery organisations (CDOs) could declare broad and abstract targets or even attempt to be ‘all thing to all citizens’ and compete effectively. But in the future, we believe it will be harder to maintain an undifferentiated service delivery model, whether it be a public or private healthcare system model.” Instead, he continued, the increasing focus on value, the rising need for responsible citizens and the changing requirements of health promotion and care delivery will force many CDOs to adopt and develop service delivery models with a new and sharper strategic focus.IBM’s report noted that most CDOs already fit into one or more of four generic service delivery models: community health network, centres of excellence, medical concierges and price leaders. However, the firm has predicted that as demand on care providers shifts, so the models for promoting health and delivering care will follow suit. CDOs and clinicians must, says IBM, develop and improve a set of underlying competencies to successfully implement new service delivery models: empowering and activating consumer citizens; collaborating and integrating; innovating; optimising operational efficiencies and IT.Dan Pelino, general manager of IBM’s Global Healthcare and Life Sciences Industry, commented: “Status quo is not an option for healthcare systems in the US and many other countries. Ultimately, the transformation of healthcare systems will require commitment and follow-through on co-ordinated, collaborative efforts among key stakeholders, particularly CDOs and clinicians at the epicentre of efforts to create more value-focused healthcare.”

International Travel Insurance Journal

36 privatehealthcarenews

Aetna announces new positions

Jelf strengthens team after purchase

Aon chooses business leader

US health insurer Aetna has announced that Eileen Auen is to join the company as the new head of healthcare delivery, medial management and geographic development. In this role, Eileen will be responsible for enhancing the firm’s competitive position through targeted network development activities, the implementation of new medical management and reporting capabilities and collaborating across customer segments to drive growth in the business.Mark Bertolini, president of Aetna, said: “Eileen’s extensive background in the healthcare industry will help us drive an effective regional growth strategy that meets specific market needs and enhances profitability of our business. She will be a fantastic addition to what is already a strong management team.”Aetna has also announced changes to its Health Care Management organisation’s leadership team, which, says the company, are designed ‘to further enhance relationships with healthcare providers, expand quality improvement programmes and intensify the organisation’s ability to meet market-level healthcare needs. Three new roles have been created for these purposes, in which Robert (RJ) Franzoi has been named head of regional healthcare management, Allen Karp has

been chosen as head of network strategy and Jay Kreuger will join the group as head of strategic planning and geographic development. All three employees will report directly to Eileen Auen.Speaking at the announcement, Auen commented: “I am pleased to have RJ, Allen and Jay in these leadership positions. They have exceptional skill and experience in identifying customer needs – including those of physicians, members and plan sponsors – and developing collaborative, effective services, products and programmes in response.”In his new role, RJ is responsible for guiding provider networks and relationships, developing quality improvement and member care programmes and overseeing compliance activities though the firm’s regional healthcare management organisations. Meanwhile, Allen will have the responsibility of leading the development of new physician and provider network models in order to increase access to cost-effective healthcare for Aetna’s customers. Jay Kreuger will oversee strategy and planning in the areas of network management, care management and informatics/reporting. He will also work with local market teams to identify and address market-level healthcare needs.

The Jelf Group has appointed Mark Nevitt as director to manage the integration of the newly acquired Clarke Roxburgh business into the Group. Formerly of Lockton, Mark will also be responsible for leading development and delivery of the 2008/2009 business plan for the new subsidiary, which continues to trade under its own brand name across the West Midlands area of England.Mark brings with him 28 years of experience within the spectrum of regional and national

insurance broking. In addition to his business management and leadership skills, he also brings to the table particular expertise in leading change and delivering improved performance across the disciplines of sales, customer service and claims.Alex Always, group chief executive of Jelf, said: “Mark is a valuable addition to the Jelf team, bringing considerable knowledge of the industry sector and a very strong track record. I am sure that his contribution both to the

integration of the Clarke Roxburgh business and its future development will be significant.”

Aon Consulting Worldwide, the global human capital consulting organisation of Aon Corporation, has announced that Mike Matsumoto has joined the New York office as senior vice-president and Japanese business leader for the US Health and Benefits practice. In this new position, Mike is responsible for developing health and benefits business with the US subsidiaries of Japan-based multinational organisations.Mike joins Aon from Konica-Minolta Holdings USA, where he held the positions of president and CEO. During his tenure there, he was

responsible for various corporate services, including directing the insurance consolidation and employee benefits cost reduction strategies for Konica-Minolta subsidiaries around the world.John Zern, US Health and Benefits practice director, said of the appointment: “Bringing Mike on board is further proof of our commitment to emerging markets such as Japan. Mike’s experience and leadership will help to bolster

our health and benefits services and our ability to deliver distinctive client value in this country.”

Dr. Colin Plotkin Consulting

27-3088 Francis Road, Richmond, British Columbia, CANADA V7C 5V9

Tel: +1 604 241 9677Facsimile: +1 604 241 0733

Web: www.plotkinconsulting.com email: colin@plotkinconsulting.com

privatehospitals

Portugal

Rua 25 de Abril, 12 Vila da Luz, 8600-174, LGS, Portugal

Web: www.luzdoc.come-mail: info@luzdoc.comTel: +351 282 780 700

Facsimile: +351 282 780 709specialiTy: General Medical

Spain

Medical CenterVirginia Villanueva de Pedro

Medical Director

Web: www.caribeasistencia.com/cmcbwww.centromedicocaribecancun.com

e-mail: vvilla@mapfre.comTel: +00 34 91 581 6707

specialiTy: Primary Care Attention

Thailand

Bangkok International Hospital. 2, Soi Soonvijai 7, New Petchburi Rd,

Bangkok 10320 THAILAND

Web: www.bangkokhospital.come-mail: jane@bgh.co.thTel: +66 2 310 3000

Facsimile: +66 2 310 3105specialiTy: general medical

8940 North Kendall Drive, Suite 601-E, Miami, FL 33176

Web: www.baptisthealth.net/internationalemail: international@baptisthealth.net

Tel: +1 786 596 2373Facsimile: +1 786 596 5979specialiTy: General Health

United States

Jackson Memorial Hospital International Jackson Medical Towers, East Tower, Suite 829, 1500 NW 12th Avenue,

Miami, FL 33136 - 9998 USA

Web: www.jmhi.org e-mail: info@jmhi.org

24hr Tel: +1 305 355 1212 Tel: +1 305 355 5544

Facsimile: +1 305 355 5545

Private Bag X5, Benmore Gardens 2010, Johannesburg, SoUTH AFRICA

Tel: +27 11 245 5777Facsimile: +27 11 783 9277

Web: www.aims.org.zae-mail: contact@aims.org.za

costcontainment

Jeffrey Baker – President390 Rabro Drive, Hauppauge,

NY11788 USA

e-mail: jbaker@medsaveusa.com Web: www.medsaveusa.com

Tel: +1 516 622 1784 Facsimile: +1 516 294 6761

Gigi Galen – President850 7th Avenue, Suite 803

New York, 10019 USA

e-mail: ggontheroad@aol.com Web: www.starhealthcarenet.com

Tel: +1 212 581 8228 Facsimile: +1 212 581 8272

healthcareinsurance

1st Flr Suite, West Hs, 46 High St, orpington, Kent, BR6 0JQ, UK

Web: www.travelandmedical.co.uke-mail: sales@travelandmedical.co.uk

Tel: +44 845 058 8000Facsimile: +44 845 053 3000

1099 N.W. 14th StreetMiami, Florida, USA

Web: www.uhealthinternational.comTel: +1 305 243 9100

Facsimile: +1 305 243 9101

privatehospitalsOn tHE MOvE

Mike Matsumoto

Mark Nevitt

www.itij.co.uk

GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS 37

Humana to acquire Metcare Health Plans

US-based BasicPlus Health Insurance has entered into an agreement with Companion Global Healthcare Inc. to include a network of accredited, overseas hospitals in its most popular limited benefit health insurance plans. Customers currently enrolled in BasicPlus FlexMed through their employer, or BasicPlus for individuals now have the option of being treated at many of the hospitals offered by Companion’s network. Members that decide to go for treatment or medical procedures overseas will receive help throughout the course of treatment, including concierge medical travel services and follow-up care in the US.Chuck Green, chief executive of BasicPlus, said the new deal brought great benefits for customers: “Since our members have fixed benefit maximums, the inclusion of Companion Global Healthcare’s option into our products allows members to limit their out-of-pocket payments while availing themselves of JCI-accredited hospitals in foreign locations. The new global benefit is a way to entice employers that have more than 100 employees but cannot afford comprehensive plans.”

US-based Humana Inc. has announced that it has signed a definitive agreement to purchase Metcare Health Plans, Inc. (MHP), a wholly owned subsidiary of Metropolitan Health Networks, Inc. in a deal estimated to be worth $14 million. The transaction will be finalised subject to regulatory approvals from the Florida Office of Insurance Regulation and the Centers for Medicare and Medicaid Services.Industry observers say that as a result of the deal, Humana will increase its Medicare Advantage

membership by approximately 7,000 members in Florida. Michael Seltzer, Humana Florida senior products CEO, commented: “We are very excited about the purchase of MHP, as it will enhance Humana’s mission to provide Medicare beneficiaries broad access to affordable healthcare in Florida. The MHP leadership team also brings Humana management expertise and expanded market presence in several Florida counties, greatly complementing Humana’s existing Florida operations.”

National Deposit is building on the success of its individual private medical insurance plan by offering a new scheme that has been designed for small to medium-sized companies. Called the Group Healthcare Deposit Account, it offers companies who employ between two and 250 staff an alternative

to traditional forms of corporate PMI.New features of the policy include premiums that are fixed for life for employees, with any changes

being the decision of the employer. As part of the scheme, the employee also has the chance to build up an asset, as half of each monthly premium goes into an employee’s personal deposit account, which builds up over time and from which they must fund 10 per cent of any claim they make. In addition, the personal deposit account can be transferred if an employee leaves the company.The policy offers cover for a comprehensive range of medical treatments including surgical operations, consultations, cancer treatment, heart surgery, diagnostic intervention and physiotherapy. There is also an unrestricted choice of private hospitals and treatment locations on offer, as well as the option of using the National Health Service.

Thought to be a first for the industry, AXA PPP in the UK has announced the launch of its First Healthcare plan, which is available for children up to the age of 18. At the moment, children can get private medical insurance through family policies or they can have an adult policy taken out for them, but there are not thought to be any policies on the market that have been designed and priced specifically for children.The plan covers consultations with specialists, out-patient tests and scans to establish early diagnosis, and will also pay for private hospital treatment if a child cannot be seen through the National Health Service within six weeks of needing treatment. Additional features just for children include covering the cost of accommodation for parents if they need to stay near a child under the age of 11 overnight as well as access to a 24-hour helpline staffed by healthcare professionals.Geoff Salter, head of product management at AXA PPP Healthcare, said: “First Healthcare is for people who may not be able to afford private healthcare cover for their whole family but who want to make sure their children are covered.”

COMPAny BrIEf

BasicPlus ties with Companion Global

new account offered by national Deposit

roxon making waves in AustraliaThe Australian Medical Students’ Association has welcomed the call by Federal Health Minister Nicola Roxon to expand training of the medical workforce into the private hospital system.Michael Bonning, president of the association, said that private hospitals must be used for training both students and junior doctors: “With the increasing number of medical students, traditional teaching settings are being stretched to the limit of their capacity. With a growing number of conditions being managed almost exclusively in the private system, we need to make use of private hospitals for medical student teaching so that we can continue to graduate comprehensively trained doctors.” He warned that such a move would require ‘ongoing government funding and the full support of hospital administrators and staff’. He also pointed out that private patients would be asked if they minded a student being present or carrying out an examination.Elsewhere, Nicola Roxon has been making waves among private health insurers, after warning them against citing her move to lift thresholds on the Medicare surcharge levy as a reason to demand

government approval for increased insurance premiums. The minister,

whose responsibilities include approving fee increases for health insurers each year, told The Australian newspaper: “I will take an extremely dim view of them using this as some reason to ramp up their premiums.” She added that the real task facing insurers, as far as she

was concerned, was to make their products better value for

consumers.

AXA launches kids policy

GlobalSelect China launchedInternational Medical Group (IMG) has announced the launch of Ping An GlobalSelect International Healthcare, a plan that has been modelled on IMG’s original GlobalSelect plan and modified for the Chinese marketplace. The product is now available for distribution through insurance brokers in China and has received full approval from the China Insurance Regulatory Commission. In developing the product, IMG teamed with Ping An Insurance.Carl Carter, managing director of IMG Europe Ltd, said the new offering is one of the most flexible plans available in the region. He continued: “Because this product can cover expatriate and local nationals who are internationally mobile, this makes it unique in the market. We have taken innovative features of our GlobalSelect product, fine-tuned them for the Chinese market and support them with multi-lingual customer service and medical provider networks.”Joe Brougher, president of the firm, added: “We have

worked closely with Ping An in the development of this unique product, and are pleased with the relationship we have with them. Having a major national insurer means both IMG and Ping An’s mutual broker networks can offer fully approved medical coverage throughout China and beyond.”The GlobalSelect plan contains four sub-plans, each offering a different choice of benefits. It is available to individuals, families and corporate groups of two or more employees who live, work or travel worldwide. In addition, the plan offers cover for expatriates and internationally travelling locals seeking cover. What’s

more, unlike many other plans, after a two-year period has expired, declared and accepted pre-existing conditions can also be covered.Mr Wupeng, general manager of Ping An P&C Insurance Company, said: “There is considerable demand for this type of product in China. We chose to work with IMG because it’s a recognised leader in this field and its philosophy of providing superior coverage and customer service was an excellent fit with our own similar corporate values.”

Dutch take coveted top spot in global surveyIn a poll about healthcare in 10 developed countries, it has been revealed that Americans are the least satisfied with their healthcare system, while the Dutch are very happy with theirs. The poll, conducted by Harris Interactive, aimed to show a range of opinions about which systems are the best.It was clear that healthcare consumers in the US are demanding change – one third of those polled believe the system needs a complete re-design, while a further 50 per cent feel that fundamental

changes must be made. George Terhanian, president of Harris, told Reuters: “Given that all countries other than the US have universal healthcare systems in place, this may invite questions on why the US remains the only wealthy, industrialised country without such a system.” At the other end of the scale, a mere nine per cent of Dutch people think an overhaul of the system is necessary, compared to 12 per cent in Canada and Spain, 15 per cent in Britain and France, 17 per cent in

Germany and New Zealand, 18 per cent in Australia and 20 per cent in Italy. The Harris survey also showed that 70 per cent of the French and 59 per cent of the British public think their health services are ‘the envy of the world’. Terhanian pointed out that the research has demonstrated ‘it is by no means clear through these surveys that universal healthcare systems represent the so-called magic pill’.

NEWSWIREUS private equity firm Formation Capital LLC has agreed an $85 million deal to acquire Haven Healthcare, the financially troubled operator of more than 24 nursing homes in New England. Genesis HealthCare of Pennsylvania will manage and operate the homes on behalf of Formation.

The Blackstone Group has offered to buy Apria Healthcare Group Inc. in a deal said to be worth $921.9 million, offering a sizeable premium on the home healthcare company’s falling shares.

Private equity firm Advent International is said to be on the verge of entering exclusive discussions to buy UK-based Craegmoor Healthcare for around £300 million. Craegmoor operates nursing and care homes for those suffering from mental disabilities.

Healthcare leaders from more than 20 countries attended the Joint Commission International’s second Advanced Practicum for Accreditation, Quality Improvement and Patient Safety in Chicago recently. Experts discussed key issues and delegates had the opportunity to visit accredited hospitals.

KPC Healthcare Services has finalised its plans to set up an integrated healthcare city in West Bengal. The proposed venture will come up beside its private medical college in Kolkata.

Cathay Century Insurance and Fubon Insurance have received the go-ahead from the Taiwanese Financial Supervisory Commission (FSC) to sell health insurance. The FSC said the move will enable Taiwanese consumers to buy less expensive policies.

International Travel Insurance Journal

phn feature38

The fact we even have such a word as ‘nosocomial’, which means a disorder associated with being treated in a hospital,

is a cruel paradox, but the reality is that there is risk in seeking cure even though healthcare providers attempt, as best they can, to ‘at least, do no harm’. Hospital patients throughout the world are becoming imperiled by staff expected to do more, see more patients, deal with unfamiliar ailments of unknown origin, and keep up with technologies and procedures that seem to morph into obsolescence every decade.Sir Liam Donaldson, chairman of the World Health Organization (WHO) World Alliance for Patient Safety (an international consortium convened to improve hospital safety standards worldwide), asserts: “No healthcare knowledge is more important than how to prevent harm to patients… However, action to reduce known risks has often been far too slow.”

Waging warRecently, the headlines have all been about pandemics of assorted exotic varieties skipping from continent to continent. Yet right in our very hospitals, we are waging war not only against lethal infections such as MRSA, C.difficile and drug-resistant pneumonias and tuberculosis, but against deteriorating service levels and increasing dangers caused by such basic failings as dirty premises, substandard hygiene, unanswered calls for assistance, unaided bathroom falls and fractures, medication errors, surgical mischance (leaving instruments in patients), amputating the wrong foot, operating on the wrong patient, misdiagnoses, misdirecting patients, postoperative infection … and the list goes on.Karen Timmons, CEO of the US-based Joint

Commission International (JCI), which inspects and accredits hospitals and other healthcare facilities around the world, admits that ‘patient safety is a challenge facing nations in all regions of the world’. And, ironically, this happens nowhere more keenly than in the developed countries – those who spend the most on healthcare.According to a recent international survey conducted by the US-based Commonwealth Fund – which is heavily invested in health policy, health reform and performance improvement – American hospitals ranked last in three of six questions about quality of care asked of chronic or intensive care patients in six nations. The survey revealed that American patients were: more likely to report a recent medication mistake than patients in New Zealand, the UK and Germany; more likely to report that they had been given incorrect diagnostic or lab test results or experienced delays in being notified about abnormal test results than did patients in all five comparison countries; more likely to report that they acquired an infection in hospital than were patients in Germany (the best performing country in this question category); more likely to report that their doctor only sometimes, rarely or never reviewed their medications than patients in Germany (again the best performing country); more likely to report that their doctor sometimes, rarely or never explained the side-effects of medication than patients in Australia, Canada and New Zealand; more likely to report that no one discussed what medications they were using than patients in Australia and Germany. In that survey, no country consistently achieved better performance than all others, and some that were at the top in one category sat at the bottom in others. Solace for none.Results such as these prompted the Commonwealth Fund, in concert with the WHO Collaborating

Centre on Patient Safety, and the World Alliance for Patient Safety, to initiate a seven-country collaborative project that will leverage the implementation of five standardised patient safety solutions to prevent avoidable catastrophic events in hospitals. Known as the ‘High 5s’, the project involves participation by Australia, Canada, New Zealand, the UK, the US, Germany and the Netherlands.

Interestingly, when a healthcare quality assessment group in the US, HealthGrades, recently analysed the performance of hospitals using 13 key patient safety indicators (PSIs), it found that hospital-acquired infections correlated particularly well with overall PSI scores, and that infection rates could be used as a proxy for overall hospital patient safety. It seemed to reflect ‘a culture of safety’ in given hospitals and it showed also that hospital-acquired infections accounted for almost 30 per cent of the total excess cost related to patient safety incidents. The conclusion – find a hospital with high rates of MRSA or C.difficile or other infectious galaxies and you’re likely to find other safety hazards.

Invasion of the superbugsTo read the world’s mainstream media headlines, one would think that MRSA (methicillin resistant Staphylococcus aureus, sometimes known as multiple antibiotic resistant s. aureus) arrived with the recent post. But it, like the staph aureus with which it is linked, and infectious diseases like C.difficile, or

even the omnipresent noroviruses, have plagued hospitals worldwide for years.The US Centers for Disease Control and Prevention estimates that people get infections while in American hospitals, nursing homes or other healthcare facilities 1.7 million times each year and 99,000 people die from them. And just recently, an article in the Journal of the American Medical Association reported that MRSA (which was first reported in 1961) itself killed an estimated 19,000 Americans in 2005 – 85 per cent of them infected in hospitals. The situation is no better, and possibly worse, in other countries where MRSA is thought to be endemic and is present in up to 60 per cent of s. aureus infections.According to Eurosurveillance Weekly, Staphylococcus aureus is the commonest cause of bacteraemia (bacterial blood infection) and is one of the top three causes of hospital-acquired infections. Vulnerability to MRSA colonisation (on the skin and in the nose and other locations on and in the body) and the risk of infection increases with the duration of hospital stay, exposure to intensive care, previous antibiotic treatment and previous stay in another hospital where MRSA was present. Surgical wounds and catheters provide easy entry points for staphylococci and local standards of hygiene also affect risk. Though some effective antibiotics still exist to conquer such infection, between 10 per cent and 50 per cent of patients with staphylococcal septicaemia still die. A European Commission research project which involved Britain’s Health Protection Agency showed that out of approximately 300 European hospitals studied between 2002 and 2005, those in southern and western Europe had the highest levels of MRSA, and those with the highest MRSA prevalence also had the greatest levels of antibiotic use. Recent research released in the UK showed a 72-per-cent increase

Going into hospital sick and coming out sicker is not the result any of us expect in this age of medical marvels. But it’s happening all too often, and few countries are being spared the effects of hospital-borne accidents, mistakes, oversights, acts of negligence, or the growing scourge of drug-resistant infections. Milan Korcok reports

Hospital safety: is it out of reach?

patient safety is a challenge facing nations in all regions of the world

www.itij.co.uk

39 phn feature

in deaths linked to C.difficile in 2006, compared to figures from 2005. The report, compiled by the Office of National Statistics, said the infection was mentioned on 6,480 death certificates in England and Wales in 2006, a huge rise from 3,757 in 2005. More than half of the 6,480 certificates registered C.difficile as the underlying cause of death and the rest noted it as a significant factor. The figures also showed that C.difficile-associated deaths were nearly four times more likely than deaths from MRSA, the figure for which fell slightly in 2006, having risen steadily for the past 10 years. The government’s Healthcare Commission called the figures ‘disturbing’, but added that they reflected recent measures taken by hospitals to combat superbugs.Brian Duerden, chief microbiologist at the Department of Health, said the increase in the number of death certificates citing C.difficile could actually be the result of more accurate medical records: “The chief medical officer wrote to the National Health Service in July 2005 to make clear that we wanted infections such as MRSA and C.difficile to be reported more accurately on death certificates. These statistics from 2006 show that this move has worked.”The European Union’s Centre for Disease Prevention and Control (ECDC) also recently reported that the spread of hospital-acquired infections was now the main disease threat in Europe, despite continuing concerns over tuberculosis and HIV. The US CDC too has warned that deaths from hospital-acquired infections such as MRSA now exceed deaths from HIV.On the other hand, it also showed that those hospitals that took aggressive, early action to prevent MRSA, earned the cleanest records. And for that, the Dutch have set the standard, although the Danes and the Finns, who have also routinely employed aggressive screening measures have been extremely successful at containing the spread of MRSA. (Denmark’s MRSA prevalence, 33 per cent in the 1960s, now remains below one percent). By contrast, MRSA rates in hospitals in bordering countries Germany and France are considerably higher than in the Netherlands. According to the European Society of Clinical Microbiology and Infectious Diseases, the rate of MRSA infection in Germany increased from two per cent in 1990 to 23 per cent in 2003, and in France stood at 33 per cent in 2002, in Italy and Portugal 38 per cent, and the UK and Greece 44 per cent. These percentages refer to the levels of MRSA as a proportion of all bloodstream infections.According to a recent report from the European Union’s Centre for Disease Prevention and Control,

the infection rates by superbugs in British hospitals are only slightly worse than Slovakia, Hungary, Poland and the Czech Republic, and better only than Portugal, Malta, Cyprus and Romania. In October 2007, the UK’s Healthcare Commission released figures showing that about a quarter of primary care trusts and acute hospital units in London and the Southeast were failing in their attempts to contain superbug infections and their vectors of infection were mostly dirty wards and inadequate sterilisation of equipment.

Search and destroyWriting in the journal European Hospital, Dr Jan Kluytmans, professor of medical microbiology and infection control at the Vrije Universiteit Medical Centre in Amsterdam, notes that for many years, the Netherlands has had a very low incidence (less than one per cent) of MRSA despite a high incidence in surrounding countries. Dr Kluytmans notes that to achieve their admirably low levels, the Dutch have since the 1980s acidulously clung to a tough ‘search and destroy’ (S&D) strategy relying on early recognition of carriers of MRSA, their immediate isolation, eradication of means of transmission, and a zero-tolerance approach to potentially infectious conditions in hospitals. S&D requires all patients with MRSA to be isolated in private rooms; all patients transferred from foreign hospitals and suspected MRSA carriers to be screened by taking nose, throat, sputum samples, and isolated if need be; for contact patients and healthcare workers to be routinely screened; and for hospitals to have strict antibiotic control policies to prevent the proliferation of the immunity to the effects of antibiotics that overuse of such drugs over the years has spawned. In country after country, the need to clean up hospitals and get healthcare workers back to believing in the basics of sound hygiene – starting with good hand washing practices – has become a healthcare mantra. But there needs to be more to it than that. Dr Stephanie Dancer of the South General Hospital in Glasgow writes in The Lancet Infectious Diseases that even if everyone washes their hands properly and as often as they should, the risk of infectious transmission remains if the hospital environment is heavily contaminated. Given ‘the propensity for people to pick, touch, or blow their noses, it is not surprising that carriers will often harbour their own strain of s. aureus on their fingers and then pass them on through the various inanimate objects they come in contact with. Dr Dancer cites objects such as ‘computer keyboards, door handles, tourniquets, pens, television sets, stethoscopes, telephones, beds, bedside tables, equipment packaging, paper and

patients’ notes and toys’ as just a few examples.Can hospitals afford to counter-attack such invasions on so broad a scale? Are their finances not already stretched to a breaking point? On the other hand, can they afford not to? The answer appears self-evident in the experience of the Dutch, the Finns and the Danes. And in the US, hospitals in Pennsylvania, Connecticut and Massachusetts that instituted pilot patient screening programmes modelled after the Dutch, found their rates of MRSA infection dropped by up to 90 per cent. At the University of Pittsburg hospital, the screening tests, cleanup of gowns and gloves and other precautions cost that hospital only $35,000 a year, while it saved more than a projected $800,000 to cover the cost of infection once established.In a recent interview in the publication Scientific American, Dr Richard Shannon, chairman of the Department of Medicine at the University of Pennsylvania was asked about his successful campaign to reduce infections in intensive care. He said: “We took the Toyota production system and applied it to placement and maintenance of catheter insertions.” The approach was later extended to ventilator insertions. He said that after developing standardised procedures for everything from putting on a hospital gown and cap to washing hands to actually placing the catheter, ‘we trained people and observed them’ instead of just handing out a document with instructions. Leadership, said Dr Shannon, was the key. “(And) this will never occur, until a senior person says, ‘I’ve had enough’.”

MRSA itself killed an estimated 19,000 Americans in 2005

The US CDC too has warned that deaths from hospital-acquired infections such as MRSA now

exceed deaths from HIV

influx of immigrants, has put the country at the forefront for investment in the private healthcare sector.“The Spanish health system is under pressure on two fronts,” said Masfurroll, “For a start, life expectancy is high, so there is more demand from an ageing population. Then, you have the fact that the population of Spain has grown by around seven million people in the last 10 years.”Masfurroll founded USP in 1998 and by the end of that year, the company was managing four hospitals – it now has 37, with revenues of up to €280 million suggesting just how much potential there is in the marketplace. Private equity giant Cinven has also got in on the Spanish act with a €675-million investment in Mercapital last year. The deal gave Cinven 65 per cent of the capital, leaving management with 25 per cent, and 10 per cent in the hands of Caixa Geral de Depósitos of Portugal, where USP has a joint venture.Simon Rowlands, a partner with Cinven, described Spain as ‘one of Europe’s most interesting growth stories in private healthcare at the moment’. He added: “The Spanish national health service is under huge pressure to deliver quality service on time. With waiting lists expanding rapidly there is nothing other than a positive view of private healthcare scheme.”USP Hospitales has also won a tender to operate 13 hospitals in Morocco, and the firm has made it clear that it is ‘scouting the globe’ to seek out other investment opportunities. In particular, Masfurroll said he sees expansion potential in other Mediterranean countries such as Italy, as well as in Eastern Europe.

Healthy outlook for Spanish private providers continued from page 33

The end of balance billing?similar lawsuit with Cedars-Sinai Medical Centre.The law in California regarding the practice of balance billing somewhat murky when compared with other states – New Jersey and Colorado, for instance, require insurers to pay the doctors’ bills in such cases. However, regulators in California appear unsure of what to do. In 2005, regulators fined Health Net $250,000 for underpaying emergency room doctors and other physicians and in 2006, Governor Schwarzenegger ordered them to ban balance billing. The DMHC has spent the past two years trying fruitlessly to negotiate a compromise between the insurers and the hospitals. This spring, the agency decided to outlaw the practice and has since drafted regulations to that effect, but because the regulations aren’t expected to come into play until the autumn, Prime Healthcare is being pursued through the courts.

continued from page 34

International Travel Insurance Journal

40 SERVICEDIRECTORY To have your company listed in the Service Directory email: dave@itij.co.uk

CATEGORY KEY Air Ambulance

Air Ambulance Interior

Aircraft Performance Solutions

Assistance Companies

Catastrophic Claims Specialist

Cost Containment

Claims Management

Claims Subrogation

Commercial Repatriation Specialists

Critical Care Patient Transport

Funeral Directors

Healthcare Clinics

Hospitals

Legal Services

Medical Escort on Commercial Airlines

Medical Provider

Medical Screening

Re-insurance

Travel Agents

Web & Design Services

AFRICA Air Ambulance Network Kirk Pacheco – President

905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com

#210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 Florida 34684 Fax: +1 727 786 0897 USA

AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Wilson Airport emergency@flydoc.org LangataRoad www.amref.org PO Box 18617 Tel: +254 20 600 090

Nairobi Fax: +254 20 344 170 KENYA

European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange alert@air-ambulance.com L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007

Fax: +49 711 7007 7009

JET ICU Bart Gray – President 17076 Helicopter Drive email@jeticu.com Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428

USA Tel: +1 727 524 9825 Fax: +1 727 524 982

Netcare 911 Aeromedical Wayne Thomson - Flight Operations Mgr Netcare 911 House flight@netcare.co.za

49 New Road www.netcare911.co.za Halfway House Tel: +27 11 254 1392 Midrand 1685 Fax: +27 11 254 1405 SoUTH AFRICA

Skyservice Air Ambulance David Ewing – VP Int. Market Development YUL/Trudeau Int Airport david_ewing@skyservice.com 9785 Avenue Ryan www.skyservice.com/airambulance

Montreal (Quebec) N AmericaToll Free: +800 463 3482 H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096

AUSTRALASIAAir Ambulance Network Kirk Pacheco – President

905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com

#210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 Florida 34684 Fax: +1 727 786 0897 USA

Asia Assistance Partners Siriporn Wongurai – Int. Ops. Director 184/235 Forum Tower thailand@aapartners.net 36 Flr Ratchadapisek Rd www.aapartners.net Huaykwang Tel: +662 645 3733-5

Bangkok 10320 Fax: +662 645 3732 THAILAND

Asia Medical Assistance Abhijeet Sachdev – Vice President DLF City-ll privat.airambulance@asiamedassist.org M.G Road www.privathealthcaregroup.com New Delhi Tel: +91 9899 198 198

Gurgaon 122002 Fax: +91 1242 235 2527 INDIA

CareFlight International Colin Robshaw – Co-ordinator Westmead Hospital Campus international@careflight.org PO Box 159 www.careflight.org Westmead Tel: +61 1300 655 855

NSW 2145 Fax: +61 2 4751 2995 AUSTRALIA

European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange alert@air-ambulance.com L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007

Fax: +49 711 7007 7009

Goodmans Rescue 24 Hrs Ground & Air Ambulances Dr Satish K Bhardwaj – Director M-2 Greater Kailash-Part 1 grskb@yahoo.com New Delhi 110048 www.goodmansrescue.com INDIA Tel: +91 11 2923 1665

Mob: +91 98 1001 2126 Fax: +91 11 2923 4665

Hope Ambulance Service Dr Charles Johnson – Medical Director 56 Upavon Road info@hopeambulance.com Singapore 507745 www.hopeambulance.com SINGAPoRE 24hr Tel: +65 6100 1911

Fax: +65 6400 5254

JET ICU Bart Gray – President 17076 Helicopter Drive email@jeticu.com Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428

USA Tel: +1 727 524 9825 Fax: +1 727 524 982

Medical Wings Dr Sommart Somsiri – Medical Director 222 Room 3259 m.w@medicalwings.com

Donmuang Int Airport Moo 10 www.medicalwings.com Viphavadee-Rangsit Rd, Sikan Tel: +662 247 3392 Don Muang, Bangkok 10210 Fax:+662 535 4355 THAILAND

Mediflight Chris Craft – Operations Manager Royal Adelaide Hospital info@mediflight.com.au

North Terrace www.mediflight.com.au Adelaide Tel: +61 8 8378 6938 SA 5000 Fax:+61 8 8423 3077 AUSTRALIA

ozevac Anne Mordey – Operations Manager PO Box 299 info@ozevac.com Hampton www.ozevac.com

Victoria 3188 Tel: +61 409 537 333 AUSTRALIA

Pacific Flight Services Pte Ltd Katherine Yeo – Assistant Marketing Mgr ST Aerospace Engineering Bldg charter_flight@pacific.net.sg

Seletar West Camp www.fly-pfs.com Seletar Airport Tel: +65 6481 3756 797796 Fax: +65 6482 1727 SINGAPoRE

Skyservice Air Ambulance David Ewing – VP Int. Market Development YUL/Trudeau Int Airport david_ewing@skyservice.com 9785 Avenue Ryan www.skyservice.com/airambulance

Montreal (Quebec) N AmericaToll Free: +800 463 3482 H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096

South Pacific Air Ambulance Scotty Watson – Managing Director ops@spaa.co.nz NEW ZEALAND www.spaa.co.nz

AUSTRALIA Tel: +64 9256 9000 SINGAPoRE Fax: +64 9256 9111

EURoPEADAC-Ambulance Service Robert Glueck – Marketing & Sales Director Am Westpark 8 info-ambulance@adac.de 81373 Munich www.adac.de/ambulance GERMANY Tel: +49 89 76 76 52 85 24-h alarm centre:

+49 89 76 76 50 05

AeroMed 365 Brian Brooker – Clinical Director Worth Corner Business Cntr brian.brooker@aeromed365.com

Turners Hill Road www.aeromed365.com Pound Hill Tel: +44 8707 596 999 Crawley RH10 7SL Fax: +44 8707 559599 UK

AIR AMBULANCE (CoNT.) AIR AMBULANCE

www.itij.co.uk

41SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: dave@itij.co.uk

Med Call GmbH Michael Diefenbach – CEO Black and Decker Str. 1-3 info@medcallgmbh.com 65510 www.medcallgmbh.com

Idstein Tel: +49 61 2695 3708-0 GERMANY Fax: +49 61 2695 3708-11

Medic’Air International Dr Herve Raffin – General Manager 35 rue Jules Ferry operations@medic-air.eu 93170 Bagnolet www.medicair.com Paris Tel: +33 141 72 1414 FRANCE Fax: +33 148 57 1010

Medical Jet Services & Partner W Dichtl Radetzkystr 19 office@medicaljetservice.com Vienna www.medicaljetservice.com 1030 Tel: +43 1 600 1212 AUSTRIA Fax: +43 1 713 2799-19

Red Star Aviation Mustafa Atac – CEO Sabiha Gokcen Int Airport redstar@redstar-aviation.com J Blok Kurtkoy www.redstar-aviation.com 34912 Tel: +90 216 588 0216

Istanbul Fax: +90 216 588 0225 TURKEY

Skyservice Air Ambulance David Ewing – VP Int. Market Development YUL/Trudeau Int Airport david_ewing@skyservice.com 9785 Avenue Ryan www.skyservice.com/airambulance

Montreal (Quebec) N AmericaToll Free: +800 463 3482 H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096

Swiss Air Ambulance/REGA Walter Stunzi – PR/Marketing Mgr PO Box 1414 ops@rega.ch Zurich Airport www.rega.ch

CH-8058 Tel: +41 333 333 333 SWITZERLAND Fax: +41 44 654 3590

Tyrol Air Ambulance Jakob Ringler – Managing Director PO Box 81 taa@taa.at A-6026 www.taa.at Innsbruck Airport Tel: +43 512 224 220

AUSTRIA Fax: +43 512 288 888

Air Ambulance Network Kirk Pacheco – President 905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com

Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com

#210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 Florida 34684 Fax: +1 727 786 0897 USA

AirMed International LLC Jeffrey T Tolbert – President 1000 Urban Center Drive mgoodwin@airmed.com Suite 470 www.airmed.com Birmingham Tel: +1 205 443 4840

AL 35242 Fax: +1 205 443 4841 USA Toll Free: +1 877 633 5387

Air Medical Ltd Glenn Salt – Flight Operations Manager Oxford Airport operations@airmed.co.uk Kidlington www.airmed.co.uk Oxfordshire Tel: +44 1865 842 887

OX5 1QX Tel: +44 1865 370 642 UK

Augsburg Air Ambulance Roland Schoberth – Director Roseggerstr 17 info@ambulanzflugdienst.de D-86368 www.ambulanzflugdienst.de Gersthofen Tel: +49 821 299 1020

GERMANY Tel: +49 821 299 2030

EMC Meditrans Servé de Klerk – President Hoevestein 23 info@emc.nl Postbus 4190 www.emc.nl 4900 CD Tel: +31 162 496 000 Oosterhout Fax: +31 8 42 24 64 86

THE NETHERLANDS

Euro-flite Air Ambulance Juhani Missonen – Coordinator Helsinki International Airport juhani.missonen@jetflite.fi PO Box 187 Tel: +358 20510 1900 FIN-01531 Fax: +358 20510 1901

Vantaa FINLAND

European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange alert@air-ambulance.com L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007

Fax: +49 711 7007 7009

FAI – rent-a-jet AG Volker Lemke – Director Sales & Marketing Flughafenstrasse 100 lemke@fai-ag.de D-90268 Nuremberg www.rent-a-jet.de

GERMANY Tel: +49 911 36009 31 Fax: +49 911 36009 59

German Red Cross Air Amb. Serv. Andreas Speich – Managing Director Aufm Hennekamp 71 a.speich@grcairambulance.de 40225 Düsseldorf www.grcairambulance.de

GERMANY Tel: +49 211 917 49911 NEW

24 hr Alarm: +49 228 230 023 Fax: +49 211 917 49921

Global Medical Support otto Karud – Marketing Director Ullevaal University Hospital gms@snla.no 0407 Oslo www.globalmedicalsupport.com NoRWAY Tel: +47 22 96 50 50

Tel/Fax: +47 22 96 50 51

IFRA Dr Christian Steindl – Director Bahnhofplatz 13/5 office@ifra.at POB 160 www.ifra.at 3500 Krems Tel: +43 2732 825 610

AUSTRIA Fax: +43 2732 851 01

Jet Executive International Charter Günter Krahé – Marketing & Sales Mündelheimer Weg 50 sales@jetexecutive.com D-40472 www.jetexecutive.com Düsseldorf Tel: +49 211 602 7775

GERMANY Fax: +49 211 602 77766 “Homebase FRA & MUC”

JET ICU Bart Gray – President 17076 Helicopter Drive email@jeticu.com Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428

USA Tel: +1 727 524 9825 Fax: +1 727 524 982

Mayoral Executive Jet Paulo Vassar – Commercial Director Dominguez Toledo S.A. paulo@mayoral.es 118 La Orotava www.mayoralexecutivejet.com Malaga 29006 Tel: +34 952 048 609

NEW SPAIN Fax: +34 924 048 612

AIR AMBULANCE (CoNT.) AIR AMBULANCE (CoNT.)

International Travel Insurance Journal

42 SERVICEDIRECTORY To have your company listed in the Service Directory email: dave@itij.co.uk

AIR AMBULANCE (CoNT.)

NoRTH AMERICAAerojet Stuart Hayman – President 4631 NW 31st Ave info@aero-jet.com #220 www.aero-jet.com Ft Lauderdale Tel: +1 954 730 9300

FL 33309 Fax: +1 954 485 6564 USA

Aeromedevac Air Ambulance Jesus Mendez – Provider Relations 681 Kenney Street flightrequest@aeromedevac.com Gillespie Field Airport www.aeromedevac.com El Cajon Tel: US: +1 619 284 7910 CA 92020 Tel: Mexico: 00 1-800-832-5087

USA Fax: +1 619 284-7918

Air Ambulance Network Kirk Pacheco – President 905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com

Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Professionals, Inc. Brian L. Weisz – President Ft. Lauderdale Executive Airport sales@airambulanceprof.com 1535 South Perimeter Rd www.airambulanceprof.com Hangar 36B Ft. Lauderdale Tel: +1 954 491 0555

Florida 33309 Fax: +1 954 491 6114 USA

Air Ambulance Specialists, Inc. Donald Jones – President 8001 S.Interport Blvd. info@airaasi.com Suite 250 www.airaasi.com Englewood Toll Free: +1 800 424 7060 CO 80111 Tel: +1 720 875 9182

USA Fax: +1 720 875 9183

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com #210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 Florida 34684 Fax: +1 727 786 0897

USA

AirMed International LLC Jeffrey T Tolbert – President 1000 Urban Center Drive mgoodwin@airmed.com Suite 470 www.airmed.com Birmingham Tel: +1 205 443 4840

AL 35242 Fax: +1 205 443 4841 USA Toll Free: +1 877 633 5387

American Care Air Ambulance Joel Reynolds – General Manager 8775 Aero Drive americancareair@aol.com Suite 120 www.americancareairambulance.com San Diego Tel: +1 858 627 0515

CA 92123 Fax: +1 858 627 0534 USA

Canadian Global Air Ambulance Jeff McIntosh – President Toronto jmcintosh@canadianglobalair.ca Winnipeg www.canadianglobalair.ca Vancouver Toll Free: +1 800 563 3822 CANADA Tel: +1 204 888 5555

Fax: +1 204 888 9111

European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange alert@air-ambulance.com L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007

Fax: +49 711 7007 7009

JET ICU Bart Gray – President 17076 Helicopter Drive email@jeticu.com Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428

USA Tel: +1 727 524 9825 Fax: +1 727 524 982

Life Flight International Inc. Chris Connor – Operations Victoria International Airport info@lifeflight.ca Viscount Business Center www.lifeflight.ca

103-9800 McDonald Pk Rd Tel: +1 250 655 1630 Sidney, British Columbia Fax: +1 250 656 9394 CANADA

National Air Ambulance George Martinez – Mgr Flight Co-ordination 3495 SW 9th Ave inquiry@nationalairambulance.com Fort Lauderdale www.nationalairambulance.com

FL 33315 Tel: +1 954 359 9900 USA Fax: +1 954 359 9500

Skyservice Air Ambulance David Ewing – VP Int. Market Development YUL/Trudeau Int Airport david_ewing@skyservice.com 9785 Avenue Ryan www.skyservice.com/airambulance

Montreal (Quebec) N AmericaToll Free: +800 463 3482 H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096

AIR AMBULANCE INTERIoRAir Ambulance Technology Egon Kuntner – President A-5282 aat@airambulancetechnology.com Ranshofen www.airambulancetechnology.com

AUSTRIA Tel: +43 7722 85051 Fax: +43 7722 85051-22

AIRCRAFT PERFoRMANCE SoLUTIoNSRAISBECK Engineering Nick Nicholson – Sales Manager 4411 South Ryan Way nick@raisbeck.com Seattle WA98178 www.raisbeck.com

USA Tel: +1 206 723 2000 Fax: +1 206 723 2884

ASSISTANCE CoMPANIESAFRICA

AIMS Bernadette Breton – Managing Director Private Bag X5 contact@aims.org.za Benmore Gardens 2010 www.aims.org.za

Johannesburg Tel: +27 11 245 5777 SoUTH AFRICA Fax: +27 11 783 9277

AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Wilson Airport emergency@flydoc.org Langata Road www.amref.org PO Box 18617 Tel: +254 20 600 090 Nairobi Fax: +254 20 344 170

KENYA

Netcare 911 International Assistance Brenda Durow - International Assistance Mgr Netcare 911 House assist@netcare.co.za

49 New Road www.netcare911.co.za Halfway House Tel: +27 11 254 1387 Midrand 1685 Fax: +27 11 254 1405 SoUTH AFRICA

West African Rescue Association Florian Zagel - Managing Director Klotey Cresent 6 assist@westafrican-rescue.com

North Labone www.westafrican-rescue.com Accra Tel: +233 21 781 258 GHANA Tel: +233 244 312 496/7 Fax: +233 21 781 259

AUSTRALASIAAsia Assistance Partners Siriporn Wongurai – Int. Ops. Director 184/235 Forum Tower thailand@aapartners.net 36 Flr Ratchadapisek Rd www.aapartners.net Huaykwang Tel: +662 645 3733-5

Bangkok 10320 Fax: +662 645 3732 THAILAND

Asia Medical Assistance India Abhijeet Sachdev – Vice President DLF City-ll opsindia@asamedassist.org

M.G Road www.privathealthcaregroup.com New Delhi Tel: +91 9899 198 198 Gurgaon 122002 Fax:+91 2440 147 28 INDIA

Asia Medical Assistance Thailand Abhijeet Sachdev – Vice President 50 Soi Sukhumvit opsbangkok@asamedassist.org

19 Sukhumvit Road www.privathealthcaregroup.com Klongtoey Nau, Wattana Tel: +66 225 833 55 Bangkok 10110 Tel: +91 9899 198 198 THAILAND Fax:+66 225 822 77

Assistance online Bertrand Guichoux – CEO Zendai Cube Edifice 6/F bertrand-guichoux@assistance-online.com.cn

58, Changliu Road, www.assistanceonline-china.com Pudong Tel: +86 21 6104 9500 200135 Shanghai Fax: +86 21 6104 9484 CHINA

Customer Care Pty Ltd Janine Benson – Operations Manager Level 3 janineb@customercare.com.au

60 Miller Street www.customercare.com.au North Sydney 2060 Tel: +612 9202 8222 NSW Fax: +612 9202 8220 AUSTRALIA

First Assistance Mary-Jo McDonald – General Manager PO Box 17-310 rescue@firstassistance.co.nz Greenlane www.firstassistance.co.nz Auckland Tel: +64 9 356 1650

NEW ZEALAND Fax: +64 9 525 1278

Global Assistance & Healthcare Mario Babin – Chief Executive Officer Jalan Pattimura global@global-assistance.net 15 Kebayoran Baru www.global-assistance.net Jakaita Tel: +62 21 725 8115 12110 Fax: +62 21 725 7961

INDoNESIA

South Pacific Air Ambulance Scotty Watson – Managing Director ops@spaa.co.nz NEW ZEALAND www.spaa.co.nz

AUSTRALIA Tel: +64 9256 9000 SINGAPoRE Fax: +64 9256 9111

EURoPE & THE MEDITERRANEANADAC-Ambulance Service Robert Glueck – Marketing & Sales Director Am Westpark 8 info-ambulance@adac.de 81373 Munich www.adac.de/ambulance GERMANY Tel: +49 89 76 76 52 85 24-h alarm centre:

+49 89 76 76 50 05

www.itij.co.uk

43SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: dave@itij.co.uk

AGI Assistance Dr Jacques Guedj – Medical Director 99 Bis, Avenue du agiassistance@free.fr Général Leclerc 75014 Paris Tel: +33 1 43 95 00 55

FRANCE Fax: +33 1 43 95 00 66

ARC Transistance Hans Biekmann – Network Director Avenue des Olympiades 2 hans.biekmann@arctransistance.com 1140 Brussels www.arctransistance.com BELGIUM Tel: +32 2 706 6660

Fax: +32 2 706 6601

Assistance Plus Liana Absaliamova – General Manager 6th Floor info@assistplus.ru 19 Zhukov Proezd www.assistplus.ru Moscow 115054 Tel: +7 495 748 8735

RUSSIA Fax: +7 495 748 8741

Atlantic Assist Adriano Gouveia – Operations Manager Rua da Alfandega 10-2.D info@atlanticassist.com PO Box 750 www.atlanticassist.com 9000-056 Funchal Tel: +351 291 214 200 Madeira Fax: +351 291 214 202

PoRTUGAL

Express Assist Vardan Azatian – General Director 11-th Radialnaya, 2 eac@expressassist.ru

115404 www.expressassist.ru Moscow Tel: +7 495 775 2090 RUSSIA Fax: +7 495 775 2091

Global Voyager Assistance Costas Danilenko – CEO PO Box II cdanilenko@gvassistance.com 125124 www.gvassistance.com Moscow Tel: +7 495 775 0999

RUSSIA Fax: +7 495 775 0998

Mapfre Asistencia Natalia Jorquera – Int Com & Mkt Mgr Sor Ángela de la Cruz, 6 najorqu@mapfre.com 28020 Madrid www.mapfreasistencia.com SPAIN Tel: +34 91 581 4998

Fax: +34 91 581 1850

Marm Assistance Jill Atac – CEO Sabiha Gokcen Int Airport marm@marmassistance.com J Blok Kurtkoy www.marmassistance.com 34912 Tel: +90 216 588 0588 Istanbul Fax: +90 216 588 0602

TURKEY

med con team GmbH Michael Weinlich – Managing Director Gerhard-Kindler-Str.8 operations@medconteam.com 72770 Reutlingen www.medconteam.com Tel: +49 7121 433 660

GERMANY Fax: +49 7121 433 619

MK International Emergency Serv Minas Kaloumenos – General Manager 95, Ioanninon Street mk@mkassist.gr 10444 Tel: +30 210 5154600 Athens Fax: +30 210 5131660

GREECE

Save Assistance France Franck Molinier – Director of Business Dev. 19 rue de Provence molinier@saveassistance.com 78310 www.saveassistance.com

Maurepas Tel: +33 13062 6752 24hr Alarm Cntr: +33 13062 1122 FRANCE

SoS International Helle Drager – Comms & Marketing Manager Nitivej 6 sos@sos.eu DK-2000 www.sos.eu

Frederiksberg Tel: +45 7010 5055 Copenhagen Fax: +45 7010 5056 DENMARK

TBS Team 24 d.o.o Edvard Hojnik – General Manager Ljubljanska Ulica 42 info@tbs-team24.com

2000 Maribor www.tbs-team24.com SLoVENIJA Tel: +386 2618 2301 (Croatia, Slovenia, Fax: +386 2618 5800 Bosnia-Herzegovina, Macedonia, Serbia-Montenegro, Kosovo)

NoRTH & CENTRAL AMERICAASISTUR Emilio Guevara – Managing Director Prado 208 asisten@asistur.cu e/ Colon y Trocadero www.asistur.cu Habana Vieja Tel: +537 8664499

Ciudad Habana 10100 Fax: +537 8668087 CUBA

Assured Assistance Inc. Martha Turnbull – Director of Operations 6880 Financial Drive martha.turnbull@rbc.com Mississauga Tel: +1 905 816 2495

Ontario Fax: +1 905 813 4719 L5N 7Y5 CANADA

ASSISTANCE CoMPANIES (CoNT.)ASSISTANCE CoMPANIES (CoNT.)Global Excel Management Brian Allatt – CEO 73 Queen Street corpinfo@globalexcel.ca Lennoxville, Quebec www.globalexcel.ca JIM IJ3, CANADA Tel: +1 866 566 1130

4242 Cranmore Court Fax: +1 819 566 8335 Belle Isle, Fl 32812, USA

Medex Assistance Corporation Linda McGee – SVP of Sales 8501 LaSalle Road info@medexassist.com Suite 200 www.medexassist.com Baltimore Tel: +1 410 453 6300

MD 21286 Fax: +1 410 453 6301 USA

oneWorld Assist Taka Katsube – Dir Assist & Cost Mngment 10th Floor tkat@oneworldassist.com 6081 No.3 Road www.oneworldassist.com

Richmond, BC Tel: +1 604 303 2113 V6Y 2B2 Fax: +1 604 276 4593 CANADA

SelectCare Worldwide Jacques LeTual – Director of Business Dev. #1201 jacques.letual@selectcareworldwide.com 438 University Avenue www.selectcareworldwide.com

Toronto Tel: +1 416 340 7265 NEW

M5G 2K8 Fax: +1 800 533 2350 CANADA Toll Free: +1 866 261 6718

TMCA Margaret Whartom – Ops Manager 217 Broadway margaret@tmcatravel.com Suite 600 www.tmcatravel.com NYC Tel: +1 212 964 8580

NY 10007 Fax: +1 212 406 1520 USA

World Travel Protection Canada Inc. Dr Ron Mayer – President & Chf Med Officer 400 University Avenue ron.mayer@wtp.ca 15th Floor www.wtp.ca

Toronto Tel: +1 416 977 3565 Ontario M5G IS7 Fax: +1 416 205 4676 CANADA

SoUTH AMERICACardinal Assistance Alberto C. Chapur – President Av. Cordoba 890 7° piso albertoch@cardinalassistance.com (C 1054AAU) www. cardinalassistance.com

Capital Federal Tel: +54 11 4129 7514 Buenos Aires ARGENTINA

CATASTRoPHIC CLAIMS SPECIALISTDr Colin Plotkin Consulting Dr Colin Plotkin – Managing Director 27-3088 Francis Road colin@plotkinconsulting.com Richmond Tel: +1 604 241 9677 British Columbia Fax: +1 604 241 0733 V7C 5V9

CANADA

CoST CoNTAINMENTAFRICA

AIMS Bernadette Breton – Managing Director Private Bag X5 contact@aims.org.za Benmore Gardens www.aims.org.za 2010 Tel: +27 11 245 5777

Johannesburg Fax: +27 11 783 9277 SoUTH AFRICA

EURoPEChargeCare International Christiane Burniston – Managing Director Monument Business Park admin@chargecare.co.uk 1D, Park Offices www.chargecare.co.uk Warpsgrove Lane Tel: +44 1865 400 007

Chalgrove, Oxford Fax: +44 1865 400 707 UK Mobile: +44 777 44 35 649

Marm Assistance Jill Atac – CEO Sabiha Gokcen Int Airport marm@marmassistance.com J Blok Kurtkoy www.marmassistance.com

34912 Tel: +90 216 588 0588 Istanbul Fax: +90 216 588 0602 TURKEY

Medical Claims International Spain Fatima Guillen Grande – Managing Director C/Ciudad de Aguilas No.2 mcispain@mcimanager.com Local 2A www.mcimanager.com Madrid 28030 Tel: 00 34 913 016 145

SPAIN Fax: 00 34 913 016 160

oneWorld Assist Taka Katsube – Dir Assist & Cost Mngment 10th Floor tkat@oneworldassist.com 6081 No.3 Road www.oneworldassist.com

Richmond, BC Tel: +1 604 303 2113 V6Y 2B2 Fax: +1 604 276 4593 CANADA

International Travel Insurance Journal

44 SERVICEDIRECTORY To have your company listed in the Service Directory email: dave@itij.co.uk

CoST CoNTAINMENT (CoNT.) CoMMERCIAL REPATRIATIoN SPECIALISTS

MedEscort International Craig Poliner – President 1730 Vultee Street medescort@fast.net Allentown www.medescort.com PA 18103 Toll Free: +1 800 255 7182

Tel (US): 610 791 3111 USA Fax: +1 610 791 9189

Voyageur Aeromedical Travel Marc Lucas – General Manager Voyageur Buildings marc@voyageur.co.uk 43 Colston Street www.voyageur.co.uk Bristol Tel: +44 (0)117 927 3554 BS1 5AX Fax: +44 (0)117 925 5940

UK

FUNERAL DIRECToRSAntea International Funeral Assistance Marica Hunyadi – Managing Director Mihálkovics utca 12 antea@t-online.hu H-1091 www.antea.hu Budapest Tel: +36 30944 0944 HUNGARY Fax: +36 1216 6107

Funeral Home AURIGA Ltd. Helen Pradova – Chief of Intnl Dept B. Nmcové Street 1052/1 pradova.auriga@iol.cz 412 01 aurigalt@iol.cz Litomerice www.funeral-assistance.cz CZECH REPUBLIC Tel: +420 724 257 899

Fax: +420 416 735 800

Funeralcare International Roger Waddington 221 Upper Richmond Road funeralcare.international@letsco-operate.com Putney www.co-operativefuneralcare.co.uk

London Tel: +44 20 8788 5303 SW15 6SQ Fax: +44 20 8788 2525 UK

Global Networks Funeral Assistance Cristina Almudi – Managing Director 23 Blindmans Lane info@gnfa.info Cheshunt www.gnfa.info Hertfordshire Tel: +44 1992 640 066 EN8 9DR Fax: +44 1992 785 030

UK

John Allison Monkhouse Co., Ltd (Thailand) Apple Kaewprasert – General Manager President Park View Tower apple@monkhouse.com.au 99/243 (30B) Pine Tower www. monkhouse.com.au Sukhumvit soi 24 Tel: +66 2382 5345-7

Klongton Klongtoey, Bangkok Fax: +66 81 584 5942 THAILAND

KCH Repatriation Specialists Robert Rowntree – Managing Director 83 Westbourne Grove info@kchrepatriation.com Bayswater www. kchrepatriation.com London W2 4UL Tel: +44 20 7313 6920

UK Fax: +44 20 7313 6999

MK Funeral & Transportation Services Minas Kaloumenos – General Manager 95, Ioanninon Street mk@mkassist.gr 10444 Tel: +30 210 5154600 Athens Fax: +30 210 5131660

GREECE

Rowland Brothers International Melanie Walkling – Partner 299-305 Whitehorse Road info@rowlandbrothersinternational.co.uk West Croydon www.rowlandbrothersinternational.co.uk Surrey Tel: +44 20 8684 2324

CR0 2HR Fax: +44 20 8684 8000 UK

Servilusa Vanda Castro – Manager Int Dept Agencias Funerarias SA internacional@servilusa.pt International Dept. www.servilusa.pt Rua do Entreposto Industrial Tel: +35 121 470 6300

8-2 Esq, 2610-135 Amadora Fax: +35 121 470 6499 PoRTUGAL

ZEGA Roberto Funeral Home Cristina Zega – General Manager Via Clelia, 26/28 cristina@zega.it 00181 Rome www.zega.it ITALY Tel: +39 06 78 40 300

Fax: +39 06 78 02 488

HEALTHCARE CLINICSAmerican Medical Center Natalia oleinik – Insurance & Assistance Companies 26 build 6 Prospekt Mira info@amcenter.ru 129090 www.amcenter.ru

Moscow Tel: +7 495 933 7700 RUSSIA Fax: +7 495 933 7701

Luzdoc Dr Maria Alica Silva – Medical Director Rua 25 de Abril info@luzdoc.com 12 Vila da Luz www.luzdoc.com

8600-174 LGS Tel: +351 282 780 700 PoRTUGAL Fax: +351 282 780 709

NoRTH AMERICAGlobal Excel Management Brian Allatt – CEO 73 Queen Street, Lennoxville corpinfo@globalexcel.ca Quebec, JIM 1J3, CANADA www.globalexcel.ca

4242 Cranmore Court Tel: +1 866 566 1130 Belle Isle, FL 32812, USA Fax: +1 819 566 8335

Global Medical Management Raija Itzchaki – COO 7901 SW 36th Street contact@gmmusa.com Suite 100 www.gmmusa.com

Davie Tel: +1 954 370 6404 FL 33328 Fax: +1 954 370 8613 USA

Health Systems International Peggy Novotny – VP / Gen Mngr Intl Bus. 5975 Castle Creek Parkway pnovotny@us-hsi.com Suite 100 www.us-hsi.com Indianapolis Tel: +1 317 806 2000

IN 46250 Fax: +1 317 806 2033 USA

Medsave USA Jeffrey Baker – President 390 Rabro Drive jbaker@medsaveusa.com Hauppauge www.medsaveusa.com NY 11788 Tel: +1 516 622 1784

USA Fax: +1 516 294 6761

SelectCare Worldwide Jacques LeTual – Director of Business Dev. #1201 jacques.letual@selectcareworldwide.com 438 University Avenue www.selectcareworldwide.com

Toronto Tel: +1 416 340 7265 NEW

M5G 2K8 Fax: +1 800 533 2350 CANADA Toll Free: +1 866 261 6718

Star Healthcare Gigi Galen – President 850 7th Avenue ggontheroad@aol.com Suit 803 www.starhealthcarenet.com New York 10019 Tel: +1 212 581 8228

USA Fax: +1 212 581 8272

TMCA Margaret Whartom – Ops Manager 217 Broadway margaret@tmcatravel.com Suite 600 www.tmcatravel.com NYC Tel: +1 212 964 8580 NY 10007 Fax: +1 212 406 1520

USA

United Health International Philip Brun – Director of Business Development 15500 New Barn Road p.brun@hygeia.net Suite 200 www.hygeia.net Miami Lakes Tel: +1 305 594 9291 Ext.3312 FL 33014 Fax: +1 305 594 9201

USA

CLAIMS MANAGEMENTGlobal Assistance & Healthcare Nathan Hannah – TPA Mgr Asia/Pac Jalan Pattimura nathan.hannah@global-assistance.net 15 Kebayoran Baru www.global-assistance.net Jakaita Tel: +62 21 725 8115

12110 Fax: +62 21 725 8951 INDoNESIA

Global Excel Management Brian Allatt – CEO 73 Queen Street, Lennoxville corpinfo@globalexcel.ca Quebec, JIM 1J3, CANADA www.globalexcel.ca 4242 Cranmore Court Tel: +1 866 566 1130

Belle Isle, FL 32812 USA Fax: +1 819 566 8335

SelectCare Worldwide Jacques LeTual – Director of Business Dev. #1201 jacques.letual@selectcareworldwide.com 438 University Avenue www.selectcareworldwide.com

Toronto Tel: +1 416 340 7265 NEW

M5G 2K8 Fax: +1 800 533 2350 CANADA Toll Free: +1 866 261 6718

Star Healthcare Gigi Galen – President 850 7th Avenue ggontheroad@aol.com Suit 803 www.starhealthcarenet.com New York Tel: +1 212 581 8228 10019 Fax: +1 212 581 8272

USA

CLAIMS SUBRoGATIoN

Medsave USA Jeffrey Baker – President 390 Rabro Drive jbaker@medsaveusa.com Hauppauge www.medsaveusa.com NY 11788 Tel: +1 516 622 1784

USA Fax: +1 516 294 6761

www.itij.co.uk

45SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: dave@itij.co.uk

HEALTHCARE CLINICS (CoNT.)AUSTRALASIA

CareFlight International Sue Robshaw – Co-ordinator Westmead Hospital Campus international@careflight.org PO Box 159 www.careflight.org

Westmead Tel: +61 1300 655 855 NSW 2145 Fax:+61 2 4751 2995 AUSTRALIA

Medic’Air International 每递安国际 Dr Huaqun Gao – Medical Director 885 Renmin Road operations@medic-air.cn Huaihai China Building www.medic-air.com Room 808 Tel: +86 2163 558289 200010 Shanghai Fax: +86 2163 558285

CHINA

Medical Wings Dr Sommart Somsiri – Medical Director 222 Room 3259 m.w@medicalwings.com

Bangkok Int Airport www.medicalwings.com Viphavadee-Rangsit Rd, Sikan Tel: +662 247 3392 Don Muang, Bangkok 10210 Fax:+662 535 4355 THAILAND

Mediflight Debra o’Brien – Operations Manager Royal Adelaide Hospital info@mediflight.com.au North Terrace www.mediflight.com.au

Adelaide Tel: +61 8 8223 6618 SA 5000 Fax: +61 8 8223 6340 AUSTRALIA

EURoPEAeroMed 365 Brian Brooker – Clinical Director

Worth Corner Business Cntr brian.brooker@aeromed365.com Turners Hill Road www.aeromed365.com

Pound Hill Tel: +44 8707 596 999 Crawley RH10 7SL Fax: +44 8707 559599 UK

EMC Meditrans Servé de Klerk – President Hoevestein 23 info@emc.nl Postbus 4190 www.emc.nl 4900 CD Tel: +31 162 496 000 Oosterhout Fax: +31 8 42 24 64 86

THE NETHERLANDS

Voyageur Aeromedical Travel Marc Lucas – General Manager Voyageur Buildings marc@voyageur.co.uk 43 Colston Street www.voyageur.co.uk Bristol Tel: +44 (0)117 927 3554 BS1 5AX Fax: +44 (0)117 925 5940

UK

NoRTH AMERICAAeromedevac Air Ambulance Jesus Mendez – Provider Relations 681 Kenney Street flightrequest@aeromedevac.com Gillespie Field Airport www.aeromedevac.com El Cajon Tel: US: +1 619 284 7910 CA 92020 Tel: Mexico: 00 1-800-832-5087

USA Fax: +1 619 284-7918

Air Ambulance Network Kirk Pacheco – President 905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com

Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com #210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198

Florida 34684 Fax: +1 727 786 0897 USA

American Care Air Ambulance Joel Reynolds – General Manager 8775 Aero Drive americancareair@aol.com Suite 120 www.americancareairambulance.com San Diego Tel: +1 858 627 0515

CA 92123 Fax:+1 858 627 0534 USA

Life Flight International Inc. Chris Connor – Operations Victoria International Airport info@lifeflight.ca Viscount Business Center www.lifeflight.ca

103-9800 McDonald Pk Rd Tel: +1 250 655 1630 Sidney, British Columbia Fax: +1 250 656 9394 CANADA

National Air Ambulance George Martinez – Mgr Flight Co-ordination 3495 SW 9th Ave inquiry@nationalairambulance.com Fort Lauderdale www.nationalairambulance.com

FL 33315 Tel: +1 954 359 9900 USA Fax: +1 954 359 9500

MedEscort International Craig Poliner – President 1730 Vultee Street medescort@fast.net Allentown www.medescort.com PA 18103 Toll Free: +1 800 255 7182

Tel (US): 610 791 3111 USA Fax: +1 610 791 9189

MEDICAL ESCoRT oN CoMM. AIRLINES (CoNT.)Number one Health Group Dr Charlie Easmon – Director 1 Harley Street info@numberonehealth.co.uk London www.numberonehealth.co.uk

W1G 9QD Tel: +44 207 307 8756 UK Fax: +44 207 504 3758

HoSPITALSASIA

Bangkok Hospital Medical Center Judy Mitchell – Third Party Payor Services Bangkok International Hospital judy@bgh.co.th 2 Soi Soonvijai 7 www.bangkokhospital.com New Petchburi Road Tel: +66 2310 3000

Bangkok 10320 Fax: +66 2310 3105 THAILAND

Piyavate Hospital Intl. Health Care Dr. Tanatip Suppradit – CEO Piyavate International Hospital akanit@piyavate.net 998 Rimklongsamsaen Rd. www.piyavate.com (Rama IX Rd.), Bangkapi, Tel: +66 2625 6500

Huay Kwang, Bangkok 10310 Fax: +66 2625 6890 THAILAND

Privat Hospital Abhijeet Sachdev – Vice President DLF City-ll info@privathealthcaregroup.com M.G Road www.privathealthcaregroup.com New Delhi Tel: +91 9899 198 198

Gurgaon 122002 Fax: +91 124 235 3794 INDIA

Wockhardt Hospitals Pradeep Thukral – Head International Mrktg Mulund Goregaon pthukral@wockhardt.com, wockhosp@gmail.com Link Road www.wockhardthospitals.net Mumbai Tel: +91 9819015749 400 078 Tel: +91 22 26596502

INDIA Fax: +91-22-55994242

EURoPEAmerican Medical Center Natalia oleinik – Insurance & Assistance Companies 26 build 6 Prospekt Mira info@amcenter.ru 129090 www.amcenter.ru

Moscow Tel: +7 495 933 7700 RUSSIA Fax: +7 495 933 7701

Xanit Hospital de Benalmadena Dr. Juan Bosco Rodriguez Hurtado – Director Camino de Gilabert s/n xanit@xanit.net Benalmadena www.xanit.net 29630 Tel: +34 952 367 190

Malaga Fax: +34 952 367 191 SPAIN

NoRTH AMERICABaptist Health Int. Center of Miami Yohandra Fuentes – Finance Manager 8940 North Kendall Drive international@baptisthealth.net Suite 601-E www.baptisthealth.net/international Miami Tel: +1 786 596 2373 Fl 33176 Fax: +1 786 596 5979

USA

Jackson Memorial Hospital Int. Abbe Bendell – Interim Vice President Jackson Medical Towers info@jmhi.org East Tower, Suite 829 www.jmhi.org 1500 NW 12th Avenue 24 hr: +1 305 355 1212 Miami, FL 33136-9998 Tel: +1 305 355 5544

USA Fax: +1 305 355 5545

University of Miami Health System Jose Quesada M.D., M.B.A. – Dir Finance & Operations 1099 N.W. 14th Street ihcinfo@med.miami.edu Miami www.uhealthinternational.com Florida Toll Free: +1 877 442 8676 USA Tel: +1 305 243 9100

Fax: +1 305 243 9101

LEGAL SERVICESPannone LLP Andrew Morton – Head of Travel Litigation 123 Deansgate law@pannone.co.uk Manchester www.pannone.com M3 2BU Tel: +44 (0)161 909 3000 UK Fax: +44 (0)161 909 4444

MEDICAL ESCoRT oN CoMMERCIAL AIRLINES

AFRICAAMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Wilson Airport emergency@flydoc.org Langata Road www.amref.org PO Box 18617 Tel: +254 20 600 090

Nairobi Fax: +254 20 344 170 KENYA

International Travel Insurance Journal

46 SERVICEDIRECTORY To have your company listed in the Service Directory email: dave@itij.co.uk

Scanners ‘strip’ passengersCivil liberty campaigners in the US are up in arms about plans to introduce airport scanners that visually remove passengers’ clothes. The powerful new scanners are set to be installed at airports across the US, including Washington, DC, New York and Los Angeles. When they are installed, passengers will be shut in glass booths while a detailed 3D image of their body is made and shown onscreen to security guards. The Transport Safety Authority (TSA) said the booths close around the passenger and emit ‘millimetre waves’ that go through clothing to identify metal, plastics, ceramics, chemical materials and explosives.However, worries have been voiced by the American Civil Liberties Union, whose director of the Technology and Liberty Program, Barry Steinhardt, said: “People have no idea how graphic these images are.” In order to protect passengers’ rights, their faces will be blurred and the images will not be saved. A spokeswoman from the TSA said passengers were not obliged to use the machines, as they can choose to be patted down instead. Which begs the question: ‘If they’re optional, won’t the terrorists simply choose the other option?’

Surgeon uses hammer to remove nailSurgeons in Kansas used some fairly basic technology to help them recently, after a man doing some DIY managed to shoot himself in the head with his nail gun. George Chandler was nailing boards and lattice when a two-inch nail pierced his hat, shot through his skull and lodged itself in his brain.Chandler said of the incident: “The gun went off and I just felt a little sting. I’m fi ne really.” He had been working with a friend when the nail gun’s hose became entangled, in the efforts to untangle it, the gun went off, but at fi rst the two men couldn’t fi gure out where the errant nail had gone: “He asked me if I saw where it went and I said I’m not sure, but I felt something on my head,” said Chandler.With the hat nailed to his head, he was rushed to hospital, where a doctor decided the best way to remove the nail was not through modern, keyhole surgery, but in fact to use a claw hammer from the maintenance department.

Curry grounds fl ightA British Airways jet had to be diverted recently when passengers onboard thought they smelt poisonous gases – it was in fact the smell from a giant container of curry spices in the plane’s cargo hold. The fl ight from Belgrade to London was forced to make an emergency evacuation after passengers panicked, fearing a terror attack. At fi rst, offi cials suspected a canister of powerful acidic chemicals had burst open in the hold, but Serbian authorities confi rmed that the smell ‘spread from the package of an aromatic food spice’.Dozens of passengers fl ed the plane after it was returned to Belgrade and contained on a special emergency procedure runway at the airport. Emergency workers wearing breathing apparatus reportedly helped ‘screaming passengers’ off the plane before the real source of the stench was discovered.

GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GR

AP

EV

INE

• GR

AP

EV

INV

INE

GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INV

INE

GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

IN

E • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E • DIAry DAtES

6-9 SeptemberCasualty & Property Insurance Underwriters Annual Meeting & Seminar

Philadelphia, PA, USwww.cpcusociety.org

11-12 SeptemberMeasuring & Managing Mortality & Longevity Risk

London, UKwww.life-pensions.com

21-23 September9th China Rendezvous

Chinawww.asiainsurancereview.com/pages/conferences

24-25 September4th Insurance Executives’ Summit on Technology

Shanghai, Chinawww.asiainsurancereview.com/pages/conferences

2 OctoberLife and Pensions Italia

Milan, Italywww.life-pensions.com

12-15 October

Global Business Development Institute 10th Annual Conference

Las Vegas, NV, USwww.gbdi-conference.org/

14-17 October15th International Association of Insurance Supervisors

Budapest, Hungarywww.iais2008.org

30 OctoberSolvency II and Risk Management for European Insurers

Brusselswww.life-pensions.com

5-6 NovemberTh e IEA & Marketforce’s 8th Annual Conference

� e Queen Elizabeth II Conference CentreLondon, UK

10-14 NovemberInternational Travel Insurance Conference (ITIC)

Intercontinental HotelBudapest, Hungary

www.itic.org.uk/

11-12 NovemberTh e Reactions Insurance Conference 2008

� e Westin, Times Square, New York,US

14 NovemberWorkplace Safety & Insurance Conference

Lancaster House, Toronto, Ontario, Canada

Grapevine

MEDICAL SCREENINGTravel & Medical Insurance Services Lara Suttie – Call Centre Manager 1st Flr Suite, West House sales@travelandmedical.co.uk 46 High Street www.travelandmedical.co.uk Orpington Tel: +44 845 058 8000

Kent BR6 0JQ Fax: +44 845 053 3000 UK

Travel Screen Sandra Howell – General Manager The Seedbed Centre info@travelscreen.co.uk Vanguard Way www.travelscreen.co.uk Shoeburyness Tel: +44 1702 587 007 Essex SS3 9QY Fax: +44 1702 584 731

UK

WEB & MEDIA ADVERTISINGV Creative Design Steve Annette – New Media Director Voyageur Buildings info@vcreativedesign.co.uk 43 Colston Street www.vcreativedesign.co.uk Bristol Tel: +44 (0)117 922 6600 BS1 5AX Fax: +44 (0)117 925 2040

UK

MEDICAL PRoVIDERAMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Wilson Airport emergency@flydoc.org Langata Road www.amref.org PO Box 18617 Tel: +254 20 600 090 Nairobi Fax: +254 20 344 170

KENYA

Atlantic Assist Adriano Gouveia – Operations Manager Rua da Alfandega 10-2.D info@atlanticassist.com PO Box 750 www.atlanticassist.com 9000-056 Funchal Tel: +351 291 214 200

Madeira Fax: +351 291 214 202 PoRTUGAL

TRAVEL AGENTSVoyageur Aeromedical Travel Marc Lucas – General Manager Voyageur Buildings marc@voyageur.co.uk 43 Colston Street www.voyageur.co.uk Bristol Tel: +44 (0)117 927 3554 BS1 5AX Fax: +44 (0)117 925 5940

UK

47ONTHEMOVE

www.itij.co.uk

The Claimers illustrated by Chris Duggan, concept by Ian Cameron © Voyageur Publishing & Events Ltd

AIG names Willumstad

Aviva appoints Hodges

Bridge joins Harper Grey

Chubb boosts personal lines

first Assist strengthens team

Groupama enhances legal team

IrDA has new chairman

raisbeck chooses Lidstone

American International Group, Inc. (AIG) has announced that its board of directors has chosen chairman Robert Willumstad to the additional position of chief executive officer; Robert succeeds Martin Sullivan, who is leaving the company. George Miles, chairman of the Nominating and Corporate Governance Committee of the Board of Directors, noted: “Martin successfully led AIG through the crisis it faced when he became CEO in 2005, and he has made significant contributions over the past three years in executing AIG’s strategy and building on its global franchise.”Robert, meanwhile, told reporters he was honoured by the opportunity he had been given. He continued: “Although conditions in the credit markets continue to create significant challenges in several areas of the business, AIG has great people throughout the organisation and an unrivalled global franchise with tremendous long-term growth potential.”

Aviva has appointed Mark Hodges, chief executive officer of Norwich Union Life, as an executive director to its plc board with immediate effect. Mark will join the company’s two existing executive directors, group chief executive Andrew Moss and group finance director Philip Scott. Mark has worked for the group for the last 17 years, having joined NU in 1991 just after qualifying as an accountant. In April 2006, he was appointed to the position of CEO of NU Life, and since then he has implemented a new strategy, which has resulted in increases in both new business and profits.Lord Sharman, chairman of Aviva, said: “We took the decision to increase the number of executive directors on our board and I am delighted that we have appointed Mark, who has an exceptional mix of experience and abilities.” Andrew Moss added: “Mark is an outstanding executive with a rare mix of operational strategic expertise. He has already developed our UK business significantly and his leadership skills will be an asset to us in delivering our … strategic vision.”

Kieran Bridge has joined the firm Harper Grey LLP in Vancouver, Canada, as senior associate counsel. Kieran takes with him significant expertise in the areas of insurance, environmental and commercial litigation practice groups. He is also founding director and a past president of the Travel Health Association of Canada. He provides legal advice to both the association and many of its members, as well as to travel insurers and their related parties in Canada and internationally.Speaking to ITIJ, Kieran said: “I am very pleased to join Harper Grey, which is a very experienced insurance and medical law firm. Their international contacts through the TAGLaw network of firms will be invaluable to my travellers’ assistance and claims work.”

Chubb Insurance has announced two key appointments recently. Chris Lewis has been named as personal lines development underwriter for London, while Stephen Wilkinson has been chosen as UK and Ireland appraisal manager.Chris Lewis has been with the company for 11 years, latterly as a senior underwriter, and his new role has been created as a result of the rapid growth in personal lines business for the company. As part of his new role, Chris will be a member of the recently created London Independent Broker Team, which follows the management of Mike Smith.In his new position, Stephen Wilkinson is responsible for the UK-wide appraisal team. He has nine years of experience in appraising Chubb, and in addition to the new managerial role, he will continue to play an important part in providing such services to the firm’s ultra high-net-worth clients.Simon Mobey, personal lines manager at Chubb Insurance, said he was delighted with the appointments. He continued: “Both Chris and Stephen have a proven track record and have played a vital part in our success to date. With our continued expansion in the high and ultra-high-net-worth markets they will be crucial in developing broker relationships and ensuring our appraisal service remains ahead of the rest.”

First Assist Legal Protection has appointed Richard Hermida as the new head of after-the-even (ATE) underwriting.Graham Hollebon, general manager at First Assist, said: “Richard joins us at an exciting time. Our business is growing rapidly and we want to continue to provide the very best ATE underwriting service in the market. With his excellent experience Richard will help make our service even better.”Richard joins First Assist from Elite Incident Management, where he was a national sales manager, and had also previously held the position of head of operations. He began his career at Lloyds TSB in 1994 and held various roles there, including team leader and call centre manager, before moving to Legal & General and then Elite.

Ben Speers has been chosen to fulfil the role of legal advisor at Groupama UK Services, and will report directly to Rosemary Whitfield-Jones, who is group company secretary at Groupama Insurances and in-house legal counsel to the firm’s UK insurance and broking subsidiaries. Ben has been practicing law for eight years, having done his training with Australian firm Minter Ellison, and has also previously worked for broker Health Lambert.In his new role, Ben is responsible for day-to-day transactional legal work for the insurance underwriting and broking business within Groupama UK’s portfolio and will also support the legal work surrounding any acquisition and corporate change activities.Rosemary Whitfield-Jones commented on the appointment: “Ben is a real asset to the team, taking responsibility for the essential day-to-day legal work that comes with being part of a busy and growing UK insurance group. He has precisely the skills and experience we need and Ben is already developing to be a very effective addition to the team.”

The Indian government has appointed J Harinarayan, a retired chief secretary of Andhra Pradesh, as the new chairman of the Insurance Regulatory and Development Authority (IRDA), effective immediately. Mr Harinarayan, who is the third chief of IRDA since it was first established in 1999, will serve a five-year term, succeeding Mr CS Rao. Speaking after his appointment, Harinarayan told local paper Economic Times: “My mission would be to widen and deepen insurance penetration in India and encourage competition among insurers to give a better deal to consumers. We need to look at the role of various distributors, including agents and brokers, and also encourage direct marketing of retail insurance products.” He added that the other changes he could make include lowering the premium on mediclaim policies to make the voluntary health insurance policy more affordable to consumers and finding ways in which to ensure greater transparency in unit-linked insurance plans.

In mid-June, Gary Lidstone joined the Raisbeck Engineering team in the position of director of engineering. In his role, he will lead the group in their continuing innovation of productivity-increasing systems for both business and commercial aircraft. In addition, he directly manages all personnel in the engineering department as well as its external resources, such as DERs and consultants. He will report to Sam Jantzen, Raisbeck’s chief operating officer. Speaking on the appointment, Sam said: “Gary’s extensive engineering knowledge and management experience at Boeing, Pratt & Whitney and Garrett will provide our engineering team with the direction, insight and innovation to take Raisbeck to the next level.”

GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GR

AP

EV

INE

• GR

AP

EV

INV

INE

GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INV

INE

GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

IN

E • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

Mark Hodges

Ben Speers

Kieran Bridge

Gary Lidstone