Transcript Document

Role of Health Tourism in Global Health
Service Crisis
Anil K Maini
President – Corporate Development
Apollo Hospitals Group
Global Medical Tourism Market
• Important source of revenue in developing
nations
– Revenues exceeded US$ 20 Billion in
2004
– Revenues expected to grow to US$ 100
Billion by 2012
• Indian medical tourism growing at 15%
annually
Source: Medical Tourism: Global Competition in Health Care by Devon M. Herrick, November 2007, National Center for Policy Analysis.
Strong Drivers for Medical Travel
• Aging overseas population.
• High cost of healthcare in developed countries.
• Long waiting periods for tertiary care.
• Large un-insured & under insured healthcare
market.
• Lack of tertiary care facilities in developing and
under-developed countries.
Medical Tourism Patients
Recent McKinsey study identified the major reasons
patients travel abroad for medical care
– 40 percent from less developed nations
seek advanced, high quality care
32%
More High
40% Tech
– 32 percent from developed nations seek
higher quality care from advanced
hospitals in developing nations
– 15 percent from countries with socialized
medicine who seek faster access and no
waiting lists
– 13 percent from developed nations seek
healthcare at lower costs than available at
home
• Primarily from the U.S.
Lower Cost
Faster Access
15%
13%
Better Quality
Fastest Growth Potential
is in the Market Segment
Seeking Lower Costs
Source: Mapping the Market for Medical Travel by Tilman Ehrbeck, Ceani Guevara and Paul Mango, May 2008, McKinsey Quarterly.
Three key blocks of providers of medical tourism
Americas, EMEA and S/SE Asia
Americas
Europe / Middle East/ Africa (EMEA)
Americas
Europe / Middle East/ Africa (EMEA)
South / South East Asia
South / South East Asia
UK
Canada
Czech Rep.
Hungary
Canada
US
Antigua2
Mexico
Costa Rica
Antigua
2
Barbados
2
Mexico
Brazil
Costa Rica
Barbados2
UK
Japan
Czech Rep.
Hungary
US
Japan
Philippines
India
U.A.E
Thailand
Malaysia
India
Singapore
Thailand
U.A.E
Brazil
S. Africa
Malaysia
Singapore
Philippines
Australia
Australia
S. Africa
Source of medical tourists
for South / SE Asia1
Providers of treatment
India & Apollo: An Emerging Healthcare Hub
in South-Asia
The Apollo Story
• The Apollo Hospitals Group was started by Dr. Prathap C.
Reddy in 1979
• The Group started its first hospital in Chennai in 1983 with a
initial bed strength of 150
• Over the past 25 years the bed strength today stands at over
10,000
• With over 44 managed and owned hospitals, Apollo is Asia’s
largest healthcare network
Apollo Group - Medical Achievements
Touched over 12 million lives
6,40,000 Preventive Health Checks
Treated over 75,000 Foreign Patients from 75 countries
Done over 100,000 cardio thoracic surgeries
Done 10,000 Kidney Transplants, 350 Bone Marrow Transplants
First successful liver transplant in India, at Apollo Delhi
Pioneered interventions and surgical procedures
Apollo Delhi first hospital to be accredited by JCI, in India
Our Objective
• To create a long term “win–win” Healthcare
Delivery Strategy for overseas Patients and
Payers.
• To provide premier value-added services that
allow overseas patients to effectively leverage,
emerging cost effective global medical treatment
alternatives.
Medical & Health Travel
Medical Travel
• Focused on treatment of acute
illnesses, elective surgeries like
Cardiology, Cancer,
Orthopedics etc.
Health Travel
• Focused on Wellness, Rejuvenation,
Preventive Health, Image Health,
combined with Traditional Medicine
like Ayurveda, Yoga etc.
Is There a Drop in Medical Travel?
Yes
For Health Travel for cosmetic & dental
surgery, wellness etc.
No
For Medical Travel for high end
Tertiary Care & Quaternary Care
(For Life Threatening Diseases)
Patient/Market Profile for Medical Travel
• Countries not having adequate healthcare services
(SAARC, Middle East, Gulf, CIS and Africa).
• Un-insured and under insured overseas patients mainly
from USA. Large number of US Insurance majors &
Corporates looking at cheaper healthcare options, overseas.
• Waitlisted patients in UK and Canada.
• Patients seeking procedures not covered by Insurance e.g.
Dental, Cosmetology, Bariatric etc.
Our Proposition
 Clinical outcomes on par with the World’s best Centers
 Internationally qualified & experienced Specialists
 Technology Edge – 3rd Generation equipment & infrastructure
 Competitive costs – 1/10th of costs in the West
 Quality of service:
No waiting time
JCI Accreditation
Patient centric care
 Choice of location for patients in India, among Apollo locations
 Medications are also much cheaper, often 50% of that in the US
 English speaking staff & Doctors
Key Evaluation Criteria
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Hospital reputation
Doctors training & reputation
Cost
Post-operative care
Proximity
Convenience
Visa availability
Cultural similarities
Family and friends' recommendation
Main Super-Specialties Sought
•Cardiology
•Joint Replacements
•Cosmetic Surgery & Dental
•Spine Surgery
•Bariatric Surgery (Gastric Banding)
•Cancer
•IVF
•Kidney & Liver Transplants
•Bone Marrow Transplant
Auxiliary Services
Services to the patients start from the moment they contact the Hospital till the
time they land in India and leave back for their home country. Some of these
auxiliary services include:
Airport pick-up & drop
Visa/Sightseeing arrangements
Translators
Coordinating appointments
Accommodation for companions
Locker facilities
Cuisine
Cutting Edge Technology
320 Slice CT Scan
3.0 Tesla MRI
CyberKnife
PET CT
Role of Telemedicine
Apollo is a pioneer in the field of Telemedicine and is credited with
being the first to set up a Rural Telemedicine Centre in 1999.
Now, Apollo has established this
concept in overseas markets like
Kathmandu, Lahore, Khartoum,
Lagos, Aden, Colombo & Dhaka.
Soon, Telemedicine will be a very important cog in the Medical
Tourism wheel & all Providers and Facilitators will need to use it
effectively.
Cost Advantage
PROCEDURE COSTS IN INDIA & US
PROCEDURE COST (US$)
US
INDIA
Heart Surgery
100,000
9,000
Bone Marrow Transplant
300,000
30,000
Liver Transplant
350,000
60,000
Joint Replacements
60,000
8,000
Cosmetic Surgery
50,000
5,000
Accreditation – A Must
Apollo Hospitals, New Delhi
First Hospital in India to be Accredited by JCI
Apollo Chennai, Hyderabad, Bangalore,
Ludhiana & Dhaka are also JCI Accredited
A Good Base To Build On
The next leap will come from
geographical growth internationally,
backed by sound brand and
product strategy
We Must Differentiate to Seek Greater Market Share
Turkey’s USP
•Europeans’ wallets have shrunk as a result of the global economic crisis,
pushing them to seek ways to lower their medical costs.
•That search has put Turkey on the map as a popular destination for those
wanting lower-cost healthcare.
•One thing that also plays to Turkey’s favour is its high standards in medical
care, as no less than 24 Hospitals and Clinics have JCI status, more than in
almost every EU country.
• In 2007, the number of foreign patients in Turkey was 150,000. Last year, the
number of foreigners treated in Turkey increased by 40% to 200,000.
•Turkey mostly receives patients from the Netherlands, UK, Belgium & France.
There has also been an increase in Middle Eastern patients who have begun
to prefer Turkey to Europe. Currently Turkey’s medical tourism market is worth
around US$500 million, and it has the potential for many times that.
U.S. Market
U.S. – A Worsening Problem
• The US Census Bureau estimates that by 2020, the population of
seniors, currently 13 percent of the total US population, will grow to 17
percent. This graying of America will propel the demand for healthcare
products.
• For people with good insurance or other financial resources, the US
offers the best care in the world. But, for the 47 million Americans who
lack insurance or the ability to pay, world-class care is a distant dream.
• Patients with chronic illnesses represent the highest cost and fastest
growing group in healthcare. The US healthcare system is not
structured to manage them. Thus, a large number of Americans no
longer have access to healthcare or are at grave financial risk if they get
sick.
• Little likelihood that these problems will be remedied for decades.
Broadening the U.S. Market Reach
300M US population consists of:
•47M uninsured
•8M with >$75K income & 35-64 age range
•250M insured (of which roughly 40M are underinsured)
•150M employer provided benefits
Current retail target
•70M covered by self-insured companies market is less than 3%
•80M covered by private insurance
•20M direct purchase of private insurance
•80M government provided program
Adding self-insured employers expands
US market opportunity ten-fold
Growing U.S. Medical Tourism Market
• Estimated Medical Tourism 150,000 patients from U.S. in
2005
– Most traveling to Latin America and Mexico
• Estimated Growth
– Possible increase to 500,000-700,000 patients per year
– US$33 Billion in potential cost savings
– Option increasingly available through employers and medical insurance
carriers
U.S. Market Will Increase Dramatically if Insurance Companies
Cover the Cost of Healthcare
Sources: Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism by Josef Woodman, Healthy Travel Media, March 2007
Mapping the Market for Medical Travel by Tilman Ehrbeck, Ceani Guevara and Paul Mango, May 2008, McKinsey Quarterly.
WellPoint Overview
WellPoint Serves Approximately
35 Million Medical Members
One in nine Americans have coverage from WellPoint.
ME
WI
NY
NV
CA
IL
CO
MO
VA
KY
GA
TX
BC or BCBS licensed plans
UniCare >100K members
CT
OH
IN
NH
MA
Wellpoint Inc. USA – Press Release
•Health insurer WellPoint Inc. will dabble in medical tourism next year
when it launches a pilot program that sends patients to India for some
surgeries.
•WellPoint's pilot program will allow people to travel to hospitals in either
Bangalore or New Delhi for procedures like joint replacement or upper
and lower back fusion.
•WellPoint subsidiary Anthem Blue Cross and Blue Shield in Wisconsin
will set up the medical care and take care of scheduling and travel
service.
•The insurer will cover the travel and lodging costs for both the patient
and a companion. It will offer the program only for people who receive
insurance through Wisconsin-based Serigraph Inc., a self-insured
printing company that employs about 700 people in the U.S. and does
business in India, which was part of the reason WellPoint picked that
country.
Medical Tourism Landscape
When would someone choose to leave the country for a
medical procedure?
• Anthem conducted an online
survey regarding medical
tourism
– 160 consumers and 149
employers responded
– 60 percent have traveled
internationally
Respondents were willing to travel overseas for
medically necessary or cosmetic procedures
 Less than 30 percent with no incentives
 57 percent if travel expenses (airfare, meals,
lodging) are covered for member
 67 percent if travel expenses are covered for
member and one companion
 73 percent if travel expenses are covered for
member and companion, plus a cash incentive
Proposed Incentives for Members
• Members will have no member cost share for
surgery claims when provided through the Medical
Tourism benefit
– No member copays
• Patient can select a travel companion to accompany
them
• All travel arrangements and costs will be handled for
the member and their selected companion
– Airfare, hotel, transfers, visas, etc.
Why Medical Tourism
New trend emerging
– Rising medical costs
– Increased cost sharing for insured members
– Consumerism
Lack of competition among providers domestically
(geographic monopolies)
New tools for an increasingly savvy consumer
– Global marketplace
– American corporations losing competitiveness with health
care cost trimming away profits
Guidelines for Identifying Procedures for
Medical Tourism
(1) The procedure is elective in nature
(2) The patient is able to travel
(3) The surgery is commonly performed at the
referral hospital with demonstrable quality
outcomes
(4) Local follow-up care upon return home can be
arranged, if needed
(5) The patient can safely travel within a reasonable
time, post procedure
Member Eligibility
Member Eligibility for Medical Tourism Benefit:
– Covered member or adult dependent (18 years or older)
– Employer coverage must be primary coverage
– Member must be scheduled for an eligible Medical
Tourism procedure (see separate list of eligible
procedures)
– Member must be otherwise fit to travel, with no other
complicating medical conditions
– Member must be interested in the Medical Tourism
benefit (Medical Tourism must be an optional benefit)
Member Experience
The Member:
Talks to the surgeon to decide whether he or she is comfortable
with the surgeon
Decides they want to travel internationally for surgery
Picks a date for the surgery
Travels with a companion of his or her choice, through travel
arrangements made specifically for the member
Has surgery at an accredited facility with world-class surgeons
Apollo Research Findings
US Market
AMA Guidelines for Medical Travel
(a) Medical care outside of the U.S. must be voluntary.
(b) Financial incentives to travel outside the U.S. for medical care should not inappropriately
limit the diagnostic and therapeutic alternatives that are offered to patients, or restrict
treatment or referral options.
(c) Patients should only be referred for medical care to institutions that have been accredited by
recognized international accrediting bodies (e.g. Joint Commission International-JCI).
(d) Prior to travel, local follow-up care should be coordinated and financing should be arranged
to ensure continuity of care when patients return from medical care outside the US.
(e) Coverage for travel outside the U.S. for medical care must include the costs of necessary
follow-up care upon return to the U.S.
(f) Patients should be informed of their rights and legal recourse prior to agreeing to travel
outside the U.S. for medical care.
(g) Access to physician licensing and outcome data, as well as facility accreditation and outcomes
data, should be arranged for patients seeking medical care outside the U.S.
(h) The transfer of patient medical records to and from facilities outside the U.S. should be
consistent with HIPAA guidelines.
(i) Patients choosing to travel outside the U.S. for medical care should be provided with
information about the potential risks of combining surgical procedures with long flights and
vacation activities.
Challenges and Perceptions – U.S. Patients
Survey Results - Top Concerns
Quality of Care
Hospital Reputation
Experimental Care
Personal Referral
Cost
Safety
Country Location
Cleanliness
0
10
20
30
Percent
40
50
Commonly Sought Procedures – U.S.
General / Cosmetic surgeries and Cardiology account for more
than 60% of the procedures
Focus Value Ratings
Cardiac
While the general market is large, this procedure is often covered
by health insurance. However, this is currently an area of
excellence for Providers meriting further investment.
Bariatric
Large and growing market. Frequently not covered by health
insurance. Procedure required by individuals of all income levels.
Motivation includes cosmetic and health reasons.
Orthopedic
Large market size, however this procedure is often covered by
health insurance. For those without health insurance they may
choose to delay or avoid treatment rather than pay out of pocket.
Transplant
Small market size. This is frequently covered by health insurance
further diminishing the size of the market.
Cosmetic
Cost savings may not be sufficient to cover travel costs, already
a well developed market in Latin America, does not correspond
with hospital brand image for complex procedures.
Fertility
Small market size. South Africa has a significant hold on this
Segment of procedures.
Messaging
Cost Savings- same quality, but lower costs
Median US Cost
Combined Travel &
Treatment Cost
Savings
Hip Replacement / Resurfacing
$50,000
$9,000 - $14,000
$41,000 - $36,000
Knee Replacement
$45,000
$8,000 - $13,000
$37,000 - 32,000
CABG (heart bypass)
$100,000
$9,000 - $14,000
$91,000- $86,000
Heart Valve Replacement
$125,000
$9,500 - $15,000
$115,500 - $110,000
Heart Pacemaker/Defibrillator
$60,000
$6,000 - $11,000
$54,000 - $49,000
PTCA (Angioplasty) with Stent
$70,000
$6,000 - $12,500
$66,000- $67,500
Spinal Fusion
$75,000
$7,000 - $13,000
$68,000 - $62,000
Gastric Bypass
$45,000
$10,500 - $15,000
$34,500 - $30,000
$20,000 - 60,000
$3,500 - $11,000
$56,500 - $9,000
Type of Procedure
Laparoscopic Surgeries (Gall
Bladder, Hysterectomy, etc.)
Source: IndUSHealth;; Procedures and Pricing; 2008.
Post-operative Care
• Post surgery care is a major concern for most
overseas patients.
• Patients, who have returned to their home country,
have expressed concerns over the ability to obtain
prescribed medication or medical care, should there be
complications after the surgery.
• Medical institutions seeking to attract foreign patients
should consider working with local hospitals/associations
for referrals and offering complete care for the patient
after they have returned to their home country.
Overall: Thailand, Singapore and India are most
advanced in medical tourism ...
Thailand
No. of medical
tourists
(2006)1
Annual growth
(from previous
year)
~ 660 K2
• 12%3
Revenues from
medical tourists
(2006 US$)1
Revenues from
medical tourists
(%)
No. of hospitals
accredited by
JCI
Recognition
Singapore
India
~450 K
• ~20%
750 Mn4
~300 K
• ~25%
425 Mn
Malaysia
Philippines
~300 K
~100 to 200 K
• 28%
440 Mn
54 Mn
• ~30%
125 Mn
• 20-40%
• 30-50%
• 10-15%
• ~5-30%
• <5%6
• 3
• 11
• 8
• 0
• 2
• “Top 10 international
HC destinations”
- News Week
• “Best medical/
wellness tourism
destination”
- Travel Weekly
2007
• Relatively new player
in medical tourism
• Lacks international
recognition (e.g. no
profile in “Patients
without Borders”)
... with differentiated positionings
Based on relative cost, quality, service, physical infrastructure and types of specialties
Thailand
Positioning
Good quality
elective &
tertiary care
with friendly
service
Singapore
India
High end /
complex
quality acute
care
High end care
at the lowest
price
Quaternary
Tertiary
Tertiary
Quaternary
Malaysia
No clear
positioning
Philippines
Low-cost quality
provider for
overseas
Filipinos and
Micronesia
Relative
Treatment price
Quality of
medical care
Service
Physical
Infrastructure
Focus
Wellness,
Elective, Tertiary
( “routine”1 )
Elective
Tertiary
(“routine”)
Poor
Wellness
Elective
Tertiary
Excellent
Key Strategic Considerations
For Turkey, India & Asia
Medical Travel is a promising new industry
in India & Asia, offering prospects for hospitals to
augment patient growth.
It is with a clear view of the addressable market
potential, internal strengths & limitations, as well
as the level of external competition, that healthcare
providers & facilitators may best move forward, to
realize this potential.
Our Goal
To make India the
‘Global Healthcare Destination’
Thank You