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Medical Tourism: An Expert Explains Healthcare Globalization Basics

What is medical tourism?

Medical tourism, at its simplest, is when people leave their country for another in pursuit of healthcare, whether a quest for faster treatments, for the sake of time-sensitive health issues, or for considerably cheaper state-of-the-art treatments, for the sake of their wallets, when some common surgeries and hospital stays in the U.S. can run in the tens of thousands.

Ruben Toral, founder of MedeGuide, an online international doctor directory featuring over 3,000 doctors in 10 countries, and former director of JCI-accredited Bumrungrad International Hospital in Thailand, a pioneer in medical tourism, spoke to SpaFinder staff earlier this month.  Toral’s affiliated hospital in Thailand operates similar to and is said to have the feel of a five-star hotel: Accommodations are more hotel-like than hospital-like, food options and boutiques within the facility are broad and international in scope and the overall atmosphere is more serene than frenetic, complemented by first-class medical care and service.

Toral says, for a time, the U.S. was the central medical tourism destination for Latin America, with institutions for superlative cancer care, like Johns Hopkins, the Mayo Clinic and Memorial Sloane Kettering.  In the wake of 9/11, both the U.S. and Europe placed visa restrictions on many travelers from the Middle East, thereby creating a shift that opened up other countries as hubs for medical tourism.
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Medical tourists are traveling for anything from chemotherapy to fertility to multiple cosmetic plastic surgeries − and at “third world prices,” Toral says.  Things like labor and malpractice are far less costly outside of the U.S., he explains, and the system is “less amorphous than the U.S.”: There is little ambiguity in costs, and medical bills are paid in cash.  Medical costs can run anywhere from 50 percent to 80 percent less expensive for comparable procedures than the U.S.

The tidal wave for Toral’s hospital, in particular, followed a story on 60 Minutes on CBS that aired in 2005 about medical tourism. The story spotlighted his hospital and a few American patients struggling with the cost of medical care.  One uninsured post-heart attack patient from Louisiana, grappling with the need for quintuple bypass surgery to live, as well as the hundred thousand-dollar plus cost, researched the hospital and found a U.S.-trained physician and had the surgery three days after his arrival in Thailand. He was able to avoid draining his life savings or finding himself unable to have the operation, essentially saving his life.


The outsourcing of healthcare, though up to an eighth of the cost for care in the U.S., is not currently embraced by U.S. insurers, national policy makers or the mainstream, despite the exploding numbers of uninsured or under-insured, Toral says. He speculates the resistance due to already built-in products and providers around U.S.-insured care, and insurers deem those who seek care abroad to be a small constituency.  On the contrary, Toral says. While the U.S. is not yet monitoring the volume or dollars spent by those who seek healthcare abroad, he is seeing the industry/market explode: In 2009, Bumrungrad, one of Southeast Asia’s largest private hospitals and founded in 1980, claims that international patients comprise about 42 percent of patient volume; about 30,000 patients a year come from North America.  Many countries are finding their specialty in the global healthcare market: Mexico for bariatric surgery, Costa Rica for dentistry, Barbados for in vitro fertilization and Brazil for plastic surgery and cancer treatment, he says.

Toral expects the globalization or outsourcing of healthcare to continue to flourish, as the U.S. no longer has a lock on quality care and Americans are paying more out-of-pocket for their healthcare than ever before. The convergence of the Internet is also a factor.  The uninsured are learning more about the alternative to outsource their healthcare and can readily find expert-trained care, many who are U.S.-educated.



Similar to medical tourism, which Toral called “a stepchild of tourism,” is wellness tourism, where visitors go abroad for comprehensive checkups, lifestyle modifications and detox programs. Patients are combining holiday and healthcare and the marketing opportunities are ripe, he says, as people are getting the message: “Come to Thailand to feel better.”  Both niches in tourism are fruitful as those who go typically stay longer and spend more than average tourists, and most importantly, they come back, Toral says.

What do you think? Will offshore medical care go mainstream and gain the acceptance of national policy makers, major insurers and employers?

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In Demand: Complimentary & Alternative Medical Services

It appears that more people than ever want complementary and alternative medical services, including services like reiki…and even hospitals are listening.

In fact, according to a recent article from the American Medical Association, the number of hospitals offering complementary and alternative medical services has tripled since 2000, with 42 percent of the 714 hospitals surveyed stating that they provide unconventional therapies. Hospital executives listed patient demand as the top criterion in choosing which therapies to offer, according to a report released in September by the American Hospital Association’s Health Forum and the Samueli Institute, a think tank that supports alternative medicine. In 2000, just 14% of hospitals told AHA researchers that they provided complementary therapies.

“They are responding to the needs of their patients and the communities they are serving, while trying to differentiate themselves in the marketplace,” said Sita Ananth, a Samueli Institute researcher who wrote the report, in the AMA article. “These hospitals are really trying to see how they can address the needs of the person as a whole — mind, body and spirit.”

Nearly two-thirds of hospitals offering alternative services provide massages on an outpatient basis, and half offer pet therapy in the hospital. About 40 percent of these hospitals offer acupuncture or music and art therapies, and one in five alternative-friendly hospitals provides reiki,  said the report, based on a survey conducted in March 2010.

About 70% of executives at hospitals providing unconventional therapies said they are doing so because they are clinically effective. This is in line with SpaFinder’s 2011 Trend Report, which highlights evidence-based medicine as a driver in the spa industry.

While there are plenty of spas that have been offering alternative therapies for a while now, perhaps medical and wellness spas that don’t may benefit by including a few alternative and complementary therapies in conjunction with its medical spa services, as Ananth said that the alternative therapies are intended to supplement conventional medical interventions.

“Many of these services are low-risk,” she said in the published article. “Patients are looking for the best of what both conventional and complementary therapies can offer, and hospitals are responding by offering these choices.”

Medical spas: Do you offer alternative therapies and how responsive are your clients? To help you in your research in implementing new therapies to your treatment menu, check out Spa Evidence. It’s the world’s first portal designed to help people explore the medical evidence that exists for spa and wellness therapies. The site covers 22 modalities, from acupressure to yoga, and has aggregated all of the evidence-based research from four respected databases. The best part about it is it’s free!  The portal also has logos and banners available for download that you can add directly to your website; and, for those looking to customize SpaEvidence.com, there is a “white label” option (cost associated) by SelfOptima, the portal’s developer.

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Not Too Late to Participate in SpaFinder’s Medical Spa Month

SpaFinder’s Medical Spa Month is underway, and it’s not too late to sign up to introduce your medical spa business to thousands of new consumers in your area. During the month of August, we will be spotlighting participating medical spa partners on our homepage, blog and various dedicated e-mails that will reach hundreds of thousands of spa and wellness enthusiasts who are looking for their favorite cosmetic spa services.

You can participate by offering a free consultation and a $100 credit on any cosmetic procedure valued at $300 or more. We’ll share all of your spa’s contact information on a page dedicated to educational content about the cosmetic spa treatments that customers want to learn about and try, making it a great opportunity for engaging first-time medical spa customers and those looking for new cosmetic options.

Sign up now for SpaFinder’s Medical Spa Month and reap the benefits of having your business introduced to thousands of spa- and wellness-minded consumers! To learn more, contact Alyssa Rode at Alyssa.Rode@spafinder.com or 212.924.1161.

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Australia to Test Botox for Asthma

Botox, most frequently injected into areas of the face to diminish wrinkles, will be injected into the voice box of asthmatic patients as a part of a study at the Monash Medical Centre in Australia for its potential use in helping ease their symptoms.

While we heard about the studies behind Botox for migraines, this trial is the first of its kind in the world. Spurred by a recent survey by the university, which found that about half of severe asthmatics suffer problems with their voice box as well as their lungs, the study will include 30 participants and will span a year, beginning in a few months, the Telegraph reported. The problems discovered in the survey were similar to vocal cord dysfunction, which causes abnormal movement of the voice box muscle, a condition which Botox has been used to fix.

The trial will explore the idea that the Botox will relax the muscle that controls the voice box, which may allow for asthma patients to breathe easier.

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Before & After: Seeing Virtual Results

In the past few years, there have been a few plastic surgery iPhone apps introduced in the marketplace, such as Plastic Surgery Dr. 90210  from Simoni Plastic Surgery, Shafer Plastic Surgery App, Body Plastika, and the more game-like iSurgeon. Joining the crowd is Allure Medical Spa’s newly introduced app, designed to help prospective plastic surgery patients visualize their outcomes.

Boost Your Beauty, an iPhone app, includes before and after photos, but it also features a visualization tool that allows prospective patients to upload a photo to see how various plastic surgery procedures will change the way they look. With a swipe of the finger you can shrink your waist or give yourself a nose job. Results can also be shared with friends when you’re done altering your photo.

An instructional section of the app features slideshows with information on various surgical and non-surgical procedures, such as eyelid lifts, liposuction, and varicose vein treatments.

Have your patients have tried apps such as these before coming in for a consultation or medical spa appointment? What do you think about them – are they handy or harmful when it comes to a prospective patient’s expectations?

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August is SpaFinder’s Med Spa Month – Join Us!

Let SpaFinder help you reach more customers. Participate in our special Med Spa Month marketing program.

All you need to do is offer a free consultation plus a $100 coupon* good towards a cosmetic procedure, and SpaFinder will include your spa information and offer details in a custom Club Spa e-newsletter, blasted to our consumer database of nearly a half million spa enthusiasts!

If you would like to be a part of SpaFinder’s special promotion, please contact medspainquiry@spafinder.com byJuly 25!

Make the most of your listing and the power of SpaFinder!

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Equinox Partners with Spa 7 to Offer Medical Spa Treatments

Equinox is taking the definition of wellness beyond just fitness with a new partnership with Spa 7 medical spa. While the health club chain already has spas at four of its clubs, Spa 7 will bring laser-based medical treatments, such as laser hair removal, skin rejuvenation, skin tightening, body contouring and more, to two West Hollywood, California, Equinox clubs by fall of this year. The new full-service trilogy of fitness, day spa and medical spa has already rolled out in one West Hollywood location.

“We have the most innovative procedures but clients also get to reap the benefits of the use the gym and spa facility the day of their treatment,” Pamela Yager, co-founder and spa director of Spa 7, told SpaFinder, adding that there is the potential of spreading beyond West Hollywood. “They’ll get to go to classes, use equipment, and go on the spa sun deck. We’re delivering on Equinox’s tagline, ‘It’s not fitness, it’s life.’”

Nicole Vitale, senior director of spa at Equinox said that because Spa 7 has a good reputation in California, it seemed like a great fit.

“We always want to expand our services and offer everything we could,” Vitale told SpaFinder. “We’re excited to have them on board and I think it will be a great partnership going forward with everyone learning what they do from laser hair removal to body sculpting, and the photofacials that they do are great.”

The biggest point of differentiation for Spa 7 is that it’s the only spa offering the new Solar Facial treatment in the country, Yager added. This treatment offers fillers without injections. More information will be rolling out soon.

“It’s sort of a one-stop shop concept,” Yager said. “I like to use the saying ‘We know you’re getting it; get it here.’”

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Plastic Surgery Defies Recession, Group Botox on the Rise

Photo via Flickr user stevendepoloPlastic surgery procedures increased nearly 10 percent from 2009 to 2010 with more than 9.3 million surgical and non-surgical procedures logged in 2010, at a cost of nearly $11 billion, according to Dr. Grant Stevens, chairman of the media relations committee of the American Society for Aesthetic Plastic Surgery (ASAPS), which commissioned a study released this month. Dr. Stevens is also a board certified plastic surgeon and founder of Marina Plastic Surgery Associates in Marina del Rey, CA.

“We were surprised and thrilled to see increases in a variety of areas because it points to a positive change in economic indicators for 2010 – 2011,” said Dr. Stevens. “In my own practice, I’ve seen a major increase in demand by men – the study showed an increase overall of 88 percent since 1997, breast lifts, and generally a bigger caseload proving that beauty is recession proof.”

Patients between the ages of 35 and 50 accounted for 44 percent of the total, the majority of any age group.  Requests for liposuction, eyelid surgery and abdominoplasty (tummy tuck) topped the list of most requested surgical procedures, according to Dr. Stevens.

“According to the ASAPS study, 19 percent of the patients belong to an ethnic minority,” Dr. Stevens said. “That’s a major uptick, since traditionally many surgery practices have catered to white women. It’s great news.”  He added that laser procedures, including laser hair removal, as well as chemical peels and breast reduction, are also popular and getting more so.

“The ASAPS study demonstrates that people of all ages and races want to look better, be it for themselves, a significant other or because they are seeking employment,” Dr. Stevens said.

Also, Botox was far and away the most requested non-surgical procedure. In fact, Anita Wolf, a registered nurse at Madison Skin and Laser Center in New York has noticed that what was once a procedure done in secret is becoming a group activity.

“In the past we found that people didn’t want anyone to know they were receiving Botox or filler injections,” Wolf said. “Today, they are happy to attend a Botox party with friends, sisters, brothers, and even their moms and receive treatment together, so we’ve added a party element including free food and beverages and giveaways,” states Wolf who has worked in aesthetic medicine for over seven years.

The medical spa will be hosting a Botox/Filler Party on April 19th, just in time for Mother’s Day.

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‘The Doctors’ Co-Host and Dr. Ritu Chopra Launch New Skincare and Beauty Line

Co-Host of “The Doctors,” Andrew Ordon, M.D., F.A.C.S., and his colleague, Dr. Ritu Chopra, have launched RATIO, a new line of anti-aging skincare and beauty products. Befitting of the new line’s name, the two doctors have combined their talents and skills in Eastern/ Western medicine to create a synergistic ratio of blended ingredients for balanced skincare therapy resulting in a renewed, smooth, and youthful complexion.

“With decades of experience, I’ve brought a unique combination of training, procedures, and quality of care to my patients,” said Dr. Andrew Ordon in a release. “When I commit to something I always do it 100 percent. I’ve accomplished this through the enhancement of each patient’s natural beauty with the latest techniques in cosmetic and reconstructive surgery. The collaboration with Dr. Chopra on the development of RATIO is an expansion of this commitment to taking beauty enhancement and skin care products to a new level.”

Retailers and medical spas in the U.S. will soon carry RATIO.  Currently products available in the RATIO line include a cleanser, eye serum, facial serum, moisturizer, and mineral powder. An expanded line is expected to be launched in the near future with sensitive skin, baby skin, body exfoliant, self tanner, oil-free skincare, and men’s skin care products.

“There are no magic potions or lotions, however, there are synergistic anti-aging skincare ingredients,” said Dr. Ritu Chopra. “RATIO’s unique fusion of Eastern and Western medicine ensures this superb line of beauty products will be recognized as revolutionizing anti-aging skin care. With our unwavering commitment to pioneering advanced healing for all aspects of skin and health care RATIO brings a fresh perspective to the skin care industry.”

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Botox Equals Weight Loss?

Recent studies have shown that Botox® is more than a wrinkle-filler – now it seems it can help those struggling with weight loss.

The Doctors
Watch the Meet the Doctors segment with Dr. Robynn Chutkan.

A new (and ongoing) study suggests that botulinum toxin products such as Botox® can be injected into the walls of the stomach to suppress appetite. Patients are sedated at the time of procedure, as doctors use an endoscope to view the stomach’s interiors before injecting the Botox®.

The botulinum toxin “temporarily relaxes the muscles of the stomach so that it can’t contract as vigorously, and you feel full faster and you eat less food,” explains Gastroenterologist Dr. Robynne Chutkan, founder of the Digestive Center for Women, on a recent episode of The Doctors. Clinical trials showed that the food stays in the stomach longer, delaying emptying time and cutting the maximum tolerated volume, or the amount of food and liquid it takes a person to feel full, in half.

“The peak effect takes about two to three weeks, just like botulinum toxin in the skin where it takes a few weeks to kick in, it’s the same thing in the stomach,” Chutkan said.

Only ten patients thus far have been treated, says Chutkan, who shared with viewers a video of the procedure being performed on her own stomach. “It’s subtle, but you definitely feel full faster,” she says, noting that she lost seven pounds in three weeks.

In other Botox® news, the U.S. Food and Drug Administration recently approved Botox® injections to prevent chronic migraines in adults. (People with chronic migraines are categorized as those suffering from headaches 15 days or more per month.) The FDA advises the preventative treatment be injected every three months around the head and neck area to dull future headache symptoms.

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