Following Serge’s Lasik operation we were very suprised by the pricing methods of each hospital. Going to many places, we have seen different types of clinic layout, different girls at the reception desk but all in all more or less the same machines! But the prices were like the fireworks we needed to make a funny article.  

• fixed price per eye: “hey, we are specialists, don’t worry”.
• price according to the pathology (normal according to us) and often price ranges determined by further examination
• price according to a first examination (normal but tough to cater to international patient). This is a little lke the russian roulette if no price range was provided, but it shows the profficiency of the practionners
• price according to age (the older you get the more difficult hence the higher price according to the clinic using this price policy)
• price according to the seniority of the medical staff involved (a senior surgeon with 500 Lasik surgery costing 1,5 times the price of a junior surgeon). If your surgeon looks like Ramses II, you’d better have a few millions USD in your back pocket.
• Price with and without follow up (it s like taking an Acer laptop with no guarentee: pure suicide)

I found a lot of hitmen to get rid of you but their asking price are … heterogeneous!

Serge paid 2800 euros but gosh his eyes have everything you could make glasses off, myopia being trite for his bad eyes. The price tag is certainly double to what he could have gotten in Thailand. He learnt the price after his medical consultation (that he had to pay for whatever happens) and decided the next morning he would do it whatever the price was. I must admit that giving the price after the customer/patient commited itself with a medical visit has some advantages…

Serge Fabre, my dear business partner, was now sure of his decision: it was LASIK at Excellence. Bye, bye glasses, aurevoir les lunettes, adios gaffas.

One morning he went to have a preliminary check up. The verdict came within two days: his right eye needed more correction than the left, he was a little bit of everything eye wise, here is the price tag, are you willing to proceed Mr Fabre? Serge was really tired of his glasses and when he understood that recovery time will take only 3 to 4 days he was 100% ok.

After a mere 5 days, the operation was set up. It was very fast according to him with almost no sensation. No blood, no sweat, no tears… Where is the drama!!! but after, I had the biggest laugh of 2008.

Serge came the following day to our office with dark pitched sunglasses, the one that Jack Nicholson was wearing in Easy Riders… I had my own Ray Charles at the office. He didn t want to take them off fearing to hurt his eyes. Actually he just had to  firmly protect his eyes for a day before going out in the daylight, with his 80 s glasses. From transparent high tech looking glasses, to these pre Ronald Reagan Ray Bans, what a rip off! I immediately ran to the shopping center to buy a leather jacket and a motor bike, we had something great  going on.

I Know, I could have find a better picture (look at this shirt!), but at least you can witness his nasty grin, saying: Ain’t I sexier now?

I must admit that after he was feeling confident enough to get rid of his dark glasses, I had the impression of seeing a new man. His face changed, became rounder (to me), he looked younger, sharper and even… wiser. What an aesthetical makeover thanks to Lasik. Serge told me he was feeling strange without his glasses on, as if his nose was lighter but needed to be heavier (I translate litterally, sorry if it sounds strange). but wow he lost 50 years in the process and looked again like an angel! He was seeing even better than with his glasses and told me: “If I knew how good I could feel, I would have done better”

Here is our first customer being extra extactic over his first procedure.

Now Serge, tell us, what will be your next medical tourism experience. take a look to our catalogue on Bemyspa.com someday….

I talk, talk, talk about medical tourism: but many people can object me, “till you never tried it, you never know what it’s all about”

My partner Serge Fabre, though in his late 50s is an indiana Jones of the modern ages when it comes to experiencing his business. As a tourism expert he travelled to all kind of destinations from Las Vegas to the jungle in Burma. Now that we are willing to indulge in Health Tourism he told me: “Raphael, I am going to see by myself if what we are offering to our customer is worth it”

So now we had to think hard about what he could do in terms of elective surgery: an aesthetic operation? He is, I must admit, still a Don Juan, so he does not feel any particular needs. Perhaps some more abs, but he swims regularly so it s ok… Dentistry? Not really, his teeth are perfect. Hair implants? I would like to see him with hiars (look at his bonze like picture)… Eyes? Oh yes, that s it, get rid of these horrible glasses Serge, please!

Serge with glasses. He looks happy, but like an old owl is happy, like a monk preaching his past experiences, not living them. By the way, I am sorry for all the readers that try to understand what Serge is doing on this picture I have no clue!

So we were thinking about a destination to try. We have our offices in Singapore but were looking all around Asia. Serge then visited a few places to inquire about LASIK procedure. He got from a friend a price from l’institut Rotschild in Paris has a benchmark. We went to several places in Bangkok and Singapore exclusively. It was an easy experience, without any stress. In the cab in Bangkok I asked Serge if he realized that he was going to have a surgery performed on him, and he seemed very serene as if he was on a shopping trip looking for a tie. I like dramas so I must admit I was disappointed to see him so confident

We never got a precise price, as the price will depend on the amount of correction to do on each eye, as they are also independant (the left could be in a worse shape than the right). However, the price ranges given by the hospital were all below what he could have get in one pof France’s best clinics. In Singapore, he has visited many facilities following the advice of friends and ended opting for Excellence, a top notch clinic in Singapore. Serge will tell you, it’s a very very nice clinic, you feel great being there. A 5 star hotel like facility, a notch above what we have seen ini other places. But furthermore what played a major role was the fact that many people referred to this clinic as one of the best. We don’t know the truth about it but it didn’t matter, Serge was happy to go there.

The price? It was 20% more expensive than what he could have gotten in Thailand. But he was willing to have the best price on quality ratio, so there was no problem. And it ended up costing 35% less than in France, which is not neglegible on a four figure operation… so what wasthe outcome?

This morning, I made my little trip through some websites to get news about the medical tourism industry and noticed that the Health Business Blog by David Williams was talking a paper called Medical Tourism: Implications for Participants in the US Health Care System backed by his two companies (MedPharma Partners LLC, a health care and life sciences consulting firm and MedTripInfo.com).

The paper is pretty optimistic about medical tourism, something that is perfectly understandable as it is both companies core market. What is interesting is the fact that David Williams is a former consultant (BCG, LEK) hence he has a systemic view on the whole industry. Let’s take a close look at what he is saying:

Here are their predictions:

A. US health insurers will start to provide coverage for medical tourism in 2008. Mini-med plans and small employers -not big health plans and blue chip companies– will lead the way.

My take: I feel it is true to a certain extent. Indeed, some US insurers have made some noise in Thailand and Singapore with medical tourism authorities and are to launch tehir new products begining 2008. Small initiatives were made by entreprneurs but you need a strong financial power to have a sustainable model. in fact, the problem with these insurance models are the adverse selecton effect and the high risk of failure (the medical travel insurance’s population are not the best insurable commodities often, though this is a different game if we are talking about corporate insurances). I ll say ok for B2B, not yet for B2C.

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B. State governments will begin to embrace medical tourism by 2010.

My take:This will be limited to a few States. Some States will bodly show their teeth as they feel they cannot acknowledge their structural problems fearing some social ruckus. Some States will certainly pave the way when 10 S&P 500 will have implemented their medical travel solutions. All in all, it’s corporate America! Still, medical travel?? What are we talking about: heavy surgery abroad or dental and cosmetic surgery? For the latter I still think it will be a taboo even though it is the real core market…

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C. Opposition to medical tourism by US physicians will be relatively modest.

My take:their two main points is to say that 25% of the US physicians are foreign born plus that medicine is a global profession. This is a little bit too easy. It is not because you are foreign born that you will feel confident sending someone looking for an angiography to india! It is not because you know some experts in neurosciences from Singapore that you will encourage someone to have an arthroscopy in Sinigapore! Actually, what medical tourism needs is a clean track record to convince doctors. A doctor will always look for what he feels is best for his patient and even though medical travel can be a last chance solution, it is not yet seen as the BEST solution

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D. Medical tourism won’t have a major, direct impact on US health care costs, but the secondary impact will be substantial.

My take:I really like what they are saying! Their idea is to point out the fact that medical travel can only help trimming a very small chunk of the US medical bill (a max of 5% of every American decides to go abroad to have heavy surgery). The secondary impat aims at the wake up call that could happen if people start shifting towards Asian and South American Hospitals. Practices will be bettered, gain of productivity substantial and new binary practices (such as telemedicine) enhanced. Viva Medical Tourism.

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To me, this last point is really interesting. It reminds me the theories of creative destruction by Schumpeter that considers competition as a way to “creatively destroy”: from the shambles of a concept or company can surface a better product/concept/operation… In the same way, the US medical industry needs to shake up: 12% increase per year on corporate medical costs is ludicrious, most notably in a period when some mid sized US companies are looking for a new breath of life or just praying to get absorbed. Yet, the main problem is that medical travel is seen as something easy to operate and to enforce while it is not, and the sector itself must endure a hearsh competition from the US hospitals to thrive and find the appropriate business model and marketing messages… The creative destruction hence goes both ways as today, medical travel agencies are not able to attract an important number of customers and must mend their way if they want to be ready for the major changes predicted by MedTripInfo. 

The White Paper can be downloaded here!!

A few days ago I remembered one very trite fact. Before 1965, Singapore was still part of the Third World and quickly positionned itself as one of its leaders. I read about an innovative public management with highly paid top public servants many public private collaborations, an efficient central planning. But what really shocked me was that in 1965 the average  age in Singapore was 18,8 years old, while now it’s 32,7. Now, the demographic transition is well consumed as Singapore will have 1/4 of its population beyond 60 year old in 2030!

The Tan Toc Seng hospital - A new fashionable hangout for old people?

This ageing population is posing huge problems as Singapore hasn’t yet adjust to the high health cost implied. In fact today; Singapore has an extremly low private health expenditure barely toping the 2,5% of GDP against Mamoth expenditures such as in the UK 17,8% in 2004 or Australia 34,2%. Even though this is mainly due to the little amount of second opinion requested, the welfare system(that is not equalitarian but socially oriented) or even the small number of hypocondriac people (compared to some European countries), this small figure is stemming from a healthy population. This figure should indeed soar up to 5% by 2030, exactly the same figure  than in 1965.

All in all, Singapore has been viewed for years by the World Health Organisation as the 5th or 6th best medical system in the world. The central planning is perfectly channeling its demographic evolution while promoting the expansion of medical tourism activities (Singapore is expecting 1 million medical tourists per year in a short horizon). The number of beds should grow as the City  State establish itself as the best medica hub in the World but is gearing towards a bicaphal approach: geryatrics and the outsourcing of general medical procedures… Not exactly the same thing…

The last days were extremely interesting for me. I was really wandering in the medical tourism jungle, checking which definitions people had in mind. I remember writing the ‘About this website’ page a week ago and I was so unsatisfied by this page that I decided to shelve it and rewrite it later. 

Every time I have a debate about medical tourism, people portray this industry as an unethical way of making money using the despair of people who can’t afford surgery in their country, plus a dangerous production system with all the infamous stories of botched mammoplasty or rhinoplasty.

Yesterday during a dinner, I tried to argue with a cardiologist that medical tourism is not boiling down to low cost procedures but is a wider access to unknown techniques perfectly mastered in Asia. These techniques range from ayurveda to tsubo chiatsu to Lasik surgery etc etc. I acknowledge the cost differential (we were talking about angioplasty) but for me, he was focusing on a non sustainable medical tourism. 

I am using the words ‘non sustainable’ because I feel that the existing business models of medical tourism are all one shot models:

+ heavy medical procedures motivated by a low cost effect or long waiting lists

+ no follow up stemming from the procedure + no customer relationship management approach. 

It is a run and gun approach that certainly has people smearing about the association of words ‘medical tourism’. But again there is hardly any tourism implied by this method> I have pinned this idea as medical travel. Let’s call it INDUSTRIAL medical tourism (as an input -output chained process)

 Yet, this is definitely not the vision I have about medical tourism. NOT AT ALL !

To me, medical tourism in Asia is an open window leading to the best healthcare procedures in the world, innovative techniques to solve rare condition techniques, the best preventive care solutions, unheard of manipulative therapies plus an opportunity to enjoy a tourism experience and so forth. Perhaps my definition is wrong but this is what medical tourism sounds to me. One could argue that I am speaking about health tourism…

 

Medical and Health Tourism as we define it as a longer life expectancy and a higher volume than the classical model

When considering biological methods such as herbalism or manipulative techniques such as psychotherapeutic postural integration or ayurveda are we only talking about health? These techniques are a genuine front end to medical procedures so how can they be restrained to mere health procedures… Medical tourism must be a sustainable experience and therefore must entice repeated visits: diversifying methods, proposing long term follow up (using tools such as the PRM we have previously reviewed) 

Here is my real first tentative definition of Medical Tourism, that we will call from now on Medical and Health Tourism: 

 ‘ an experience of medical and healthcare techniques culturally connected to a specific place or technically knitted to an hospital for preventive, aesthetic or curative needs ’ 

Experimenting these techniques boils to an exploratory approach that is tied up with traditional tourism (going from one place to another to try out a technique etc etc) but with the particularity of positively affecting our body  Talking about how angioplasty could cost only 10000 USD is definitely not the goal of this blog.   

Discovering medical tourism is going to take a major u turn. In order to carry out a clearer perspective on what we consider medical and health tourism is we will from now on stress upon THIS definition of medical tourism by digging into health and medical procedures specific to Asia and all the techniques that can make medical tourism a sustainable tourism.  

There has been a sprawling development of medical centers in Asia but more specifically of aesthetical centers with the need of bringing differentiated quality to potential customers. The practice of cosmetic has proved to be very profitable stirring the proliferation of smaller centers whose practitioners pose as real cosmetic surgeonseven though in a country such as Phiklippines seven years of residency education at a reputable hospital are needed to pretend such a thing.

Creating barriers of entry is a new challenge for aesthetic centers. There are several ways of upgrading the quality of a center:

+ recruiting seasoned surgeons

+ showing dedication to care, prevention and decease treatment, the primary functions of doctor in an aesthetic center

+ using breakthrough technology 

The Aesthetic and Dermatology Center that has opened in March 2007 in Manilla is a perfect example of this upward trend through the use of new technologies to complement the surgery such as Aesthera, a machine used for hair removal and skin rejuvenation or the LPG machine (named after its designer, French engineer Louis Paul Guitay) to prepare the body before liposuction, or to contour the body after the procedure. This example put forward the high degree of penetration of new technology; innovation is an important differentiation factor of medical procedures in Asia as some treatments are approved and available in Asian hospitals months before their actual diffusion in the US and in The UK

The new paradigm … not the old woman!

Defining a new paradigm

The Health industry is gaining foothold on the Medical industry as a new paradigm surfaces. In fact, the new trend is not to wait to get sick or spend on chronic care but get to grip with our pitfalls at an early stage through medical screening. Indeed, Medical check ups appears as the real centerpiece of this new paradigm. However,  the cost of an extensive medical check up is extremly high in the US and some parts of the check up are not available in some hospitals. On the other hand when looking at Asian Hospitals we find that the top JICT accredited hospitals are well equiped to treat demands of extensive check ups and offers a real cost differential.

Hence, Medical tourism should focus in a near future on light medical procedures such as Medical Check ups to open the total array of services connected to medical tourism. Medical check ups appears as the stepping stone of the industry, but how?