Your Business: Medical tourism – growth industry or a burden?
The status quo in Israel means perpetual shortages of beds and staff.
By HAROLD GOLDMEIERRambamHospital_210513_A(photo credit: Rambam Hospital)
Medical tourism tops the list of emerging industries among health-care and Treasury officials around the world. Hospital administrators are avid to generate income for their cash-strapped institutions, while doctors want foreigners as private patients for the extra income. Tour companies see it as a natural extension of their business. More than 40 countries are marketing themselves as medical destinations.Israeli politicians vacillate, pressed by patient advocacy groups and old-guard ideologues wanting to preserve health-care services for Israeli citizens in a country with limited resource. The status quo in Israel means perpetual shortages of beds and staff.In many of the wards and emergency rooms, patient beds congest hallways and cubbies. Four or six patients share bathrooms and showers, and they can wait weeks to take tests and longer for lab results. Israel’s hospital occupancy levels exceed 96 percent, compared with 76% for OECD countries. Can a small country like Israel capitalize on a vibrant industry without harming quality care for its citizens? I had two experiences with Israeli hospitals this summer. I spent a week in Asuta (north Tel Aviv). It is a modern, sleek, exceptionally clean facility hosting two patients to a room and a private toilet and shower. Nurses readily responded to patients. A nutritionist visited me twice in the week, carefully selecting a menu delivered from the kitchen to suit my digestive needs. A cardiologist reviewed my case before surgery, examined me afterwards and wrote an order for follow-up when I got home. A healthy partnership let my kuppa (insurance company, part of the national health system) arrange the pre-surgery tests in their facilities.Everyone with hospital experiences tells me this is more like a medical-tourist experience than an everyday Israeli one.My daughter-in-law had a baby elsewhere in a maternity ward with excellent postpartum and pediatric care. Beds in the hallways, four patients to a room crammed together with little space for kvelling guests, bathrooms and showers down the public hallways shared by several rooms full of patients, shows the underbelly of hospital experiences in Israel.There are two medical systems today in most countries, and the gap is growing. Hospitals serving poor communities are existing by maximizing government reimbursements. Many barely meet accreditation qualifications in deteriorating buildings, with minimal sanitation and cleanliness, or patient amenities.To attract wealthy patients, suites resemble pharaonic penthouses with fancy furniture and luxury linens, with nary a beeping machine-blinking light. They market stellar reputations in cardiac care, headache and pain management, orthopedic and bone treatment, cancer treatments employing traditional medicines and holistic approaches.Maternity ob/gyn centers have midwives on staff, and afterbirth rest suites for that home feel. Stylishly furnished birthing rooms replace sterile labor and delivery theatres. Many US hospitals maintain their own air transport facilities, flying dignitaries almost to the door, and offering tour and shopping holidays for family and friends while patients recover.Israel is changing in spite of itself. A report released in April 2013 from the Health Ministry estimates medical-tourism revenues skyrocketed from NIS 54 million in 2009 to NIS 119m. in 2011. Some 30,000 medical tourists annually spend nearly $5,000 per visit, compared to about $1,500 for sightseers. The tail is wagging the dog, and the clamor from hospitals and doctors to build their service network is increasing. A Knesset committee for regulating medical tourism, a euphemism for putting a stranglehold on its growth and development, lies fallow in a professor’s desk somewhere.Foreigners are drawn to Israel’s reputation as a world leader in trauma medicine, bio-tech, dental implants and IVF services, with lesser quality and higher-priced care back home. Maintaining allegiance to a tenacious web of antiquated ideologies, union self-interests, and fatigues bureaucracies, is pharisaic resulting in what no one wants– services and care diverted to people spending lots of money at the expense of patients relying on government reimbursements.
Dr. Bruce Rosen and Keith Kanel foresaw the trend in 2010: “Key challenges facing Israeli healthcare include a decline in the publicly financed share of national health expenditures, a growing shortage of nurses and a projected shortage of physicians, and persistent gaps between population groups in health outcomes and healthcare utilization” (Healthcare in the US and Israel).Here is a partial plan one group proposed to me: • A string of smaller, private hospitals or medical centers built with private investment funds in a strategic alliance with government hospitals and health-insurance companies can open in attractive locations for tourists. Doctors and nurses from around the world will practice in Israel for three to six months or longer. The Health Ministry must accept credentials from abroad, granting medical licenses and work visas to temporary professionals.• The facilities will be luxurious, welcoming places with multilingual staff offering cardiology, IVF, oncology, orthopedics, plastic surgery, dental surgery, gynecology and urology. Cardiac centers, imaging centers, genetic, gastroenterology and pathology centers will house state-of-the-art equipment. Patients will be allowed to choose the dates of their surgeries and their surgeons; they consult with their family physicians before and after the procedures by telephone, video-conferencing or on the Internet.Tours of Israel, communications equipment while in Israel and a special department to process insurance claims will be among the services.Medical tourism creates jobs and income, saves lives and gives Israel a chance to promote its national message (hasbara).The Dartmouth School of Medicine is named for Dr. and Mrs. Seuss (Theodor and Audrey Geisel), who quipped, “Sometimes the questions are complicated and the answers are simple,” but at the juncture where medicine meets capitalism beware, “Step with great care and tact. And remember that life’s a great balancing act.”Dr. Harold Goldmeier is the managing partner of Goldmeier Investments LLC and an instructor of business and social policy at the American Jewish University, Aardvark Israel, in Tel Aviv.
