The First European Congress on Health Tourism (ECHT) 2008 took place in Munich, Germany. Although largely concerned with the links between Germany and the Middle East, particularly the Gulf region, there was a great deal of interest for all participants in medical travel and global healthcare. Patients have been travelling from the Gulf to Germany for decades, and these numbers have increased as patients have been reluctant to travel to the US or have been discouraged by visa requirements.
Nevertheless, Germany, for all the attractions of its high level of healthcare, faces challenges not least from Asian competitors and the recent strength of the euro.
The Congress was officially opened April 10 by organiser Uwe Klein, who introduced His Excellency Khalifa Al Harthy, the Ambassador of the Sultanate of Oman. Al Harthy pointed out the close links between the two countries. He detailed these as not only consisting of two-way trade and education, but also tourism, with some 150,000 Germans visiting Oman last year, the highest number from any European country, and Oman Air beginning a direct service between Oman and Frankfurt from June of this year. Al Harthy pointed out that Germany has for some time been a favoured destination for Arabs, attracted by both the service and security they can hope to receive in the country. But he warned that Asian countries in general, and Thailand in particular, were becoming hotspots as a result of their high service levels and competitive costs.
These remarks were echoed by Abdulaziz Al-Mikhlafi, GHORFA Germany (the Arab German Chamber of Commerce and Industry). He said there were good business links between Germany and the Gulf, and some 200,000 Arabs visited Germany in 2007. Yet competition was strong, with patients able to search all over the world for the right facility. In addition, the huge wealth of the Gulf region and the current high price of oil, has allowed renewed investment in infrastructure, including health facilities. The Gulf countries want to treat their own patients and have plans to attract people from within and without the region.
The opportunities for facilities in the United Arab Emirates (UAE), and particularly Abu Dhabi, were made clear. Dr Franz Benstetter, head of managed care services in the health division of Munich Re, detailed the current move in Abu Dhabi “from governmental compensation towards a health insurance system”.
Dr Benstetter explained that the move in Abu Dhabi was triggered by the increase in healthcare expenditure in the Emirate, from 6.9 percent of GDP to 9 percent between 1990 and 2005.
Faced with many of the same challenges as developed and developing countries around the world, namely an ageing population, prosperity diseases, scientific and technical progress and supplier-induced demand, the Emirate determined that the existing system was not prepared. There was a possibility of an inflationary spiral or the need for cost control or rationing of healthcare.
Previously the healthcare system had been free for nationals and heavily subsidised for expatriates, the majority of whom are labourers from the Indian subcontinent. There were clear challenges with regards to access, transparency, quality, costs and efficiency.
The figures were small compared to many countries, with a total population of only 1.85 million inhabitants, of which 1.4 million, or around 80 percent, were expatriates.
The UAE reportedly has the second highest prevalence of diabetes worldwide with recent figures suggesting that one out of five people in the UAE aged 20 to 79 already lives with diabetes.
The solution in Abu Dhabi was for the government to partner with private insurer Munich Re allowing access to a management team and existing systems, and incentivising it to assist a quick build-up. The aim was to guarantee the sustainability of the healthcare system, and also reduce costs while at the same time increase the quality of care. An important mid-term aim was to improve the quality of healthcare in the Emirate by providing a guaranteed source of funding for facilities.
The first move was to ensure that all expatriates were taking out health insurance, and so in 2005, a law was passed making it compulsory for employers and business owners in Abu Dhabi to provide health insurance for their expatriate employees and their families and a National Health Insurance Company – Daman was established.
A basic product for those earning less than AED4,000 per month (US$1,089) was introduced, for which the insurer was Daman and the subsidised policy cost was AED600 (US$163) per year. There was another policy for those earning above AED4,000 per month (US$1,089), with a group of 27 insurers competing with one another to offer different products with risk-based pricing.
By the end of 2007, there were 971,000 members of the scheme and the intention was to move on to extend the scheme to nationals. The hope is that the new policy will attract providers, encouraging developers to build more hospitals, increasing funding to the sector. The scope of coverage is now wider and facilities should be encouraged to be more ambitious.
Tourism and medical tourism: the worldwide growth
Dr Luigi Bertinato, director of international health and social affairs office, Department of Health and Social Services, Veneto region, Italy
HCA International Hospitals – Outstanding Clinical Quality
Elizabeth Boultbeem, head of international business, HCA International
Beat Huber, founder and president, The Swiss Leading Hospitals Group
Patient Streams – Identifying and serving target markets in medical tourism
Dr Prem Jagyasi, business development and marketing with Lifeline Healthcare
Medical tourism – a UK perspective
Keith Pollard, managing director, Treatment Abroad