Medicine: Traveling Patients
Hadassah is making strides in the field of medical tourism, attracting people from around the globe with its many sophisticated specialties. .
Whether it’s the grueling journey to ancient Greece’s healing sanctuary at Epidauria, crossing 19th-century Europe for its medicinal spa waters or seeking miracle cures at shrines like Lourdes in France, the sick have long been willing and even anxious to travel for their health. Now as never before people are looking worldwide for health care options.
“With today’s ease and affordability of international travel, with its instant communications and availability of information, health care choices have become global,” says Amitai Rotem, director of marketing at the Hadassah Medical Organization in Jerusalem.
In the past decade, a dozen countries in Central and South America, the Far East and Europe as well as India, Malaysia, South Africa, the Philippines and the Dominican Republic have been making significant and successful investment in the highly profitable field of medical tourism (also called medical travel or health tourism)—with Arab nations close on their heels. In Israel, however, which has long treated individuals who have made their way to its hospitals from around the world, there has been no concerted national effort to build this burgeoning industry. Until now.
“Medical tourism today constitutes less than 1 percent of Israel’s tourism income, with only 10,000 foreign patients coming to the country each year and spending $30 million on treatments in Israeli medical institutions,” says Dr. Shlomo Mor-Yosef, director general of HMO. “This can and should be more than tripled in the next five years to bring in an annual $100 million that Israel can use to improve its health care and disease-prevention strategies. With our world-class medicine, medical tourism should be designated a national target.”
The Hadassah–Hebrew University Medical Center at Ein Kerem began developing medical tourism seven years ago as a unit within the marketing department. Hanna Tidhar, a Hadassah tourism department veteran and a longtime advocate of medical tourism, was appointed international patient coordinator.
“That first year, I constituted the entire international unit, which brought in $500,000,” she says. “Every year since then, we’ve doubled the number of international patients and now have a staff of six to manage them. In 2007, around 1,000 international patients came to Hadassah, earning $10 million for the medical center. Our five-year goal is at least to double that number again and bring in some $25 million to put back into upgrading medical, teaching, research and auxiliary services.”
The numbers may sound large, but if Hadassah achieves its goal, it will win no more than a very modest share of what David Hancock, author of The Complete Medical Tourist: Your Guide to Inexpensive and Safe Cosmetic and Dental Surgery (John Blake), predicts will be a $40-billion-a-year world industry by 2010.
Why do sick people travel, and how can they be encouraged to travel to Israel and Hadassah? Rotem identifies three primary reasons why people look for health care away from home, over and above the more frivolous one of combining treatment with vacationing and sightseeing.
“First is cost,” he says. “In the United States, for example, there are 80 million Americans who have no medical insurance and millions more are considered underinsured, figures that are likely to soar in coming years. For them, costs overseas are 30 to 80 percent lower than what they would pay at home. Heart bypass surgery in the U.S., for instance, costs $200,000. In Israel, the same procedure and its aftercare cost only $20,000.”
A second motivation is the waiting time that plagues overburdened health systems. In 2005, there were 782,936 patients waitlisted for different procedures in Canada. “In Britain, patients regularly wait up to 18 months for hipreplacement surgery,” says Rotem. “Sometimes their condition deteriorates during this time, permanently confining them to wheelchairs. In Israel, the average wait for such surgery is two weeks.”
And the third reason is treatments unavailable at home. “One example is ovum donation, which is permitted in some countries but not others,” he says. “Another is a noninvasive radiowave treatment for prostate cancer that hasn’t yet received [United States Food and Drug Administration] approval, but is already offered in [other] countries.”
But why should patients go to Israel rather than any other country catering to medical tourists? “In Israel, as I said, coronary bypass surgery costs $20,000, whereas in India it’s only $10,000,” says Rotem. “But in health care, money isn’t the sole consideration, because inferior medical care isn’t worth having at any price. With standards paramount when it comes to treatment, issues such as international health care accreditation, evidence-based medicine and quality assurance are all likely to be weighed by the medical tourist. Here, Israel gains from its superlative health care reputation as a developed country with Western-trained physicians…. And the name of Hadassah, in particular, is globally known and admired.”
Hadassah and israel also offer a complete array of sophisticated specialties. The disciplines at Hadassah most sought by medical tourists are orthopedic surgery (particularly computer-assisted hip and knee replacement), ophthalmology, plastic surgery, neurosurgery, oncology and bone marrow transplantation.
In much of Eastern Europe, the Far East and Central America, however, medical tourism is built on cosmetic surgery in spa-like facilities.
“When medical tourists come to Hadassah for aesthetic surgery, it is most often reconstructive,” says Tidhar. “There was, for example, a 4-year-old boy from Nicosia in Cyprus whose scalp and ear were burned away on one side of his head when he was trapped inside a blazing car. He received treatment at Hadassah. Dr. Alex Margulis, head of our Pediatric Plastic Surgery Service, used expanders to grow skin on the undamaged part of the child’s scalp with which to replace the scarred burn tissue, and then reconstructed a new ear out of cartilage from the child’s chest.”
There is more such work with medical tourists ahead for Dr. Margulis and his department. “We’ve received a substantial donation for aesthetic surgery on 12- to 16-year-olds from Russia,” says Rotem. “The first patient has just completed her treatment. Born with only one ear, she left here with two.”
Many of Hadassah’s international patients come from Cyprus. Markella Hadjiantoni, 47, who came to Hadassah with her husband, Spyros Hadjiantoni, in July 2007 for a bone marrow transplant, is one of them. “I had been fighting ovarian cancer for two years by then,” she says. “I was operated for it in May 2005 in Larnaca, where we live, and underwent chemotherapy in Nicosia. But in November 2006, it came back, and this time I was unable to tolerate the chemo.”
“Markella’s doctors told her she had little time left,” says Spyros, an electrician at a Larnaca hospital. “We heard about bone marrow transplantation at Hadassah from a friend at home, so we came here to see.”
“We knew it was a risky treatment,” says Markella. “I thought: If I am lucky, I will survive. If not, I’ll die knowing I’d done everything to live.”
While Hadjiantoni was prepared for her treatment, she and her husband stayed for a month in Hadassah’s Ein Kerem Hotel a four-star residence located in the heart of the medical center. She then spent 64 days in Hadassah’s bone marrow transplantation department.
“The hospital became our home and the staff became our family,” says Spyros. “Especially after things started going wrong. Markella’s body would not produce white cells after the transplant. In December, the doctors told us to bring our children here to say goodbye.”
The Hadjiantonis’ 15- and 24-year-old sons and 20-year-old daughter came to Israel. “When I saw them, I realized how bad things were,” Markella says. “I gathered all my power—and the white cells came.”
The couple is currently living in a rented apartment outside the hospital while Markella completes her treatment. Other than the wig she wears while her hair grows back, she looks well and is busy entertaining friends she has made in Israel.
“We know that we are very fortunate,” says Spyros. “Had we stayed in Cyprus, I would have lost Markella months ago.”
Currently, the majority of Hadassah’s medical tourists also come from the Former Soviet Union, Jordan and, discreetly, other Arab countries. “We treated a physician from Iraq who took a bullet in his face,” says Tidhar. “His sister lives in the U.S., and she moved heaven and earth to get him to us, bringing him through Turkey. Our doctors rebuilt his face. He went back to Iraq, declining to take with him any of his Israeli medical records. Months later, he got a visa to the U.S. and contacted us from there, asking us to send on the records.”
A greek policeman, badly beaten in the line of duty, had no such secrecy issues. The Greek police force put the paralyzed man on a stretcher and flew him to Israel on a Hercules aircraft. Four months later, he boarded a plane home on his own two feet.
“My phone never stops ringing,” says Tidhar. “A lot of calls are simply queries. After a new treatment for multiple sclerosis was reported in the press, for example, I must have taken 200 queries about it. But most calls are about specifics, from which doctor to consult to whether health insurance applies to how to get to us from the airport…. We help families of long-term patients find accommodation. Hadassah drivers do airport pickups, take patients to a hotel overnight, bring them to the medical center the next morning and escort relatives around Jerusalem.”
Hadassah’s medical tourism campaign has become increasingly focused, says Tidhar. “With the  opening of our hotel, our auxiliary facilities are complete,” she explains. “We send air ambulances staffed with medical teams. Our physicians stay in touch with the international patients they treat as long as necessary and consult with their doctors at home. And we are building a network of medical tourism agents in different countries to market our services, with HWZOA in the United States an additional and significant marketing resource.”
Last December, Hadassah began marketing on the Internet. “More and more patients…go to the Web for information,” says Rotem. “So we launched a $20,000 Internet campaign in English and Russian to promote complex surgery of the knee, hip, eye, brain and nervous system at Hadassah—all of them procedures in which our surgeons are world class and our costs are lower than in medical centers abroad.”
The attraction of Hadassah’s inexpensive, high-quality medical care looks set to expand for years to come, and its historic helping hand is now more far-flung than ever before.