When a five-year-old boy from a small village in Kazakhstan was diagnosed with a severe blood disease requiring a bone marrow transplant, his family had to sell its herd of sheep to send him and his mother to Israel for an operation at Rambam Medical Center in Haifa. A year later the mother returned to the village with a healthy little boy and speaking fluent Hebrew.
Another man came to Hadassah University Hospital, Ein Karem, from England after learning that his knee-replacement surgery, for which he would have had to wait 18 months, could be performed in Israel within 10 days. He decided to pay for the operation, which costs some $20,000, and thereby save himself several long months of agony.
As part of the world's transformation into a small global village, the phenomenon of medical tourism has picked up in the past few years: Increasingly, patients who have trouble obtaining or affording medical care in their home countries seek cheaper or better alternatives elsewhere. There is even a popular guide, "Patients Beyond Borders," which lists all the affordable and desirable medical treatments available around the world.
In India, for example, the development of medical tourism has been declared a national goal, with the aim of reaching an annual revenue of $1.2 billion by 2012. Anyone who pictures Indian hospitals as facilities with poor conditions and low-quality health care could not be more wrong - all across the country there are state-of-the-art private medical centers with physicians trained in the United States. Considering that the cost of bypass surgery at such a center is a mere $10,000 - less than one-tenth of what it costs in the United States - it is easy to understand why India is becoming a highly attractive medical destination for more and more Americans.
Israel, too, has been affected by the trend and is emerging as a popular destination for medical tourists. In recent years, many thousands of visitors have come to Israel to undergo medical procedures. In 2006 alone, for example, some 15,000 foreigners flew to Israel for complex procedures such as bone marrow transplants, heart surgery and catheterization, oncological and neurological treatments, rehabilitation after a car accident and more. The procedures themselves, along with the money patients and their families have spent on accommodations, sightseeing and shopping, have brought no less than $40 million into Israel's coffers.
What makes Israel an attractive destination for medical tourists? "People come here for different reasons," says Amitai Rotem, director of marketing at Hadassah. "For example, people come here from Cyprus, Bulgaria and elsewhere, all countries with high-quality health care that don't always cater to all specializations - bone marrow transplants, for instance, are not performed in Cyprus.
"Then there are the Americans, who come here because they can get first-rate health care for a fraction of what it would cost them in the U.S. For example, an American with no health insurance would pay $120,000 for bypass surgery in the U.S. At Hadassah the procedure costs $35,000, and that includes all the necessary arrangements, such as airfare, accommodations and food for both patient and family. This means that ultimately, even with all the added expenses, the patient pays less than one-third of what the same operation would cost in the U.S."
In vitro fertilization (IVF) is another reason why medical tourists flock to Israel, known for its high success rates and considerably lower costs: IVF costs $3,000-$3,500 here, compared to $16,000-$20,000 in the U.S.
"The level of medical care in Israel is very high, and the Israeli health care system has a very positive image," adds Ina Bergman, head of the International Medicine Department at Rambam, which treats some 1,000 medical tourists a year. "Israel has centers of excellence - areas for which Israeli specialists enjoy worldwide fame - such as orthopedics, which is very advanced in Israel because, unfortunately, we have so much experience in treating trauma."
Then, of course, there is the Dead Sea, the most famous therapeutic resort in the world for psoriasis patients. Thousands flock there each year and stay for nearly a month. Germans, for example, receive funding for the flight and visit as part of their state- sponsored health package.
Source of income
Of course, the main beneficiaries of the surge in medical tourism and the main engine driving it are the hospitals, which owe a growing chunk of their income to non-Israeli patients: "Foreign money flows into the hospital in addition to all the arrangements with Israeli health insurance companies," says Herve Deknuyat, Administrative Director of Medical Tourist Services at Sheba Medical Center, Tel Hashomer. "Up until a year ago, state hospitals could only receive a certain amount of income from medical tourism, and the remainder of the money went to the state. This regulation was scrapped in 2007, which has given us a great incentive to nourish the area further."
For the state, too, medical tourists are an excellent source of income: "Revenue from medical tourism comes not only from the patient and the procedures he or she undergoes, but also from the people who accompany the patient and pay for flights, accommodations, restaurants and shopping," explains Hadassah's Rotem. "A tourist who comes here for one bone marrow transplant leaves behind more money than a plane full of pilgrims, who hardly spend a cent."
"It's a branch of tourism in its own right, and a trigger for bringing many more tourists, because a person who travels to Israel for surgery and is treated warmly and meets nice, helpful Israelis goes back home and becomes an ambassador for Israel," says Nir Crystal, head of marketing at the Herzliya Medical Center, which treats thousands of medical tourists every year. Given the financial potential, hospitals are willing to invest considerably in marketing in order to reach a patient on the other side of the world.
"We work with doctors, agents, tourism companies, medical companies and anyone else in the field," says Bergman. "There's an information chain: a patient in a small village in the Russian periphery, for example, will not travel to Moscow in search of information, so we have to network as much as possible with agents who pass information on to each other. Usually they get to the patient after two to four 'links' in the chain. It is a system based on a great deal of personal work and contacts, and we are now beginning to enjoy the fruits of our marketing efforts, which started more than a decade ago."
Another useful tool for the hospitals is, of course, the Internet. "The information available on the Internet today is tremendous," says Rotem. "Recently, for example, there was a story in one of the local papers about a new research project conducted at Hadassah involving multiple sclerosis. Within three weeks we had received 500 inquiries from all over the world, although the research is still at a very early stage. In the Internet age, people track down every new thing."
Hadassah recently launched a $20,000 international Internet campaign meant to increase the number of medical tourists. Hospitals also collaborate with insurance companies and various organizations bringing patients to Israel, such as charity foundations and even foreign governments.
The results are promising: "In the last five years, the number of medical tourists at Hadassah has grown exponentially, because we have been investing in marketing, and the potential is enormous," says Rotem. Other Israeli hospitals also report a steady growth in the number of medical tourists.
In light of the impressive revenue, it is no wonder that hospitals are willing to offer foreign patients the royal treatment in order to lure them here. "We have an international department made up of 13 women who speak 11 languages," says Crystal. "The department takes care of all the necessary procedures for the medical tourist, from obtaining the visa to Israel, to arranging payments with the insurance company, getting him or her a ride from the airport, arranging accommodations for family members, translating medical documents into Hebrew, having an interpreter present during the hospital stay and even organizing sightseeing tours after the release from the hospital."
State hospitals also go to great lengths to escort the patient, who, besides being in a delicate physical condition, is unfamiliar with both the country and language: "The contact begins months before the actual procedure," Bergman says. "We receive the medical documents, help with the passport and visa, sometimes help to obtain funding, and during the hospital stay help the family to find an apartment, go with them to the supermarket and explain what people eat here, help with the medication and the laundry. At least in the first few days, until the culture shock has worn off, we stay very close to these patients."
By the way, foreign nationals coming to Israel for treatment can choose their hospital, but they cannot always choose the surgeon, as regulations forbidding private medical care at state hospitals apply to them, too. "We make very sure that medical tourists will not get preferential treatment compared to Israeli patients," says Beknit. A person who wants to be treated by a particular surgeon can, however, opt to go to a private hospital.
Given how attractive its health care system is, people familiar with the subject believe Israel is far from exhausting the potential of medical tourism. Prof. Shlomo Mor-Yosef, the director general of Hadassah, said a year ago that he estimated the income from this activity could reach $100 million a year. He claimed that this might become one of Israel's main sources of income from tourism, and that it may improve the state of the country's public health-care system as well.
So what needs to happen in order for this promising branch to develop? "It's all a matter of investing in marketing and infrastructure," says Rotem. "If the Israeli government takes this as seriously as the Indian government does - the sky is the limit." The state has indeed begun to grasp the potential and will soon begin to distribute a special guide for potential medical tourists, co- produced by the health and tourism ministries.