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.
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
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
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
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
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
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.
Israel, communications equipment while in Israel and a special department to
process insurance claims will be among the services.
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.
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