Discovering Medical Tourism

As stated in the previous article, Indian medicine has a great asset: its past. In fact, Ayurveda, the hollistic medicine principle derived from centuries of medical tradition, is an original medicine with a certain efficiency that can be built into a decisive competitive factor by Indian hospitals!

Previously, we talked about preventive care and diagnosis according to ayurvedic medicine. What about Disease management? there are four main methods by which and Ayurvedic physician manages disease:

• Cleansing and detoxifying (shodan)
• Palliation (shaman)
• Rejuvenation (rasayana)
• Mental Hygiene and Spiritual Healing (Satvajaya)

Cleansing and detoxifying (shodan)

This is the gore part of Ayurvedic medicine unfortunately and this can really scare off any person willing to discover ayurvedic medicine: pancha karma is all about vomiting, bowel purging, nasal douching to remove toxins from the body. The good part is that in preparation for cleansing an herbal oil massage may be performed (oil is well absorb by the skin and helps to eliminate toxins while passing through the body). herbs can also be introduced in certain parts of the body (especially the noze) to increase resistance to enzyme reaction. After the cleansing, the patient is given ghee (clarified butter) and yogurth to restore the intestinal flora.

Hi! Let me take care of your bowels

Palliation (shaman)

Shaman focuses more on the spiritual part of the healing and uses a combination of herbs, fasting, yoga streches, breathing exercices, meditation and lying under the sun (ah! that’s better than cleansing the body). in fact, the sun is not only a source of heat and light but according to ayurveda a way to better absorb vitamin D, to improve circulation and to strenghten the bones (the time of exposure required depends on your dosha type). Actually Shaman is often used as an alternative to pancha karma (see above ) for those who are mentally weak to undergo this kind of treatment (like me!). Shaman is really sweeter: one of the herbal therapies prescribed consists in consuming honey with certain herbs such as pippili (long pepper), ginger, cinnamon and black pepper…

Meditation as an alternative to cleansing

 Rejuvenation (rasayana)

Rasayana is a program of tonification which is similar to a physiologic tune up.  It is used to restore virility and vitality to the reproductive system, countering strterilirty and infertility, bringing forth healthier  progeny and improving sexual performance. Ayurvedic medicine uses three methods for rayasana: special herbs prepared as powder, pills, jellies and tablets; mineral preparations specific to a person’s condition and exercices (again yoga exercices).

Mental Hygiene and Spiritual Healing (Satvajaya)

Satvajaya is a method aiming at releasing psychological stress, emotional distress and unconscious negative beliefs. This is one of the precursors of stress management and operates in a very original and “modern” way. The categories of satvajaya include mantra or sound therapy to change vibraotry patterns of the mind, yantra or concentrating on geometric figures to take the mind out of ordinary modes of thinking and gems, metals and crystals for their vibratory healing powers.

Yantra: one type of the geometric figures to alleviate stress 

CONCLUSION 

All in all, Ayurvedic medicine is extremly original and should be put forward by Indian hospitals as an innovavtion in treatment. When people hear about Ayurveda they can barely figure out hwat it’s all about. My gut feeling is that some Indian HospitalGroups are being too conservative and too “un Indian” in their product offer for international patients. Again if the market is price driven today, I really think that it will all result to quality on a few years: ”MADE IN KOREA” used to be a problem but then Hyundai and Samsung surfaced with their different and new products to propell the cognitive perception  of Korea very high in people’s mind. To  me, the same can occur with the label ”OPERATED IN INDA“: nobody will feel confortable with it up until quality and differentiation  will be knitted to Indian medical providers

The United Kingdom is made out of 4 sub countries as you all know: Wales, Scotland, Northern Ireland and England. What is really flabbergasting is the fact that each country has its own national health system and even though interoperability exists there are some differences in terms of organisation but also in terms of vision.

Will the Highlander register in Scotland or in England?

Let’s talk about what really interests us namely On line medical follow up. England is by far the leader among all 4 systems with various initiatives stemming from the NPfIT, the largest e healtrh project in Europe:
+ first the NHS CRS (Care records services) that allows GP to access patients data when the latter are consenting
+ the PACS (Picture Archiving Communications Systems) where at the end of 2006 83 million pictures were already stored
+ Electronic hospital bookings with a rythm of 10000 bookings a day
+ the EPS (electronis transmission of prescription) 16 million prtescriptions among the 370 million in England wentr through a dediacted electronic portal in 2006
+ The N3 (new national network), heralded as the largest VPN in Europe a very important component for the validity of a medical system.

Hence, we can point out a huge number of positive points, yet, England is not perfect and furthermore the UK. Today there are 12000 different systems available for 250000 NHS staff in England? Why that? Is it because the aforementionned systems are barely efficient or because medical system is the hot potato considering the huge investment driven by the English NHS?

One of the main problem we have noticed in many countries is the lack of focus on leading up an aggregator that makes sense from a legal and technical point of view. A lot of operators are trying to interpret the thinking of the NHS bigwigs yet nobody is able to promote the best solution. Another problem could stem from the lack of vertical integration in the software business. When thinking about an OS (operating System) we clearly see a link between the promoter of an equipment (such as a PC) and the software. Couldn’t this be done to a certain extent for medical devices?

The last days were extremely interesting for me. I was really wandering in the medical tourism jungle, checking which definitions people had in mind. I remember writing the ‘About this website’ page a week ago and I was so unsatisfied by this page that I decided to shelve it and rewrite it later. 

Every time I have a debate about medical tourism, people portray this industry as an unethical way of making money using the despair of people who can’t afford surgery in their country, plus a dangerous production system with all the infamous stories of botched mammoplasty or rhinoplasty.

Yesterday during a dinner, I tried to argue with a cardiologist that medical tourism is not boiling down to low cost procedures but is a wider access to unknown techniques perfectly mastered in Asia. These techniques range from ayurveda to tsubo chiatsu to Lasik surgery etc etc. I acknowledge the cost differential (we were talking about angioplasty) but for me, he was focusing on a non sustainable medical tourism. 

I am using the words ‘non sustainable’ because I feel that the existing business models of medical tourism are all one shot models:

+ heavy medical procedures motivated by a low cost effect or long waiting lists

+ no follow up stemming from the procedure + no customer relationship management approach. 

It is a run and gun approach that certainly has people smearing about the association of words ‘medical tourism’. But again there is hardly any tourism implied by this method> I have pinned this idea as medical travel. Let’s call it INDUSTRIAL medical tourism (as an input -output chained process)

 Yet, this is definitely not the vision I have about medical tourism. NOT AT ALL !

To me, medical tourism in Asia is an open window leading to the best healthcare procedures in the world, innovative techniques to solve rare condition techniques, the best preventive care solutions, unheard of manipulative therapies plus an opportunity to enjoy a tourism experience and so forth. Perhaps my definition is wrong but this is what medical tourism sounds to me. One could argue that I am speaking about health tourism…

Medical and Health Tourism as we define it as a longer life expectancy and a higher volume than the classical model

When considering biological methods such as herbalism or manipulative techniques such as psychotherapeutic postural integration or ayurveda are we only talking about health? These techniques are a genuine front end to medical procedures so how can they be restrained to mere health procedures… Medical tourism must be a sustainable experience and therefore must entice repeated visits: diversifying methods, proposing long term follow up (using tools such as the PRM we have previously reviewed) 

Here is my real first tentative definition of Medical Tourism, that we will call from now on Medical and Health Tourism: 

 ‘ an experience of medical and healthcare techniques culturally connected to a specific place or technically knitted to an hospital for preventive, aesthetic or curative needs ’ 

Experimenting these techniques boils to an exploratory approach that is tied up with traditional tourism (going from one place to another to try out a technique etc etc) but with the particularity of positively affecting our body  Talking about how angioplasty could cost only 10000 USD is definitely not the goal of this blog.   

Discovering medical tourism is going to take a major u turn. In order to carry out a clearer perspective on what we consider medical and health tourism is we will from now on stress upon THIS definition of medical tourism by digging into health and medical procedures specific to Asia and all the techniques that can make medical tourism a sustainable tourism.  

Medical call center is perhaps one of the most interesting niches in the call center business as it only represents 3% of the total activities of call centers in Europe and in the US (acc. Euromonitor) yet it is expanding at a very high rate.

The underlying question is dual: is customer satisfaction high with medical call centers and are medical call centers efficient? Some experiments were done to analyse this second point

In July 2006, PHT Corporation, the market-leading provider of electronic patient reported outcome (ePRO) solutions made an experiment in partnership with Temple University School to investigate the potential clinical benefit of using call centers, staffed by pulmonary medical personnel, to support and follow up with Pennsylvania residents suffering from chronic obstructive pulmonary disease (COPD).

A bunch of friends indeed…

COPD is not an isolated chronic pain but a real health issue. According to the Pennsylvania Department of Health, COPD was responsible for 8 million office visits, 1.5 million emergency room visits, 726,000 hospitalizations, and 119,000 deaths in the year 2000 throughout the United States.

This trial is unique because it is evaluating the impact patient access to a call center may have on reducing hospitalizations and deaths due to COPD exacerbations and on improving patient quality of life, lung function, and everyday activity levels.

The technology used (the LogPad), implemented by PHT on Palm, automatically calculates a graded score from baseline and triggers an on-screen alert telling the patient to contact the call center if certain thresholds are reached. At the same time, a software, PHT StudyWorks allows call center personnel to review real-time reports online, enabling them to prepare for a subject’s call or to identify and contact patients who triggered an alert but chose not to call.

Reactivity is the key benefit of this new kind of medical call center. In fact, many people who have access to a call center at an instant T can feel that the exacerbation they suffer from at this very moment is not the right trigger even though they are in real dire straights. Hence, improving the classification and quantification of symptoms that herald an exacerbation may greatly benefit those who suffer from COPD.

The medical call centers is hence well adapted for chrnoic pains because of its abaility to closely follow up subscribers. Yet, is the medical information delivered satisfactory and/or efficient?

While talking about medical tourism with one of my friends achieving a degree in computing sciences at Centrale Paris, the latter told me to check out Voluntis a specialist in medical follow up. I found this advice extremely interesting as I was still wondering how medical tourism could work without a good follow up service. 

Voluntis is a specialist of PRM, patient Relationship Management. Besides the fact that it is a French technology (Yes!!) sponsorised by the ANVAR, the PRM is a multi channel medical device that brings coaching, medical advice and regular check ups through various instruments most notably SMS, mobile applications, call centers… This company created in 2001 has developed Medpassport, the core software that permits to diffuse this medical education and coaching service.

Using a PRM: feeling healthier?

Quoting Pierre Leurent, the CEO of Voluntis: “This innovative paradigm offers the unprecedented opportunity to bring value to the key health care stakeholders at the same time: pharmaceutical companies, payors, physicians, pharmacists and patients”. Indeed, when looking at their customers we find companies such as AstraZeneca, Sanofi-Aventis, Roche, Bayer or Respironics. 

A PRM mainly serves to assess dynamic health issues such as chronic pain and be able to follow timely any negative evolution. The PRM helps to increase the reactivity of a follow up team, however I wonder how a PRM could be used to track preventive care issues.. Could we design such a tool as an interactive device to check out a medical tourist?

We will try to further investigate this technology in the following weeks by directly meeting with Voluntis and understand how it could fit with the development of medical tourism activities…