1 st German Arab Health Care Forum Berlin, Wednesday, 13 th of December 2006

1. A new approach forHealth Care TourismThe transfer of knowledge and experience from Germany to Middle East is opening new sustainable Business Models 1st German Arab Health Care Forum Berlin, Wednesday, 13th of December 2006 Prof. Dr. Dr.h.c. Fried Oelschlegel Saudi German Hospitals Group

2. Healthcare Tourism; trial of a definition • Definition: • The term refers to the increasing tendency among people from the developed, developing, and underdeveloped countries, or regions , wheremedical services are either very expensive, or not available, to leave their countries in search for more affordable health options, often packaged with tourist attractions. • The common perception is : • Patients traveling to doctors depend from offered ( expected) • quality,price, and waiting time of cure • Medical tourism is the act of traveling to other countries to obtain medical, dental, and surgical care. The term was initially coined by travel agencies and the media as a catchall phrase to describe a rapidly growing industry where people travel to other countries to obtain medical care, while at the same time touring, vacationing and enjoying the attractions of the countries which they are visiting.

3. Health Care tourism is more… • Patients traveling to doctors. • Doctors traveling to patients. • Doctors traveling to (meet) doctors (conferences). • Doctors traveling for further education & training. • Students traveling for education. • Medical companies traveling for business. • Health Care tourism is an esteemed but growing market of annual app. 80 billions US $at present • ( WHO; Yearbook 2005 )

4. Five main sources…. •  Receiving ( accredited ) high-quality health care more cheaply and more quickly in some developing countries as Poland , Hungarian, but also Singapore, Thailand, Indonesia. •  Increasing presence of a large sector of citizens without health insurance, and even more with health coverage that they consider inadequate. •  Some employers, but also Insurance companies concerned about rising health care costs, are using financial incentives to encourage employees / clients to experiment with medical tourism. •  No advance care on the spot ; specialized care limited available e.g. Middle East. •  Long waiting list’s for standard performances to increasing prices ; collapsing Health Care Systems in Europe and America.

5. Negative Perceptions Hygiene/Unsanitary Medical Insurance Instability Pollution Terrorism Prone Inadequate Cover Backward & Bureaucratic Communal Unrest Underdeveloped Insurance Frauds Connectivity Accreditation No Global Players No Flights!! No Uniformity Overseas Companies Refuse Reimbursements Bad Roads ISO, CRISIL, ICRA Backward WEST: JCIAHO Medical Tourism Perceptions & Worries Foreign Patient’s Point of View

6. Countries Promoting Healthcare Tourism Example-South Africa specializes in medical safaris : Visit the country for a safari, with a stopover for Plastic Surgery, a Nose Job, and a chance to see lions and elephants

7. Prices Comparison of some Medical Procedures:

8. Tourist Arrivals Forecast In 2005: more than 1.6 Mill people pur -chased travel - and healthcare tours to Asia. 150,000 foreigners sought care in 2004 in India alone; for 2005 and the following years a 15% growth annually is esteemed . Medical tourism in India is forecast to generate over $2 billion in revenue by 2012, according to a study by McKinsey, and the Confed-eration of Indian Industry. Dubai has increased the number of tourists from 2001 = 3,63 Mill to 6,67 Mill in 2006; the goal is 15 Millions tourists in 2010

9. What are the benefits ( 1 ) ? • Tangible: • Source of additional national income through wealth transfer from foreign countries . • Cost advantages in tariff over the developed countries. • Creating attractive working places. • Improve information sharing. • Increase efficiency of patient care process, reducing / cutting of waiting lists. • Strategic alliances with business partners within and outside the country. • Technology and knowledge transfer. • Better logistics performances both in internal and external.

10. What are the benefits ( 2 ) ? • Better utilization of Infrastructure and skilled manpower. • Opportunity for development in infrastructure in Health, Tourism and Travel. • Connectivity & synergy effects with air, road, rail and information and communication industries. • Clustering of medical Travelers – new business fields. • Health opportunities for foreign patients may lead to better health care standards for Nationals. • Scope for Research and Development to offer comprehensive medical solutions. 

11. What are the benefits ( 3 ) ? • Intangible: • International acceptance and reputation for the country as a global healthcare provider. • Social and cross cultural experience. • International customer relations. • Global Marketing and Medical Trade relations. • Brand image of nation as world class healthcare destination – attractive investment place !!! • Patient satisfaction & Competitive advantage. • Strategic Public - Private Partnerships.

12. Is there something what makes Germany more attractive as India, Singapore, Dubai, Cape town …. ? • better prices ? • better medical quality ? • better educated , trained and motivated medical staff ? • better equipped and designed hospitals ? • better international accredited and controlled quality ? • lower infection rate; lower mortality rate, lower complication rate ? • better service for patients and relatives ? • better understanding and tolerance for other cultures and religions ? • more attractive traveling facilities and airports ? • more attractive tourist destinations ? • more safety ? • What could be the arguments for going to Germany ?

13. Good & bad cards • Some is matching – the most doesn’t fit ! • Not matching are all these aspects which are related to the German governmental organized Health Care System. • Unchanged and a high reputation – also under competitive aspects - have : • The high quality of excellent educated, trained • and further educated medical staff. • The German skills – hard worker, discipline, • organized, culture of thinking. • The ethical common understanding for patients • and their personal needs. • Result :The particular (doctor, nurses etc) YES! ; • The system – NO !!! • Bad cards in the game !

14. Consequences – globalization of Health Care • The old clichés and methods of marketing to attract the “wealth Arab private patients” to come to Germany for treatment by blue eyes and fairy hair is a running- out model. • Far away from the global reality are the “ underdeveloped “ health caresystems outside of Europe or USA. • Strong and sustainable competitors are coming up in South Africa, India, Thailand, Indonesia, Malaysia, Singapore, Dubai – and only a question of time – from China with the same or better quality, lower prices and much better customer focused service. • Health Care City projects are in real planning and under construction in Shanghai, Delhi, Istanbul, Tripoli, Kuala Lumpur at present. • All these projects are designed to attract foreign patients, all are focused on Health Care Tourism. There will be a surplus of capacities; the global market will switch from a demand market to a supply market. • The offers on these markets will be comprehensive with an integrative approach of all fields of medicine.

15. Health Care Tourism - The integrative approach- HEALTH CARE PROVIDER PRIVATE CLINICS & DAY-CARE POLYCLINIC INDUSTRY PLAYERS GOVERNMENT NURSING SCHOOL TERTIARY HOSPITAL Academic Medical Centre CENTERS OF MEDICAL EXCELLENCE FURTHER EDUCATION FACILITIES MEDICAL COLLEGE FITNESS / WELLNESS & REHABILITATION

16. The reverse tendencies and directions Doctors traveling to regional medical centre of excellence with their belongs: Knowledge Experience and Skills Patients traveling to regional medical centre of excellence, near to their families

17. The effects • Doctors traveling to a pool of patients – more economic efficient. • Patients must not leave their social, cultural and religious environment. • The money for treatment will be re-invest in the home country. • The doctors have the same or better working conditions and better compensations. • The effect for education, further education and practical training for the patients country is a very important added value. • The “network” between the local Medical Centre of Excellence and the home countries ( organization to organization ) will be more effective and sustainable than between persons ( doctors) to persons ( patients ). • The new approach will stop and turn over the “ brain train “ from developing / developed countries to the Europe and the USA. The young national countries will cut the bonds of dependence from the West and will develop an own and competitive health care system.

18. The SGH approach in practice Sample 1: 2005 132 German C3/C4 professors are working as locums in SGH Hospitals at present ; they have treated 8.230 patients stationary and app. 14.800 ambulatory. For treatment “ at home in Germany “ they have encouraged additional app. 950 patients. They gave app. 530 lectures and training courses for their colleagues in KSA and Yemen Sample 2: SGH Hospital Sana’a (Yemen) Yemen has spent app. 300 Mill US$ for stationary treatment of Yemenites in Jordan cause the lack of tertiary hospitals. SGH has invest app. 50 Mio USD in this 300 beds hospital, the Government became a Joint Venture Partner; no any patient has to be send abroad; the money for treatment will remain in Yemen; TraditionalHealth Care tourism – no need ! The “ lasting win-win effect “ from this kind of cooperation : personal, political and economical for both parties is much more important than to attract patients to come to Germany; Traditional Health Care tourism – no need !

19. andmore …. First “ real” Joint Venture as PPP between the private organized SGHG with governmental German Universities in different structured partnership. German Universities are offering in defined medical & managerial responsibility medical performances as own braches under their brand “ on the spot “; Traditional Health Care tourism – no need ! Sample 4: SGHG has signed last month a contract with an USA global player in the medical industry to built up a hospital chain of 10 Non-For-Profit Hospitals in Africa with participation of the great develop-ment funds , charity- foundations and doctors organization. Patients from Africa – if they need advanced medicine help – must not more travel abroad- Traditional Health Care tourism – no need ! Sample 3 : SGH Dubai- Al Barsha General Hospital + 6 Centre of Medical Excellence; 600 beds

20. This approach is our strategy We invest in these countries from them we knows that patients have to travel abroad to achieved “ state of art medicine “ We design , construct and equip in these countries hospitals which are fulfilling international standards ( DIN 1469 ) by German Architects. We bring in these countries German knowledge, experience and skills by our German “Visiting Professors” as “ state of art medicine “ We add to our investments in medical care also investments in medical education by German curricula and exchange program We are doing that in KSA, Yemen, UAE, Sudan, Libya, Egypt, Ethiopia, Turkey, Kazakhstan, Pakistan, and… Other well known groups as APOLLO, WOCKARDT, NETCARE, CAPIO, JOHN HOPKINS, HARVARD… have similar strategies – going to the markets of future – and these are in Africa and Asia.

21. We are looking for partners to share our vision …… …to help developing countries in Africa and Asia to improve a national health care system which is tailored on the regional needs and offering basic & advanced medical care in “ state of art quality”, to suitable prices with an unlimited access for all – to make these countries independent from each kind of the traditional Health Care Tourism to going abroad - to Europe or USA; except in very rare cases and circumstances, Insha Allah ! At least : To all Representatives of the Governments, Universities, the medical & pharmaceutical Industry, the Finance Institutions - Feel free to be invited to come with us and to contact us . Not the “ tourism “ is the solution for the Health Care Systems ; crossing borders COOPERATION is the most important term of our common future for the sake of the mankind.

22. A WORD OF THOUGHT “It is not the strongest of the species that survives, not the most intelligent, but the one most responsive to change.” Charles Darwin ( 1809 – 1882 ) END