Health and Medical Tourism Presentation to NW Tourism Lekgotla Dr Tshepo P. Maaka Serokolo Health Tourism (Pty) Ltd 10 S

1. Health and Medical Tourism Presentation to NW Tourism Lekgotla Dr Tshepo P. Maaka Serokolo Health Tourism (Pty) Ltd 10 Sept 2009

2. Presentation Layout • What is medical tourism? • Segments of Health Tourism • Who are health and medical tourists • Why do they travel and where do they travel from? • How big is Medical tourism internationally and locally? • Why SA as a medical tourism destination? • Serokolo Health Tourism • Case Study- Creating a medical tourism experience • Summary: • Who is in the value chain of medical tourism • Benefits of medical tourism • Growth and Development Challenges

3. What is medical tourism?

4. What is Medical Tourism? Industry where people from all around the world are travelling to other countries to obtain medical, dental and surgical care while at the same time touring, vacationing and fully experiencing the attractions of the country they are visiting” It is all about the experience!!!! Medical tourism began primarily with elective and cosmetic surgery generally not covered by medical insurance, but growing numbers now travel for life-saving and medically-necessary procedures such as cardiac surgery. Furthermore people combine medical check-ups with travel both internationally and locally

5. Segments of Health Tourism • Medical Tourism • Dental Tourism • Spa Tourism • Wellness Tourism (health tourism) • Culinary Tourism • Sports Tourism • Accessible Tourism • Assisted Residential Tourism (Ambient Assisted Living Abroad)

6. MEDICAL TOURIST Life-saving procedures Elective and necessary procedures Stay longer, min 10 days Minimal tourism activities Travel with companion International (can be local) Quoted on medical history HEALTH TOURIST Health seekers Dental and cosmetic surgeries Medical check-ups/Screening Packages: Spa therapy and revitalization/wellness Short-stay < 1/52 Combine health travel with lots of tourism activities, golf, safari, shopping, food Travel alone Local and international Pre-packaged Who are these tourists?

7. RESEARCH FINDINGS Emerging medical tourists • Indonesia, Africa, • Unavailability of required medical services in • own country • Quality and safety concerns of medical services • in own country • Relatively high costs of medical and health • services • Exclusions and non-coverage of services by medical insurance companies • May be able or unable to pay • Usual services purchased are life-saving and medically-necessary procedures • May purchase elective procedures • Tourism aspect of offering may not be important Traditional medical tourists are residents of industrialised countries… Traditional medical tourists • USA, Canada, Great Britain, Western Europe, Australia and Middle East Countries of origin • Rise in life expectancy and surging demand for healthcare services in own country • Rise in non-communicable diseases that require specialised services • Increasing burden on healthcare services leading to long waiting periods* • High costs of medical and health services • Exclusions and non-coverage of services by medical insurance companies • High malpractice insurance fees Reasons for medical travel • Generally able to pay • Disposable income • Usual services purchased are elective procedures especially cosmetic surgery • Combine medical service with a vacation Comments …but these are being joined by people from other countries including from developing countries. Note: according to the UK Patient Association in the UK more than 1 million UK citizens are waiting for hospital treatment and the maximum waiting time for an NHS operation is set at 6 months in 2005.

8. Medical tourism is a rapidly growing industry with various factors contributing to its increasing popularity High health care costs in industrialised countries Decreasing levels of medical insurance coverage Ease and affordability of international travel Advancement in telecommunications International/bilateral trade agreements Proven safety of healthcare in select foreign countries Rapidly improving technology and standards of care in may countries of the world High standards and quality of care in developing countries that now offer world-class medical services Lower costs Rapid access and privacy Favourable currency exchange rates in the global economy Medical tourism is a product of the globalisation of medical and health care services Medical tourism is a result of customer driven demands for healthcare services Medical tourism presents an affordable, enjoyable and safe alternative to having medical, dental and surgical procedures done in the home country.

9. Cost comparison SA Costs

10. Summary of countries participating in medical tourism Source: Mckinsey Study summary

11. Where do medical tourists go?

12. Just how big is this industry?

13. Converging forces in medical Tourism Airlines Medical Traveler Convergence Point Medical Travel GDP Growth $ 60bn in 2006 and $100bn global industry by 2012 (???Recession figures) Health and Medical Services Hotels and Resorts Adapted from Globalysis 2006

14. What about SA?? • Total visitors to SA in 2007/ 8 = Approximately 10 million • 4.5% are medical visitors (Monitor, 2001 report) = 450,000 • 50% treated in Joburg (conservative assumption) = 200,000 • Each accompanied by one companion • Ave length of stay is 10 days (5 in hospital, 5 days out) • Ave medical procedure R25,000 (i.e. 5 days in hospital) • Ave out of hospital spend is R1,250 x 5 days = R6,250 • 1 private health group sees 200 per month in 5 hospitals • Estimated total revenue per annum R9.8 billion Adapted from City of Joburg 2009

15. Why should we promote SA as a medical tourism destination?

16. SA is a medical pioneer: The world’s first heart transplant was done in SA on the 3rd of December 1967 CAT was co-developed by a South African born Physicist Allan Cormack in 1972 SA has the world’s first surrogate grandmother, who gave birth in October 1987 The world’s oldest surviving sextuplets were born in SA on Jan 11, 1974 SA has the medical infrastructure Our private healthcare systems was ranked 4th in the world in 2004 We have the largest ARV programme in the world Part of a global HIV Vaccine Initiative Our medical institutions have international accreditation World renowned medical and surgical specialists Single digits infection rates Clinical outcomes comparable to USA and UK, and even better Most of our private wards sit at 65% occupancy rates Centres of excellence (excellence drived medical tourism The Endometriosis Institute of Southern Africa iThemba Labs Medical Radiation Group - only hadron therapy centre in Africa The Walter Sisulu Paediatric Heart Institute Fertility Clinics Sports Institutes 1/…medical facts

17. 2/… • Medical tourism improves health delivery systems • strengthens public health delivery systems • We have the only 64-slice CT scan in Africa • We have most MRI and CT scans in Africa • SA is seen as a hub for international travel for Africa • SA seen as a hub for medical care in sub-Saharan Africa • Reverses the brain drain • Keeps medical resources within the African continent • Improves healthcare delivery systems for locals • NEPAD • Proximal to most African countries South of the Sahara • Medical tourism allows for “Africans to do sth for themselves”

18. Serokolo Health Tourism (Pty) Ltd

19. 2008 to date International membership Global client base Diversified product offering- consulting, training Diversified client base Solid operations Solid local tourism partnerships The History.... 2007 Partnership with all hospital groups in SA Partnership with laboratory and radiology groups Partnership with GTA • 2006 • Registration Serokolo Health Nigeria • 1st foreign Government contract for services • 1st medical tourism conference SA 2005 1st medical tourist (Canada) 2004 Serokolo Health South Africa founded www.serokolo.co.za

20. Our services

21. Creating the Medical Tourism experience.....

22. A Case Study(1) • Nigerian: • “Lost confidence in own national healthcare delivery system” Prof Babatunde Oshotimehin , Minister of Health • Previously looked to the US and UK for medical care • Seasoned traveller • Medically aware • Affluent • Knows the “perception” SA has about Nigerians • Perceives SA to be like the “rest of Africa” • Does not know you!!!!! • Heard about the good steaks at the “Meat and Co” • Loves shopping and the “glitz and glamour” of Sandton City • Was told about Sun City • Church activities “part and parcel” of his weekly routines • Carries no credit cards or medical aid card • Has two to three cell phones- poor internet connectivity

23. Where am I going?

25. Contact from doctor or patient Patient information form completed and sent to SHT Specialist sourced and quote finalized 1 2 3 Final arrangements are made upon receipt of payment and reflection in our bank account (within 72 hours of receipt of payment) Quote is sent to patient (global estimate quote) 4 5 Patient arrives in South Africa SHT representative meets the patient at the airport Patient is transported to hospital and handed overto treating specialist 6 7 8 Patient in hospital - SHT visit and case management Arrangements are made for patient to leave South Africa Accommodation for recuperation is arranged prior to patient’s discharge from hospital Accommodation for family member Tours for family /spouse 10 9 Medical records, report and service review 11 ©Step-by- Step Process

26. Establish rapport • Prompt response- within 4 hours ideal, 24 hours sufficient (call centre) • Use local contact as you are a “faceless person” in SA • Provide a medical tourism itinerary upfront • Provide CVs of Drs if requested • Aesthetics • Speak the same language: • Medical aid, medical insurance- • Discovery, Bonitas, Hygeia HMO, BUPA, Aetna • Have a medical services welcome gift!! • Seamless process • Done through medical tourism facilitators or service providers • Simplify the process • Forex • Negotiate convenient appointments with surgeons upfront • Full integration of all service providers in the value chain • Reduce time spend between clinical service providers • Consistent in Pricing • Provide Pricing upfront and in USD (with a rand equivalent) • Be very transparent

27. Which currency????

28. Provide an All in one experience(Two many hands spoil the broth) • Vitalab Clinic • Concierge desks in hospitals • “Medical tourism precincts, zones” • Provide more information • Invest in doctor-patient relationship in a short space of time • Spend time with the patient daily (Drs be visible) • Explain concepts thoroughly • Keep the referring Doctor and family updated • Provide comprehensive clinical services • Hip surgery+ comprehensive check-up • Be culturally sensitive • Provide interpreters if no Portuguese, French, Spanish or Russian Dr to send patient to • KEEP THEM SAFE!! • Indemnity & Insurance • Post-op care • Processes for complaints • Structured Tours!! • Recuperate in an accommodation not too far from medical services

29. Who creates the experience?

30. In closing.....

31. Medical tourism value chain services Courtesy of City of JHB 2009

32. Benefits of Medical tourism • Medical visitors • tend to stay longer – 5X longer • Combine hospital stay with convalescence, plus leisure & shopping • Often accompanied by one or more persons • More likely to be higher-income individuals - higher per capita spend • Hospitals & clinics • Increased capacity & demand contributes toward retention of medical staff and procurement of state of the art technology • Reinvestment in SA rather than offshore • Improvement public health care facilities e.g. Folateng units in Academic Institutions • Accommodation, Retail, Entertainment , transport • Medical tourists spend more time in metropoles and spend more per capita • Employment opportunities for semi-skilled sector, esp. women and young people • SMME Sector • Low barriers to entry in tourism sector (guided tours, taxi services, B&Bs, etc)

33. Growth and Development Challenges • Negative perceptions of the some parts of the country both internationally and locally (crime, energy, HIV) • Lack of information from a visitor perspective of world-class medical expertise, facilities • Air accessibility is currently priced at the higher end of the spectrum. • RSA long haul destination for visitors from UK, USA & Europe • Visa and immigration issues are a disincentive for the African market. • Restrictions on medical practitioners promoting themselves • SAMA regulations prohibit commercial brokers from recommending patients to any doctor • SA Tourism currently under-estimates the significance and potential ROI of medical tourism • Cottage industry mentality among existing players in the sector • High priced intl. insurance products / lack of local products • Dept of Health legislation on private health care pricing

34. Thank you for the opportunity!!!!!!! Dr Tshepo P. Maaka www.serokolo.co.za healthtours@serokolo.co.za “We’ll treat you well”