Caroline Ratner from IMTJ spoke to Dr Uwe Klein of Health Care Strategy International GmbH about cruise ship medical tourism. Medical tourists will soon be able to have medical treatment and procedures on board cruise ships, using the medical facilities already present on the ships, and recuperate while cruising and relaxing in a holiday setting.
Do you think the majority of medical procedures will be cosmetic and medical?
At the moment the majority of procedures are for cosmetic and beauty medicine. But there are certainly other options which can be offered and are in development. These include; aesthetic dermatology, lasik, dental, phlebotomy and also preventive medicine and screening including high technology diagnostics such as CT and MRI.
What other types of surgery do you think people will opt for?
There are serious intentions to bring orthopedic surgery on board as well which is feasible but I would exclude neurosurgery at the moment. So much is possible nowadays, especially with advances in endoscopic surgery, I see a huge potential to replace land based large operating theatres with small non-sterile units for endoscopic surgery and this applies at sea as well as on land. Once you have explored the potential of this technique, you can then start to explore the potential and the different directions in which cruise ship medical services may develop and what can be offered to patients.
Do you think cruise ship medical travel is a good idea?
Good is relative. It will be good for patients wanting to be treated and serviced as true customers. It will enable world renowned specialists to be hired for a defined period of time to meet and treat a selection of patients on the ship. Additionally it may be cheaper to buy medical services at sea compared to price structures currently in place in land based units because the facility management is less costly compared to many land based units. Logistics and supply may be tricky, but you have other economic advantages which make health care affordable for many patients although this may lead to less patients for some specialized land based units.
How are you involved in this area of medical tourism?
I am currently involved with others in forming a group of experts and founders to establish a “chain of clinics at sea”. We are currently evaluating the potential with entrepreneurs and doctors who want to explore this field of investment. And we’re also looking at the challenge of installing a quality management system for medical service units on ships. Managed care is another area which is also really interesting.
What structures will be in place to reassure patients if something goes wrong?
All the large cruise ships have helicopter platforms and emergency care units.
How will cruise ship medical services be accredited?
It’s a good question. The seven seas are not owned by any state. One could argue that the flag under which the ship is registered means that you must follow the related national legislation .....but would patients find this acceptable when the flag is from a small state somewhere in Africa? We will look at this very thoroughly. It will be a good opportunity to bring the heads of leading institutions together in order to talk about this, which can only be a good thing.
Under whose jurisdiction are the doctors/healthcare providers if they are in international waters?
As far we have been advised by the malpractice insurance companies, the ships are under the jurisdiction of the country where the ship is registered, but we need to get some further international clarification on this. I believe that when we do have clarification it will trigger an interesting process and dialogue within the medical tourism community regarding the “global health” issue. You cannot just take the nationality of the doctor into account because his team might be international and mistakes in medicine often happen as a result of a combination of different factors and personnel working in the team. Like the health care integration process within the EU, this issue will question and challenge the paradigms which health care systems currently use to defend their reasons for not breaking with current practices, traditional behavior and protocols.
What kind of assurances will patients be offered before setting off on the high seas?
One of the most reassuring aspects of „treatment onboard“ is that unlike on land, the doctors will be available all the time you are at sea for pre and post operative attention.
What are the post-operative advantages to patients?
Patients will be able to recuperate in a pleasant environment, with no hospital atmosphere and will receive a higher level of service from non-medical staff than they would in a clinic as they will be treated as customers and not “patients”. Patients will be surrounded by happy vacationing passengers, have multiple entertainment opportunities, and even while recovering can enjoy the weather and the cleanest air on the planet with higher standards of cuisine than in any clinic. I call this ambient “healing” where the environment is more integrated and “healing” than in a traditional clinical environment.
Is this an opportunity for new people to come into the market or do you suggest that it is only for the experienced MT healthcare provider?
I think both. We need the cooperation of the established institutions and their support to create a network serving several liners with medical professionals working on board on a part time basis. On the other hand I would not exclude new people who are starting to specialize in this area and who recognize this for the interesting opportunity that it is.
Do you think this is a good business opportunity?
Definitely but only if the quality management aspects are managed and integrated by one organization, which means that the medical service units are run and managed by one provider who will coordinate the logistics and professional manpower on board.
How will the business model work/function? Will it be the same as any other medical travel operator?
On board medical tourism will need to take a different approach to attracting patients than traditional land based business models. In one way it will be less complex; once the patient is on board, he will be in an integrated healing environment for the duration of the cruise and won’t leave the ship until his rehabilitation and after care is complete. Everything will be available on site, there will be no transfers to other locations, and most importantly no communication gaps which means that there won’t be any interruptions to the flow of patient medical information/records between different health professionals, this means a continuity of patient care by an interdisciplinary team. As there is no way to get off the ship mid-passage“destination management” aspects should be easier.
On the other hand the selection and decision making process for some treatments requires a more careful approach. You cannot, as it is possible in land based medical services, see the doctor for an initial check and evaluation and then four weeks later come back for the treatment. The success of cruise ship medical tourism will be partially dependent on the cooperation between land and sea based services which we are aiming to achieve in the future.
Will travel agents work with facilitators or medical groups or will they operate independently?
I do not know what they will do in the end, but I feel that providers and facilitators will to have to cooperate and work closely together to integrate the travel and medical packages. This will be necessary to ensure they can service the patient successfully both logistically and medically. In any event certain agreed precautions will have to be put in place, especially in cases of patients wanting to fly home before they have completely recovered.
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