• Bali to get international hospital, foreign doctors - Asia Times

    Bali to get international hospital, foreign doctors
    New facility to provide top care for Indonesians who get treatment in Singapore, Malaysia, Thailand, Japan and the US
    Perturbed at Indonesians spending nearly US$7 billion a year on medical treatment abroad, the government is building an international hospital on a newly-closed golf course in Bali that will allow foreign doctors to actively practice in Indonesia for the first time. “If this comes to fruition, we expect that no more of our people will travel overseas to get health treatment,” President Joko Widodo told a December 28 ground-breaking ceremony for a project that is being undertaken in partnership with America’s famed Mayo Clinic. According to official statistics, more than two million wealthy Indonesians seek healthcare treatment in Singapore, Malaysia, Thailand, Japan and the United States in preference to local hospitals, many of which are not as bad as they are painted.Only last month, former president Susilo Bambang Yudhoyono flew to Minnesota for treatment of early-stage prostate cancer at the Mayo Clinic’s Rochester headquarters after consultation with his own team of Indonesian doctors. But while Singapore’s much-vaunted health system, in particular, plays an important role in providing second-opinion diagnosis and specialist care unavailable at home, many Indonesians travel there for easily-treatable minor ailments as well.
    That is until the onset of the Covid-19 pandemic. The case for an international hospital became more compelling when Singapore closed its doors to overseas visitors, shutting down its billion-dollar medical tourism industry and ruining the island’s reputation as a reliable safe haven. The new facility is being built on the 41-hectare Bali Beach Golf Course, a 50-year-old, nine-hole layout at the northern end of Sanur, the sleepy outpost favored by foreign pensioners and mostly elderly tourists on Bali’s east coast. Refurbished in 2005 on land owned by the State Enterprise Ministry, it is the second Bali golf course to close in four years. The stunning 18-hole Nirwana course has fallen into disrepair since billionaire Hary Tanoesoedibyo unsuccessfully tried to convert it into a six-star resort using the Donald Trump brand name. The new Bali International Hospital is scheduled to open in 2023 in what Widodo has described as a special economic zone, providing a convenient alternative for an estimated 600,000 Indonesians who now seek treatment abroad. Well aware of the shortcomings exposed during the pandemic, the president says the government will also intensify its efforts to attract investment in pharmaceutical plants to make drugs more readily available at a cheaper cost to its 270 million-strong population. State Enterprise Minister Erick Thohir, a key member of Widodo’s cabinet, says Indonesia hopes to reduce pharmaceutical raw material imports from 95% to 75% over the next four years, initially using locally-grown herbs and petrochemical derivatives.
    India’s pharmaceutical industry, by comparison, supplies 50% of the global demand for vaccines, 40% of the generic demand for the US and 25% of all medicines for the United Kingdom. The worldwide market was valued at about $1.1 trillion last year. The government has provided few details on the cost of the Bali venture, but the involvement of the Mayo Clinic has already stirred controversy because foreign doctors will likely become an integral part of the medical staff. When he first announced plans for the hospital last year, Maritime Affairs and Investment Coordinating Minister Luhut Panjaitan said Widodo had already approved a special visa for “first-class doctors who can practice and transfer technology.” The Indonesian Doctors’ Association strongly opposes opening up the local medical profession to foreign practitioners, but it may relent if the government confines any relaxation of the rule to oncologists and other specialists.
    The designation of a special economic zone may also mean that the Lippo Group’s Siloam chain and other privately-owned hospitals will be excluded from bringing in foreign doctors – apart from those now hired for purely administrative duties. The new facility will have 300 wards and space for 30 intensive care beds, in addition to a nursing school and also an academic research center to fill a requirement for more specialized care. A Mayo Clinic spokesperson has clarified that the organization will not be investing in the hospital, only in advising on its development, planning and design and also in honing administrative efficiencies and effectiveness when it begins operations.


  • Why Medical Tourism Is Drawing Patients, Even in a Pandemic - The New York Times

    In recent years, while still on her ex- husband’s health insurance policy, she had received hormonal treatments to ease the pain so she could go about her daily life. But since her divorce last year and the coronavirus restrictions placed on the beauty industry in March, those treatment costs have become prohibitive, especially with no insurance.“There is no real cure for endometriosis, but if I want to free myself from this pain then I need to get a hysterectomy,” Ms. Jackson said, her voice shaking as she described the procedure to remove her uterus. “As if the surgery isn’t bad enough, I need to find 20,000 bucks to pay for it, which is just crazy so I’m going to have to find a way to go to Mexico.”
    The coronavirus pandemic has pushed millions of Americans into poverty and stripped more than 5.4 million American workers of their health insurance, according to a study by the nonpartisan consumer advocacy group, Families USA. Many people like Ms. Jackson have experienced a significant deterioration in their health because they have delayed medical procedures. The fear of large medical bills has outweighed fear of contagion for some, giving rise to an increased number of patients seeking medical treatment in a foreign country.
    “We are seeing a pent-up demand for medical tourism during the pandemic, particularly in the U.S. where a fast-growing number of Americans are traveling across the land border with Mexico for health purposes,” said David G. Vequist IV, the founder of the Center for Medical Tourism Research, a group based in San Antonio, Texas, and a professor at the University of the Incarnate Word in San Antonio. Even before the pandemic, millions of Americans traveled to other countries for savings of between 40 to 80 percent on medical treatments, according to the global medical tourism guide Patients Beyond Borders. Mexico and Costa Rica have become the most popular destinations for dental care, cosmetic surgery and prescription medicines while Thailand, India and South Korea draw in patients for more complex procedures including orthopedics, cardiovascular, cancer and fertility treatment.
    In 2019, 1.1 percent of Americans traveling internationally did so for health treatments, according to the National Travel and Tourism Office, although that figure only accounts for those who traveled by air and does not include the thousands of travelers who crossed the United States-Mexico border. Definitive statistics on medical tourism are hard to come by because countries have different recording methods and definitions of the sector.
    Medical tourism has been decimated by coronavirus restrictions, but, even so, the twin crises of the economy and the enormous strain that Covid-19 has placed on the already faulty American health care system are pushing many patients to travel. Demand for nonessential surgeries has also been building up after more than 177,000 scheduled surgeries were postponed in the United States between March and June in 2020, according to the Center for Medical Tourism Research. “Our market has always been what I call the ‘working poor’ and they just keep getting poorer,” said Josef Woodman, the chief executive of Patients Beyond Borders. “The pandemic has gutted low-income and middle-class people around the world and for many of them the reality is that they have to travel to access affordable health care.” In April, following the initial global lockdown to curb the spread of the coronavirus, medical travel bookings were down by more than 89 percent in the most popular destinations, including Mexico, Thailand, Turkey and South Korea, according to Medical Departures, a Bangkok-based medical travel agency. Since August, the numbers have slowly been rebounding, but bookings in Mexico, which has seen an uptick in American travelers in recent months, are still down by 32 percent compared to the same period of August to December in 2019.


  • Covid-19 : en Calabre, des hôpitaux en souffrance

    Miné par un endettement très lourd et de lourds soupçons d’infiltration mafieuse, le système sanitaire calabrais – en Italie, la santé est du ressort des régions – a été placé sous tutelle d’un commissaire extraordinaire depuis 2010. Depuis, en dix ans, aucun des problèmes structurels auxquels la région est confrontée n’a connu ne serait-ce qu’un commencement de réponse. En 2007, un contrat avait été signé entre l’Etat et la région prévoyant la construction de cinq hôpitaux, afin de résoudre le problème du sous-équipement. Par la suite, ce nombre a été réduit à trois. Finalement, treize ans après cet accord, rien n’a été fait. Pire, plusieurs structures ont été démantelées. A une trentaine de kilomètres de Reggio Calabria, la plaine de Palmi, qui rassemble plus de 160 000 habitants, est une des parties les plus délaissées de la région. Dans cette zone, les quatre petits hôpitaux qui existaient encore, au début des années 2000, ont été « rétrogradés » en « maisons de santé », et le chantier de grand hôpital prévu par le contrat Etat-région de 2007 n’a pas encore commencé. « Depuis plus de dix ans que les commissaires extraordinaires gèrent la région, ils n’ont fait que fermer des structures, et encourager les départs de personnes qui n’ont pas été remplacées », accuse l’écrivain Mimmo Gangemi, ancien cadre technique de l’agence de santé de Palmi, qui a assisté ces dernières années au lent démantèlement du système.
    Depuis plusieurs semaines, le poste de commissaire est vacant, et le feuilleton de la nomination du nouveau responsable a provoqué dans tout le pays un mélange d’amusement et de consternation. Début novembre, Saverio Cotticelli, qui occupait le poste depuis 2018, a été démis de ses fonctions après une désastreuse prestation à la télévision, dans laquelle il s’est montré incapable de dire quelles étaient les disponibilités de la région en matière de soins intensifs, et semblait découvrir en direct qu’il aurait dû élaborer un plan d’urgence contre le coronavirus. Son successeur annoncé, Giuseppe Zuccatelli, a dû renoncer après quelques jours, pour avoir déclaré au printemps que les masques ne servaient à rien. Quant au troisième candidat pressenti, Eugenio Gaudio, ancien recteur de l’université romaine de la Sapienza, il a vite jeté l’éponge, affirmant que sa femme « ne voulait pas aller s’installer à Catanzaro [le siège de la capitale régionale] ». Comme si le tableau n’était pas assez sombre, le président du conseil régional, Domenico Tallini (Forza Italia, droite modérée), a été arrêté jeudi 19 novembre pour des soupçons de malversations en lien avec la puissante ’Ndrangheta, la Mafia calabraise.
    Face à cette situation ubuesque en pleine urgence sanitaire, le gouvernement a appelé au secours le chirurgien Gino Strada, fondateur de l’ONG Emergency, pour installer des hôpitaux de campagne dans la région. Comme dans un pays en guerre. Habitué depuis des années à fonctionner avec des bouts de ficelle, le personnel sanitaire calabrais déploie pourtant, face à la crise, des trésors d’invention. A Gioia Tauro, dans la plaine de Palmi, un complexe de quarante lits pour les malades du Covid a été déployé en quelques jours, avec le soutien de la Croix-Rouge italienne, mais les personnels manquent de tout. « Les commissaires nous coupent toutes les ressources depuis des années, mais ils se gardent bien de mettre un terme aux vrais gaspillages, aux factures payées plusieurs fois ou aux dépenses aberrantes, comme ce local administratif de 3 000 mètres carrés, à Palmi, où travaillent à peine 20 personnes, pour un loyer annuel de plus de 200 000 euros versé à un propriétaire jouissant de grosses protections », confie sur le parking désert un habitant résigné, sous couvert d’anonymat. Depuis des années, les Calabrais, comme des millions d’autres habitants du sud du pays, ont pris l’habitude, en cas de maladies graves, de prendre l’avion pour se faire soigner dans les structures ultramodernes de Lombardie, de Vénétie ou d’Emilie-Romagne. Ce tourisme médical interne, en constante augmentation, a un coût exorbitant pour les régions les plus pauvres du pays, et procure un surcroît de ressources aux plus riches – les indemnités versées par les régions du Sud à celles du Nord sont estimées à 5 milliards d’euros par an –, alimentant encore le déséquilibre. Mais, en temps de pandémie, les frontières intérieures du pays se referment, si bien que les habitants se trouvent livrés à eux-mêmes, conscients du fait que les hôpitaux locaux auront à peine les moyens de les soigner