Society of Actuaries2009 Health Spring Meeting

A Personal Medical Tourism Experience

June 8, 2009

Actuarial Management Strategies, Inc.AMS

Presented by: Alison J. Saifer, FSA, MAAA

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Copyright and Disclaimer

This presentation is for informational and discussion purposes. All material contained within this presentation is believed to be reliable and is based upon market experience and knowledge of Actuarial Management Strategies, Inc. (“AMS”). AMS does not certify to its accuracy or completeness. This document and its contents are proprietary to AMS and may not be copied or reproduced without the express consent of AMS.

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Background: Alison J. Saifer, FSA, MAAA

Health Care Consultant (Actuarial/Financial/Business) for:

Reinsurance Companies

Direct Carriers

MGUs

Attorneys

Investors

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Types of Products

Employer Stop Loss Limited Medical/ Mini-Med First Dollar, including High Deductible Plans Travel Carve Outs – Transplant, Dental, Drug, Vision Student Accident and Medical Blanket Special Risk Pet Insurance

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The Hot Topic of Medical Tourism

Everyone is talking about it, but is anyone actually doing it?

Many have determined that the potential for cost savings, even after accounting for travel and accommodations is significant

After looking at it from an actuarial perspective, decided to participate in an actual experience

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The “Mock” Trip

I’m Not a Doctor, I Just Think All Those Actuarial Exams Qualify Me to Act Like One!

May 27 – June 1, 2009

Bangkok, Thailand

Medical Services Needed…. All parts currently working…, so how about an

executive physical?

Traveled with an Insurer, Reinsurer, Reinsurance Intermediary

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Agenda

Tour of Bangkok Hospital

Meeting with Hospital Senior Management

Tour of Rehabilitation Clinic and Holistic Medical Center

Tour of Samitivej Sukhumvit Hospital

Meeting with a Group That Does Aphaeresis Treatments Not Available in the US

First Hand Experience with Some Medical Tests and Treatments

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What about the Tourism Component?

Dining Experiences

Tour of the City

Visit to the Bangkok Night Market

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Trip to Bangkok

After 26 hours of travel, arrive in Bangkok, tired, but excited

A concierge was waiting for us with a sign AT OUR GATE

Helped us with luggage, through customs and to a waiting car

Transportation to the hotel

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Bangkok Hospital – Meeting with Management

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Bangkok Hospital – Meeting with Management (continued)

JCI Accredited

In 2007, 37% of Patients Were International 9.4% are Americans – mostly expats living in Thailand

and surrounding areas

Most Doctors Have Excellent English Skills, so Language is Not a Big Barrier

“High Tech with a Light Touch” State of the art equipment Caring, dedicated staff with Thai hospitality

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Bangkok Hospital (continued)

No Waiting

No Shared Rooms – Extremely Clean and Quiet

Doctors Spend Time With Patients

Affordable, Even After Allowing for Traveling and Accommodations

Look After the Family, Not Just the Patient

No Visiting Time Restrictions Apartments available in the hospital

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Bangkok Hospital (continued)

Seamless Service Referral Center Concierge Services

Transportation from airport, to hospital Take people shopping, tourism trips Re-booking flights Stress free

Medical Coordination Communication with Referees

Patients go home with discharge folders

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Bangkok Hospital (continued)

Longer Inpatient Stays Than US Not rushed out of hospital

Re-Hab Patients May Stay at Hotel and Come Back Daily to Hospital

24/7 Service Saturdays and Sundays are very busy Routine operations may happen at 8pm

Hospital is the Center of Healthcare

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Bangkok Hospital (continued)

Package Pricing Getting you back home is part of their responsibility May advise you to stay longer before you are ready to

travel home Cost of Wait time before you are “fit to fly” included Doctors or nurses may fly back home with you

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Bangkok Hospital (continued)

Typical US Patients are: Well traveled Have passports Understand technology

Typical Procedures Include: Cardiac stem cell therapy Computerized diagnosis and radiotherapy for cancer Joint replacement surgery Clinical trials

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Bangkok Hospital Tour of Facility

Extremely Clean No Hospital Smell People Smiled and Greeted

You as They Passed By Rooms Were Large and

Comfortable, and “Hotel-Like”

Patients Drugs Kept in Locked Box in Patient’s Room

Photo Taken at Registration and Then on Every Page of Medical Records

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Bangkok Hospital Tour of Facility

Procedure Prices Posted on the Wall at the Hospital

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Bangkok Hospital Tour of Facility

Outpatient Dialysis Area

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Bangkok Hospital Tour of Facility

Apartments Available in the Hospital for Family Members or Patients with Outpatient Procedures

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Bangkok Hospital Tour of Facility

Starbucks Coffee and Au Bon Pain in Hospital

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Holistic Medical Center

Integrated with Medical Care

State of the Art Equipment

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Samitivej Sukhumvit Hospital

JCI Accredited

40% of Patients are International Japanese, then American Mostly expats living in Thailand or surrounding areas 10% of revenue from medical travelers

Thai Patients are Upper and Upper-Middle Class

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Samitivej Sukhumvit Hospital (continued)

Karaoke in Room

Internet in Room

24 Hour Hot Line to Nurses Station Using Skype and Web Cams – Face to Face Communication After Discharge

Connectivity Externally - Pre and Post Care Facilitated Through Web

Consult with doctor face to face before patient comes to Thailand

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Samitivej Sukhumvit Hospital (continued)

Apartments Available in the Hospital – About $80

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Day 2 – Tour of City

Concierge Services Provided Us Transportation, Tour Guide

Visit to Grand Palace

Wonderful Thai Food

Incredible Hospitality

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Day 3 - Patient

Concierge picked us up at hotel at 7:30 am for 8 am appointment on SUNDAY (appointment had been made electronically from home)

7:50 am check-in at International Medical Center Desk – handed us voucher for Starbucks or Au Bon Pain so we could eat once we were finished with lab work

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Day 3 – Patient (continued)

8:05 am called and all vitals, blood and urine taken

Water available at every turn

8:20 am finished with lab piece and head upstairs for chest x-ray

Waiting for us, no paperwork, NO WAIT

The longest wait we had was the time it took us to change into hospital gown for chest x-rays

Were told we could come back in 1 hour for consult with the Doctor

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Day 3 – Patient (continued)

8:40 am – Cappuccino and Croissant at Au Bon Pain

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Day 3 – Patient (continued)

Appointment at 9:40 am with Dermatologist Refused escort to other building – all signs in English, so

no problem finding it! Arrive at 9:05 am Called into patient room at 9:25 am

Doctor was waiting for ME in the room Consult over at 9:45 am, when exam and all my

questions were answered in English Cost 750 baht - $22

Services requested – all prices explained Were a fraction of costs in USA

NO WAIT for Services All services provided by friendly, attentive and

knowledgeable professionals, including the Physician

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Day 3 – Patient (continued)

Payment was made and our concierge was waiting for us with a sandwich and water bottle

But first, back to the International Medical Center for our test results

Check in at 11:40 am (with no appointment)

Called to speak with Physician at 11:45 am who went over in detail the results of all the labs and showed me my chest x-ray

I had come down with a sore throat, so after an additional exam was given a prescription for an antibiotic and headed out at 12:00 pm

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Day 3 – Patient (continued)

Pharmacy was around the corner. Arrived at 12:00 pm and was on my way with my filled Rx at 12:05 pm

Back at the IMC, I was provided a hard copy of all my results and told that a formal report would be done in 1 hour and that I could pick up or it could be emailed to me

Concierge then provided for a last delicious, authentically Thai meal, a trip to the night market, and transportation back to the airport at 4 am Monday morning

Another concierge met us at the airport and facilitated us through the check-in and customs process

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Day 3 – Patient (continued)

Cost of the Check-Up Including: Physical exam CBC Blood sugar Liver Function Test Kidney Function Test Lipid screening Urine Analysis Chest X-ray Physician Consult of Results Full Written Report

$2,600 Baht or $74

Unparrelled, Courteous and Timely Services – PRICELESS!

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Patient Experience

All Professionals I Came in Contact with (perhaps 20) had Excellent to Fluent English

All Care was Provided Professionally, Politely and Efficiently

All Facilities Were Immaculately Clean

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General Observations

Always Felt Safe, Cared For and Never Left Stranded The Food was Delicious – No One Got Sick and All

Enjoyed the Cuisine The City was Interesting and Culturally Rich The People Were Incredibly Hospitable, Attentive and

Professional All Hotels, Restaurants and Sights We Were Exposed

to Were Very Safe and Excellent by American Standards

Never Experienced a Language Barrier The Medical Care was Efficient, Professional and

Provided in a Superior Manner to that of the US

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Most Important Questions

And If I Really Needed a Medical Procedure, Would I Go Back?

ABSOLUTELY!

Only True Down-Side for Me was the Long Trip, But the Care, Quality and Opportunity to Visit a New Country and Experience the Culture Made It Worth While

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Thank You !

Alison J. Saifer, FSA, MAAAPresident

(215) 862-8390

asaifer@actmgmt.com

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