Healing The World
Israel attracts medical tourists with its advanced treatments and lower costs.
What do you want to do on your next trip to Israel? Float in the Dead Sea? Dance all night in Tel Aviv? Pray at the Kotel? Get a knee replacement?
While tourism to Israel rests heavily on its recreational, religious, natural and historical offerings that attracted a record 3.5 million visitors in 2012, Israel is looking to make moves in the growing international medical tourism market.
The number of people coming to Israel for medical procedures is a tiny fraction of overall tourism, just some 30,000 people in 2012, but the draw is about much more than Dead Sea spa resorts and the Tiberias hot springs, or “healing therapy tourism,” which has been going on for decades.
Israel’s advanced medical and bio-technological research and know-how are magnets for those seeking medical procedures and treatments that are less expensive, higher quality or unavailable where they live.
Amitai Rotem, marketing director for the Hadassah Medical Organization, is one of Israel’s mavens on medical tourism. Working from a simple, but professional and technologically impressive office at Hadassah Medical Center in Jerusalem, he credits technology for the international growth of the industry.
“Not surprisingly, it’s the Internet that has opened up opportunities,” Rotem said. “Now it’s not difficult to search specialties, treatments reputations and price. Medicine has become very specialized and you can locate experts around the world. Everyone can read about a center that is superior in what they are looking for.”
Rotem says the two main draws for Americans are the range of specialty treatments and infertility treatments that adhere to Halachah (Jewish religious law).
Israeli specialties include laser technology, cutting-edge stem-cell research and extensive clinical research and studies focused on neurological disorders like multiple sclerosis (MS), Alzheimer’s and Parkinson’s diseases, which have earned the country an international reputation.
These specialties draw patients from around the world, including Dr. Jason Bodzin of West Bloomfield, who went for stem-cell treatment after being diagnosed last September with amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease.
“When we found out about the opportunity in Israel, we jumped on it,” Bodzin said. “There really aren’t a lot of different places to go.”
Bodzin, a past president of the Detroit Surgical Association, knows there is no cure for ALS. He has the highest regard for the care he has received from his American physicians and the University of Michigan’s world-class and pioneering ALS Clinic, which he visits every three months, but the stem-cell treatment available in Israel was not available here.
“I was a young 67 until this disease,” Bodzin said. He worked out three to four days a week, swam and, just a few years ago, hiked the Grand Canyon. Today he relies on a walker because of his lack of balance. While his workout has changed, he still exercises three times a week to try to retain muscle mass.
He had to retire last Nov. 30 because he couldn’t do surgery anymore.
“Talk about your world being turned upside down in a heartbeat,” said his wife, Pearlena, an active volunteer in Detroit’s Jewish community.
But hope comes from Israel. Unlike the U.S., where politics hinders stem-cell research, in Israel it has broad political support, in part, because Jewish religious authorities encourage it for its life-saving potential.
“In Israel, the laws are very progressive,” Rotem explained.
Bodzin’s daughter, Beth, who lives with her family in Maale Adumim, outside of Jerusalem, naturally spoke with her best friend about her dad’s condition. Then her friend called a friend of hers, the daughter of Professor Reuven Or, head of Hadassah’s Medical Center’s Department of Bone Marrow Transplantation, Cell Therapy and Transplantation Research Center.
As it turned out, Dr. Or knew of a current stem-cell trial and, while only Israelis were eligible, he knew he could provide the same treatment to Bodzin.
“They said I was a good candidate because I’m early in the course of the disease,” Bodzin said. Another hopeful sign is that ALS usually progresses slower in older adults.
So, in February, the Bodzins flew to Israel. At Jerusalem’s Hadassah Medical Center some of his bone marrow was collected in what Jason termed “a slick and quick procedure” that took just minutes. The idea was to harvest stem cells from his bone marrow. After the painless procedure, the Bodzins went shopping. They spent some time with Beth and her family, then returned to the United States to wait.
Six weeks later, they were back in Israel so Jason could undergo a stem-cell infusion, where the cells that were multiplied in a “clean room” were injected back into several parts of his body. The hope is that reparative cells would proliferate and significantly slow, and even reverse, some of the deterioration Jason has experienced.
Shura Gruper, Hadassah’s medical tourism coordinator, says they found in treating MS “that when the body gets a pulse of new cells, it helps healing” and the growth of the disease slows. “We decided to try it for ALS, but we have no results yet, but we hope to show them within the next two years.”
Jason has experienced some improvement in strength in his left hand, but nothing dramatic. It’s still too early to assess the full impact of the treatment. Meanwhile, because Jason is a longtime oenophile — a connoisseur of fine wines — the Bodzins are leaving on a trip in late July to Bordeaux, France, to visit some of the country’s top wineries.
“[The disease] is not going to stop us from doing everything,” Jason said as Pearlena nods in agreement. In fact, the couple took on a daunting task recently by moving to a West Bloomfield apartment from their Southfield home of more than 30 years.
Economics And Morality
Rotem, who has been at Hadassah for 13 years, says they became active in the medical tourism business about eight years ago. While some are concerned that bringing foreigners for treatment will compromise the care available for Israelis, Rotem says the most significant impact has been to provide crucial dollars to Hadassah and other hospitals, imaging institutes, labs and research facilities, all of which greatly benefit the Israeli population while advancing medicine overall.
He also hopes medical tourism will help slow or end the significant brain drain of some of Israel’s best and brightest who must go abroad for opportunities.
For example, the hospital’s revenue from medical tourism has grown from about $1 million in 2003 when there was no special attention given to medical tourism, to $16 million in 2007. Last year the revenue totaled $27 million, providing roughly 5 percent of the medical center’s budget. In the same five years, total Israeli medical tourism revenue has risen from $110 to $162 million. These numbers don’t include other boosts to the Israeli economy like hotels, food, recreation and other things those coming for medical care want and need.
Growing this profit center is very important, given the serious financial challenges currently facing Hadassah and other Israeli hospitals due, in part, to generous medical coverage but low government reimbursements.
“At Hadassah, we operate at 103 percent capacity year-round,” Rotem said. “The government controls payment of nurses and doctors and the cost of hospitalization, and we cannot cover the expenses with just Israelis.”
Beyond economics, Rotem says the program provides important non-tangible benefits, like saving lives and making friends.
“We care about people,” he said. “When we have services that can only be offered here, it is the moral thing to do to offer them to foreigners. Plus, we hope it will be a bridge to peace, making good relations with Palestinians and the Arab states.”
Another draw is fertility centers. Including the Hadassah Medical Center, Israel has 24 recognized fertility centers and has become a world leader in in-vitro fertilization (IVF) treatment. In fact, Israel has the highest per capita rate of IVF in the world, with “test-tube” babies now accounting for nearly 5 percent of all Israelis born.
The sensitivity and accommodation of Halachah brings many Jews from abroad, but others come because the treatment is top-notch and the cost is one-third to one-fourth of what it costs in the United States.
Overall, Americans make up a small fraction of those seeking medical treatment in Israel. The majority come from what Rotem termed “underserved countries,” with approximately 30 percent from Eastern Europe, 60 percent from the former Soviet Union and 10 percent from Africa and the Middle East.
Most are not Jewish. Those with good health insurance and access to adequate care largely prefer to undergo treatment in their home countries. If they don’t have insurance, they look to where the treatments are cheapest, like Singapore, Thailand, India and Mexico.
A broad estimate is that a treatment that would cost $100 in the U.S, would cost $10 in India, $50 in Europe and $30-40 in Israel. A hip replacement is only about 10-20 percent less expensive in Israel than in the U.S., but heart bypass surgery is 75-85 percent cheaper.
Those seeking cosmetic and other elective surgeries not covered by insurance can experience a significant cost saving by coming to Israel, even when factoring in travel and hotels. But other countries can still be cheaper.
Increasingly, insurance companies are considering treatment in foreign countries as a way to save money and not increase premiums. This is a promising trend for Israel because the real growth in patients and revenue will come from cracking the North American market.
Estimates are that upwards of 1.6 million Americans went abroad for medical treatment last year, much of it cosmetic, and that annual growth of 35 percent per year could continue for some time.
Others are less concerned about cost, and are drawn by higher-quality care than they can get at home, or like Bodzin, they come for procedures that are not available at home. The cost for his stem-cell treatment was $36,000, payment in advance, not including travel or other costs. None of it was covered by insurance.
Israel’s biggest centers for medical tourism are its largest hospitals: Sheba Medical Center, Tel Hashomer; Ichilov Hospital, Tel Aviv; Rambam Medical Center, Haifa; the Rabin Medical Center, Petah Tikva, as well as Hadassah University Hospital Ein Kerem, Jerusalem.
Two private hospitals also attract medical tourists: Assouta Medical Center in Tel Aviv and the Herzliya Medical Center.
All are stepping up their game. Hadassah has even built a 96-room hotel connected to its Ein Kerem hospital by a mall with restaurants, a pharmacy, a bank and other shopping so patients and their families can be comfortable and remain close by.
It also has established IMER (International Medical Evaluation and Referral), a department staffed by 40 employees who provide translation, transportation and coordination to visitors. Not only can they send doctors abroad to conduct a medical evaluation or a medical team to bring patients to Israel, but, if the country and facilities allow, they will even conduct medical procedures there.
In 2009, the U.S.-based Medical Tourism Association (MTA), a membership-based international nonprofit trade association for the medical tourism and global healthcare industry, opened an office in Israel; one of its 13 offices outside of the United States.
Recently, the MTA held a conference in Israel on joint marketing for private and public institutions that brought together the major medical centers, the Ministry of Tourism and other government officials to plan for growth.
So, in the not-too-distant future, those ads with pictures of people frolicking on the beach, visiting holy sites and floating in the Dead Sea may also include people happily recovering in the sun from a knee replacement.
By Don Cohen, Contributing Writer