Medical Tourism in Dubai - Research Paper Example

?Running Head: MEDICAL TOURISM IN DUBAI Medical Tourism in Dubai and Cardiovascular Care at the American Hospital Dubai Oud Table of Contents Introduction 3 Aims and Objectives 4 Research Questions 5 Overview 5 Dubai 5 Medical Care in Dubai 7 Medical Tourism in Dubai 8 Cardiovascular Care 8 Beating Heart Surgery 9 Sentinel and Adverse Events Policy 10 Critical Analysis 10 Medical Tourism 10 Equity of Care 12 Standards of Care 13 The Beating Heart Technique 14 Conclusion 15 Executive Summary 18 Resources 19 Medical Tourism in Dubai and Cardiovascular Care at the American Hospital Dubai Introduction Death in the United Arab Emirates (UAE) comes most often from cardiovascular illness than any other cause. Although it is the leading cause of death in the nation, only 28% of all deaths come from cardiovascular illness which is much lower than the rest of the world where worldwide statistics are 48% in the industrialized nations. Cardiovascular disease affects 82 out of every 100,000, while in comparison, cancer occurs in 50 out of every 100,000 (United Arab Emirates yearbook 2005, 2005, p. 247). With the level of cardiovascular disease being the highest form of death in the nation, evaluating programs for cardiovascular care is essential in understanding the strengths and gaps that are occurring within care. Stolley and Watson (2012) list the United Arab Emirates as a medical tourism destination for cardiovascular care. Americans stated in a poll asking the question if they would travel to a foreign nation in order to get better care that they would 88%. Medical tourism is a planned travel that is defined by procedures rather than by the destination. There are 35 facilities in the UAE that are accredited by the Joint Commission International (JCI) for destinations for medical tourism specialties. Dubai was the first region in the Arab states to have a hospital accredited for medical tourism by the JCI. Among the now 35 facilities is the American Hospital Dubai Oud located in Dubai in the UAE (Medical Tourism, 2013). The American Hospital Dubai serves the people of the United Arab Emirates, the surrounding Gulf nations, and those who are willing to travel to the UAE in order to have their medical care taken care of at an affordable, yet state of the art facility. The hospital was designed with American standards of healthcare in mind and is operated through the perspective of American medical care. The physicians are all North American Board certified or have been qualified through parallel forms of education and training programs. The American Hospital Dubai is the first hospital that was accredited by the JCI and in 2012 they were reaccredited for the fifth time (Medical Tourism, 2013). There are several different services that can be purchased at the hospital. These include not only the cardiovascular services, but an obesity clinic which does bariatric surgery, Cochlear implant services, and total joint replacement services. The cardiac services include most necessary procedures for the heart including angioplasty and bypass surgery with access to robotic cardiac surgery through the Da Vinci Surgical System (American Hospital Dubai, 2013). The costs of an average bypass surgery in the United States is about 100,000 dollars, but can be purchased in the UAE for about 15,000-18,000 dollars, US which includes travel expenses. The following paper will examine the cardiac care in the American Hospital Dubai from the perspective of medical tourism. The paper will examine medical tourism to the hospital as well as the care given to local population. The health care system will be examined in order to determine equity, while the use of the hospital by both local and foreign patients will be examined for equity, efficiency, and effectiveness for cardiac care. Through an examination that is made from analyzing secondary research, the hospital cardiac unit will be evaluated. Aims and Objectives The aim of this paper is to evaluate the cardiovascular unit in the American Hospital Dubai in relationship to care given to the regionally local inhabitants and to the medical tourists who come to the nation for care. The paper will also aim to examine the equity in care that occurs at the hospital as well as the efficiency and effectiveness with which they deliver care. The following objectives will frame the inquiry: To discover the level and quality of care that is in the cardiovascular unit, the Heart Center, found at the American Hospital Dubai. To discover if there is equity of care within the cardiovascular unit of the American Hospital Dubai To discover if medical tourism is a recommended form of care and if the American Hospital Dubai is a destination that should be considered. To evaluate policies for safety within the protocols of the hospital. To evaluate the use of beating heart surgery within the Heart Center in the American Hospital Dubai Through the use of these objectives, the focus of the paper will be established. Research Questions The following research questions will be used to frame the inquiry: Does the ambition to attract medical tourism into Dubai provide for the best possible use of their facilities? Is the financial value that is found at the American Hospital Dubai providing for also finding a high value of care in the cardiovascular unit? Do citizens of the UAE have the same level of care in the American Hospital Dubai cardiovascular unit as do medical tourists? Does the healthcare system of the UAE provide for equitable care? Do the standards in the hospital meet those found in Western hospitals as is claimed? Does the use of beating heart surgery at almost 100% provide the best overall care for the patients? These questions will define the nature of the inquiry and help to maintain the focus of the paper within the objectives that have been stated. Overview Dubai Dubai is an emirate that belongs to the seven Emirates that makes up the United Arab Emirates within the eastern Arabian Peninsula. As the second largest Emirates it is likely that it is the most well-known within the world because of its active and rising economy, business connectivity through globalization, and as a wealthy nation that is a desired destination for travel. Dubai has over 6.16 million guests as of 2005 and in the first six months of 2006 had over 3 million travelers into the Emirates. Travelers are calculated to be 40% business and 60% leisure (American Hospital Dubai, 2013). Dubai emerged as a financial power through oil revenues which made up about half of the GDP in the state, but by 2005 the oil business only made up just 5.4%. Recognizing that eventually oil would run out, the rulers of Dubai endeavored on manifesting ambitious projects to diversify the economy. Trade, manufacturing, transport, construction and real estate have all been developed in order to support the growing economy. Dubai is currently the 21st most expensive city in the world. Current leadership is under the rule of Sheih Mohamed bin Rashid bin Maktoum, Prime Minister and Vice President of the UAE (Bennett, 2008) The city-state of Dubai is run as a constitutional monarchy with the ruling family being the Al Maktoum family. Equal treatment of the citizens of Dubai has been put into the constitution as an article, indicating that all people, regardless of race, religious beliefs, nationality or social status should be treated equal. Workers that are brought in from foreign regions have a much more difficult time. They are often forced to work inhumane hours, not allowed to leave because of obligations for work, and will not see their families for years even though they send home money regularly. They are not afforded public health care privileges. The Human Rights Watch (2006) organization wrote that “These abuses include unpaid or extremely low wages, several years of indebtedness to recruitment agencies for fees that UAE law says only employers should pay, the withholding of employees’ passports, and hazardous working conditions that result in apparently high rates of death and injury”. The nature of life in Dubai is based upon inclusion, thus those outside of the included populace have a much different life than do those who are citizens. One of the ways in which Dubai is promoting its emerging modernism is through becoming a destination for medical care. Through a series of healthcare objectives in the 21st century, the state has become a “hub for specialized medical care and a center for medical education and research, covering more than 30 countries including the Middle East, North Africa and the Indian Subcontinent” (American Hospital Dubai, 2013). Medical Care in Dubai In a very short decade the system of healthcare and facilities has increased greatly in the UAE. Healthcare is under a comprehensive and publically funded system for the care of the citizens. The growth in the industry of medical care has grown in leaps, rather than in measures, the building of facilities in frenzy in the middle of the last decade. The quality of care has been a specific goal for the UAE, thus the standards are high and the quality of care at a competitive level. The costs in the UAE for medical tourism are higher than in most destinations but the quality of care is unrivaled (Jagyasi, 2011). There are three government funded hospitals in the nation, with emergency care free (Bennett, 2008). Medical care is provided by the government, so until the concept of medical tourism began to flow, there were very few private beds in the state. Of the 7000 beds available in 2006, only 1000 of them were in private care facilities (Jagyasi, 2011). The costs of the system were heavy on the government. One of the ways in which this was countered was to require mandatory health insurance for people who were not citizens, but working in the UAE. Thus, the full comprehensive care available to citizens was no longer available to people working in the nation for foreign based countries who were not citizens of the UAE. Medical Tourism in Dubai One of the reasons that Dubai has worked to build high quality medical facilities in Dubai is because previous to the turn of the 21st century people in the nation were going outside of the Emirates to seek their medical care. In order to redirect citizens from going overseas into Asia or Europe for their medical care, the state build the Dubai Healthcare City. While competing on price was not possible, competing on quality became the standard on which the healthcare system was built within the Emirates (Connell, 2011). The Joint Commission International was developed in order to accredit hospitals in the United States for Medicare, but has since begun giving accreditation to hospitals throughout the world in relationship to medical tourism destination. In 2006 the organization developed regional offices in Dubai to serve the regions of South-East Asia and the Middle East. Currently, the JCI has accredited over 300 health care organizations with clinical care programs in 39 countries. The standards set by the JCI indicate that a medical facility aspire to and achieve the best possible care with modern and current methods of health care (Connell, 2011). Medical Care at the American Hospital Dubai Cardiovascular Care The Heart Center at the American Hospital Dubai does over 600,000 heart bypasses per year. The standard for care is to provide American level care to patients. Cardiac care is exemplary, with the treatment of a variety of cardiac conditions addressed through advanced forms of intervention and surgical procedures. As it has been accredited by the JCI which sets standards according to American levels of expectations, the hospital provides for the patient a premium set of services. Along with interventional and cardiology procedures, the Center is “one of a small select group of medical centers worldwide, and among the few private healthcare institution in the region, capable of undertaking advanced interventional and surgical procedures, such as minimally invasive cardiac surgery and beating heart bypass surgery” (American Hospital Dubai, 2013). The Heart Center provides tertiary care as well, allowing for a wider and deeper set of services The Center has cardiology diagnostic tools as well as advanced cardiac surgery procedures. There is a “cardiac catheterization laboratory (Cath Lab), including nuclear medicine as part of the new diagnostics package” (American Hospital Dubai, 2013). There is a new Cardiac Intenstive Care unit with ten beds which is operated by the American Board of Certified Physicians. The facility also has a 64 multi-slice CT scanner (American Hospital Dubai, 2013). Beating Heart Surgery Surgery that is done without stopping the heart is referred to as beating heart surgery. This is safer for the patient, reducing trauma and allowing for a more rapid recovery. The skill to perform a beating heart surgery requires a high level of skill and education to perform the work, but it also provides for a much better outcome. Beating heart surgery can also be used for a series of other procedures, including those where the repair of vessels are concerned. Other advantages include a reduction in the risk of lung or kidney failure as well as retention of cognitive functions that are at higher risk for stroke after a stopped heart procedure. Those with higher risk issues before surgery that involve breathing or kidney function have a greater success rate with beating heart surgery (American Hospital Dubai, 2013). The Center has performed more than 500 beating heart procedures and currently performs almost 100% of its procedures with these techniques. Beating heart procedures are now used with both low and high risk patients, making this technique the best possible procedures for patients with the hope of the best possible outcome (American Hospital Dubai, 2013). Sentinel and Adverse Events Policy The sentinel and adverse events policy for the American Hospital Dubai is based upon the acknowledgement of an adverse event such as a death which is then addressed within 24 hours. The policy allows for intense analysis of what happened and how the occurrence details can be improved for the future. The policy applies to employees including the various disciplines that are involved in the event, across discipline lines as necessary. A sentinel or adverse event is defined as “an occurrence involving death or serious physical or psychological injury, or the risk thereof. The definition of analysis is to find the root cause, finding the factor that that can be identified as having led to the event. Criteria include those events that are classified as near miss or sentinel events. Once an event occurs, the medical director, the performance improvement director and the analysis team must be notified within 24 hours in order to start investigating the event. The investigation is concluded within 72 hours of the initiation (Understanding and preventing, 2008). The policy once the root cause of an event has been identified is to put into place an action plan that will prevent further events of a similar nature from occurring. Ongoing education occurs at least once a year to make sure that all employees are aware of the changes that have been put into place, with frequent update that are used to spread information. Critical Analysis Medical Tourism The idea of medical tourism provides for a wide number of concerns that arise when considering the option. The first consideration is the safety of the systems within the nation that is being considered for medical care. It is important to make sure that the safeguards that are being taken in any medical system meet standards of protocols that ensure the safety of the patients in their care. This includes a number of concepts, including everything from bloodborne pathogen protocols to surgical standards of cleanliness. The goal of the Dubai initiatives to retain the business of patients from Dubai from leaving their borders by creating a high quality set of facilities suggests that Dubai has a high set of standards for the care of patients who choose to use the medical city within its borders. There are several things that must be considered before attempting to get medical treatment through medical tourism to Dubai. The first is that if the visitor has a stamp from Israel, all attempts to get a visa to visit Dubai will be denied. A visa is required to enter into Dubai and a visitor can get a free visitor upon arrival into the state. Visa’s are available for 30 days which must be considered when planning a medical visit if the recovery or time until one can travel will exceed that time period. Although, extensions are available for those needing more time in this regard because encouraging visits for medical issues is being encourage by the government (Medical Tourism, 2013). In making high quality the foundation of attracting locals and visitors to the hospital, the nature of care increases and the development of research becomes a priority. The American Hospital Dubai frequently has research that comes from their study of medicine (Issues, 2012). Research capacity is an important part of a facility which means that it is looking at medicine from more than a business perspective. Research furthers knowledge and expands the disciplines within the medical field. The need to have research come from a hospital is as important as the practice of medicine. Forward thinking and the expansion of knowledge shows modernity, which is a vital part of having a good medical practice within a facility. Profit is an important part of growing medical capacities in a state. The projections from the Dubai government are that medical tourism to their nation will be a 17 billion dollar industry by 2015. Nair (2012) writes that “The rule of thumb in the medical tourism industry is that 40 per cent of travelers go for the advanced technology, 32 per cent seek better health care, 15 per cent opt for faster medical services, while only 9 per cent favor lower costs as the reason”. Creating revenue for the UAE through medical profits provides for an increase in the overall GDP of the UAE with 3.9% of the GDP derived from medical”. Equity of Care Equity of care is established through governmentally funded health care. Citizens of Dubai are given the opportunity to have care at the cost of the government. If a citizen chooses to pay for their own care, they can do that, but the government has created an urban center of healthcare facilities through which quality care has become the focus. Therefore the citizens of Dubai have the same or better access to healthcare in the Emirates than do tourists who must choose what they can afford, rather than have the medical community identify what they need and have it done. Although cardiovascular issues are the highest cause of death, the statistics show that it is not as significant as it is in Western industrialized nations, suggesting in some part that the medical care has had an impact on the effects of illness on mortality. There is a disturbing problem with equity where foreign workers are concerned. Foreign workers are brought in for labor through contracts that bleed them dry for expenses, similar to the type of contracts of indentured servants. The Human Rights Watch reports that workers who are brought into the nation are given false information about the nature of the work and are then stuck, sometimes because their passports are confiscated and kept until they pay off the debt that the company claims they owe for the expenses of living that have been occurred. When the health care system was developed, people who were in the state but not a citizen were excluded from comprehensive care. Companies are required to keep health insurance on their foreign employees, but considering the nature of the employment, this is likely at the least passed on to the employee and this contributes to the continued servitude in which they have become trapped. This issue requires a re-evaluation so that Article 25 of the constitution will mean something for people who are trafficked into the nation under false pretenses about work. In addition, prostitution is within Dubai and the women who are forced into the sex trade there are usually not citizens of the state. Women from Africa, India, Russia, and European states work as sex workers in Dubai. Men outnumber women 3 to 1 in Dubai, meaning there is a deficit of women from which to choose for companionship. Women are lured into the nation with promises of work where they are then stripped of their documents, sold in auction, or sold repeatedly to everyone from U.N. workers to the low labor workmen who pay for a few minutes of pleasure. With the nature of the sex trade in Dubai, access to services would be very limited, especially with foreign workers not covered for health care services Chakarova, 2007). Standards of Care The use of Western trained staff provides for care that is equal to that which can be found within the West. The question that must be answered is why the hospitals in UAE feel the need to use Western and primarily American based medical training. The first answer to that is that the scientifically based development of medical care is long established in American institutions and superior systems for research and publishing, access to advanced techniques, and access to superior equipment on which to learn exists in the United States, thus training there gives an advantage over less developed learning opportunities for medicine. Some European institutions have good opportunities for learning about medicine as well. As an example, Oxford University has a very good medical program. In the United States, however, there are a wider variety of places, such as John Hopkins, the Mayo Clinic, and other focalized institutions, in which advanced medicine can be discovered and learned. Multiple levels of accreditation for doctors and strong organizations that control the practice of medicine, such as the AMA (American Medical Association) means that the United States has a very controlled application of learning to the achievement of becoming a physician and surgeon (Alguire, Whelan, & Rajput, 2009). Maintaining standards of care at the American Hospital Dubai comes from several different areas of evaluation. First, the JCI maintains high standards as set by the United States through their function in the Medicare system. Maintaining high standards is required to continue accreditation. In addition, in order to continue to maintain a medical tourism presence, which is currently second in the world, the high level of care must be managed and maintained (Connell, 2011). Combining this with policies in relationship to events that had poor outcome that promote inquiry and change, the American Hospital Dubai provides efficient and effective care for both citizens and medical tourists. The Beating Heart Technique The use of the beating heart technique for heart surgery warrants some closer examination. As almost 100% of the surgeries done in the American Hospital Dubai for the heart are done with the beating heart technique, this type of surgical procedure must be evaluated. The Heart Center in Dubai has done more than 500 procedures. In the United States, the technique has been used for some time. Koutlas et al in 2000 wrote that in comparing elderly bypass patients who received beating heart coronary bypass techniques to those who used the traditional stopped heart bypass technique were found within the study to have a 100% survival rate with a lowered time in recovery than those who received the stopped heart technique. The patients receiving beating heart technique, or OP-CAB (Off Pump Coronary Artery Bypass) was operated on 53 patients with a comparison to 220 patients who received the standard version, CABG. The 220 patients had a mortality rate of 7.6%. This could be due to the increased number in the participant group, but there is a clear difference in this study between the experiment group and the control group. Long term studies have been showing that improvements in cognitive function after coronary artery bypass have been increasing. This is likely due to the use of beating heart or off – pump coronary bypass method which does not deprive the brain from oxygen (Bonser, Pagano, & Haverich, 2011). Movahed (2009) writes that beating heart surgeries give the recipient a better chance to a healthier recovery with retention of higher levels of a variety of different forms of affected areas when the heart is stopped during a procedure. Vascular surgeries end up with better outcomes when the heart remains beating. Stopping the heart is essentially killing the patient for a time. When the heart does not stop, systems are not affected outside of the surgical field or with less of an impact than might occur. Conclusion The cardiovascular department at the American Hospital Dubai, called the Heart Center, has a superior program that makes it the number two destination for medical tourists in the world, preceded by the nation of Jordan. While the system is well organized, using advanced techniques and using important protocols for examining events, there are always some improvements that can be made. The system is well monitored with a specific director in charge of events that had poor outcomes so that they can be investigated and solutions to any deficits being addressed. The biggest area of concern is not from within the organization, but through the social issues that provide for coverage for citizens, but do not provide for the healthcare of poor workers that are foreign nationals who have been coerced into holding positions in low labor but are either required to pay large sums for insurance or who are under the radar and not documented quite right and are left without any care. While having a facility that has a solid reputation internationally is a benefit to the community, it has a deficit of people are not being cared for throughout the city-state because of laws that disregard the truth about their social status. In addition while beating heart surgeries are state of the art, the cardiovascular department needs to make sure that they stay up on the latest information about techniques in the care of those in cardiovascular distress. The statistics are good for the Heart Center and the policies seem to make the location a well constructed organization. In addition to the care that is available, the government is looking to expend what is offered in relationship to being a medical tourist destination. Nair (2009) showed that it was important to the government to increase its position as a medical destination, looking for ways to include airfare and accommodations for secure recuperation after surgery so that the packages offered were comprehensive. The definition of the region as an important international medical center must first remain through accreditation, second through keeping ahead of the average cardiovascular unit in technique and knowledge, and finally making sure that tourists have proper travel accommodations to make the Heart Center at the American Hospital Dubai the premier destination for heart care in the world. Executive Summary This paper takes a look at the American Hospital Dubai through their Heart Center which cares for those with cardiovascular issues. The Heart Center uses the beating heart techniques for the various surgeries that are available because keeping a heart beating allows for a much better recovery from any sort of cardiovascular surgery that once might have required stopping the beating of the heart. What is discovered about the Center is not that there are any glaring deficits within the hospital, but that social problems outside of the hospital have caused more problems. If the hospital can contribute to the deficits in society where healthcare is concerned, the nature of healthcare in Dubai can be considered exemplary and at a standard that other nations should be envious. Resources Al, A. I. (2001). United Arab Emirates: A new perspective. London: Trident Press. Alguire, P. C., Whelan, G. P., & Rajput, V. (2009). 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