Insight into Medical Tourism in Costa Rica. Fascinating information on the growth of obesity in the U.S.

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HOW TO DESIGN A…
BENEFIT PLAN TO INCLUDE A
MEDICAL TRAVEL OPTION

2. • Medical Tourism declared • Costa Rica offers three JCI
of national and public accredited hospitals:
– HOSPITAL CIMA
interest by former President
– HOSPITAL CLÍNICA
of the Republic Oscar Arias BIBLICA
in 2009 – HOSPITAL & HOTEL LA
CATOLICA
• Formal commitment of
actual President of the • Additionally, Costa Rica is
home of Latin American
Republic Laura Chinchilla
branches of accreditation body
• In 2009 Costa Rica received like AAAASF and AAAHC
approx. 30.000 medical (deeming authorities for
travelers injecting about CMS).
U$250 million in Costa • Today there are more than
Rica’s economy 20 ambulatory clinics
internationally accredited
ABOUT COSTA RICA
Costa Rica: quality health care and nature within your reach!

3. • PROMED is the board for the promotion and quality
assurance of the Costa Rican healthcare industry.
• PROMED is a private association of accredited
Hospitals, certified Doctors, Universities and Tourist
Services, supported by the Costa Rica Ministry of
Health and the Costa Rica Tourism Board.
• Through the seal of quality PROMED makes sure
that any healthcare and recovery facility provides
with services of excellence in favor of patients
security.
ABOUT PROMED
PROMED: the gate to quality healthcare in Costa Rica!

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5. • WHAT is a Global Centers of Excellence
Program
• COMPONENTS of a Quality Program
• SPECIALTIES of a Program
• WHY Enhance Your Benefit Program
• Benefits to YOUR COMPANY
• Benefits to YOUR
EMPLOYEES/RETIREES
• HOW to Add Global Centers of Excellence
Agenda
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6. What Are Centers of
Excellence (COE)
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7. Designed to
Improve
Outcomes
Bariatric
Cost Savings Humana Provided Travel
with Reduced for Member and
Complications 1982 Companion
Every Major
City has
Multiple COE’s
Centers of Excellence (COE)
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8. Quality
Outcomes
for a
Reduced
Cost
Highly
Accredited
English
Speaking
Providers
JCI
Accredited Specialized
(similar to Targeted
US Procedures
Standards)
What is a GLOBAL CENTERS
OF EXCELLENCE PROGRAM
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9. Joint Commission Joint Commission
Accreditation – United States Accreditation - International
• Correctly ID Patient • Correctly ID Patient
• Improve Effective • Improve Effective
Communications Communications
• Improve High-Alert Med • Improve High-Alert Med
Safety Safety
• Ensure Correct site, • Ensure Correct site,
Correct-Procedure, Correct-Procedure,
Correct-Patient Surgery Correct-Patient Surgery
• Reduce Risk of Health • Reduce Risk of Health
Care – Associated Care – Associated
Infections Infections
• Reduce Risk of Patient • Reduce Risk of Patient
Harm Resulting from Falls Harm Resulting from Falls
Although US Accreditation is different the standards for the International Community are
same and in some cases more stringent
Accreditation
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11. Reduced
THE PATIENT ADVOCATE Cost
IS THE KEY !!!
Facilitating the process
for the member
- Medical Necessity
- Providing Cost and Adverse
Measurable Patient
Provider Options Outcome
Outcomes Advocate
Protection
- Coordinating Travel
and In-Country
Transportation
- Facilitating Claim
Payment
- Providing Medical Enhanced
Follow Up Contact Clinical
Service
Components of a Global
Centers of Excellence Program
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12. Measurable Outcomes
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13. Volume of
Procedure at
Facility or by
Provider
Complications Morbidity
Re-admission or
Secondary Mortality
Infection Rates
Measurable Outcomes
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14. Measurable Outcomes
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15. • Increased Level of Service
• RN patient ratio 4:1
Nursing • US nursing ratio can exceed 10:1
•Many US/ Western Trained Physicians
•Technologically advanced hospitals
Technology/ •Example: oxygen chamber to enhance healing after surgery
Training •Private rooms
•Recovery Centers with personalized care
•Patient Advocate coordinates return to home country; follow patient through
Follow up recovery
Enhanced Clinical Experience
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16. Enhanced Clinical Experience
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17. Domestic US International
• Mal-practice • Insurance Policy
Insurance
• Specific
• Legal System
• Protections for
• Protracted
• Uncertain both patient and
• Up to 33% of Award to employer/plan
Lawyers
• Outcome
• Adversarial Assured
• Outcome
Uncertain
Adverse Outcome Protection
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18. Up to 50%
Up to 90% on
savings in Up to 80%
Prescription
Medical for Dental Savings
Drugs
Package Price
Reduced Cost
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19. • Savings of up to 80% on Dental Procedures
• Most US dental plans pay 50% up to $1000-$2000
annually costing member thousands, if not tens of
thousands out of pocket
• Package price savings of approximately 50% for
Medical
• Saves Plan Money (ERISA allows use of tax advantage
dollars)
• May save employee money (FSA, HSA, Possible HRA)
• Prescription Drug savings
• Nexium 30 day 40 mg, available OTC for $22
• US cost $160, prescription required
• One of the TOP 5 drug in ANY US corporate medical
plan
Reduced Cost
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20. • Knee
• Sleeve
• Hip
• Lap Band
• Shoulder
• Roux-en-Y
• Full Rehabilitation
Included
Orthopedic Bariatric
Major
Plastic and
Surgery Cosmetic
Dental
• Face/Neck • Implants
• Body Contouring • Crowns
• Enhancements • Veneers
• Laser Re-Sculpting • Whitening
Specialties
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21. Company Employee
• Cost savings • Patient Advocate
• Comparable • Comparable
Quality Quality
• Enhanced Service • Enhanced Service
• Tourism
• Competitive
Difference • Potential Cost
Savings
• Embracing Global • Dental
Workforce • Cosmetic
Solutions • Potential Design
Changes to Reduce
Out of Pocket Cost
Who Benefits? EVERYONE !!!
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22. • Self Funded Employer – Houston
• 2 employees
• BMIs of +40 and 32
• Procedure – Gastric Sleeves
• Outcome – at 6 months more than 100lbs
combined – No complications.
• Cost –
• Houston $30,000 -$35,000
• Costa Rica $14,000 (included travel, hotel,
surgery, complication insurance, companion)
• Savings = 53%
CASE STUDY 1
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23. • Employee seeking full mouth reconstruction
• Employer Dental plan annual maximum $2,500
• Cost –
• Houston $38,000 over 6 months
• Absent from work 21 days
• Costa Rica $16,000 over 2 weeks,
• Absent from work 14 days
• Savings –
• Employer 7 days of lost time ($8,500)
• Employee $22,000 ($35,500 - $13,500)
CASE STUDY 2
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25. Design Plan
Decide on
Specialties
Incentives Competitive
Obtain
Committee
Contract with
Patient Enhanced
Advocate
Approval
Organization Benefit
Amend
Documents
Employee
Communications Offering
HOW TO ADD THIS TO YOUR PLAN
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26. Prevalence Of Obesity…Trends Among
U.S. Adults between 1985 and 2009
Definitions:
• Obesity: Body Mass Index (BMI) of 30 or higher.
• Body Mass Index (BMI): A measure of an adult’s
weight in relation to his or her height, specifically
the adult’s weight in kilograms divided by the
square of his or her height in meters.

27. Obesity Trends* Among U.S. Adults
BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

28. Obesity Trends* Among U.S. Adults
BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

29. Obesity Trends* Among U.S. Adults
BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4”
person)
No Data <10% 10%–14%

30. Obesity Trends* Among U.S. Adults
BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

31. Obesity Trends* Among U.S. Adults
BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

32. Obesity Trends* Among U.S. Adults
BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

33. Obesity Trends* Among U.S. Adults
BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

34. Obesity Trends* Among U.S. Adults
BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

35. Obesity Trends* Among U.S. Adults
BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

36. Obesity Trends* Among U.S. Adults
BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

37. Obesity Trends* Among U.S. Adults
BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

38. Obesity Trends* Among U.S. Adults
BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

39. Obesity Trends* Among U.S. Adults
BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

40. Obesity Trends* Among U.S. Adults
BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

41. Obesity Trends* Among U.S. Adults
BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

42. Obesity Trends* Among U.S. Adults
BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

43. Obesity Trends* Among U.S. Adults
BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

44. Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

45. Obesity Trends* Among U.S. Adults
BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

46. Obesity Trends* Among U.S. Adults
BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

47. Obesity Trends* Among U.S. Adults
BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

48. Obesity Trends* Among U.S. Adults
BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

49. Obesity Trends* Among U.S. Adults
BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

50. Obesity Trends* Among U.S. Adults
BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

51. Obesity Trends* Among U.S. Adults
BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

52. Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009
(*BMI ≥30, or about 30 lbs. overweight for 5’4” person)
1990 1999
2009
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

53. THANK YOU!
The Council for International Promotion of Costa Rica Medicine
PROMED
US phone number (305) 381-2988
Costa Rica +506 2201-5265
info@promedcostarica.com

54. Obesity Trends Among U.S. Adults
between 1985 and 2009
Source of the data:
• The data shown in these maps were collected
through CDC’s Behavioral Risk Factor Surveillance
System (BRFSS). Each year, state health
departments use standard procedures to collect data
through a series of telephone interviews with U.S.
adults.
• Prevalence estimates generated for the maps may
vary slightly from those generated for the states by
BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly
different analytic methods are used.

55. • In 1990, among states participating in the Behavioral Risk Factor
Surveillance System, ten states had a prevalence of obesity less than
10% and no states had prevalence equal to or greater than 15%.
• By 1999, no state had prevalence less than 10%, eighteen states had a
prevalence of obesity between 20-24%, and no state had prevalence
equal to or greater than 25%.
• In 2009, only one state (Colorado) and the District of Columbia had
a prevalence of obesity less than 20%. Thirty-three states had a
prevalence equal to or greater than 25%; nine of these states
(Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri,
Oklahoma, Tennessee, and West Virginia) had a prevalence of
obesity equal to or greater than 30%.

56. Citations
• BRFSS, Behavioral Risk Factor Surveillance System
http: //www.cdc.gov/brfss/
• Mokdad AH, et al. The spread of the obesity epidemic
in the United States, 1991—1998 JAMA 1999;
282:16:1519–22.
• Mokdad AH, et al. The continuing epidemics of obesity
and diabetes in the United States. JAMA. 2001;
286:10:1519–22.
• Mokdad AH, et al. Prevalence of obesity, diabetes, and
obesity-related health risk factors, 2001. JAMA 2003:
289:1: 76–9
• Vital Signs: State-Specific Obesity Prevalence Among
Adults —United States, 2009 MMWR 2010;59(30).