Jordan Report




First in the region for medical tourism


Following a recent report by the World Bank that ranks Jordan in the top five in the world and number one in the region with regards medical tourism Middle East Health visited the Kingdom to speak to some of the leading hospitals in Amman to gauge why the country is so successful in attracting foreign patients for treatment.

The Hashemite Kingdom of Jordan is an attractive country for foreign medical patients for many reasons. The Kingdom has a long history, relative to other countries in the region, of sound medical practice by highly qualified physicians. It has remained politically stable and secure, while many of its neighbours have been or are currently in turmoil. Its strategic geographical location makes it easy to access – it’s just a short flight from all countries in the Middle East, as well as from North Africa and the ‘Stans’, the former Soviet Union countries to the north and east. The country has a well developed infrastructure – its road network is first class and there is a bigger more modern airport being built outside Amman, the capital. From a healthcare point of view, most of the leading hospitals in Amman are accredited by the robust and rigorous Joint Commission International, putting them on a par with the top hospitals in the United States.

Arabic is the language of choice, but English is also fairly widely spoken in Amman.

For relatives accompanying patients, or for recuperating patients, the Kingdom has some of the world’s most remarkable tourist sites, such as the well-preserved Roman ruins of the city of Jerash, the Dead Sea and the incredible rose-red city of Petra carved into the mountains around 300BC. These are all easily accessible from Amman, which itself is a fascinating city and reputedly one of the oldest permanently inhabited cities on Earth. A further attraction is the climate in Amman which, due to it elevation, remains pleasantly cool in summer while much of the rest of the Middle East is uncomfortably hot.

Growth

Medical tourism to Jordan has been increasing year on year. When Middle East Health last visited Jordan in 2009, the country was already well-established to receive medical patients from overseas. Key hospitals in Amman such as the King Hussein Cancer Center (KHCC), the Specialty Hospital, the Arab Medical Centre and Al Khalidi Medical Center, had established foreign patient departments and concierge services to smooth the process for patients seeking treatment at these facilities. When we spoke to Dr Fawzi Al Hammouri, then chairman of the Jordanian Private Hospitals Association, he explained that these hospitals were receiving patients from northern Saudi Arabia (Amman being closer to these people than Riyadh), Sudan (a few wealthy individuals) and many patients from Iraq (as a consequence of the war in that country at the time).

This time around we spoke to Dr Awni Al-Bashir, the new president of Jordan’s Private Hospitals Association. He pointed out that Jordan is experiencing a 10% growth in foreign medical tourist numbers year on year. In 2010 patients came from 102 countries to seek treatment in Jordan, he said. However, he pointed out in a recent interview with the Jordan Times that the potential for growth in this sector was limited by the number of hospitals available.

“There are 61 private hospitals in the country and a further two are under construction,” Dr Bashir said, adding that the available hospitals were struggling to cope with the rising number of patients seeking treatment in the country. “There is a need for more investment in the sector.”

Interestingly, several hospitals we spoke to in Amman on this trip in May are all in the throes of expansion to cope with the influx of foreign patients. The demand is clearly there.

And they are expanding their horizons. Most of the hospitals treating foreign patients receive them from neighbouring countries like Iraq and Palestine, but several of the hospitals we spoke to said they are actively targeting countries in North Africa as well as the former Soviet Union countries.

Drawback

Speaking to the Jordan Times, Dr Bashir noted that one of the drawbacks for medical tourism in Jordan was that there was no “medical accountability” law, which prevented US health insurance companies referring their patients for treatment in Jordanian hospitals. In other words there is no legislation to enforce patient rights and protect them against medical error. The US is a potentially big market as the costs for certain medical procedures in Jordan can be as low as a quarter of that in the US.

According to a Jordan Times report in February this year, a draft medical accountability law has been drawn up, but has not yet been passed to the lower house of parliament for consideration.

We visited several hospitals in Amman. Following is a brief overview of three of these hospitals with a focus on medical tourism.

King Hussein Cancer Center

The King Hussein Cancer Center (KHCC) is one of several hospitals in Amman that is bursting at the seams in trying to cope with the fast growing demand for cancer care. The JCI-accredited hospital has a high profile in the region as one of the best cancer referral centres. KHCC has established programmes that focus on all stages of cancer care; from prevention and early detection, through diagnosis and treatment to palliative care. The centre is also accreted by the JCI as a disease-specific cancer center, making it the only such centre in the Arab world with this accreditation. This has come about through the KHCC developing local disease-specific protocols for diagnosis and treatment of cancer, rather than relying on US or European protocols.

Speaking to Middle East Health Dr Mahmoud Sarhan, MD, CEO and Director General of KHCC, explained that the hospital was constructing a new wing because of growing demand. He said that KHCC had completed a new wing in 2008 with the addition of 60 beds. However, the new expansion currently under construction will add a further 200 beds to the hospital. It is and expected to be completed by the end of 2013.

“We are seeing a growth of about 200 new cases a year,” he said. “In 2010 we saw about 4,800 new cases and the year before that around 4,600 new cases. This is higher than the growth of the population which is about 2.5-3%.

“We think this growth is due to the aging population and the continuous exposure to carcinogens, such as smoking. For example, if you take the whole population there are about 120 new cases per 100,000. If you look only at the population over 60 years of age there are about 600 new cases per 100,000 of population.”

Life expectancy in Jordan is increasing and with more people living into old age the country is facing an increasing burden of cancer, as well as other chronic diseases such as diabetes and cardiovascular disease.

“In 2010 there were 5,000 new cases of cancer in Jordanians and a further 2,000 new cases of cancer in foreigners in Jordan,” Dr Sarhan said.

“About 45% of these are treated at KHCC, about 66% of which are Jordanians and around 34% non-Jordanians.”

Speaking at a King Hussein Cancer Foundation fund-raising event in Abu Dhabi in March this year, HRH Princess Ghida Talal, Chairperson of the Board of Trustees of the King Hussein Cancer Foundation, explained the attraction of Jordan for medical tourists saying: “We are fortunate to have the King Hussein Cancer Center which provides comprehensive cancer treatment comparable to that of the best cancer centres in the West, with the additional distinction of being here in our own region, where patients can remain among their families and loved ones, cared for by doctors and nurses who speak our Arabic language and who understand our fears, all at one third the cost of receiving treatment abroad.”

Country of origin

The non-Jordanians treated at KHCC come from the following countries, according to Dr Sarhan: Iraq and Palestine make up about 50% and the others come from Syria, Sudan, Libya and Yemen with a handful from a variety of other countries.

The new expansion will consist of two towers with a combined area of 83,360 sq m. It will be attached to the current hospital, will house a 2,000 sq m cancer research facility and a public blood stem cell bank. One tower will have outpatient clinics across 10 floors. The second tower will be for inpatients. It will have 11 floors in total with radiotherapy, radiology, operating rooms, 24 ICU rooms, 24 paediatric rooms, 24 leukemia rooms and several floors of general patient rooms.

KHCC collaborates with several key international centres including: St Jude’s Children’s Research Hospital in the US; The Lombardi Cancer Center of Georgetown, US; Susan G Komen for the Cure, US; The Sick Children’s Hospital, Canada; National Cancer Institute, Egypt and the August Victoria Hospital, Palestine, among others.

Istishari Hospital

Istishari Hospital is Amman’s newest private hospital. The current new management took over the hospital in 2008. In August 2010 it received JCI accreditation. It is a 108-bed, high-tech, multi-specialty hospital using some of the most advanced medical technology available including a 1.5T MRI and a 64-slice CT scanner.

“We have five Centres of Excellence,” Zahira Haram, chief executive and experience officer, Istishari Hospital, told Middle East Health, when we visited the hospital in May. They are cardiovascular, gastroenterology, newborn medicine, infertility, hematology/oncology. The hospital has six ORs all equipped with (negative pressure) laminar flow, to cut out airborne infection. One of these theatres is a dedicated cardiovascular surgery and includes a cath lab.

Istishari Hospital has a full digital Hospital Information System in place. All in all, this is a state-of-the-art medical facility.

Their doctors are all well qualified. The cardiac team, for example, are all Harvardtrained doctors.

Quality is key to healthcare in the hospital, explained Haram. The hospital has established a quality control department to continually assess quality on all levels at the hospital.

“We also conduct a continual patient survey to have an on-going assessment of patient satisfaction and to ensure patient services are of the best quality,” she said.

The hospital has initiated several unique and innovative features. To ensure quality of service in the hospital they employ ‘patient representatives’, whose exclusive job it is to visit every patient in the hospital after admission to check whether they are happy with the services and to handle any complaints.

“We have also set up a team to double check all billing. They will go through each bill before it is issued to ensure patients are not being overcharged,” she explained.

The hospital has a range of accommodation, including three luxurious Royal Suites, several spacious two-room suites and large first, second and third class air-conditioned rooms.

It is an upmarket private hospital, and since reducing their reliance on insurance payors, they have seen a 40% increase in the number of “out-of-pocket” payors.

Foreign patients

The hospital has an established International Patient Services department to cater to medical tourists. This is also well placed on their website – www.IstishariHospital.com – reflecting the importance this hospital places on this market. The hospital also has a non-profit concierge service.

“We’ve seen patients from 57 countries. Before the conflict [the Arab uprising currently sweeping parts of the Arab world] we saw patients mainly from Libya, Yemen and Saudi Arabia.

“It is the hospital of choice for foreign embassies based in Jordan. The embassies recommend this hospital to tourists in the country who need medical care,” Haram pointed.

She pointed out that the hospital is listed on the Jordan stock exchange. “As a public company we have to be totally transparent with our finances. We also try to reflect this in the culture of the hospital, with the staffing in particular who are hired on merit and equal opportunity.”

Even the architecture of the building reflects this transparency, with a lot of glass there is openness and a flow of natural light.

Ishtishari is also expanding to cope with high demand for their services. “Planning has been approved for a 14-storey tower adjacent to the hospital. The priority for this expansion is to house more outpatient clinics,” Haram explained.

“Our biggest patient growth is in oncology, although we are also experiencing considerable growth in the IVF unit,” Haram said.

Haran emphasised that the hospital has a patient-centred approach to the way they operate and “we make it clear to all patients on admission that they should know their ‘rights and responsibilities’ as patients.”

Specialty Hospital

The Specialty Hospital is one of Amman’s leading private hospitals. It has been honoured with several awards over the years in testament to its prestigious position in Jordan, such as the King Abdullah II Award for Excellence.

“We are the only hospital in Jordan to have received this award and we have received it twice,” Dr Fawzi Al-Hammouri told Middle East Health when we visited the hospital in May this year.

This multi-specialty facility has JCI accreditation and it has a long list of firsts: They were the first to introduce 3T MRI in Jordan, the first to introduce 64-slice CT in the country and the first to introduce hyberbaric oxygen therapy, among other forward-thinking initiatives.

The hospital treats many foreign patients.

“In 2010 we treated 45,000 non- Jordanian patients – about 25% of capacity,” Dr Hammouri pointed out. “At some points 50% of our patients have been non-Jordanian.”

Like other leading hospitals in Jordan, Specialty Hospital has a foreign patients department and concierge service to handle all necessary arrangements for foreign patients seeking treatment at this facility.

To cope with growing demand for their services, this hospital has also expanded.

“We opened a new wing to the hospital in 2010 with a further 230 patient rooms. We now have capacity to take another 45,000 patients from abroad,” he said.

The new wing has 10 ORs with laminar flow and hepa filters.

“We’ve seen a noticeable reduction in surgical infections with these state-of-theart operating theatres,” Dr Hammouri pointed out.

“The air in these rooms is changed 18 times per hour and goes through six filters.”

The new wing also houses 18 royal suites.

Before the Arab uprising Specialty Hospital received many of their foreign patients from Libya, which ranked number two on their list for medical tourist.

“But now there are no flights from Libya, so currently most of our patients come from Palestine, Iraq, Saudi Arabia, Sudan and Yemen,” Dr Hammouri said.

“And we’re starting to receive patients from the former Soviet Union countries, such as Uzbekistan and Azerbaijan,” he said.

“We’re also looking at targeting North and West African countries such as Chad and Nigeria, as well as Arab-speaking people in Europe.”

He explained that 2009 to from 2010 they saw a 10% increase in foreign patients. “We expect this to increase again this year by another 10-15%,” Dr Hamourri said.

He said there were several reasons why medical tourism was growing in Jordan and not only for patients from neighbouring countries, but also from Europe and the US.

“There are, of course, economic reasons,” he said, “As the cost of treatment here compared to Europe and the US is considerably less expensive, while the quality remains high, but there are other reasons as well.

“For example, if we look at IVF: in Germany you are not allowed to choose the sex of the baby. In Jordan there is no legislation prohibiting this so prospective parents who would like to choose the sex of their baby come here for IVF treatment. Also in Germany in vitro testing for diseases like Thalassaemia is not allowed, but it can be done here.”

With Jordan’s stability in a sea of Arab turmoil, its reputation for providing some of the best quality healthcare in the region, its modern state-of-the-art medical facilities and the country’s many easily accessible tourist attractions, the Kingdom looks set to keep its status as the premier destination for medical tourism in the region for some time to come, while expanding this prestige further afield.

 Date of upload: 15th Aug 2011

 

                                  
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