The promise of medical tourism in the Caribbean

The Caribbean medical tourism industry is absolutely booming, based on metrics such as pledges, promises and memoranda of understanding. However, tangible developments are sporadic and fairly small in all but a handful of the Cayman Islands’ neighbors. 

 

As of September, Health City Cayman Islands developers had construction in progress, financing, and leadership from well-known medical organizations. Pending disaster such as a major hurricane, it appears developers will achieve their goal of having the 140-bed hospital open for business in February 2014. 

While it seems that just about every country in the region is expressing ambitions about fostering medical tourism, most of the projects lack the three aforementioned traits of Cayman’s development: actual construction, solid funding and established partners. The Cayman project is also far grander in ambition. 

 

Health City Cayman Islands  

Health City Cayman Islands, locally known as the Dr. Devi Shetty hospital, is a partnership between Dr. Shetty’s India-based Narayana Hrudalaya and Ascension Health Alliance, the largest private nonprofit health network in the U.S. The 140-bed hospital, with a price tag of $50 million, will initially offer cardiac, cardiologic and orthopedic services. The goal is for the hospital to grow into a 2,000-bed facility with all major specialties, a medical school and assisted living facilities, over 15 years. The US$2 billion project will also incorporate supporting development such as hotels, retail and offices. 

With 2,000 beds, the envisaged healthcare facility in East End would rank as the third-largest hospital in the U.S., behind only New York-Presbyterian Hospital (2,292 beds) and Florida Hospital Orlando (2,141), and would be larger than Jackson Memorial Hospital in Miami (1,724), according to a June article in Becker’s Hospital Review. By comparison, Dr. Shetty’s original NH Health City in Bangalore, India, has 3,000 beds. 

For Cayman’s development to reach its potential, however, the country must invest in significant upgrades to its infrastructure in order to accommodate the more than 1 million stay-over medical tourists anticipated per year. 

Even the initial hospital is projected to bring in a considerable number of stay-over medical tourists, some 87,600 per year, according to projections cited by then-Premier McKeeva Bush in April 2010, in relation to the then-planned 200-bed hospital. 

 

Jamaica, Barbados, Bahamas  

Medical tourism plans are more modest elsewhere in the Caribbean, even in the relatively large countries of Jamaica (2.7 million people), Barbados (274,000) and Bahamas (347,000). 

In February, Jamaica’s national investment and trade promotion agency signed a memorandum of understanding with a North Carolina-based group of medical professionals who have links to Jamaica for a US$170 million facility. The first phase of the project calls for a 50-75 bed hospital specializing in plastic and cosmetic surgery, bariatric services and dental procedures. When completed, the facility will have 200 beds.  

The project is aimed at attracting medical tourists from North America and the Caribbean. Recent information materials from Jamaica Promotions Corporation indicates that American Global M.D. is seeking equity investment or joint venture partnerships for the project. 

In June 2011, the American World Clinics company signed a lease with the Barbados government for property including a former private hospital, which is now vacant. The US$100 million hospital would have 50 beds.  

An April article in Barbados Today said 30 doctors, mostly from the U.S., had signed on to participate in the hospital, which would offer surgical procedures in a variety of disciplines. As of April, the hospital’s projected opening date had been pushed back from summer 2013 to 2015, as developers were waiting on the Barbadian government’s approval and finalizing the financial structure of the project. In June, Barbados Today reported that the company was preparing to start construction on the project. Separately, a Barbadian developer had just announced his own plans to build a US$300 million hospital.  

In April, American World Clinics visited the Bahamas to pitch a plan for a US$200 million-$250 million hospital that would also offer surgical procedures. The news of the company’s visit prompted an unfavorable reaction from the Bahamas’ local, private Doctors Hospital, which is promoting its own medical tourism initiatives, including spinal surgery and prostate cancer treatments. According to news reports, American World Clinics is also exploring opportunities in the Canary Islands, Uruguay and Asia. 

 

Smaller Caribbean locales  

Apart from the larger nations, smaller Caribbean jurisdictions closer in size to Cayman have their own projects. 

In Turks and Caicos, a private 20-bed hospital offers orthopedic and spinal procedures to U.S. and Canadian visitors targeted by a Tennessee-based company called Global MedChoices. The hospital is one of two in the country built and operated by Toronto firm InterHealth Canada. 

In July, a Canadian consultant told the Bermuda Royal Gazette that the Bermuda Hospitals Board owed him US$70,000 in relation to an initiative to bring a rehabilitation clinic to the territory. 

In July 2012, St. Kitts and Nevis officials broke ground on the planned US$15 million New River Medical Centre, a 22-bed facility offering elective surgeries. The original completion date for the project, in partnership with a Georgia-based Princeton Healthcare Inc., was late 2013. However, in May one of the country’s opposition members noted that the new government’s budget did not mention the proposed medical facility, according to an article in SKN Choice Times. 

Last fall, a group of Miami doctors pitched a proposal to start a facility called The American Clinic in St. Maarten that would offer surgeries and other specialty services. According to St. Maarten’s Today Newspaper, developers intended to break ground on the US$140 million project toward the end of 2012. The first phase would consist of a 100-bed hospital with 100 bedroom suites for recovering patients and families.  

The second phase, costing US$120 million, would be a cancer center with less than 100 hospital beds and about 100 suites. Although the company signed a memorandum of understanding with the country’s previous government, as of March the company was still discussing its ideas with the current government, according to the newspaper. 

In September 2012, the newspaper reported that The American Clinic had been looking at building its project in Grand Cayman until it learned about Dr. Shetty’s proposal. 

According to a 2013 article in the Island Studies Journal by John Connell of the University of Sydney, Grenada is pursuing the creation of a new hospital linked to a proposal for a “university hospital town and medical resort with a flagship Four Seasons Hotel.” The Grenadian government named London’s Balfour Beatty Capital as the preferred bidder for the new hospital. According to a presentation, the broader proposal additionally calls for a US$446 million capital project, including medical teaching facilities, hotels, retirement homes, luxury homes, a “residential university town” and other educational facilities, with financing possibly being provided by the Exim Bank of China. 

The Island Studies article also refers to somewhat “vague” plans announced last year in Trinidad and Tobago for U.S. private sector-funded “five star medical centers.” 

 

Existing medical tourism  

Several Caribbean countries do have existing medical tourism initiatives. 

For example, Barbados has the private Barbados Fertility Clinic, which reportedly draws hundreds of patients per year, both locals and tourists. According to the Island Studies Journal article, about 80 percent of the fertility clinic’s patients were tourists, and half of the tourists were from within the Caribbean. The clinic is accredited by Joint Commission International, a U.S.-based group that issues “seals of approval” for international medical facilities. 

Doctors Hospital in the Bahamas was the first hospital in the English-speaking Caribbean to gain JCI accreditation, according to the Island Studies Journal article. (Health City Cayman Islands plans to seek JCI accreditation.) 

In Bermuda, the public hospital has a new prostate cancer facility that offers treatments not approved by U.S. regulators, bringing in hundreds of medical tourists. The hospital’s Department of Pathology is JCI-accredited. 

Additionally, Antigua and Barbuda has an addiction treatment center; St. Lucia offers alternative medicine; and Trinidad and Tobago offers ophthalmology, cosmetic surgery and orthopedic services. 

However, medical tourism in the broad region is still dominated by relatively large nations such as Brazil, Costa Rica, Cuba and Panama. Brazil is renowned for plastic and cosmetic surgery, while Costa Rica is known for dentistry. Cuba has long been recognized as providing superior health care and boasts the highest number of doctors per capita in the world. Cuba has developed unique procedures to treat eye and skin pigment disorders. A 2003 BBC article states that Cuba derived about US$40 million a year from medical tourism. The largest obstacle to medical tourism in Cuba is the U.S. embargo, which prevents supplies and people from going to Cuba from the U.S. Most medical tourists to Cuba are from Europe, Russia, Latin America and the Caribbean. The website for Havana Hospital advertises open heart surgery on three days’ notice for US$9,000-$15,000. 

Panama, meanwhile, has two JCI-accredited hospitals, one affiliated with Johns Hopkins Medicine International and one affiliated with Baptist Health South Florida and Texas Children’s Hospital. 

While most proponents of medical tourism in the Caribbean cite the flawed U.S. healthcare system as a driver of demand for overseas facilities, the U.S. is a magnet for incoming patients from the region (including Cayman). According to a June 2012 report from the United Nations Economic Commission for Latin America and the Caribbean, the impact of U.S. healthcare reform on demand for medical tourism is not yet known. 

According to the report, increased insurance coverage may mean that fewer U.S. residents may need to go abroad for procedures. On the other hand, increased coverage may lead to increased demand for U.S. facilities, meaning more residents may go abroad in order to get quicker service. 

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The first phase of Health City is a 140–bed hospital providing cardiac and orthopedic services.

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