Medical tourism expert Maria Todd reviews senior medical tourism destinations in Latin America that are ripe for investment

Last month, I interviewed my mentor, Dr Maria Todd, CEO of Mercury Advisory Group about creating senior (“third age”, in some cultures) long stay medical tourism development projects. This month, I’ve continued the discussion by addressing where she believes the best places might be to build them.

You may recall from the previous article, that Dr Todd has extensive gerontology business development and managerial work experience. She worked as a senior ombudsman in a multi-location retirement community in South Florida in the 1980s, She also was the project manager to restore three successful abandoned South Florida beachfront hotels into a multi-purpose state-accredited senior memory-care, adult congregate living facility (ACLF). One of them also featured a medical cosmetic surgery tourism respite and recovery spa on an adjoining section of the property.

Dr Todd also managed a 30-seat hemodialysis center and nephrology medical group, a cancer treatment medical group, a gastroenterology medical group, and a gerontological internal medicine and cardiology medical group in Fort Lauderdale. She’s also worked as a surgical nurse. As a bonus, in particular for this topic, few people who have that healthcare work pedigree also worked in travel and tourism during their career as she has. Suffice it to say, she is highly-qualified to assess a market for investment appropriateness in senior health tourism destination development.

I asked her to consider Latin American senior medical tourism destinations with a composite ranking that considers the following elements:

  • the availability of high-quality medical care
  • reasonable cost of living
  • built infrastructure
  • temperate climate
  • things to do to maintain a stimulating, active lifestyle
  • expatriate integration into the community, and
  • long-stay visa availability for vetted, financially-qualified pensioners.

Todd: Well, to start, I’ve heard some nice things about Ecuador, as the top destination for expats, but they never followed through after three of their tourism officials took up two-and-a-half hours of my time in a meeting in Lima, Peru and extended an invitation for me to visit Cuenca. My cousins who were raised in the Caribbean really enjoy Ecuador and have spent a lot of time there, but I am unfamiliar with it, so let’s set that off to the side to discuss at some other time. It’s possible that they felt they weren’t ready for me to do a site inspection, after I outlined what “readiness” looks like. Who knows? There are lots of competing destinations with which I am more familiar.

Maria Todd presented a half-day workshop in Bogota at an investment conference hosted by the Colombian Government. One of three visits to Colombia for medical tourism strategy development, she lectured  and met government officials, including then President Uribe, in travel clothes because luggage didn’t arrive with her, even though “the show must go on.”

Next on my list is Colombia. I’ve been there several times. In fact, the COTELCO (its hoteliers’ trade association) invited me to speak there on one occasion, promised to pay my speaker fee funded by public-private funds, and then reneged, leaving me holding an invoice for $2080. (The $80 was for the additional Fedex courier fees to resubmit my invoice and reimbursement paperwork, which had to be notarized. After two attempts, we gave up in exasperation. Our firm and our associates won’t work with Colombia health tourism stakeholders again until it is paid.) If they ever clear their balance, I’ll let you know and you can update this article, but I am not holding my breath for payment. I share this so that others who go after me will be forewarned. They approached several of our colleagues to come and speak at subsequent events – I assume they did so without realizing that those experts are associated with us and won’t agree to go without prepayment and clearing the old balance due. Medical tourism may be global, but the community of true experts is small, and most of the best of the best are associated with Mercury Advisory Group as subcontractors. Knowledge of these situations is our only true leverage, as consultants. It is truly a brand blemish on an otherwise promising destination.

Resentment aside, in terms of healthcare, it has many excellent facilities that I have personally inspected, and it offers some special economic zones in Bogota and Medellin that include medical tourism exportation. Facilities there have accreditation from ICONTEC and the Joint Commission International (JCI), which to me is costly and redundant. If investors are going to enter that market, they have to pencil in an extra quarter of a million dollars to level the playing field by obtaining accreditation with both those programs.

The arrival into the airport is somewhat off-putting with all the military presence and big huge guns, but it depends if you see glasses as half- empty or half-full. The target market persona for senior medical tourism product would be a well-seasoned traveler that sees that as an attempt to control and prevent crime. Colombia has a huge stigma in the mind of most baby boomers because of all the drug-related violence when those boomers were younger, in the 1980s. In terms of quality of life, Colombia is the second most biodiverse destination on Earth.

Third on my list is Panama. Their healthcare is high quality, and their Pensionado visa is a huge well-planned bonus. This is a great example of a government with a sharp eye on attracting senior expatriates with modest income. The visa is available to anyone with a lifetime pension of over $1000 per month. It gives visa-holders excellent discounts on a variety of monthly living expenses, restaurants, entertainment costs, and airfare. There are thriving expatriate communities, good roads, good Internet service, and lots of sunshine. I did a mystery shop there for a medical tourism investor client a few years back. Johns Hopkins is in a co-branded arrangement with Punta Pacifica Hospital, in Panama City. PPH is one of five popular hospitals in Panama, but I have not had the opportunity to do deep-dive inspections of any of them, the the extent I normally do when evaluating a market for medical tourism destination development. From a “grey data” perspective, investors should consider it worthy of consideration for the right project.

Maria Todd, Medical tourism class monterrey mexico
Maria Todd of Mercury Advisory Group teaches a class on third-party reimbursement to hospital leaders in Monterrey Mexico.

Fourth on my list is Mexico. Due to its proximity to the U.S., it is a popular destination for American and Canadian expatriates. The healthcare I have personally inspected in Guadalajara, Juarez, Tijuana, Monterrey, Puerto Vallarta, Reynosa, and Mexicali, compare with the U.S in terms of quality. Colleagues from our firm whose opinion I respect have examined other locations and we all agree, there are many destination options throughout Mexico.

It is time for Mexico to “graduate” from individual stakeholder “free-for-all” to developing a national brand of medical tourism destination excellence. I meet with government and industry leaders every time I go there, but if they don’t seize the moment soon, I fear that competing countries will pass them by.

It is as if the medical tourism development there is “stuck”. Hospital and clinic leaders have the money and competency to develop their own brand, but they cannot (and should not) be expected to develop the “national brand”. They also have neither the budget nor the authority to develop and promote the “medical tourism” brand. That’s the responsibility of the public sector to develop.

Maria Todd met with investors and public officials regarding medical tourism development for the State of Chihuahua in 2013. To date, there’s been no forward movement.

The government must take the leadership of this national health tourism initiative and develop a national framework law, brand, and brand standards if it wants to place Mexico on the map as the “go to” destination for senior medical tourism destination development. As a strategy, it should tie its early-phase health tourism strategy to its expatriate popularity for quick wins. The options for favorable dialysis market development there is something I’ve studied in depth. All along the northern frontier there are many people who cross the border on foot, by car, and by bus who patronize the medical tourism suppliers most of which are never counted in official statistics for medical tourism, because there’s no official record-keeping system, so it is impossible to size the market. My trained eye and experience tells me there’s potential in many pockets of Mexico for senior medical tourism investment for destination development.

While there is a lot of talk about Costa Rica and medical tourism, our firm has had several consultants go there and come back with nothing overly-exciting to report. One is a former hospital administrator with more than 35 years of “national chain hospital” experience in managing hospitals, and another a nurse with advanced degrees, certification as a case manager, a former diplomatic nurse escort for US ambassadors, and about 6 years of medical tourism facilitator experience. Neither were overly impressed at a technical level when they visited the three most popular hospitals. The medical tourism hospitals and clinics generate a lot of publicity, but I’ve never been there, so my opinion of Costa Rica’s senior medial tourism investment and development potential would be strictly conjecture. While it is true they compete, I view it as a destination that is simply plodding along. But that’s true of a lot of medical tourism initiatives in Latin America and the Caribbean.

Belize, Uruguay, Honduras, Nicaragua, Chile, Argentina, Guatemala, the Dominican Republic, Cuba, Aruba, and other countries all have announced medical tourism initiatives, but I have not been to any of them personally, so without site inspections and personal knowledge or reports from trusted observers, I won’t opine.

I was invited to Argentina in 2014 by Termatalia of Spain, but I had a schedule conflict teaching a medical tourism workshop in Ukraine on the same dates. I am looking forward to visiting Argentina later this year as a guest of the Ministry of Tourism. These fam tours take a lot of effort to arrange because of the requirements I stipulate to be able to dive deep into the healthcare product quality and strategic plans of the public policy officials and stakeholders. If I can’t do a deep dive, it isn’t worth my time and effort to travel there. I’m simply too busy to go just to look at pretty tourism destinations that have hospitals nearby.

TO Group in Lima
Maria Todd with tour operators from London, Germany and the USA tour Peru with Termatalia (2012)

I visited Peru as a guest of Termatalia in 2012. Unfortunately, they didn’t really take us to see any private hospitals or clinics. That’s not Termatalia’s focus. We toured Lima, were hosted to a nice welcome event in Callao, their primary sea port. We also visited Cuzco and the Urubamba Valley of the Andes. While it is a magnificent tourism destination, I didn’t see much in the way of private health clinics, hospitals, or medical tourism product development. There is potential there for the right project but without foreign investment, I doubt it will happen. As a senior health tourism destination, I am not completely convinced of its appropriateness because I heard nothing of a senior expat strategy for development, the altitude is high which presents problems for cardiac and respiratory compromised seniors, and the terrain is tough on arthritics even in the developed locations. The gastronomy, culture, and hospitality there is excellent!

If the Peruvian government were to ask me what I would propose for a quick start national strategy for medical tourism in Peru, without a doubt, I would rally certain stakeholders starting with Abercombie & Kent, their national airlinesome of the thermal springs resorts and hotels, and find a few premium-branded private medical and dental clinics (assuming they exist) and put together a luxury level, executive checkup travel and spa health tourism experience coupled with a culturo-eco-tourism experience, similar to what I am proposing as one of the quick starts for Greece. But before I attempted this, I would want to see them to build a regulatory framework and brand standards of care, service, and quality to provide for enforcement and accountability. I would also want them to create an “officially-recognized” badge program that the facilities and suppliers conform to regulated standards.

Maria Todd and other tour operators enjoy a private mountaintop gourmet picnic near Cuzco, arranged by Abercombie & Kent Luxury Tours.
Maria Todd and other tour operators enjoy a private mountaintop gourmet picnic near Cuzco, arranged by Abercombie & Kent Luxury Tours.

Another destination for medical tourism that has seen its share of stops and starts and seems nationally “stunded” with regard to medical tourism strategy is Brazil. Known for producing extremely talented cosmetic surgeons, members of our consulting firm have been there on some healthcare projects. No one ever comes back saying “Oh man! This place is “the place”!

A few constraints get in the way of Brazil – the first being its current laws against physician advertising. Our firm responded to a RFP to propose a comprehensive three-phase medical tourism product development strategy for Brazil, but they weren’t ready. Then we heard they brought Ruben Toral, a talented marketing and public relations consultant there, known for how he put Bumrungrad in Thailand on the map. But how can one market Brazil without a product strategy in place first? That’s a common mistake of many medical tourism startups. They have hospitals, hotels, doctors, airport, and more. They even have facilitators and capable tour operators and travel agents. Those are the raw elements. Without a strategy and a plan, a regulatory framework, favorable physician advertising laws, and a little work on their foreign affairs and visa complexity (and cost-at least for Americans) they have a long way to go to develop that market and have something to promote at a national destination level. Also, urban Brazil is not known for low cost destinations.

Puerto Rico is another market that has announced (several times) over the past decade, an interest in developing the market for medical tourism. We understand from press releases, that the Medical Tourism Association is advising their government, so I guess that means we will see Puerto Rico as an exhibitor in future conferences and events. As for product development, market development, insurer  relationship development, and a potential haven for senior medical tourism, my suspicion is that there is tremendous potential. If it will be realized is another matter entirely. I don’t know their private healthcare situation there other than from a revenue cycle and managed care perspective from previous consultations with hospitals on their insurance contracts. I do know that they struggle with U.S. healthcare reform regulatory compliance costs. Any investor going there has to consider the costs of U.S. healthcare regulatory compliance threshold costs in order to commission a facility. That’s going to be a deterrent for many investors who can simply aim their efforts at a less complicated market. The thing about senior medical tourism that gives it bonus points is that U.S. seniors can use there Medicare benefits there. Anything beyond that from me would be conjecture until I see the market and do a deep-dive situational analysis.

Finally, Aruba has begun its medical tourism initiative. Highly-respected Aruban physicians and politicians have begun discussions for development of a medical tourism citadel on the island, focused on things that would be attractive to seniors and baby boomers. The destination is regenerative medicine friendly, allowing stem cell treatments there. It is a popular and developed tourism destination, and some US hospitals have established their footprint in the market. I will be headed there in a few weeks to meet with a group of investors, government officials, and see the lay of the land. For now, everything else I could say would be conjecture, so I’ll close my comments here.

CI: Thanks Maria. You’ve provided a detailed review of these destinations and strategic insight, as usual. I am sure you could go on for hours about more details and granularity for each destination. It will be interesting to see what develops if Cuba is opened as a market that Americans can visit and spend money for healthcare and expatriate settlement, given the huge Cuban-American diaspora in the USA and the romantic notions of a tropical paradise from the writings of Hemmingway. Lucky you to be going to Aruba to meet with project investors and politicians at the height of Denver’s winter snowstorms! I’ll circle back around to cover those destinations when there’s more to learn.

I will be interviewing Dr Todd on Senior Medical Tourism Destinations in Asia and Europe in future articles. Don’t miss them!