1. Medical Tourism and Surgical Trip Tom Hamilton THamilton@CaroinaBenefitDesigns.com www.SurgicalTrip.com 1-866-313-1112

2. 2 Medical Tourism: What is it? One of the newest, most innovative options is medical tourism which is defined as the act of traveling outside one’s own country of residence for health care. This can take form of a two hundred mile drive to your parent’s birthplace, or it can mean flying half way around the globe to an exotic culture you know nothing about. For people without insurance or those needing medical procedures that insurance won’t cover, medical tourism offers an attractive alternative to rising healthcare costs.

3. 3 Access to quality medical care Lower costs… a fraction of the cost of care in the United States Why Americans Travel Outside the U.S. SingaporeTurkey India Thailand Mexico

4. 4 Medical Travel: A Preferred Option Medical travel has morphed into a preferred option for acute care procedures, surgeries, & dental care Also for: Cosmetic and bariatric surgery and other uncovered benefits Procedures not available in U.S. – robotic specialized procedures Timely access to care (Canadians & UK citizens facing waiting periods of 2-3 years)

5. 5 Lower Costs Medical Care in foreign countries costs less: From 30 percent to 80 percent less than the U.S. and Canada

6. 6 The “Tourism” in Medical Tourism Exotic Destinations

7. 7 Macro Trends: Not a Minor Thing According to the National Center for Policy Analysis (NCPA), 500,000 Americans crossed the border for treatment in 2005. A recent report by Deloitte from August 2008 entitled “Medical Tourism, Consumers in Search of Value” reports that by 2017 it is estimated that approximately 17 million Americans could be traveling overseas to engage in Medical Tourism.

8. 8 Quality and Safety Meets or exceeds U.S. standards Plus great nursing ratios Hospitals more like 5 Star hotels Joint Commission International (JCI) accreditation is a standard that monitors quality. Surgical Trip’s Network uses primarily JCI hospitals. Trained, credentialed physicians Often affiliations with U.S. hospitals and American academic centers Accreditation English-speaking doctors and professionals

9. 9 Surgical Trip provides prospective patients an all-inclusive, transparent pricing plan which includes: surgery/procedure costs airfare, lodging, transfers and a 24/7 concierge service. A suite of medical and dental procedures are available, including: Suite of Procedures o Gastroenterology o General Surgery o Gynecology o Internal Medicine o Neurosurgery o Oncology (selective) o Ophthalmology o Orthopedics o Cardiology o Cardiothoracic o Chemical Dependency o CyberKnife ® (cancer) o Dental o Detox/Rehab o ENT o Executive Health Physicals o Pain Management o Pediatrics o Plastic and Reconstructive Surgery o Urology Male/Female o Vascular o Weight Loss/Obesity Surgery

10. 10 Consumer Research Key Messages with greatest appeal: Hospitals are accredited by the body that accredits hospitals here in the US Insurance companies or employers pay the employee an incentive Doctors are Western-trained Nurse/patient ratio is lower than in the US A guest can accompany the client Drivers discovered and initiatives suggested: Levels of cash payment to the employee Size of possible premium reduction Luxurious hospital rooms and various accessories Patient comfort levels Concierge Service Marketing to younger employees Marketing to opinion leaders

11. 11 Ms Marlow’s Story Her words: “After being told by three US surgeons to have a Total Hip Replacement where they amputate the entire head of your femur, I decided to take my health into my own hands, and traveled to India for “Hip Resurfacing” surgery. Surgery took place December 1, 2005. My hospitals stay was 9 days, recuperated 4 days in a 5 star beach resort, I had one of the world’s top surgeons,, large private hospital room with plasma screen TV, wireless laptop, fridge, microwave and care second to none I have ever experienced ALL for less than $12,000! It was so amazing that I will never have surgery again in the US.” When Ms Marlow traveled to India for Hip Resurfacing surgery in 2005, there were no devices approved by the FDA at the time and her insurance would only cover a Total Hip Replacement where they amputate the entire head of your femur. She traveled to India and her experience was so amazing that she has become a major patient advocate for hip resurfacing surgery.

12. 12 Example: Decision for Hip Replacement $5000Waived $500 Patient co-payment and deductible Impact to Employee* $0$3000$1500$0 Incentive paid by ER by EE Hospital AHospital BHospital CLocal US Hospital Underlying Cost of Procedure, including Airfare and Hotel $15,000$12,000$9,000$50,000 Complication Rate for Procedure 0.5%1.8%1.1%1.2% Travel time from home (showing flight transfers required.) 4 hrs (0)22 hrs (2)30 hrs (1)0.5 hrs (0) Patient Satisfaction Score (5 point scale) 4.54.14.94.7 Net benefit to employee with variable incentive $4500$6500$8000-$5000 Assumes a $5000 copay/coinsurance at a US hospital and a variable incentive paid by employer (ER) to employee (EE) based on provider selected.

13. 13 Cost Comparison According to the American Medical Association June 2007

14. 14 TRANSPLANTATION COST Average Total Billed Charges Kidney (Living Related Donor) Liver (Living Related Donor) Bone Marrow (Autologous) $25,000 $33,000 $25,000 Non- U.S.U.S.* $171,730 $416,728 $242,835 *Source: Nationally Recognized Transplant Network Average Total Billed Charges Completed Cases, 1/1/2004 thru 1/31/2006

15. 15 Accreditation: Joint Commission International JCI, based in the U.S., is a division of Joint Commission Resources (JCR) and a subsidiary of the Joint Commission designed to improve and regulate the quality and safety of healthcare services. About 200 and growing foreign hospitals now accredited

16. 16 Accreditation: International Society for Quality in Health Care(ISQua) A non-profit, independent organization with members in over 70 countries. ISQua works to provide services to guide health professionals, providers, researchers, agencies, policy makers and consumers, to achieve excellence in healthcare delivery to all people, and to continuously improve the quality and safety of care. Based in Australia JCI is accredited by ISQua

17. 17 Criteria for Selecting Hospital Providers Reputation for quality Indicated experience in selected procedures Accreditation status Ability to provide clinical data Agreement to participate in our quality assurance and reporting program Customer service orientation Excellent nurse to patient ratio Choice of geographic location Familiarity with the needs of international patients International standards in clinical delivery and patients’ rooms World-class medical infrastructure and equipment

18. Medical Tourism and Surgical Trip Tom Hamilton THamilton@CaroinaBenefitDesigns.com www.SurgicalTrip.com 1-866-313-1112