International travelers help boost U.S. economy

According to a recent article of U.S. Department of Commerce, data show that international travelers have spent around $82.2 billion on travel and tourism-related goods and services last year, an increase of 11 percent. According to its analysis, U.S. travel and tourism exports reached a new record in the first half of 2012, and may continue to grow with a closing amount of $170 billion.

Foreign citizens’ traveling to America and buying goods and services from American companies also count toward U.S. exports. Government has paved path for U.S. tourism industry to further develop their business, providing more crucial data and enhanced interactive web content, multimedia, mobile, trip-planning tools.

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Peru: Worth a Visit and an Investment

Lately, many of us have been culling our list of countries to visit. Many nations carry warnings because of civil strife, ubiquitous explosions or just random violence. Too bad for those of us who like to travel and see new things. Too bad also for nations for whom tourism is a key income source. Yet, here is some good news for a change: Visit Peru!

I just returned from a visit there, invited by the University Ricardo Palma for lectures. With lots of travel under my belt, I was impressed by Peru and recommend a visit. The Lima airport is large, transparent and well organized. No moment of mutual distrust at customs. You push a button and get a randomized response: Red –they’ll want to see your luggage, green you go on. Luggage carts are available and free (unlike in Washington D.C.’s Reagan Airport where you have to pay three dollars). The hotels are very nice, friendly, and, unlike in Paris, with free internet access as a basic service. Given the high altitude, reduced oxygen can result in a breathing problem. That is
why many locations offer complimentary coca tea or mate de coca, which, due is
the local remedy for fatigue and pain.

Traffic was heavy, but drivers skillfully negotiated the roads (though they did use every available inch of room). Parking is difficult – you’re better off to be driven. Sure they have earthquakes, but so does Washington D.C. There is good logistical thinking for troublesome times. When flooding had torn away part of a highway, a detour parallel to the road is rough but the re-routing takes only 10 minutes.

People are very kind and welcoming. When they say ‘mi casa es su casa’ they really want you to feel at home. They immediately provide appetizers or tea. Employees are empowered: At lunch at my hotel I told my visitors how hammering in the room next to us had awakened us. The lunch manager overheard our conversation, expressed his apology, and resolutely refused any payment for lunch for all four of us (including our two outside guests).

All University events we attended were accompanied by music, poetry, flowers, dance and song. There was ongoing reference to the need for balance in life.  Work has to be within a context of enjoyment. What an inspiring idea!

The country’s mountain city of Machu Picchu reflects Inca history, capability and determination. It also shows an extraordinary clash of cultural values in the 16th century. The Inca used gold for wallpaper on rocks, to reflect the much revered Sun. The invading Spaniards saw gold as treasure, and wanted lots of it. The Inca complied by filling rooms with treasure (or wall paper) only to be murdered in appreciation. It turned out to be beneficial for Spain not to keep any gold artifacts, but to melt them
all down and re-issue them as coins of the realm. That way, nothing had to be returned to Peru. But even today, Peru continues to be a leading producer of many valuable commodities, among them silver, gold, and copper.

Peru and Peruvians like to be part of the world. For example, there are at least 8 towns and villages in the United States carrying the name of Peru. The government has initiated contact with all of them, with a particular focus on Peru, Nebraska in order to build relationships. Peru’s athletes are quite successful, with women world champions in both featherweight boxing and ocean surfing. Peruvian chefs have opened highly rated restaurants, both in Lima as well as in New York.

The minister of the economy (U.S. educated at Johns Hopkins) discusses, with help of many precise power point slides, how the gap between poor and rich can be bridged. There is little talk about socialism, but much about how to boost simultaneously the economic performance in the Peruvian beach areas, the mountains, as well as the desert. Foreign investment is welcome and sought after. There are many ideas floating about how to serve clients better, and make investment opportunities more attractive in order to achieve a minimum annual growth rate of six percent.

Here are my lessons learned for take away: 1.when it comes to narrow, dusty and curvy roads, Mercedes busses seem to have it made.  So if you have some really heavy duty motoring tasks, you know what to do. 2. You can hike the Inca trails to Machu Picchu for four days and three nights to get to the top – a memorable achievement. 3. Don’t
underestimate the train getting you there from Cusco in 90 minutes. Its design is
modern with a crew offering fashion shows of desirable Peruvian products. It runs on time every half hour, and affords spectacular views. 4.  Tourists have to pay more for services than locals.  Discriminatory, yes, but fair when looking at income levels. 5. The favorite local alcohol is the pisco, a brandy made from grapes. Combined with egg whites, lime juice and bitters it becomes pisco sour, deserving of a global reputation.

There remains much to be discovered. Peru wants to be friends – even with Spain. Hundreds of years of overgrowth has lead to jungles and ingrown mountain sides which still hide many mysterious artifices. Peru and the Andean area have already saved the world from starvation due to presenting us with potatoes and corn. The future may bring more benefits as well.

Prof. Michael Czinkota

Medical Tourism: The Christmas Gift for Global Healthcare

Co-written with James G. Dale

Consumers and providers of medical services in the United States search for opportunities to cut costs. Increasingly, it is possible to find lower-priced care alternatives abroad.
The emergence and efficiency of medical tourism may well help bridge the chasm between costs and revenues, between desire and ability.

Already today, prospective patients are traveling in ever-increasing numbers to exotic destinations like Brazil and Thailand in search of high-quality care at low cost. For years, the Cleveland Clinic has been the institution of choice for wealthy Saudi citizens. Cancer treatments and cardiac procedures for international patients are a high growth industry. The ¬demand for elective procedures such as cosmetic and dental surgery, and alternative treatments which are not approved in highly developed countries, continues to rise. Sarah Murray reports in the Financial Times that the medical tourism industry has grown by about 14 percent from 2007 to 2009, and is predicted to expand at a rate of 35 percent annually by 2010. By 2012, it may serve more than 1.6 million international patients.

The rationale behind the industry’s development is straightforward — customers search for convenience and cost-effectiveness. If comfort and coziness can also become part of the outcome, the much the better. Now, however, there are additional new key players in the U.S. government and the health care industry, who may reconsider their antagonism towards medial tourism.

A medical procedure at an Indian or Chinese hospital can cost 70 percent less of what a patient would pay in the West. For patients from countries with public healthcare systems like Canada and the UK, medical travel is already often motivated by the desire to reduce or avoid current delays and waiting periods leading up to their procedures.

The growth in medical tourism is a boon for healthcare providers in the developing world. For example, reports Murray, in India the sector is projected to expand by 30 percent annually from 2009 to 2015, which may make it worth $4.4 billion. Increasingly internationally accredited medical centers are emerging in countries such as the Philippines and Mexico, eager to accommodate the ever-growing stream of Western patients. Governments in the developing world are beginning to invest in support infrastructure in order to promote their healthcare services internationally. As their industry’s medical skills increase, their comparative advantage will attract more custom from abroad.

When dealing internationally, the essential problem of trust, is always present in the manufacturing sector. The issue takes on an even higher importance in the medical services sector, which deals with life and death. To build that trust, data and transparency will be a key issue. The flow of international students to learning centers of global excellence may ease some worries. As time passes, there will be a growing track record which can be checked and compared. International accreditation standards can increase the confidence and comfort of institutions and patients with clinics and providers abroad. Of great importance will also be the eventual better legal protection of patients and providers abroad.

A key motivator for progress will be the vocal demands of patients for quality and accreditation. But in an era in which we now plan to eventually measure and count the carbon emissions around the world, it should be possible to measure and count health care performance.

Medical tourism also gives rise to new industry growth. New companies are formed which assist patients with scheduling their procedures overseas. They help clients with planning their trips and offer in-country support, such as ¬airport transfers, after-care arrangements, hospital liaisons and dispute mediation. Most of these companies started out catering to individual clients. However, they are now expanding to offer their services to meet businesses’ demand. With the rising costs of providing employee healthcare, more corporations are searching for alternatives to home-country care, and insurance firms may use procedures conducted abroad as a lever for price negotiations.

We also need to reflect the climate implications of medical travel. The savings gained by having a procedure carried out in Panama, may turn out to be negated by a carbon tax. The systematic build up of competitive health care industries within reasonable geographic distance from prime patient groups is an important approach. One would expect there to emerge individual health care clusters for Europe, Asia and the Americas which are close to their patients and specialize in their particular health issues. Careful scheduling and travel consolidation may even permit such medical travel to soak up current excess or unused capacity, thus limiting the additional climate burden.

While the health care plan alternatives are debated, cost continues to soar. More covered people and coverage of more patients definitely will mean higher cost, unless other dimensions are changed. Right now, the government and insurance industries exert a great deal of protectionism in the health care sector, and are still stuck on the international shipment of pharmaceuticals. In light of major financial pressures, international trade in medical tourism may well offer the tipping point, which allows acceptance of more coverage while restraining costs. Offering new alternatives globally may well be the best Christmas gift for both patients and the public purse.

 Dr. James G. Dale is a practicing physician and chief of staff at Page Memorial Hospital in Luray, Virginia. He can be reached at