DESTINATION Panama
By Robin Elsham | Published: April 17, 2008
Medical tourism may be a new industry, but it's got a long tradition in Panama. For nearly a century, the country's hospitals and doctors have been treating ill passengers from cruise ships and sailors from cargo vessels transitting the Panama canal.
Lying at one of the busiest trade crossroads of the world, Panama has 94 years of experience in providing global healthcare. It's been caring for sick travelers from throughout the world since the canal opened in 1914.
Panama has particularly strong appeal for English-speaking medical value travelers, especially from the United States. The reasons are again historical, and burnish Panama's attraction with a make-up that rival destinations will struggle to match or counter.
From its founding in 1903 in a coup engineered by the United States, until the end of the 20th century when Panama finally gained sovereignty over the canal, the development of Panama was influenced strongly by U.S. control of the country's greatest asset. The most profound and long-lasting influences stem from the long presence of tens of thousands of U.S. canal workers and military personnel.
In return for providing military backing in1903 for Panama's separation from Colombia and independence, the United States received control forever ("into perpetuity") of the canal zone, and rights to maintain military bases in Panama to defend it. The U.S. bases were closed in 1999, when Panama gained sovereignty over the canal under a 1977 agreement negotiated by Panamanian leader Omar Torrijos and then U.S. President Jimmy Carter.
The presence for so long of so many Americans in Panama had a huge impact on the development of the medical industry there. The legacies are key to understanding the special competitive appeal of Panama as a medical tourism destination.
The greatest legacy: no other healthcare hub has hospitals so thoroughly steeped in U.S. ways. Panama's private hospitals are extensively staffed and run by people who trained in U.S.-run institutions. Many received their initial training at Gorgas Hospital, a U.S.-government run hospital established over a century ago to care for canal company employees. Others have worked for decades for private hospitals in Panama accredited by the U.S. government to care for U.S. military base workers and canal company retirees. Maintaining those contracts required adhering to U.S.-set standards and procedures.
That experience will make Panama's private hospitals very attractive when private U.S. health insurance providers begin introducing globalcare plans, and searching the world for hospitals to provide care. In Panama, they'll find hospitals that offer plug-and-play service. While hospitals in other foreign countries might need to invest a lot of time and money implementing changes necessary to secure U.S. corporate contracts, Panama's private hospitals won't. They'd essentially only need to obtain JCI accreditation, which so far none have but could without implementing lots of changes.
Panama 's best private hospitals are also filled with physicians who have trained at some point at hospitals in the United States. Many of these surgeons are U.S.-accredited, another big plus to U.S. institutional healthcare buyers. And these surgeons not only speak English fluently, but do so with an American intonation and manner, helpful in establishing an easy rapport with patients from the U.S. and Canada.
Panama 's location also makes it appealing. It takes just two-and-a-half hours to fly there from Miami -- not significantly longer than the time needed to fly to rival treatment destinations in Mexico or Costa Rica, and much less time than to fly to competing destinations in South America, Asia or Eastern Europe.
Panama has three hospitals of special interest to medical travelers.
Hospital Punta Pacifica is a 52-room facility built specifically to provide medical care to foreign patients. It's Panama's newest private hospital, having opened just two years ago, and the most under-utilized. As of March, it was operating at just one-third of capacity, a point of significance to foreign insurers. If insurers invest time and money vetting a foreign hospital to become an approved service provider, they won't want the set-up to sour because of flack from plan members, complaining about being repeatedly denied admission due to insufficient room.
HPP is likely to become busier if it succeeds in acquiring JCI accreditation. From its inception, HPP set its sites on becoming the first hospital in Panama to be JCI accredited, and has worked closely with Johns Hopkins Medicine International to achieve it. Hospitals cannot apply for JCI accreditation until they've been operating at least two years.
Johns Hopkins International (JHI) was an adviser to HPP from the blueprint stage, according to Guiliana Castro, the hospital's chief for international affairs. JHI now provides guidance in hospital procedures, practices and quality control; in preparing HPP to undergo the JCI accreditation process. A 10-person JHI advisory team visits Hospital Punta Pacifica every three months, to assess progress in 10 areas: quality assurance, infection control, environment of care, performance improvement, medical safety, credentialing, nursing, leadership and HR. The JHI advisory team tracks HPP's progress across more than 1,000 performance standards, according to Tita Barons, the HPP manager in charge of overseeing the entire accreditation process.
HPP was founded by a group of 20 doctors and four outside investors, including Dr. Camilo Alleyne, a former Panamanian minister of health. The founders initially planned to spend $18-20 million on building Hospital Punta Pacifica. The actual bill came to twice that amount, according to Dr. Salomon Dayan, one of the physician/investors.
Over 300 doctors and specialists are involved in treating patients at HPP, which has state-of-the-art equipment throughout the hospital.
The hospital is located in the upscale San Francisco district of Panama City, and just across the street from huge MultiPlaza mall. That sprawling development includes a Marriott Courtyard Hotel, where visitors to HPP can stay for $80 a night. It also houses an 8-screen Cineplex Theater, as well as branches of U.S. food chains Tony Roma's, Dairy Queen and Cinnabon.
Centro Medico Paitilla is another private hospital of great interest. Opened in 1975, CMP was one of two private hospitals in Panama approved to care for U.S. military personnel. The hospital lost a major source of patients when the bases closed in 1999, prompting interest now in attracting medical value travelers as patients. The hospital is currently operating at about two-thirds of capacity, according to Agnes Franqueza, the hospital's director of finance.
CMP remains one of two private hospitals in Panama chosen by the U.S. government to provide care to canal company retirees. The U.S. government pays for that hospital care.
Another factor showing the regard held for Centro Medico Paitilla: CMP is always on call whenever the U.S. president visits Panama. There are plaques in the hospital's entry lobby from the U.S. State Department, thanking CMP for its readiness to treat George Bush Sr. when he visited Panama in 1992, and Dubya when he was there in 2005.
CMP also has a long relationship with Hospital Corporation of America. HCA helped guide the start-up of Centro Medico Paitilla, and the current director of the hospital formerly worked for HCA., according to Ms. Franqueza.
Three hundred independent doctors have patient admitting rights to CMP, which takes special pride in the loyalty of its staff. Many nurses, technicians and other hospital staff have worked at CMP for decades, and the hospital has a very low staff turnover rate, Ms. Franqueza said.
Many Panamanians will tell you the country's finest private medical facility is Hospital Clinica San Fernando. It's certainly the most popular: the busiest and most crowded. Dr. Teodoro Mendez, the head of its international department, said the hospital operated at a daily average of 90 percent of capacity last year -- with many days when all 189 patient rooms were occupied.
One hundred of those rooms are private rooms, including 14 two-room suites that bill at $250 a night.
More surgeries were performed at San Fernando last year than at all other private hospitals in Panama combined, Dr. Mendez said. Nearly 7,000 surgeries were performed at the hospital last year, including many laproscopic procedures, he said. The three most common types of surgeries done at San Fernando are 1) orthopedic, 2) general surgery and 3) Ob-Gyn procedures, Dr. Mendez also said.
The hospital's radiology department too is the busiest in the country. Nine diagnostic and two interventional radiologists work in the department, which performed 65,000 studies of all types last year. A GE Infinia nuclear scanner was used to perform 3,000 exams. A 1.5 Tesla GE MRI was used to perform another 5-10 studies per day. Some 300-400 interventional cardiac procedures (e.g. implantations of stents, pacemakers, defribrilators) or stroke intervention procedures (embolization, coils) are performed per year, as well as 25-35 ultrasound exams per day.
The San Fernando hospital laboratory, which processes 450,000 tests per year, is pursuing certification through the American Pathologists Laboratory Accreditation Program, according to Gloria de Pinzon, who runs the lab. Ms. Pinzon, who worked at Gorgas Hospital for 27 years before moving to San Fernando eight years ago to bring its laboratory up to world-class standards, said the lab is expected to receive accreditation in 2009.
The lab employs 18 medical technologists, all graduates of 4-5 year university programs. Four staff are members of the American Society of Clinical Pathologists.
Hospital Clinica San Fernando also operates the largest blood bank in Panama, with 200-250 donors per month.
Patricia Lewis de Henne, the hospital's second highest-ranking executive, said San Fernando recently began the process of applying for JCI accreditation. Ms. Franqueza, the finance director at Centro Medico Paitilla, said that the hospital had periodically considered seeking JCI accreditation, but so far decided not to do so.
Panama 's efforts to market itself as a medical tourism hub shifted into higher gear recently. Since mid-2007, the country's major private hospitals have attended international conferences and medical tourism seminars, with government officials in tow. The aim is to show that Panama's healthcare industry and government have come together to develop Panama as a global service hub, like the medical industries and governments have done so effectively in India and Singapore. This government/private industry effort in Panama isn't yet as well organized and supported as in those two Asian countries.
Sometime this year, Panama's Ministry of Tourism is expected to release a 12-year "masterplan" for the development of the Panamanian medical tourism industry. It ought to make interesting reading for anyone who's livelihood is tied to development of the global medical tourism market. Panama has the capacity to begin attracting substantial patient numbers, affecting competing destinations near and far.
Robin Elsham is the managing director of Patients With Passports Corp., an international healthcare arranger based in St. Paul, Minnesota. He can be contacted at robin.elsham@patientswithpassports.com
