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Healthcare Clusters ~ Building Medical Tourism Communities

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As a young and developing industry niche, medical tourism is constantly in the process of being shaped by those involved in it. At this year’s World Medical Tourism and Global Health Congress, Dr. Jorge Cortes of Costa Rica, Dr. Fawzi Al- Hammouri of Jordan, Levent Bas of Turkey and Eduardo Villa of Chihuahua Mexico discussed the common development process each of their countries share, a development which has effectively increased medical tourism and the efficiency obtained through creating healthcare clusters.


Eduardo Villa, Director of Promotion of Chihuahua City, began his presentation by explaining that when you ask what a cluster is, everyone will have a different answer. This misunderstanding, he said, results in failed healthcare clusters around the world.

Going by the Medical Tourism Association definition of healthcare clusters, Villa defined the four stages of cluster evolution: the pre-cluster stage, the start-up stage, expansion stage and mature stage. The pre-cluster stage is before any collaboration or affiliation has begun to occur, and hospitals, facilitators, hotels and other medical tourism participants are working by themselves.

The start-up stage involves hospitals starting to work with hotels and some facilitators. The expansion stage adds insurance companies, medical tourism companies and the government to the growing network. Finally, in a mature stage there will be a “clot of collaboration between all the players.”

“The question is,” Villa posed, “at what level is your country?”

Chihuahua Medical City was started at a regional level, where they have all the key players in one area – the government, the hospitals, the facilitators and so on. “Chihuahua Medical City one year ago was in pre-cluster. Right now we are in expansion,” Villa said.

The formation of the cluster began with a diagnosis of the key factors in the market, Villa said. Once identified, they were invited to participate in the cluster. “In our case, the creation of a new association was the first step. We created a webpage, fliers and a networking strategy,” he said, adding that international accreditation was one of the most important steps taken.


The Turkish Healthcare Tourism Development Council, a healthcare cluster established in 2008, has 62 members, ranging from hospitals and hotels to travel agencies and facilitators. Levent Bas, president of the THTDC, said that having eight Turkish booths at the congress was evidence of the difference made by the presence of a medical tourism cluster in Turkey.

“We are combining all these means of medical tourism to create a common power and have better results,” Bas said. The three most important facets of the cluster, according to Bas’ presentation, are the providers, the hotels and the government.

The providers place “advertisements in foreign marketing channels and travel a lot to try to meet new corporations.” The providers are occasionally able to give sponsorships for domestic and international events, which also creates a positive effect for the cluster.

Hotels also work towards more patients in the sector, Bas said. “They make accommodations for the VIP medical tourism professionals when they come to Turkey and want to see all the facilities,” he continued. “They also sponsor domestic and international events.” In addition to the hotels, Turkish Airlines supports the cluster by giving discounts to medical tourists.

“One of the most important things is the governmental support,” Bas said. “In many countries, it is the same – the ministry of health and the ministry of tourism are the most important ministries that can support medical tourism.”

The Turkish government has set budget campaigns to support medical tourism, as well as created high standards for hospitals to meet – there are 31 JCI accredited institutions in Turkey, making it the country with the largest amount of JCI accredited hospitals other than the U.S.

Lastly, Bas discussed the importance of facilitator involvement in the cluster. “The facilitators are key factors to medical tourism,” he said. “They are the bridge between the patient and the provider.”


“Jordan lies in the Middle East, in the middle of the world. It is a small country with large aspirations,” declared Dr. Al- Hammouri, chairman of the Private Hospital Association of Jordan.

“Known for its advanced healthcare system,” Dr. Al- Hammouri continued, “Jordan sees patients mostly from other nearby countries such as Sudan, Libya, Iraq, Saudi Arabia, Yemen, Syria and several others.” Jordan, unlike many other nations, takes more revenue from healthcare delivery than it spends per capita on its own people. This, according to Dr. Al- Hammouri’s presentation, is why Jordanian medical tourism providers work to enter international markets and generate interest and feedback from all parties.

“Our case was that healthcare globalization couple with economic crisis, so an alliance was built from all stakeholders,” Dr. Al-Hammouri said. “All parties agreed that we would put our competitions aside and work together to promote the country first and develop a national plan.”

After constructing an action plan earlier this year, Jordan hosted its first medical tourism congress. Additional evidence of the success of the cluster can be seen in the 250,000 medical tourists Jordan received last year.

Dr. Al-Hammouri discussed why Jordan was a good candidate for medical tourism in the first place, pointing out that Jordan has eradicated almost all public diseases, like Malaria, from its borders. “Jordan is a very peaceful country and is well known for its political stability,” he said. “Jordan established a very good relationship with almost every country on the Earth.”

Other conducive factors include a large amount of English speaking citizens, five HCAC accredited hospitals, four JCI accredited hospitals and the utilization of the latest medical technology and equipment.


In his presentation, Dr. Cortes, Chief Medical Officer of Clinica Biblica Hospital, urged countries interested in creating a healthcare cluster to first assess their country.

“The decision to form a national original union should be made after an exhaustive analysis that may include all the sectors that interact with medical services provided,” Dr. Cortes said. “To determine whether we’ll be successful we must analyze what product we have, if it is competitive and if it has what is required for take-off.”

Dr. Cortes explained that this type of assessment is critical if products are to be marketed to profit the system by use of creative campaigns with valid proposals. In Costa Rica, for example, a “strong health sector already exists.”

The country has positioned itself not only politically, but ecologically, said Dr Cortes. “Costa Rica has turned itself into an ecological tourism destination. In the presence of this panorama, the internal analysis was begun,” which, Dr. Cortes said, was brought about by principle factors being called together by a new section of the government – the Ministry of Competitiveness.

The analysis identified the strong points of the industry, as well as the challenges it would face. “Strategies directed toward the challenges that confronted us, such as how to standardize the quality of medical care, were discussed and planned until we achieved a group consensus,” Dr. Cortes said.

Organizers, travel agencies, medical supply providers, facilitators, hospitals and others participated in the effort to establish a Costa Rican healthcare cluster, something they ultimately accomplished.

“We founded a nonprofit organization which includes all the private sectors, and we asked them to create a national seal of quality, which included obtaining international accreditation in their fields,” Dr. Cortes said. “At this time, I can tell you that 100 percent of the private hospitals are accredited by JCI.”

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