Medical Tourism Certification: Knowledge Insures a Difference


by Renée-Marie Stephano, JD,

His heart was ticking. So, too, was his time. Pablo Concepcion had to find a hospital that would enable him to receive a desperately needed heart transplant. Anytime soon would do.

The 58-year-old Miami resident driver didn’t want to wait any longer. He was a little worried that his deteriorating condition would not elevate him beyond the status of tens of patients like him waiting for the gift of life in the United States. So, Concepcion and his wife did what not many might do, but what government officials and healthcare interests in Puerto Rico hope many more may someday do: they boarded a plane from Florida for the island and a hospital that would perform heart transplant surgery.

Puerto Rico officials are banking on a steady flow of U.S. patients like the Miami truck driver caught in the cross hairs of the Affordable Care Act and others like him from points in the Caribbean and beyond. The idea is that the added patient volume will not only help to reverse the exodus of top doctors to the mainland, but will also stimulate a healthcare system that accounts for 20% of the commonwealth’s economy.

Expectations are high. In the next three years, backed by an aggressive government marketing campaign, Puerto Rico hopes to create some 3,000 jobs and inject $300 million into the island’s economy. The Puerto Rico Medical Tourism Corp., an arm of the commonwealth’s tourism structure, is reaching out not only to patients, but also to the healthcare operatives that service them. Humana and Molina Healthcare have a presence on the mainland and the island. In the short term Puerto Rico is a promising destination to expand access to care for patients from the United States and eventually offer stable solutions to island inhabitants who are not required to follow most provisions of the Affordable Care Act including the individual mandate.

Players with a stake in Puerto Rico understand that the island’s healthcare dilemma won’t be solved overnight. Too many doctors are asked to survive on Medicare and Medicaid reimbursements from the roughly 2 million. Sixty percent of Puerto Rico’s population relies on the government subsidies for healthcare.


Tax Help

Until a formula can be worked out that reimburses doctors at a level consistent with their counterparts on the mainland, the Puerto Rico Medical Tourism Corp. is promoting tax incentives and exemptions to attract investors and foreign insurance companies to the island, and give doctors a break. Under Act 399, the International Insurers and Reinsurers Act of Puerto Rico, those that set up operations on the island and underwrite large policies for clients offshore are exempt from corporate levies up to 4%; 100% of tax dividends paid and distributions; and property and premium tariffs.

The tax breaks are just a start. Proponents of Puerto Rico’s entry into medical tourism say the enticements will play a key role in making the metropolis appealing to foreign investors and patients from the United States ─ many of whom are Hispanic and have ancestral ties to the Caribbean region.

Raising the Bar

More than a few have embraced this strategy including Alberto Baco, Puerto Rico’s Secretary of Economic Development and Commerce, who understands support for medical infrastructure and professional growth are another step toward keeping pace with the competition for entrepreneurial dollars and international patients. Hospital administrators, doctors and clinical staff took his cue earlier this year when they completed medical tourism training and certification processes.

Metro Pavia Health System, HIMA San Pablo and Ashford Presbyterian Community were among the providers that participated in the first round of Medical Tourism Association training that would certify some 35 hospitals to offer services to foreign patients. Another 20 hotels including concluded related training to improve hospitality and travel operations for medical tourism patients and their companions.

Certification is by no means a small accomplishment, considering these forward-thing service outfits were the first on the island to achieve such a distinction. Francisco G. Bonet couldn’t agree more. The CEO for the Puerto Rico Medical Tourism Corporation says that training allows providers provide quality care for international patients and build valuable relationships with insurance carriers and vendors that purchase health services indirectly.

The Cardiovascular Center of Puerto Rico and the Caribbean, where Pablo Concepcion received his new heart in San Juan, stood out from other healthcare providers in the United States because there wouldn’t be much delay before treatment.

Carmen Concepcion knew very little about the clinic’s doctors and staff; certainly nothing about the cardiovascular center’s recent medical tourism certification. She knew only that she and her husband could not afford to wait for a heart transplant; that Pablo could barely walk much past his recliner without bending over out of breath; that the cost of surgery offered at the hospital in San Juan – far less than it would have been in the United States – would have to be acceptable even though their carrier would not extend coverage to Puerto Rico.

It all didn’t matter, she insisted, as she watched Pablo Concepcion walk easily to the front door of their home where he greeted well-wishers upon their return to Miami. She is happy to know and grateful to see what she sees knows now.

Renée-Marie Stephano, JD, is president of the Medical Tourism Association®, the first membership-based international nonprofit trade organization and think-tank for the medical tourism and healthcare industry. The MTA provides strategic development programs for destinations seeking to create sustainable and attractive programs for foreign direct investment. The MTA provides advisory services to investors interested in the industry and matches these financiers with medical tourism-related projects.


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