Visa rules hurt health industry as Mideast patients balk

Fewer flock to renowned medical centers in the U.S. since 9/11. While here, they and their entourages spent big money.

	[Times photo: Toni L. Sandys]
	Michael McGuinness had to shut a business aiding UAE patients.

Before the Sept. 11 attacks, Michael McGuinness of Tampa had a robust business: He helped sick people from the Middle East get treatment at America's top medical centers.

Under a contract with the United Arab Emirates, McGuinness bought plane tickets, made hospital appointments and handled other arrangements for UAE military personnel and their dependents who needed health care not available at home. Nearly 800 patients a year came to America, with the UAE's oil-rich government paying all medical costs plus living expenses.

It was big money. One baby, who had several transplants at Miami Children's Hospital, ran up a $2-million bill.

Then two citizens of the UAE and 17 other hijackers changed the course of history. It became harder to get visas for travel to the United States, and McGuinness watched his income shrink.

"I had to make a business decision - do I bleed my company of all this money or just shut it down. So I shut it down."

McGuinness - who is now developing a pair of condominium towers in Tampa - is just one example of how tightened visa procedures have affected America's health care industry.

Before the terror attacks, thousands of patients from the Mideast annually flocked to renowned medical centers such as Cleveland Clinic, Johns Hopkins and the Mayo Clinic. But since Sept. 11, the numbers have plunged - in some places, as much as 40 percent.

Initially, the dropoff occurred because people were scared to get on planes. Now, it is because many applicants have to be interviewed, fingerprinted and wait weeks for a visa.

"People from the Mideast want to travel, and in fact they are traveling for health care, but they are no longer choosing the United States because it's so difficult and takes so long," said Lisa Ramage, executive director of Cleveland Clinic's international center.

"Before, they could send their servant or driver to drop off the paperwork and pick up the visa. Now they have to stand in line with everyone else, and then the paperwork goes into the visa process, and it can take six weeks or more where they used to get it in two days."

Ramage estimates that half the patients who once would have come to the United States don't even bother to apply for a visa. Instead, they go to Thailand, Germany or other countries that are aggressively marketing their health care services and processing visa applications in just a day or two.

Even before Sept. 11, 2001, Mideasterners and other foreigners made up only a small percentage of all patients at U.S. medical centers - typically, no more than 5 percent. But they often account for a larger percentage of revenues because they or their governments pay the full cost of their care, unlike domestic patients whose insurance covers only part of the bill.

For patients McGuinness brought in from the UAE, the average hospital bill was $75,000 to $100,000. One bone marrow transplant in Seattle cost the UAE government more than $1-million.

Philadelphia International Medicine, a joint venture of nine Pennsylvania hospitals, lost 49 percent of its foreign patients last year and saw revenues fall 12 percent. That revenue figure is even worse than it looks, says chief operating officer Leonard Karp.

"Our program is five years old, and we had been experiencing a nice growth of about 50 percent," he said. "But instead of growing by 50 percent, we saw a 12 percent decrease. ... We can't grow the program if we don't have that revenue coming in."

The loss of foreign patients is a blow not only to hospitals. Studies show that for every dollar spent on health care, another $3 goes for hotels, car rentals and other services. Thus a rich patient - especially one with a large entourage - can be a boon to an entire community.

A case in point is Cleveland. Its internationally famous clinic, with a workforce of 15,000, is the city's largest private employer.

In 2000, the UAE's president, Sheik Zayed bin sultan Al Nahyan, spent several months in Ohio after undergoing a kidney transplant at the clinic. Accompanying him were 400 people.

Zayed bought a multimillion-dollar mansion. Members of the royal entourage stayed in the Ritz-Carlton and other luxury hotels. They got around in chauffeured Cadillacs and Lincolns. They also bought new Lincoln Navigators and Chevy Suburbans, then unavailable at home.

In fact, the delegation purchased so much - including entire rooms full of furniture - that UAE cargo planes were flown in weekly to transport goods back to the Persian Gulf.

Estimated impact of Zayed's visit on Cleveland's economy: $100-million.

Since the Sept. 11 attacks, the 90-year-old Zayed has not returned to the United States, instead going to Geneva for followup care. The number of Mideastern patients at the clinic plunged to zero immediately after the attacks, then rebounded to about 50 percent of what it had been, says Ramage, of the international center.

The clinic still draws wealthy foreigners, including those who have business interests in the United States and hold multiple-entry visas that let them come and go freely. But their entourages are far smaller than before.

"They would bring 20, 30, 40 people, and now they're bringing 10," Ramage said.

With few exceptions, foreigners seeking medical treatment enter on tourist visas. They must prove they can pay for their care, and they must submit a referral from a doctor in their home country, plus verification from the U.S. doctor who has agreed to treat them. For certain categories of applicants, U.S. consular officials can waive the required personal appearance.

Officials can still waive interviews, but since August they have been operating under tighter guidelines for doing so. Now, almost everyone between the ages of 16 and 60 is interviewed, and citizens of the UAE and many other countries are also fingerprinted. (As of Oct. 26, all nationalities will be subject to fingerprinting.)

"Visa processing does take longer, because we have some steps we didn't have before," said Kelly Shannon of the State Department's Bureau of Consular Affairs.

Medical centers say U.S. consular officials are doing a better job of expediting visas for those with medical problems. Some visas are now being issued in as little as three weeks.

But that is still too long for a person who is seriously ill. And it doesn't solve the problem of visas for family members or others who want to accompany the patient.

"We've seen a big drop-off in the number of children - the problem isn't that the child can't get a visa, but that the escort can't get a visa," Karp says.

Although America is still considered the gold standard in health care, other countries are taking advantage of the visa delays to promote their own services.

In Thailand, Bumrungrad Hospital had a 30 percent jump in foreign patients last year, due in part to the influx from the Mideast and prices up to 85 percent lower than in America.

"There are a lot of places that are now vying for international business, and they're not going to willingly give up on them," said David Jones of Partners International, a group of Boston-area hospitals that lost 30 percent of their Mideastern patients after Sept. 11.

"These are places that in the past one would have thought - from our sort of provincial point of view - How can they compete for quality? In fact, many are doing very well; they have superb facilities, highly trained staff and provide health care at much less cost."

Because many patients no longer come here, some U.S. medical centers are going to the patients. In August, the Mayo Clinic will open a cardiovascular clinic in the UAE, where deaths from heart disease have soared in recent years.

Johns Hopkins, which had a 40 percent drop in Mideastern patients after Sept. 11, has reaped an unexpected benefit from the Biomedical Science Division it started in Singapore in 1999. Although the main focus is on research and training, the facility now has 80 Mideastern cancer patients who go there instead of Baltimore for their followup care.

"It didn't really start out for this purpose, but (patients) sort of found it as a result of having fewer options in the U.S.," says the founder, Steve Thompson.

Cleveland Clinic, meanwhile, is courting foreigners closer to home. Its two Florida clinics - in Naples and Broward County - have seen a 30 percent increase in patients from Latin America. The main clinic in Ohio is also getting more patients from Canada, whose strained national health care system is causing long delays for treatment.

But Ramage, head of the international center, predicts many foreigners will continue to shy away:

"I don't see any change in the next two years and certainly not before the election because of homeland security issues. Now they've started fingerprinting and taking pictures at the borders. It's perceived as an unfriendly message for people who want to come into the United States."

- Susan Taylor Martin can be contacted at susan@sptimes.com

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