Ian Youngman talks on the Cayman Islands and their role in medical tourism

 

But in how a government encourages medical tourism by changing laws, including those on malpractice, medical registration, and tax, the Cayman Islands is worth examination.

IMTJ has regularly reported the plans for Dr Devi Shetty to establish a medical tourism hospital in the Caymans, and how some local doctors are opposed to the proposal. The hospital is very much dependent on attracting US medical tourists, which as we have discussed here in recent weeks may not be the ‘ many millions’ promised by some forecasters.

What should raise some concerns within the medical tourism industry is how the developer, according to the local press, has effectively held the government to ransom, before spending a solitary dollar in investment.

Medical tourism at a price

The Caymans is a group of three islands with a population of 55,000 – a British territory that has never taken full independence but became a significant offshore financial centre. It has a large finance industry attracted by its tax exemptions and privacy and is home to 70 per cent of hedge fund registrations worldwide and is also a significant banking centre. The UK government in 2009 lent it $59 million to bolster public finances. It may seem strange that a tiny offshore financial centre needed a financial bailout. The Cayman Islands thrived as a place to conduct international business with a reputation for tax efficiency; strong professional services saw finance account for 55% of national GDP. But cracks appeared in Cayman’s domestic economy after spending on personnel and ambitious infrastructure projects far outstripped public income.

In March 2010, the Miller Report – the result of an independent commission set up to analyze Cayman’s fiscal sustainability – revealed that the British overseas territory’s economy has problems. The global economic downturn tested the resilience of most offshore centres but the negative impact on public revenues was most prominent in jurisdictions that rely heavily on tourism and construction and Cayman suffered badly. The Miller Report showed that the Cayman government made plans for expansionist spending programmes and then when the economy went sour, they found themselves in a bind. In March 2011 the UK government announced a new strategy on overseas territories which basically says they will offer help and advice, but no cash, either as aid or a loan; effectively leaving the Caymans to sort out their own economic problems

With tourism and offshore finance suffering, the government has to find a way of getting revenue and increasing employment. This suggests why the local government is bending over backwards to get Dr Shetty’s scheme live. The most that other countries have done on legislation to attract medical tourism is to offer simpler visas, change laws to enable existing hospitals to attract medical tourists, and alter ownership laws to encourage investment. Cayman has taken much more significant steps, with changes to malpractice laws hand doctor registration, plus planned changes on organ donation laws. Dr Shetty’s plan is to offer lower cost medical treatment in a very high cost country, by paying doctors more than they would get at home in India, but much less than they could get a few miles away in the USA. Dr.Shetty has regularly been quoted in the US and Cayman press as saying that he would charge $10,000 for cardiac bypass surgery, much less than in the USA.

A 2000 bed hospital targeting US patients

The 2000-bed healthcare city in the Cayman Islands will target American patients. It will cost about $2 billion and could include a hospital, medical university and assisted-living facility. Construction is set to begin this year on the initial $100 million phase with a 200 bed hospital opening in 2013 that expects to get 50 % of its patients from US medical tourists and the rest from locals.

Earlier reports indicated that all the funding would come from the Shetty family's Bangalore-based hospital group, Narayana Hrudayalaya Private Ltd. Latest reports indicate that the bulk of the money will come from outside investors in India and the US, including a US insurer, US bank and Indian investor. But Dr Shetty is refusing to confirm who the investors are. This is already making some islanders nervous, as being an offshore finance centre they have had their share of dubious investors, including the notorious Bernie Madoff. Dr Shetty has been quoted in the Cayman and US press as expecting much business to come from US insurers. This is curious on two fronts- US insurers never pay the quoted price of any operation, and many US insurers could be nervous of doing business in a country where the medical negligence laws have been amended so that US court actions on negligence will not be enforceable by local courts.

Opposition from local doctors

Despite rigorous protests by members of the Cayman government that the hurriedly rushed in laws have nothing to do with the medical tourism hospital deal, that the two are linked is obvious to several locals. Chief opponent of the changes is the Cayman Islands Medical and Dental Society’s entire executive council, whose spokesman Ezzard Miller has pointed out numerous problems with the law changes.

The doctors are very concerned that the registration of health practitioners is being removed from the authority of legitimate professional bodies and placed in the hands of politicians. The Caymans' incentive package for the new hospital includes duty waivers on $800 million of medical equipment, recognition of Indian medical credentials and a discount of up to 30 percent on work permit fees for the influx of foreign workers expected to staff the hospital.

The Medical Negligence (non-economic-damages) Amendment bill 2011 was passed by the Legislative Assembly, despite the Law Reform Commission having recommended against it .The law will not only cap the awards that a court may give to a victim of medical negligence in Cayman but will also prevent any awards given in courts outside the jurisdiction in connection with doctors or hospitals that have practised there or incidents that have occurred there that exceed the $500,000 limit. The limit is a total one irrespective of how many individual incidents or doctors or hospitals are involved.

The law overrules international law and all other local law. So if a US medical tourist sued in the USA for treatment that had happened in the Caymans, won the case, and had been awarded damages, clause 4 of the law says” a foreign judgement, arbitral award or monetary compensation award is not enforceable by courts in the Islands if it exceeds the amount of damages awarded in the islands.” This latter clause means not only is it impossible for anyone to sue for more than $500,000 in the USA, if the local Cayman courts rule that there are no damages or say $20,000 only, then that is the limit that a US court can rule on. US lawyers could argue that a local law, which effectively says international law does not apply here, is actually illegal under international law. Also, the Caymans are not independent, but a UK overseas territory, so lawyers could argue that UK law can be used to overrule any local law.

The government has also made changes to the health practitioner’s law, which introduced a second tier of medical staff who will not be required to reach the normal practice standards, as long as they have medical qualifications from India and other listed countries not previously accepted in Cayman. Another legal change yet to be completed is one that the hospital has allegedly sought is a need to allow organ and tissue transplant and donation. A new committee will examine what type of legislation would be required and begin drafting that law.

You could be forgiven for thinking that with all this hurried legal flexibility from the government, that the investors have spent lots of money locally. But in a mid-March interview with local news service CNS, Gene Thompson, who has been working with Dr Shetty to help get the proposed hospital project off the ground, confirmed that a site has not yet been chosen, despite wide speculation that it may be in East End. So we have five major changes or proposed changes to the laws of the land, for a hospital that as yet has no land and no planning permission.

Gene Thompson of the Narayana Cayman University Medical Centre made a presentation in August 2010 to the Cayman Islands Tourism Association. CITA Harry Lalli of CITA put it in context, "The tourism industry in the Cayman Islands is suffocating from a perfect storm of increased fees, decreased services, decreased visitors and a declining population, and a project like this has the ability to put hundreds of millions of dollars into government immediately and billions over the life of the project. That can give tourism and all businesses here the breathing room to get back to profitability and more so, to begin to grow again." The presentation highlighted

  •     Of the forecasted US$2 billion in capital expenditure, US$200 million would be spent in the first two years.
  •     Investments in the hospital and accommodations will total US$200 million in the first phase
  •     An additional 10,000 rooms will be needed by 2024 and this will generate US$1.2 billion in construction spending
  •     Room tax will generate US$4.4 million in 2013 growing to US$56 million by 2024
  •     Tourist arrivals to increase by 87,600 for 2013 and continue up to a 1 million increase by 2025.

The mathematics of the investment are puzzling. The Caymans is a very expensive place to live and even allowing for the importation of low cost foreign workers and Indian doctors paid far less than they could get a few miles away in Miami and assembly line medical treatment, the costs will be considerably more than in India. Unless the hospital is working at or near full capacity, and getting the quoted rate rather than insurers paying a third of that rate, and dealing with high cost short-term treatment rather than the full gamut of treatments needed by locals and visitors, I am struggling to see how any investor is going to get a return on the $ 2 billion investment.

It is far from clear on what basis the projected numbers were quoted; 87,000 extra tourists in the first year of business and 1 million by 2025.The chances of getting those numbers as medical tourists are remote, but a lot may depend on what they build in the medical city. It is hard to see anyone can make sustainable profit from a medical university and assisted living. The only way I can see the investment delivering those numbers and making money is by adding hotels, holiday properties, or even a casino to the development.

Medical tourism still suffers from criticism that low cost is accompanied by increased risk of medical problems, that intermediaries are only there to make a quick profit while the boom lasts, and that some in the business are only interested in a quick buck. Much has been done to dispel these criticisms with the professional approach of most of those in this business. So when a government changes laws on medical malpractice, doctor registration, and more to entice a speculative medical tourism proposition, we should voice concerns.

FURTHER CONTENT PUBLISHED BY THIS AUTHOR

First ever UK tourism strategy

Articles, 24 July, 2019

A boost for inbound medical travel to the UK?

Assessing EU cross-border healthcare

Articles, 12 June, 2019

EU cross-border healthcare still requires improvement

Visas and medical travel

Articles, 01 May, 2019

Could visa rules deter medical tourists?

Global medical travel trends

Articles, 18 April, 2019

Get on board China’s Belt & Road initiative

UK-EU cross-border healthcare

Articles, 04 April, 2019

Predicting the Brexit effect on EU healthcare travel

Inbound US medical tourism analysis

News, 01 April, 2019

USCIPP identifies top 5 sources of medical tourists to USA

Global medical trends

Articles, 08 March, 2019

Global medical prices will keep rising in 2019

Which destination has the highest risk?

Articles, 07 February, 2019

New study compares risks of travel to global destinations

Promoting Traditional Chinese Medicine

Articles, 24 January, 2019

Will TCM move centre stage in global health tourism?

Medical Travel and Tourism Global Market Report – 1st Edition

Resources, 19 January, 2019

Special Offer: This new report discusses the dynamics of medical tourism and looks at the supply chain, business models, products and the consumer.

Medical Travel and Tourism Global Market Report – 1st Edition

Resources, 09 January, 2019

This new report discusses the dynamics of medical tourism and looks at the supply chain, business models, products and the consumer.

Chinese medical tourism scams

Articles, 11 December, 2018

Arrests in US$145m scam targeting Chinese medical travellers

Stars in the East

Articles, 06 December, 2018

The medical tourism axis is shifting

UK health tourism deception

News, 30 November, 2018

UK government figures on NHS health tourism are debunked

Global wellness tourism boom

Articles, 22 November, 2018

Wellness tourism is worth US$639bn, but what do these figures include?

EU cross-border healthcare

Articles, 09 November, 2018

EU Directive fails to meet expectations for medical tourism

Chinese outbound medical tourists

Articles, 03 October, 2018

How to tap into the Chinese medical travel market

Plea for proper figures

Articles, 19 September, 2018

International patient data overstates medical tourism reality

Anti-Tourism – did you predict THIS trend?

Articles, 30 July, 2018

UK’s Cornwall is discouraging tourists to two of its beaches this summer. Predicting medical travel trends is also dangerous.

Terrorism and political risk

Articles, 06 June, 2018

Growing global political volatility is a major risk for medical travel

“Medical tourists don’t need hotels”

Articles, 03 May, 2018

Why the growth of medical tourism is being limited by a lack of appropriate hotels

UK outbound tourism data

Articles, 16 April, 2018

Health warning on ONS 2017 data about British medical tourist volumes

Medical tourism facts and figures

Articles, 22 March, 2018

The magic of medical tourism numbers

The dangers of dealing with medical tourism financiers

Articles, 14 February, 2018

Beware financiers offering you deals that are too good to be true

Chinese outbound tourism changes

Articles, 01 February, 2018

The changing world of outbound Chinese medical tourism

Agreement on post-Brexit healthcare in EU

Articles, 05 October, 2017

Agreement reached on reciprocal healthcare for British and EU retirees

Ireland, Brexit and Cross Border Healthcare

Articles, 21 September, 2017

UK addresses position on Ireland land border

Medical tourism post-Brexit

Articles, 07 September, 2017

Brexit: Citizens living overseas are pawns for negotiators

UK citizens abroad post Brexit

Articles, 23 August, 2017

UK citizens in EU and EFTA countries

EU citizenship post Brexit

Articles, 08 June, 2017

What happens to EU/EFTA citizens in the UK after Brexit?

Brexit, the NHS and medical tourism

Articles, 02 June, 2017

Brexit bill: the half a billion pound NHS bill

European health insurance

Articles, 25 May, 2017

The European Health Insurance Card (EHIC) - a much misunderstood arrangement

EU Package Travel Directive

Articles, 06 April, 2017

Do you know about the EU Package Travel Directive?

Tele-surgery and medical tourism

Articles, 22 March, 2017

Is tele-surgery a threat to medical tourism?

Travel ban impacts tourism

Articles, 13 March, 2017

New Trump order impacts US inbound tourism

Medical travel insurance

Articles, 01 March, 2017

Clearing up the confusion: insurance and medical tourism

Growth of healing hotels

Articles, 16 February, 2017

Healing Hotels of the World and luxury customers

Trump and medical tourism

Articles, 09 February, 2017

The Trump factor: Protectionism and medical tourism

Will Brexit damage UK medical tourism?

Articles, 16 November, 2016

Refuting the claims of a "medical tourism expert"

Medical tourism in 2016

Articles, 01 November, 2016

The upside down world of medical tourism

Medical tourism cruises?

Articles, 04 October, 2016

All aboard for a healthy trip

Medical tourism associations reducing?

Articles, 01 September, 2016

Where have all the national and regional associations gone?

Medical tourism 2016 overview

Articles, 18 August, 2016

Medical tourism in 2016: What has changed?

Healthcare after Brexit

Articles, 04 August, 2016

The future of cross border healthcare in Europe

The EU debate

Articles, 20 June, 2016

Brexit and medical tourism

International and expatriate healthcare and insurance 2016

Resources, 07 June, 2016

There are more opportunities than ever for insurers and brokers to sell health insurance globally to locals and expatriates.

End of the line for Satori

News, 30 April, 2016

US medical tourism agency Satori collapses

Cuba - restrictions still apply

News, 20 April, 2016

Barriers for US medical tourism to Cuba

Clamp down on illegal transplants

News, 15 April, 2016

Kidney transplant ban in Sri Lanka

Turkey medical tourism

News, 15 April, 2016

The falling star of medical tourism

Early days for Iran

News, 14 April, 2016

Sanctions and travel restrictions still in place

Barriers to domestic medical tourism

News, 12 April, 2016

Out-dated advertising rules affect Malaysia

Incentives for Puerto Rico

News, 11 April, 2016

Puerto Rico gearing up for medical tourism

"Uninsured Americans"... Fact or fiction?

News, 07 April, 2016

New data on US insurance

Bariatric travel... hidden cost?

News, 05 April, 2016

Report on impact of Canadians' obesity surgery abroad

Malaysia stays strong

News, 03 April, 2016

Growth in medical tourism despite economic slowdown

Zika virus repercussions

Articles, 01 April, 2016

Does Zika pose a threat to medical tourism?

Global travel trends

Articles, 01 April, 2016

How will tourism fare in 2016?

Tourism troubles in Turkey

Articles, 14 March, 2016

2016: A lost year for medical tourism in Turkey?

A Gulf of medical tourism?

Articles, 26 February, 2016

How is the falling oil price affecting medical tourism in the Middle East?

National Health Systems Report 2016

Resources, 10 February, 2016

This report provides insight into the National Health Systems of over 180 countries, and what their future plans are on a simple country-by-country basis.

Rising popularity of wellness travel

Articles, 25 January, 2016

Health and wellness and the luxury market

Is Asia getting it wrong?

Articles, 10 December, 2015

Medical tourism is not global: Are asian hospitals targeting the wrong markets?

What's my target market?

Articles, 27 November, 2015

Targeting medical tourists... demographics are dead...adapt or perish!

Your next conference speech

Articles, 15 October, 2015

Insert name here... a template for your medical tourism conference speech

Planning and preparation

Articles, 25 August, 2015

Impact analysis and medical tourism

Comparing US surgeons

News, 06 August, 2015

Consumers to evaluate and compare surgeons based on complications rates and patient outcomes

Malta health plans under attack

News, 06 August, 2015

Doubt expressed about healthcare funding and medical tourism plans

Nigeria universal health coverage

News, 06 August, 2015

NHIS resolves to decentralize the operation of health insurance in the country

Egypt healthcare struggles

News, 06 August, 2015

Pressure on Egypt's ailing health care system

Regulation of Israel medical tourism

News, 06 August, 2015

Special team to investigate and prepare regulation of Israeli medical tourism

Lithuania medical tourism

News, 06 August, 2015

Lithuania rues failure of cross border healthcare

Dubai acts to reduce healthcare costs

News, 06 August, 2015

DHA introduces price regulation model for private sector health services

Australia breast augmentation package

News, 06 August, 2015

Insurer changes medical tourism option

Health insurance compulsory

News, 06 August, 2015

Chinese visitors to Taiwan must have health insurance

Trends in global healthcare spend

News, 06 August, 2015

OECD Health Statistics 2015: Reductions in spending

Saudi Arabia... compulsory health insurance

News, 06 August, 2015

Compulsory health insurance to be introduced for most visitors

South Korea medical tourism

News, 06 August, 2015

Recovery of South Korea medical tourism after MERS

Health insurance coverage in India

News, 06 August, 2015

86% of the rural population and 82% of the urban population are not covered by health insurance

Japan medical tourism

News, 06 August, 2015

Japanese plans to promote health tourism get mixed reaction

Dubai health insurance update

News, 06 August, 2015

Dubai links health insurance scheme to visa renewal

Economy problems

Articles, 31 July, 2015

Greece crisis... the implications for Greek medical tourism

Fact from fiction

Articles, 30 June, 2015

Analysing the latest "internet" facts on medical tourism

What are they up to...

Articles, 28 May, 2015

Competitor analysis in medical tourism

Working with competitors in medical tourism

Articles, 08 May, 2015

Who are your nearest competitors in inbound health and medical tourism?

Fakes, scams and frauds

Articles, 19 March, 2015

How do you know who is telling the truth?

Rallying to the Defence

Articles, 08 January, 2015

Medical tourism under attack and on the back foot

When all fails

Articles, 24 November, 2014

Ian Youngman looking into what happens after the worse happens

The future of medical tourism

Articles, 20 November, 2014

What will 2015 bring for medical tourism?

Central and South America: Health insurance, healthcare and medical tourism 2014

Resources, 14 November, 2014

This regional report provides up to date detail from recent research.

Hot topic: Ebola

Articles, 23 October, 2014

What threat does Ebola pose to medical tourism?

The medical magic

Articles, 06 October, 2014

Why do people travel for health, Ian Youngman discusses why

Medical tourism... good news?

Articles, 29 August, 2014

Does medical tourism benefit countries?

Temporary tourism

Articles, 23 July, 2014

Is medical tourism's growth based on hope or reality?

Do your research

Articles, 09 June, 2014

Knowing your market is key to success

Go compare

Articles, 22 May, 2014

Comparison sites, a threat or opportunity?

Don't believe the hype

Articles, 23 April, 2014

How medical tourism has changed and who not to believe

Tourist or Patient?

Articles, 20 March, 2014

The issues in measuring medical tourism numbers

Dental tourism trends

Articles, 21 February, 2014

Looking at the growth of the dental tourism market

The big questions

Articles, 24 January, 2014

Many problems in the medical tourism industry remain unanswered

The imperfect market

Articles, 19 December, 2013

Is the customer really looking for the cheapest surgery?

Travel insured: part 2

Articles, 04 November, 2013

Why isn't medical travel insured?

Travel insured: part 1

Articles, 21 October, 2013

What travel insurance exists?

Building and hoping

Articles, 06 September, 2013

Building a hospital rarely leads to patients beating a path to your door

Understanding customer choice

Articles, 09 August, 2013

How do medical tourist make decisions about destinations?

Stuck in the past

Articles, 28 June, 2013

Is medical tourism making the most of social media?

Headliners

Articles, 14 June, 2013

How bad news can affect medical tourism in a country

The tourism niche

Articles, 26 April, 2013

Are small industries a bad thing?

The tipping point

Articles, 12 April, 2013

Is medical tourism still a pioneer, or merely a bandwagon?

Disaster planning

Articles, 01 February, 2013

What happens when things go wrong?

Powerhouses of medical tourism

Articles, 04 January, 2013

What economies are booming in the medical tourism industries?

The numbers

Articles, 14 December, 2012

Ian Youngman revisits the figures of medical tourism

Accreditation

Articles, 21 September, 2012

Just what is accreditation in medical tourism and does it help your business?

Healthcare politics

Articles, 23 August, 2012

The impact of healthcare reform on the USA's medical tourism industry

The American tourist

Articles, 13 July, 2012

International Americans have not arrived, but what about domestic travel?

Judging quality

Articles, 15 June, 2012

Are certification and accreditation useful guides for a service's quality?

Medical tourism attacked

Articles, 18 May, 2012

Spain and the UK speak out against medical tourism

Changing world

Articles, 23 March, 2012

Ian Youngman talks on how the world of medical tourism has changed

Build it and they will come

Articles, 27 January, 2012

Is medical tourism a "Field of Dreams"?

Kolkata tragedy

Articles, 19 December, 2011

94 dead in a major fire, what does this mean for India's medical tourism industry?

Top ten tourist destinations

Articles, 14 November, 2011

Ian Youngman tries to pick out the top 2012 medical tourism destinations

Is medical tourism behind the curve?

Articles, 16 September, 2011

Friends, Fans and Followers are becoming a powerful market force

Recovering UK tourism

Articles, 23 June, 2011

Is outbound tourism from the UK recovering?

The shrinking world

Articles, 15 April, 2011

The medical tourism world is shrinking, but is this good news?

Insurance tourism

Articles, 07 March, 2011

How will health insurers adapt to medical tourism?

Medical tourism lost

Articles, 25 February, 2011

How the industry lost its way and how it can get back on track

EU directive: Cross-Border healthcare

Articles, 19 January, 2011

Ian Youngman looks at the challenges of implementation of Cross-Border healthcare

What do we know?

Articles, 10 November, 2010

Ian Youngman comments on an academic review of medical tourism

Implications of online advertising rules

Articles, 27 October, 2010

New rules may affect how medical treatment is advertised online

Changing trends

Articles, 30 September, 2010

How changes in tourism will affect medical travel

An industry out of nowhere

Articles, 03 September, 2010

A new global industry has sprung up, as have many before, what can we learn?

Europe agrees new rules

Articles, 17 June, 2010

Ian Youngman looks at the latest development of Cross-Border healthcare

USA healthcare reform

Articles, 21 April, 2010

Ian Youngman reviews the myths of the US healthcare reforms

Are you complying?

Articles, 12 March, 2010

Ian Youngman examines the new European Union Provision of Services regulation

Top ten hospitals

Articles, 27 January, 2010

Are assessments really fair?

The forgotten destination

Articles, 10 December, 2009

Oft overlooked, London could well be a slumbering giant in medical tourism

Getting social

Articles, 06 November, 2009

Medical tourism industries live and die on their press, but how good is the news ?

Legal, decent, honest and true

Articles, 22 October, 2009

Ian Youngman considers whether the medical tourism industry is both legal and ethical

Looking back at '08

Articles, 25 August, 2009

Ian Youngman looks at the predictions made back in 2008

Conference: Competition hots up

Articles, 16 July, 2009

Ian Youngman looks at the competitive market for medical tourism speakers

Will the boss pick up the bill?

Articles, 26 May, 2009

Can businesses insurers break into the medical tourism market

McKinsey's got it wrong

Articles, 26 May, 2009

A recent report on the industry makes some serious errors

The hottest American destinations

Articles, 15 May, 2009

One country serves travelling American medical care more than any other. America

Where do Americans go abroad?

Articles, 12 May, 2009

Just as we don't know how many Americans travel for care, we have no figures as to where

Americans travelling abroad for care

Articles, 10 May, 2009

Do we have any idea how many Americans would travel abroad for treatment?

How many American medical tourists?

Articles, 10 May, 2009

There are wide variations in the American medical tourist estimates. We examine a few

Delivering destinations

Articles, 28 April, 2009

Not every government is active in attracting medical travellers

Offering a premium service

Articles, 10 September, 2008

IMTJ looks at the new insurance products coming to market

Truth in statistics

Articles, 01 June, 2008

Ian Youngman talks on his work: Medical Tourism 2008: the World-wide Business Guide

South Korea: medical tourism report

Articles, 01 June, 2008

Ian Youngman is producing a new set of country specific reports, first up, South Korea

Insurance and medical travel

Articles, 10 May, 2008

Ian Youngman looks at the new products hitting the insurance market

Advertisement

ADD AN ARTICLE

Do you have an article that you’d like to share with the medical travel industry?

Publish for FREE on IMTJ.

ADD ARTICLE

Related Articles

Assessing EU cross-border healthcare

12 June, 2019

EU cross-border healthcare still requires improvement

Diasporic medical tourism

14 May, 2019

Potential in understanding diasporic medical travel behaviour

Healthcare innovation in Korea

14 May, 2019

Targeting the complex care patient: Korea’s rising global status

Hidden tourism costs

01 May, 2019

An industry on shaky ground?

Global medical travel trends

18 April, 2019

Get on board China’s Belt & Road initiative