By Daniel Thomas in London
Published: February 22 2010 18:25 Last updated: February 22 2010 18:25
Tokyo has become the world’s most expensive office location even as a fall in demand for office space has caused the first global drop in rents since 2003.
Global offices markets have all suffered an unprecedented fall in demand, according to Cushman & Wakefield, the real estate adviser.
Every region recorded falling rents in 2009 for the first time. Most developers were quick to respond to the economic crisis by shelving new building work, although the supply of offices still increased as corporate occupiers sought to cut costs by vacating or sub-letting space.
The largest rental falls came in Singapore, Hong Kong and Tokyo, where office rents fell 45 per cent, 35 per cent and 21 per cent, respectively. Ho Chi Minh City was the worst hit, with a rent decline of more than half.
Rents globally are expected to reach their low point by the middle of the year, according to Cushman & Wakefield, which added that the outlook for 2010 was more positive.
John Siu, general manager for Cushman & Wakefield in Hong Kong, said: “Demand for office space in Hong Kong’s key business districts started to pick up towards the end of 2009. We see 2010 as a year for tenants to take advantage of the rare vacancies and significantly discounted rents before the market rebounds.”
It expects demand for offices will again increase to reduce the supply of space as some big economies return to growth. Rental increases are already being recorded in markets such as the City of London and Oslo.
Kiev and Dublin were the hardest hit in Europe, with 50 per cent and 38 per cent wiped off the value of prime office rents by year end.
Rents declined 7 per cent across the US but South American markets were more stable.
The Financial Times
martes, 23 de febrero de 2010
España, ¿aliada de China en su lucha contra Estados Unidos?
J. Jacks - 23/02/2010 06:00h
Estamos en guerra. Algún ministro español oye campanas cuando observa sus consecuencias pero no sabe dónde. No se trata de una guerra militar tradicional. Supone una contienda comercial entre Estados Unidos y China de la que, por el momento, no se sabe quién resultará ganador.
Como en toda guerra, la contienda se libra en diferentes áreas, entre ellas:
a) Inversiones exteriores: desde julio del 2009, China admite que destina parte de sus reservas a controlar empresas energéticas extranjeras (Petrobras, Addax, Blackstone, los intentos en Río Tinto con ACH), del sector de materias primas o en el de las líneas de distribución petrolíferas y del gas.
El futuro son los metales raros y China ya ha dado los primeros pasos para posicionarse: no se conforma con producir en 95% de la producción mundial sino que posee el 25% de Arafura y el 50% de Lynas. La nueva generación de productos electrónicos necesita de estos metales…incluidos los misiles para defensa aérea.
El gigante asiático diversifica geográficamente sus inversiones. No invierte igual en Oceanía (68% en materias primas) que en Hong Kong (35% en el sector financiero).
b) Proteccionismo y WTO: el Gobierno Bush impuso tarifas selectivas a productos chinos (700% al acero, 106% a productos manufacturados) y el actual presidente ha aumentado la práctica (impuesto del 210% en neumáticos). En 2009, Estados Unidos “persuadió” a la WTO para que sancionara a China por incumplir con las leyes sobre propiedad intelectual. Como respuesta, China incrementa sus aranceles.
c) Tipo de Cambio. Existen múltiples frentes abiertos en este mercado, pero entre ellos destacan tres: China pide el fin del dólar como moneda de reserva internacional, presiona con el fin de la compra de deuda EEUU y usa las reservas de su balanza comercial con Estados Unidos para comprar activos denominados en euros. (1) El Banco Central Chino “recicla” esos dólares a cambio de euros para sus compras en Europa. (Nota: el proceso de reconversión de dólares en yuanes por el Banco Central Chino para evitar problemas inflacionarios domésticos tendrá una explicación futura más detallada).
d) Financiero: para algunos, China pudo tener algo que ver en la presente crisis (2) y los frutos están a la vista. Del mismo modo, Estados Unidos “aconseja” a sus entidades la no participación en el Qualified Foreign Institutional Investor.
Cuatro frentes de batalla que se desarrollan en dos escenarios distintos.
Como en toda guerra, la batalla se libra en diferentes escenarios. A los efectos que interesan a nuestro país, principalmente en dos: la Unión Europea y el ASEAN.
a) Para China, el ASEAN es “su patio trasero”. Su idea es la de usarla para internacionalizar su moneda de modo gradual de modo que en 2015 su divisa sea convertible dentro de este área. Mientras, Estados Unidos trata de dificultar ese proceso con acuerdos bilaterales del tipo FTA y con la venta de armas, la ultima $6.400 millones a Taiwán.
b) Del mismo modo, Estados Unidos siempre ha supervisado la Unión Europea. El euro fue el resultado de un programa diseñado en varias etapas: primero, la recuperación alemana de 1945 y, posteriormente, la creación de una Unión en torno a su economía, el Buba y la nueva moneda germana. Con un objetivo claro: hacer frente al enemigo de aquel entonces, Rusia.
Esa recuperación alemana, Wirtschaftswunder, se basaba en ayuda entregada por Estados Unidos, estabilidad financiera fijada por el Bundesbank y control de precios a través del Deutsche Mark (DM). Para los norteamericanos, la primera prioridad era establecer el Buba y el sistema financiero hasta el punto de que crearon el DM antes incluso que la bandera alemana.
Alemania sustentó su desarrollo en la estabilidad del marco gracias al control interno de la inflación en vez de recurrir a ajustes del tipo de cambio. Con el tiempo, y para completar la construcción de la nueva Europa, Francia se encargaría del presupuesto (PAC). Para crecer, cada cierto tiempo nuevos países se tenían que adherir. Mano de obra barata y nuevos mercados para productos del norte.
El papel de España
¿Y qué tiene esto que ver con nuestra crisis? Pues mucho. China empieza a interferir en la Unión cada vez más hasta el punto que es el segundo mayor socio de la UE y la UE es el mayor socio comercial de China. Una cooperacion que no sólo opera en términos comerciales sino a través de su inversión en deuda soberana europea de los $2 trillones de sus reservas de modo selectivo. No compra cualquier deuda.
Y es aquí donde entra España en juego. China ya es el segundo mayor comprador de deuda publica soberana española (3). Su presencia no deja de crecer, sobre todo desde el 2008 (Nota: interesante la evolución de Alemania y Luxemburgo deshaciendo posiciones y Francia ganándolas. ¿Se acuerdan del cambio de Primary Dealers del Tesoro?).
¿Por qué iba China a comprar deuda soberana española? ¿Cómo podría China ayudar a España a salir de sus crisis? ¿Y a cambio de qué? Porque España tiene algo valioso que ofrecer a China en esta guerra, el derecho de “veto” sobre tres materias cruciales en la Unión: política exterior, defensa y fiscalidad (sobre todo de cara a las Perspectivas Financieras 2014-2021) lo que de facto le facilitaría la capacidad de influir en decisiones claves de la política comunitaria.
España podría “poner una vela a Dios y otra al diablo” a fin de recibir ayuda del mejor postor para salir de la crisis. Un euro con problemas afecta a las exportaciones de China y favorece al dólar. Hace parecer a la economía americana y a su deuda como “saludable” (Indonesia y su reciente decisión sobre la deuda estadounidense) en relación con el quimérico euro y la frágil Unión.
España por si sola no tiene capacidad para salir de la crisis (aun acometiendo las reformas que pedirá la Comisión) y necesitará ayuda exterior. Si de Alemania nada se puede esperar, solo hay dos fuentes capaces de proporcionarla, el FMI y el SAFE (el CIC).
Por ahora, no se está haciendo tan mal. No quedan más soluciones ni mucho más tiempo.
(1) En diciembre pasado, China vendió $34.000 millones de deuda EEUU lo que hizo que por primera vez desde el 2005 ya no sea el principal poseedor de su deuda. A titulo anecdótico, la FED contempla un caso que permite al Gobierno EEUU no tener que pagar las deudas con un país exterior…y que aún esta vigente.
(2) China podría haber creado la crisis en EEUU a través de David Li. Algunos creen que es “curioso” que el más brillante matemático chino saliera libremente de China para acabar en JP Morgan donde crearía el soporte que permitió la burbuja de derivados. Creen “curioso” que después de la explosión de la crisis retornara a China para trabajar para el Gobierno. Curiosidades de las finanzas.
(3) Incluyendo las compras de terceros y privados y sobre los no residentes.
Estamos en guerra. Algún ministro español oye campanas cuando observa sus consecuencias pero no sabe dónde. No se trata de una guerra militar tradicional. Supone una contienda comercial entre Estados Unidos y China de la que, por el momento, no se sabe quién resultará ganador.
Como en toda guerra, la contienda se libra en diferentes áreas, entre ellas:
a) Inversiones exteriores: desde julio del 2009, China admite que destina parte de sus reservas a controlar empresas energéticas extranjeras (Petrobras, Addax, Blackstone, los intentos en Río Tinto con ACH), del sector de materias primas o en el de las líneas de distribución petrolíferas y del gas.
El futuro son los metales raros y China ya ha dado los primeros pasos para posicionarse: no se conforma con producir en 95% de la producción mundial sino que posee el 25% de Arafura y el 50% de Lynas. La nueva generación de productos electrónicos necesita de estos metales…incluidos los misiles para defensa aérea.
El gigante asiático diversifica geográficamente sus inversiones. No invierte igual en Oceanía (68% en materias primas) que en Hong Kong (35% en el sector financiero).
b) Proteccionismo y WTO: el Gobierno Bush impuso tarifas selectivas a productos chinos (700% al acero, 106% a productos manufacturados) y el actual presidente ha aumentado la práctica (impuesto del 210% en neumáticos). En 2009, Estados Unidos “persuadió” a la WTO para que sancionara a China por incumplir con las leyes sobre propiedad intelectual. Como respuesta, China incrementa sus aranceles.
c) Tipo de Cambio. Existen múltiples frentes abiertos en este mercado, pero entre ellos destacan tres: China pide el fin del dólar como moneda de reserva internacional, presiona con el fin de la compra de deuda EEUU y usa las reservas de su balanza comercial con Estados Unidos para comprar activos denominados en euros. (1) El Banco Central Chino “recicla” esos dólares a cambio de euros para sus compras en Europa. (Nota: el proceso de reconversión de dólares en yuanes por el Banco Central Chino para evitar problemas inflacionarios domésticos tendrá una explicación futura más detallada).
d) Financiero: para algunos, China pudo tener algo que ver en la presente crisis (2) y los frutos están a la vista. Del mismo modo, Estados Unidos “aconseja” a sus entidades la no participación en el Qualified Foreign Institutional Investor.
Cuatro frentes de batalla que se desarrollan en dos escenarios distintos.
Como en toda guerra, la batalla se libra en diferentes escenarios. A los efectos que interesan a nuestro país, principalmente en dos: la Unión Europea y el ASEAN.
a) Para China, el ASEAN es “su patio trasero”. Su idea es la de usarla para internacionalizar su moneda de modo gradual de modo que en 2015 su divisa sea convertible dentro de este área. Mientras, Estados Unidos trata de dificultar ese proceso con acuerdos bilaterales del tipo FTA y con la venta de armas, la ultima $6.400 millones a Taiwán.
b) Del mismo modo, Estados Unidos siempre ha supervisado la Unión Europea. El euro fue el resultado de un programa diseñado en varias etapas: primero, la recuperación alemana de 1945 y, posteriormente, la creación de una Unión en torno a su economía, el Buba y la nueva moneda germana. Con un objetivo claro: hacer frente al enemigo de aquel entonces, Rusia.
Esa recuperación alemana, Wirtschaftswunder, se basaba en ayuda entregada por Estados Unidos, estabilidad financiera fijada por el Bundesbank y control de precios a través del Deutsche Mark (DM). Para los norteamericanos, la primera prioridad era establecer el Buba y el sistema financiero hasta el punto de que crearon el DM antes incluso que la bandera alemana.
Alemania sustentó su desarrollo en la estabilidad del marco gracias al control interno de la inflación en vez de recurrir a ajustes del tipo de cambio. Con el tiempo, y para completar la construcción de la nueva Europa, Francia se encargaría del presupuesto (PAC). Para crecer, cada cierto tiempo nuevos países se tenían que adherir. Mano de obra barata y nuevos mercados para productos del norte.
El papel de España
¿Y qué tiene esto que ver con nuestra crisis? Pues mucho. China empieza a interferir en la Unión cada vez más hasta el punto que es el segundo mayor socio de la UE y la UE es el mayor socio comercial de China. Una cooperacion que no sólo opera en términos comerciales sino a través de su inversión en deuda soberana europea de los $2 trillones de sus reservas de modo selectivo. No compra cualquier deuda.
Y es aquí donde entra España en juego. China ya es el segundo mayor comprador de deuda publica soberana española (3). Su presencia no deja de crecer, sobre todo desde el 2008 (Nota: interesante la evolución de Alemania y Luxemburgo deshaciendo posiciones y Francia ganándolas. ¿Se acuerdan del cambio de Primary Dealers del Tesoro?).
¿Por qué iba China a comprar deuda soberana española? ¿Cómo podría China ayudar a España a salir de sus crisis? ¿Y a cambio de qué? Porque España tiene algo valioso que ofrecer a China en esta guerra, el derecho de “veto” sobre tres materias cruciales en la Unión: política exterior, defensa y fiscalidad (sobre todo de cara a las Perspectivas Financieras 2014-2021) lo que de facto le facilitaría la capacidad de influir en decisiones claves de la política comunitaria.
España podría “poner una vela a Dios y otra al diablo” a fin de recibir ayuda del mejor postor para salir de la crisis. Un euro con problemas afecta a las exportaciones de China y favorece al dólar. Hace parecer a la economía americana y a su deuda como “saludable” (Indonesia y su reciente decisión sobre la deuda estadounidense) en relación con el quimérico euro y la frágil Unión.
España por si sola no tiene capacidad para salir de la crisis (aun acometiendo las reformas que pedirá la Comisión) y necesitará ayuda exterior. Si de Alemania nada se puede esperar, solo hay dos fuentes capaces de proporcionarla, el FMI y el SAFE (el CIC).
Por ahora, no se está haciendo tan mal. No quedan más soluciones ni mucho más tiempo.
(1) En diciembre pasado, China vendió $34.000 millones de deuda EEUU lo que hizo que por primera vez desde el 2005 ya no sea el principal poseedor de su deuda. A titulo anecdótico, la FED contempla un caso que permite al Gobierno EEUU no tener que pagar las deudas con un país exterior…y que aún esta vigente.
(2) China podría haber creado la crisis en EEUU a través de David Li. Algunos creen que es “curioso” que el más brillante matemático chino saliera libremente de China para acabar en JP Morgan donde crearía el soporte que permitió la burbuja de derivados. Creen “curioso” que después de la explosión de la crisis retornara a China para trabajar para el Gobierno. Curiosidades de las finanzas.
(3) Incluyendo las compras de terceros y privados y sobre los no residentes.
jueves, 18 de febrero de 2010
Japanese Medical Tourism
Medical Tourism a Non-starter
It is very obvious that the Japanese hospital system is ina state of crisis. In the last couple of years there havebeen frequent reports of people dying in the back ofambulances because hospitals are rejecting them due toa shortage of emergency care doctors. The fact is thatthere is not only a shortage of people -- both doctors andnurses, but also a growing shortage of beds as well, dueto the poor financial condition of many hospitals.
A rare news report on the subject surfaced last year sayingthat of the nation's 7,785 non-psychiatric hospitals, atleast 600-700 of them were operating in the red and that ofthe 80-90 or so hospitals closing down each year (HealthMinistry statistics), about half of them were closingbecause of financial problems.
This deplorable situation is, in our opinion, of thegovernment's and medical profession's own making -- withplenty of help from the nation's aging society and thedomestic economic slump.
The first reason for our placing the blame is based on thefact that it is still illegal for a company to own andoperate a hospital, and instead only qualified doctors mayhead up a facility. This rule could only have been dreamedup to protect doctors' privileged positions in society sinceexperience abroad proves that companies are indeed verycapable of operating a care facility.
Yes, we realize that some companies such as home/officesecurity firm Secom have found ways around this ownershiplaw by appointing doctors to run a facility owned by them,but it's not a strong value proposition for investors whenyou could technically be in breach of the law at any time.As a result, hospitals are seldom run as sound commercialoperations -- and yet they still have to make profits inorder to pay salaries, equipment, and building costs.
Another issue is the "addiction" of general hospitalsnationally to prescription and services reimbursements bythe government as their main source of income. This is ofcourse what happens when you have a universal butcompulsory public health system that pretty much excludesprivate health care and is set up to allow doctors toover-prescribe (up to 50% more prescriptions compared tothe U.K., for example) as a way to make extra cash.
The Japanese public medical system currently allows forabout 5,400 procedures, each of which is strictly regulatedin terms of price and method in order to qualify forgovernment reimbursement. This system does indeed providea certain baseline of public health care, but not muchelse. You can forget about discretionary procedures as wellas new drugs and treatments from overseas that haven't yetgone through the very slow approvals process from theMinistry of Health. If you want options, you'd be best servedhopping on to a plane to Thailand or Malaysia and buyingworld-class services at highly discounted prices.
Then of course there is the fact that the system was neverintended to deal with the current flood of old people.Despite the fact that the Japanese are the healthiestamongst citizens of advanced nations around the world, thedemand for hospital beds and lifestyle disease treatmentscontinues to escalate.
As a result, the pressure is on.
The financial crisis for many hospitals has come about asthe government continues to seek ways to cut its annualspending. Targeted are all types of medical costs, butparticularly the massive amounts of fixed feereimbursements for services and drugs. The cost cutting gota boost with the Koizumi administration in 2002, when theco-payment costs for seniors was increased and an emphasiswas placed on moving from original-maker drugs to generics.The use of generics has since increased dramatically andthe government now has a goal of making 30% of all drugsprescribed to be generics by 2012, up from 18.7% in 2007.
So the scenario is ugly: an ossified system ofself-interested owners (well, the successful ones, anyway)and single-source profits that between them precludeentreprenuership and price/services differentiation. Nowthat the main source of income is getting squeezed off bythe government, what are financially struggling hospitalsto do?
It seems that one idea is to start selling services to anew category of user who is NOT bound by the rules of theJapanese health system and its pricing restrictions -- thatof the medical tourist. The Japan Tourism Agency has saidit will launch a trial program from this April to startattracting wealthy Chinese who might be interested inhaving medical procedures conducted in Tokyo. No doubt theyare trying to follow the lead of the very successfulmedical tourism sector in Thailand, where 1.36m peopletraveled for medical services that cost just 20% to 30%of similar operations/treatment in the USA and Europe.
The Agency is cooperating with about ten hospitals in Japan(mainly in Tokyo) and some university hospitals in Beijing,such as the Tsinghua University hospital. The focus will beon brain surgery, plastic surgery, and oncology. While thissounds like it could be a good idea, the JTA has admittedthat it has a number of challenges, including language,payment methods, and "other" issues.
We spoke with medical industry expert, John Wocher ofKameda Hospital in Chiba, about the feasibility of such aprogram. He pointed out many problems with bringing Chinesepatients into Japan, the least of which is the simplematter of getting cooperation from the immigrationauthorities. Specifically he mentioned the case of a Chinesepatient who was only provided a visa after THREE MONTHS ofsupplying detailed documentation of his medical need to theJapanese consulate in China. The patient was consistentlyrefused a visa despite Kameda's acceptance of the personfor treatment. Finally he was let in on a visa allowing himto visit a relative who coincidentally is living here.
Wocher then went on to say that Korea already has a medicalvisa and it is very easy to apply for. It looks like we have yetanother example of internationalization where the Koreansare leaving Japan behind in the dust.
Other problems with medical tourists are likely to be:
* Logistics -- Specialized transportation may be neededfrom the airport (expensive)
* Language -- Chinese-Japanese interpreter may be needed ona continuous basis (expensive and difficult)
* Legal -- Informed consents for operations, etc., areneeded in Chinese, specific to procedure
* Fees -- How much to charge? Chinese don't have a nationalinsurance system matched by employers
* Payment methods -- Bank transfers, UnionPay?
* Culture -- Wealthy patients are demanding -- are Japanesehospitals ready to treat their patients as customers andnot as children? We wonder...
* Amenities -- Most Japanese hospitals have utilitarianrooms -- which may be quite unsuitable for wealthy patients
* Medical Records -- Need ability to receive adequatemedical history and documentation on existing work done
* Post-operative follow-up -- Who will do this and how willthey communicate?
* Accompanying family -- Do they also get visas?
* Religious Facilities -- How many Japanese hospitals haverooms marked with the direction of Mecca?
Good luck JTA...! We think the answer to making Japanese hospitals more profitable is much simpler:
* Allow people to pay extra to get services on top of government reimbursed treatments, instead of the currentall-or-nothing approach.
* Let companies own and operate hospitals so as to providea parallel private medical care system (freedom of choice)
* Open up the medical sector to commercial competition fromforeign companies (now that's REALLY radical!)
From: Terrie's Take; www.japaninc.com
It is very obvious that the Japanese hospital system is ina state of crisis. In the last couple of years there havebeen frequent reports of people dying in the back ofambulances because hospitals are rejecting them due toa shortage of emergency care doctors. The fact is thatthere is not only a shortage of people -- both doctors andnurses, but also a growing shortage of beds as well, dueto the poor financial condition of many hospitals.
A rare news report on the subject surfaced last year sayingthat of the nation's 7,785 non-psychiatric hospitals, atleast 600-700 of them were operating in the red and that ofthe 80-90 or so hospitals closing down each year (HealthMinistry statistics), about half of them were closingbecause of financial problems.
This deplorable situation is, in our opinion, of thegovernment's and medical profession's own making -- withplenty of help from the nation's aging society and thedomestic economic slump.
The first reason for our placing the blame is based on thefact that it is still illegal for a company to own andoperate a hospital, and instead only qualified doctors mayhead up a facility. This rule could only have been dreamedup to protect doctors' privileged positions in society sinceexperience abroad proves that companies are indeed verycapable of operating a care facility.
Yes, we realize that some companies such as home/officesecurity firm Secom have found ways around this ownershiplaw by appointing doctors to run a facility owned by them,but it's not a strong value proposition for investors whenyou could technically be in breach of the law at any time.As a result, hospitals are seldom run as sound commercialoperations -- and yet they still have to make profits inorder to pay salaries, equipment, and building costs.
Another issue is the "addiction" of general hospitalsnationally to prescription and services reimbursements bythe government as their main source of income. This is ofcourse what happens when you have a universal butcompulsory public health system that pretty much excludesprivate health care and is set up to allow doctors toover-prescribe (up to 50% more prescriptions compared tothe U.K., for example) as a way to make extra cash.
The Japanese public medical system currently allows forabout 5,400 procedures, each of which is strictly regulatedin terms of price and method in order to qualify forgovernment reimbursement. This system does indeed providea certain baseline of public health care, but not muchelse. You can forget about discretionary procedures as wellas new drugs and treatments from overseas that haven't yetgone through the very slow approvals process from theMinistry of Health. If you want options, you'd be best servedhopping on to a plane to Thailand or Malaysia and buyingworld-class services at highly discounted prices.
Then of course there is the fact that the system was neverintended to deal with the current flood of old people.Despite the fact that the Japanese are the healthiestamongst citizens of advanced nations around the world, thedemand for hospital beds and lifestyle disease treatmentscontinues to escalate.
As a result, the pressure is on.
The financial crisis for many hospitals has come about asthe government continues to seek ways to cut its annualspending. Targeted are all types of medical costs, butparticularly the massive amounts of fixed feereimbursements for services and drugs. The cost cutting gota boost with the Koizumi administration in 2002, when theco-payment costs for seniors was increased and an emphasiswas placed on moving from original-maker drugs to generics.The use of generics has since increased dramatically andthe government now has a goal of making 30% of all drugsprescribed to be generics by 2012, up from 18.7% in 2007.
So the scenario is ugly: an ossified system ofself-interested owners (well, the successful ones, anyway)and single-source profits that between them precludeentreprenuership and price/services differentiation. Nowthat the main source of income is getting squeezed off bythe government, what are financially struggling hospitalsto do?
It seems that one idea is to start selling services to anew category of user who is NOT bound by the rules of theJapanese health system and its pricing restrictions -- thatof the medical tourist. The Japan Tourism Agency has saidit will launch a trial program from this April to startattracting wealthy Chinese who might be interested inhaving medical procedures conducted in Tokyo. No doubt theyare trying to follow the lead of the very successfulmedical tourism sector in Thailand, where 1.36m peopletraveled for medical services that cost just 20% to 30%of similar operations/treatment in the USA and Europe.
The Agency is cooperating with about ten hospitals in Japan(mainly in Tokyo) and some university hospitals in Beijing,such as the Tsinghua University hospital. The focus will beon brain surgery, plastic surgery, and oncology. While thissounds like it could be a good idea, the JTA has admittedthat it has a number of challenges, including language,payment methods, and "other" issues.
We spoke with medical industry expert, John Wocher ofKameda Hospital in Chiba, about the feasibility of such aprogram. He pointed out many problems with bringing Chinesepatients into Japan, the least of which is the simplematter of getting cooperation from the immigrationauthorities. Specifically he mentioned the case of a Chinesepatient who was only provided a visa after THREE MONTHS ofsupplying detailed documentation of his medical need to theJapanese consulate in China. The patient was consistentlyrefused a visa despite Kameda's acceptance of the personfor treatment. Finally he was let in on a visa allowing himto visit a relative who coincidentally is living here.
Wocher then went on to say that Korea already has a medicalvisa and it is very easy to apply for. It looks like we have yetanother example of internationalization where the Koreansare leaving Japan behind in the dust.
Other problems with medical tourists are likely to be:
* Logistics -- Specialized transportation may be neededfrom the airport (expensive)
* Language -- Chinese-Japanese interpreter may be needed ona continuous basis (expensive and difficult)
* Legal -- Informed consents for operations, etc., areneeded in Chinese, specific to procedure
* Fees -- How much to charge? Chinese don't have a nationalinsurance system matched by employers
* Payment methods -- Bank transfers, UnionPay?
* Culture -- Wealthy patients are demanding -- are Japanesehospitals ready to treat their patients as customers andnot as children? We wonder...
* Amenities -- Most Japanese hospitals have utilitarianrooms -- which may be quite unsuitable for wealthy patients
* Medical Records -- Need ability to receive adequatemedical history and documentation on existing work done
* Post-operative follow-up -- Who will do this and how willthey communicate?
* Accompanying family -- Do they also get visas?
* Religious Facilities -- How many Japanese hospitals haverooms marked with the direction of Mecca?
Good luck JTA...! We think the answer to making Japanese hospitals more profitable is much simpler:
* Allow people to pay extra to get services on top of government reimbursed treatments, instead of the currentall-or-nothing approach.
* Let companies own and operate hospitals so as to providea parallel private medical care system (freedom of choice)
* Open up the medical sector to commercial competition fromforeign companies (now that's REALLY radical!)
From: Terrie's Take; www.japaninc.com
Suscribirse a:
Entradas (Atom)
