Estimated at $20 billion annually, the medical tourism market is projected to double over the next two years, according to Patients Beyond Borders, a guide book for medical travel.

Despite Georgia’s sketchy history of medical reforms and a dilapidated medical infrastructure, some Georgian doctors, such as Dr. Mariam Kukunashvili, the director of Healthcare Agency International (HIA) in Tbilisi, believe the country can compete for international patients.

Medical tourism among Americans and Europeans is experiencing steady growth. For example, according to a 2008 report by the Deloitte Center for Health Solutions, the number of Americans traveling abroad for medical care is projected to reach 1.6 million by 2012. Countries as varied as India, Turkey, Jordan and Costa Rica have established themselves as treatment destinations, offering affordable medical procedures ranging from dental care to plastic surgery.

Kukunashvili has been bringing patients to Georgia - and sending Georgians abroad for treatment - for the past three years.

She said that while the country has its "drawbacks," Georgia is an "attractive" medical treatment destination in certain fields, in particular infertility treatments and surrogate mother selection. This is so in part because Georgia permits procedures that are banned in Europe and elsewhere. "We have our attraction - for example surrogacy egg donation - and this was the beginning," Kukunashvili said.

According to Janine Oakman, the international patient coordinator for Visit and Care, a medical tourism agency, HIA is popular with patients because it offers a database of surrogate mothers with photographs - a practice that has largely been discontinued in other countries due to privacy issues. HIA also offers background information and details about the women. "Egg donors [for HIA] generally are very intelligent and very well educated," Kukunashvili said - traits that prospective parents value.

Oakman noted that cost is an issue: Georgia is more affordable than other destinations. According to Kukunashvili, the agency charges $20,000 for the entire surrogate package, including the fee for the mother, medicines and delivery - which is a fraction of the cost for the entire procedure in the United States.

Kukunashvili could not provide a precise figure for the number of international patients, in part because she also provides transport for frozen embryos and surrogate mothers to clinics around the globe. She noted, however, that international patients make up approximately 50 percent to 60 percent of the clinic’s total business, and it is anticipated that the number will grow.

Other medical fields in Georgia are also seeking international patients, including hair transplants and dentistry. According to Oakman, Georgia is a "viable" destination for fertility procedures although not as attractive for other types of treatment due to its location. "[Georgia] is more difficult to get to for some clients," she said, noting that many prefer a direct flight to a well known destination, such as Istanbul.

Turkey is one of the most popular destinations for oncology, according to Josef Woodman, the author of Patients Beyond Borders. He lists 42 international facilities that meet US quality standards, including hospitals in Turkey, the Czech Republic and India. In an email interview with EurasiaNet, Woodman said that while he researched medical facilities in the former Soviet Union, none were highlighted in his book because he could not find "reliable internal accreditation," or any hospitals accredited by the international accreditation body Joint Commission International. Another stumbling block was the lack of hospital and clinic websites in English.

Kukunashvili and other medical and tourism professionals maintain that an obstacle is the government’s lack of interest promoting Georgia as a medical treatment destination. Less than 1 percent of the 1.3 million visitors to Georgia in 2007 came for medical or spa treatments, according to the latest figures available from the Department of Tourism and Resorts.

Dr. Archil Khomassuridze, the general director of the Zhordania Institute of Human Reproduction, said the government is doing "zero" to promote or develop the field either domestically or internationally. According to the Ministry of Health, all issues dealing with tourism - medical or otherwise - are handled through the Department of Tourism and Resorts in the Ministry of Economic Development. Beka Jakeli, the deputy chairman of the Department of Tourism and Resorts, said the government is looking into the country’s potential for medical tourism, although their priority is to recapture the country’s Soviet-era legacy as a regional spa destination.

While Jakeli agreed that there is a future in medical tourism for specific procedures, he argued that this is a "long term" goal that requires more time and more investment than the desired revitalization of the spa industry. "In the Soviet [era], Georgia was famous [for medical treatment at spas]," he said, noting that there are approximately 100 operating resorts in Georgia today with a potential of double that.

But Ia Tabagari, the general manager of Caucasus Travel and the president of the Georgian Incoming Tour Operators Association, Georgia’s Soviet-era legacy is not enough to compete with well known medical destinations for spas or other medical procedures. "India, everyone knows. Turkey, everyone knows where it is located. [But] why go to Georgia," she asked. "We need a lot of marketing."

/Eurasianet/