COSTA RICA AND GLOBAL HEALTHCARE OPPORTUNITIES GLOBAL HEALTHCARE: COMPONENTS

International movement of patients and retirees • Medical Tourism and Retirement Living abroad

Establishment of operations abroad exterior International Medical Brigades • Offshoring of Hospitals and Retirement Communities

International movement of students and healthcare Clinical Trials and Medical professionals Research abroad • Educational tourism and International Practice

Outsourcing of healthcare services and related services • Outsourcing in health Remote Healthcare services (Corporate medical travel, • Telemedicine imaging, medical transcription, medical • Second Opinions billing, insurance reimbursement) ABOUT PROMED

• PROMED is the Costa Rican Healthcare Chamber representing, promoting and protecting the interests of the healthcare sector. Also, it is the board for the international promotion and quality assurance of the Costa Rican healthcare industry. • Through the seal of quality PROMED makes sure that any healthcare and recovery facility provides with services of excellence in favor of patients security. • Since 2006, PROMED organizes efforts for the development of the global healthcare industry including training, inter- institutional coordination, international promotion and partnerships PROMED: the gateway to quality healthcare in ! MEDICAL EDUCATION OFFSHORING AND PARTNERSHIPS

Proven Track Record... Medical Education

• Costa Rica ranked 37th in the “Higher • 8 Medical Schools (7 private, 1 public) Education and Training” Pillar (The • 6 Medical Schools accredited by SINAES Global Competitiveness Index 2014- (the National Accreditation System for 2015) Higher Education) • 21st in “Quality of the education • Formerly accredited by NCFMEA (National system” indicator (The Global Committee on Foreign Medical Education Competitiveness Index 2014-2015) and Accreditation) and in the process of • 16th in “Quality of management renewing accreditation schools” indicator Pillar (The Global Competitiveness Index 2014-2015) • INCAE Business School among best 10 business schools in Latin America (QS Global 200 MBA Rankings 2014/15) MEDICAL EDUCATION OFFSHORING AND PARTNERSHIPS

• Costa Rican experience – Diversity of international programs (full career, semesters, summer courses, study tours) – Housing with Costa Rican families – Student VISA – Student Life activities – Possibility to practice in Costa Rica after one additional year of internship and compliance with the requirements of the medical local laws. CLINICAL STUDIES IN LATIN AMERICA

• Latin America has been the region that has shown a major increase in the pharmaceutical market (12%) beyond mature markets as North America and Europe (3%). • A future growth of USD 80 billion incomes is projected CLINICAL STUDIES IN LATIN AMERICA High Quality Standards and Training in Western Latin America ofers a supply of highly trained physicians and well-equipped sites for conducting clinical trials. Most physicians in the region have completed their postgraduate studies and specialty qualifcations in the U.S. or EU, and medical training standards are high. Clinical study professionals are part of a respected community that exchanges clinical and scientifc expertise. And, experience has shown that investigator sites reliably provide high-quality data in the required timeframe.

Generally, physicians are eager to participate in clinical trials because the opportunity brings medical advances to their patients, ofers professional prestige, and is a supplemental source of income.

All Latin American countries have adopted the International Conference for Harmonization (ICH) Good Clinical Practice (GCP) guidelines, and the area boasts several laboratories that have been certifed by the College of American Pathologists (14 in Brazil, 10 in Mexico, and 4 in Argentina). The local Ethics Committees and Ministries of Health conduct routine audits of facilities.

Audits performed by the U.S. Food and Drug Administration (FDA) confrm that quality standards are high. Out of 10 global regions, Latin America has the second highest percentage of inspections with no action indicated (NAI). (See Figure 7) FDA INSPECTIONS 2005-MARCH 2014 Figure 7: FDA Inspections 2005-March 2014

No Voluntary Ofcial Countries Included (excluding countries Inspections Region Action Action Action with no inspections) Since 2005 Required Indicated Indicated CIS Georgia, Russia, Ukraine 102 70.6% 28.4% 1.0% Argentina, Brazil, Chile, Colombia, Costa Latin America 100 61.0% 38.0% 1.0% Rica, Ecuador, Guatemala, Mexico, Peru India India 44 59.1% 40.9% 0.0% Bulgaria, Croatia, Czech Republic, Estonia, CEE Hungary, Latvia, Lithuania, Poland, Romania, 166 54.2% 45.2% 0.6% Serbia, Slovakia Austria, Belgium, Denmark, Finland, France, Western Europe Germany, Italy, Netherlands, Norway, Portugal, 242 50.8% 48.3% 0.8% Spain, Sweden, Switzerland, United Kingdom United States United States 2099 49.5% 43.7% 6.7% Hong Kong, Malaysia, Philippines, South Korea, Asia Pacifc 48 47.9% 52.1% 0.0% Taiwan, Thailand China China 19 42.1% 57.9% 0.0%

Source: http://www.fda.gov/downloads/Drugs/InformationOnDrugs/UCM111343.zip Source: http://www.fda.gov/downloads/Drugs/InformationOnDrugs/UCM111343.zip (Accessed March 17, 2014)

8 I Clinical Trials in Latin America CLINICAL STUDIES IN COSTA RICA

• Good Clinical Infrastructure and Proven • Easy access to patients. The fact that most Quality of Clinical Studies (see FDA inspections). Costa Ricans live within large urban areas means that Costa Rica accounts with excellent medical recruitment efforts can be concentrated and that trial professionals and internationally accredited logistics simplified. institutions (JCI accredited hospital). Costa Rica was • Willing and compliant patients. Costa Ricans ranked 36 (2000, WHO) among best healthcare are, generally, eager to participate in clinical trials systems in the world when their physicians recommend doing so. • Excellent regulatory timelines for study start up • Proximity to North America. The country´s (new law in 2014; CONIS/CEC) time zone is convenient for interactions with • Epidemiologic profile similar to developed headquarter offices of North American R&D countries companies. • Season inversion from the Northern Hemisphere. By extending studies into Latin America, sponsor companies can pursue year-round research on conditions that are tied to seasons (such as pneumonia, the flu, and allergies for example). • Easy access to a diverse patient population. MEDICAL TODAY

• Declared of national and public • Procedures interest by President Oscar Arias – 42% dental in 2009 and President Laura – 10% Plastic and esthetic Chinchilla in 2012 – 22% (orthopedics, bariatric, • In 2016 Costa Rica received general , gynecology, approx. 70.000 medical travelers oncology, ophthalmology) injecting about U$500 million in – 10% Other procedures (Dermatology, Costa Rica’s economy Physiotherapy, Audiology, Rehabilitation) – 16% Preventive Medicine • Origin – 83% United States – 11% Canada WHY COSTA RICA FOR CARE?

STRATEGIC LOCATION ECONOMIC AND POLITICAL STABILITY QUALITY OF LIFE JCI ACCREDITED HOSPITALS STATE-OF-THE ART MEDICAL TECHNOLOGY QUALIFIED MEDICAL PROFESSIONALS TOP SUSTAINABLE TOURISM DESTINATION COSTA RICA SAFE DESTINATION FOR MEDICAL TRAVELERS

•International Accreditation •Network of more than 210 •Costa Rican Boards offices troughout the Certification United States and Canada •Authorization by Local •Partnership with Authorities (Minister of Homewatch Caregivers Health) •Privacy SEAL OF QUALITY FOLLOW UP PROMED CARE

INSURANCE CONFLICTS COVERAGE OF RESOLUTION THE NETWORK

•General Liability coverage of •Costa Rican Judicial System Providers (Malpractice is a Felony in Costa Rica) •General Liability Coverage of Tourism Providers plus •International Conciliation and Arbitration through the Medical Expenses specialized Center of the •Complications Coverage American Chamber of Commerce of Costa Rica CORPORATE MEDICAL TRAVEL

• https://www.youtube.com/watch?v=xiQ6GUs1XeE A SPECIAL INVITATION…