Israel is the only "western" country in the Middle East.  With a population of 7.4 Million, it is well known for innovation, both from developing & export, & for technology adoption.  The high level of medical care is led by a few university hospitals in the 4 major cities. Being a small country, one may feel that everybody knows everyone.

A few tips that may help a company considering entering the Israeli market:

• Regulatory – if you have CE or FDA approvals you shall not have regulatory difficulties.

• Reimbursement - Define the procedures of your product, most of the products don’t need special reimbursement (especially if they are a part of the procedure), if you need special reimbursement – it could take 1-3 years, but it does not prevent penetration of the products to the Israeli market to some extent.

• Procedures opportunities - Define the KOL (Key opinion leaders) by the number of procedures, their activity and/or by number of patients that they see, not by their name. The use of media for personal PR may bias one away from the real high volume clinicians.

• Define the market segment -

The Israeli market offers great opportunities for all the product segments:

ü  Low cost products - The health expenditure in Israel is one of the highest worldwide. The MOH and hospitals try to reduce the expenditure on the medical devices.

ü  New technologies: The regulatory and the reimbursement allow fast penetration to the market. However, pricing may pose a problem sometimes .But the private market (35% of the procedures) could be a great solution as a first penetration step.

• Allocate the distributors – In Israel you will find  a large number of medical distributors.  You have to be careful, because Israeli people are very ambitious. You have to check their background, their products portfolio and receive recommendation from the KOL. Also, you have to manage a close and friendly relationship with them, while checking the opportunities all the time. It is recommended to allocate distributors  who are familiar with the MOH and sick fund system, having a deep understanding in regulatory and reimbursement issues, having a good presence in the private market.

• Define early adapters – most of the KOL in Israel are early adapters . But for innovative medical device, one has to define the relevant KOL, with commitment for the products and should have willingness for a long standing commitment, since the chances of moving away are high in case of Innovators.

• High end technologies – If you have new technologies (and not “me-to” technologies that compete only in terms of price) divide your target for private market and public market. Technologies are found to grow faster, if penetration is performed via the private market first.

• Rabbis – Israel is mainly a Jewish country. Although most of the peoples are not religious, a fair number of people consult with special rabbis known as "medical professionals". Rabbis are giving second opinion regarding the treatment, regarding the doctors  & the technologies. In case of innovative, pioneering technologies, after getting the support of the right doctors, it's highly recommended to inform this group of influential people.

Timing your medication appropriately can be crucial to the success of any treatment regime whether it be to cure a life-threatening condition or simply to alleviate troublesome symptoms.

When best to take a medication depends on the active ingredient, what product form the medication is in, the nature and severity of the condition to be diagnosed, prevented or treated, as well as individual diet and lifestyle. The detailing that your doctor or pharmacist provides often centers on maximizing the effectiveness and safety of the medication.

Getting as much of the active ingredient to be absorbed into the body can be an important goal of correctly timing your medication. Some medication is better absorbed when taken with meals or specific foods while the absorption of others is inhibited when taken in the same way. Extremely little of an osteoporosis medication like Fosamax (alendronate) already ever gets into the body, let alone reaches the bones, under fasting conditions from a single dose. This medication needs to be taken with plain water and without food or other drink, weekly on the same day in an upright position upon first rising. Already more than 99% of a single dose will be excreted out of the body under such conditions and if the medication is taken with food or at other times during the day, the amount absorbed can be further reduced by half or more.

Some medications may be safer to take with food rather than on an empty stomach. In better assuring the long-term safety of a painkiller class of medications known as NSAIDs, it may be advisable to avoid taking the medication aspirin for instance, on an empty stomach and to either take the medication with or after food or together with an antacid.

Active ingredients can require a specific dose and timing strategy to be most effective. This is especially so for different types of antibiotics in treating infections. An antibiotic medication like cloxacillin may require four times a day dosing to maintain effective blood levels in treating a skin infection while ciprofloxacin, an antibiotic of a another class that acts differently, may only require once or twice a day dosing to treat a urinary tract infection.

The product form can play an important role in when and how often a medication is taken. Long-acting, delayed or sustained release preparations can work to release the active ingredients of a medication product differently or consistently throughout a day allowing the medication to be therapeutic despite being dosed only once instead of multiple times in a day. In managing blood pressure for instance, chronotherapeutic medication has been developed to work in tandem with the body's natural circadian rhythms and in effect, to best tackle the peak blood pressure that tends to occur upon awakening. Innopran XL (propranolol) can be taken just once at night before sleeping. Technology allows the release of the medication's active ingredient four hours after taking it, with resulting peak blood levels that coincide with the morning spike in blood pressure.

The nature of a medical condition can also help to determine when it is best to take a particular medication. Cholesterol is synthesized by the body, often during sleep in the night hence the arising notion that it may be most advantageous to dose cholesterol-lowering medication like Zocor (simvastatin) or Mevacor (lovastatin) in the evenings. Conditions like migraine, fever and gout may have acute symptoms that occur unpredictably and can often require medicating regardless of the time of day.

Incorporating individual diet and lifestyle patterns often facilitates compliance with taking medication and can be crucial to effectively treating a chronic condition like diabetes without unduly reducing quality of life. To best control the condition, insulin injections may be administered as well as oral medication taken before, with or after food to coincide with specific anticipated spikes in blood sugar levels. In consultation with the treating doctor, oral medication may be timed with meals or scheduled for consumption either consistently in the morning or the night to facilitate lifestyle and compliance.

When specific medications are used to moderate elements of diet and nutrition, taking these consistently with meals can be important to treatment success. A weight-loss medication like Xenical (orlistat) is often best taken with meals or times of food intake that involve the most consumption of fats as these get bound by the medication and are passed out from the body. The cholesterol-reducing medications colestipol and cholestyramine also act in a similar way and are best taken with meals.

Timing medication for best outcomes can be especially important when having to take five or more medications consistently. In such cases known as polypharmacy, it becomes increasingly important not just to match medicating with specific time slots before, with or after food, but also to space out the different medications appropriately so as to avoid negative interactions that could lead to ineffective medicating or even direct harm to health.

In timing your medication, discuss the various considerations with both your treating doctor and pharmacist. This will optimize a safe and effective medication regime and better your treatment outcomes.

Medical tourists from different countries travel for health care purposes to those countries having quality healthcare services at reasonable prices. So they spend extra money on travel, health care and accommodations on the places of treatment. Medical tourism is an old concept because thousands of years ago people traveled for medical purposes or for spiritual treatments to different countries. Many factors are considered while choosing a destination place for medical tourism such as high healthcare services and costs, waiting for certain procedures, availability and affordability of international travel, quality and latest technology used in the treatment.

Some of the most popular places include Europe, Japan, Middle East, UK, United States, Canada and Costa Rica. These places are popular due to the quality of their health care services, technology and competency of physicians. The hospitals of Bolivia, Colombia, Brazil, Argentina, Costa Rica, Mexico, Cuba and Turkey are popular for Cosmetic surgery treatments. Surgeons of South American countries like Bolivia, Brazil, Colombia and Argentine lead in plastic surgery due to their experience and knowledge. Plastic surgery is very common in Argentina, Bolivia, Mexico, Colombia and US. Slovakia, Belgium and Poland are entering in the business of health care and medical tourism.

A large number of Americans are going abroad for health care although the facilites of health in US are also availabe. There are many intermediary companies which provide help in medical tourism. These companies offer global health care at reasonable costs. There are different commissions and societies which care for the quality and standards of the hospitals available for medical tourism. Counteries such as Malaysia, Thailand, India and Costa Rica have many infectious diseases as compare to Norht America and Europe . So medical tourists need to stay for some time in the country which they choose for health care because travel soon after surgery can create many complexities. Tourists having breath and heart related problems avoid long flights and combine their vacation tours with medical tours. Read the full post »