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Economics of Autism: Andrei Maximov

Medical tourism counts over 3 thousand years. Bathing establishments were an integral part of sports facilities in Ancient Greece.

After the Romans had conquered Greece, they took over not only its arts and sciences, but also its experience in hydropathy, or water cure. Unlike the Greeks, however, who were using only cold water in their baths, the Romans started building baths and swimming pools using the water of the hot springs—they called them thermae (from Greek θερμός thermos, “hot”).

The word came into usage after a town’s name in Sicily where the waters of the hot springs had been used for healing purposes: it was called Thermae. One more term of the medical tourism is ‘spa’, and it is related to a small town in Belgium, Spa, located in the foothills of the picturesque Ardennes. Today Spa is better known for its racing circuit and Formula One World Championships while during the Middle Age it was famous for its healing waters that were popular with the European aristocrats. Russian emperor Peter the Great had spent several days in Spa taking medicinal baths and drinking healing waters.

He was so much impressed that as soon as he got back home he gave orders to look for medicinal waters in Russia. Many locations were discovered at the time, and G. Schober, Peter the Great’s physician in ordinary, a German, called them ‘Kurort’, i.e. health resort (from German ‘Kur’ – health treatment, cure and ‘Ort’ – place, location). This was when all kinds of ‘vody’ (waters in Russian) appeared on Russian maps: Martsialnye Vody, Lipetskiye Vody, Sergievskiye Vody, Caucasian Mineralnye Vody and many others. During the Soviet period Georgia was deservedly regarded as the health resort region for the whole country, with the most popular balneotheraputic spas and health centers: any trade union member had as his or her most cherished dream an opportunity of getting a voucher for a health trip to Tskaltubo, Borjomi or Likani.

Medical tourism today has gone far from what used to be “water cure”. Vast sums of money are related with it now: its earnings increased more than tenfold in the last ten years—from 40 billions to half a trillion US dollars, and its share in the global GDP will reach 2% soon (to compare, it is only two times less than the GDP share of the whole global agriculture!).

The rationale is quite varied for different medical tourists: some is ready to pay any amounts of money for highly qualified medical care (mostly for the treatment of cancer, cardiologic and orthopedic conditions) while others prefer to get their dental work done where it’s cheaper. The latter goes also for trips to have plastic surgery done while still others in Canada or the USA cannot wait until their turn is up at their medical insurance company, so they prefer to travel to Latin America or Eastern Europe where they can get immediate medical assistance for less money. Medical tourism is especially rapidly growing in the developing Asian countries, such as India, Thailand, Korea, and China, where the treatment of many illnesses that are not covered by medical insurance in the patient’s home country may cost one quarter or even one tenth of the sums needed for analogous procedures in the USA.

Georgia is, unfortunately, on the sidelines of these developments. Well, Georgians do participate in the medical tourism, yet mostly as patients, be it in Turkey, Israel, Germany or France. No reverse current is noticeable. Certain separate projects for reviving and developing balneological spas (Tskaltubo and Borjomi) are being realized, but they are neither here nor there in terms of changing the game for Georgia’s national economy as a whole. This is a separate topic that should be discussed, of course, with the understanding that this industry is highly competitive and that Georgia has not been able to demonstrate special competitive advantages.

Yet, I would like to share my ideas here regarding a very specific niche of medical tourism that is becoming ever more popular in the global market. If handled properly and professionally, this could become a niche for Georgia to fill within the foreseeable future.

I am referring to courses of medical cure (both short-term and long-term) for children, teenagers and adults suffering from autism spectrum disorders. It is no secret that a true autism epidemic is raging in today’s world and that it is becoming ever more widespread every year. The demand for rehabilitation and social adaptation services is growing even faster as far as children with special needs are concerned. Parents are ready to pay any sums of money so that their child can become a part of the society. They are, however, very eager to see positive results which can be achieved only through the implementation of the international scientific and practical experience in treating this condition.

In my view, the best results in this area were achieved in Israel and Switzerland. Three-week courses of one-on-one coaching at one of the Israeli rehabilitation centers cost 13600 US dollars for the young patient’s parents (without food and board) while the cost of the 20-day study course at the Swiss FEDEA School is 16 thousand US dollars. A six-month study program at the FEDEA School costs close to 100 thousand US dollars (school from 9 a.m. to 4 p.m., Monday through Friday, with the rest of the time to be spent with the parents; living costs not included). The school provides guarantees, in fact, that after the six months the student’s IQ will increase by 10-30 points! People from all around the world come to get the treatment at this school, and its site is supported not only in all major European languages, but also in Arabic, Hindi and Chinese!

It might seem that there is nothing easier than acquire the methodology, master the therapy and then start offering rehabilitation procedures in return for a fee. Unfortunately, this is exactly how it happens most of the time… Superficial attitudes in dealing with autistic patients do exist everywhere, not only in Georgia. When treating other conditions one must purchase expensive equipment, medications, use high-tech facilities, while with autists one may get an impression that any specialist can handle them after only short training courses.

Yet, quite the reverse is true! Finest nuances are very important in this case, and they can only be appreciated only with the accumulation of major practical experience and when acquiring knowledge at the confluence of such disciplines as psychology, pedagogics, neurophysiology, pediatrics, neurology, genetics and behavioral analysis. There are only few certified specialists of this kind in the world, and this is why they cost so much. Swiss experts make every cent of their very expensive program work for the client while there is no use seeking help from quite many medical centers in other countries even if they were to pay parents for approaching them in the first place… Incorrectly applied therapeutic procedures become counterproductive for the little autists.

What should Georgia do in this respect? First and foremost, “clean up the act” in its own “kingdom” in order to avoid mistakes which have been already made in other countries. Let us list them.

  1. “Georgia is an exception to the rule”. This is an assertion that Georgia, supposedly, has been spared the global epidemics of autism due to the singularity of its national character and its traditions that exert positive influence on families and regulate social behavior. Not true: if the number of children diagnosed with ASD (Autism Spectrum Disorder) was not rising quickly in Georgia over the last decades, then it only means that no effective professional diagnostics are in existence around the country, especially at an early stage. That is, children have not been getting adequate therapy, parents were not aware of the kind of problem they were facing, and little children have been losing their life’s chance for a rehabilitation in the future.
  2. All children and adults with special needs and/or with physical challenges deserve the state’s attention and are worthy of its financial and social support. Yet, both state officials, teachers and health care workers must remember that all people with disabilities are different! They have different needs, they must get different therapeutic procedures, and their chances for social adaptation are different as well. It is categorically prohibited to put in one group little children with organic deficiencies and autistic kids. They will all be negatively affected.
  3. The autist spectrum of each child requires an individual route of rehabilitation. There is no cure-all solution, no universal formula applicable to any patient. Any thoughtless copying of known and generally accepted methods (whether it is inclusion in education, alternative communications for nonspeaking children, sensory, ABA or other types of therapy) may not only provide no alleviation, but become counterproductive.
  4. The most important fact for the state: spending 10 Lari today for early diagnostics of autism and creation of national rehabilitation system the state budget would save 1000 Lari tomorrow. That is, by returning both children and their parents into the society as its full-fledged members. And vice versa: all those children that were not timely diagnosed as autistic will not go away. Most of them will live off their parents, the society and the state for the rest of their lives.

A professional rehabilitation system for children with ASD must be established. Workshops on internationally acknowledged therapies should be conducted, supervised by recognized global experts, the true gurus of autism control. We should start an intensive and persistent program aimed at training highly skilled specialists in this area who could help children in Georgia. At the same time, we should develop the highly profitable medical tourism.

Especially since Georgia is a great place for combining the therapeutic courses for the little kids and the full-fledged recreation of their exhausted parents. Georgia does have three competitive advantages in this respect. First, it is in Georgia that autists may feel to have come to a wonderland. Why? Because Georgians are incredibly hospitable and they are also very affectionate to children, any children. If the society in the country is correctly attuned to the issue, Georgians could easily create an “autist-friendly environment” both for autistic children and their parents across the whole country, from city shuttles to theaters and restaurants.

Second, Georgia’s climate, nature and sightseeing attractions can make not only children, but also their parents happy and well-adjusted. While the kids will be getting their treatment with the specialists, parents can go sightseeing, enjoy their spa procedures, eat great food at restaurants thus getting their well-deserved reward.

Third, to accomplish all of that specialists are needed, people with sound expertise, practical experience and big hearts. There are big hearts in Georgia all right, as they always used to be. What is now needed are only expertise and experience.

Article by Dr. Andrei Maximov