resources: in Malaysia, for example, the government has increased the allowed stay under a medical visa from 30 days to 6 months. It should be added that good doctors are not enough, if clinics/hospitals are not properly managed, or if nurses and other paramedical personnel are not properly trained or qualified. Required investments in infrastructure and technology are also important: in Taiwan, the government has announced a USD 318 million project to help further develop the country’s health services. Also, the absence of a world database on the safety and quality of care has increased the importance of international voluntary standards: the Joint International Commission (JIC) accredited over 120 hospitals worldwide, and several other organizations, such as the International Society for Quality in Health Care (ISQUA), the National Committee for Quality Assurance (NCQA), the International Organization for Standardization (ISO), and the European Society for Quality in Healthcare (ESQH), have taken steps to ensure that medical travelers receive the highest-quality cares (Deloitte, 2008).

# **Case-study n°7 SWOT Analysis, health services trade, Morocco**

|**_Str_**|**_engths_**|**_Weaknesses_**|
|---|---|---|
|-<br>-<br>-<br>-<br>-|Lower cost of services compared to Europe.<br>Cultural heritage, diversity of the landscapes and<br>tourist attractions, climate.<br>Geographical and cultural, including language,<br>proximity with Europe.<br>Facility of access to property and resulting strong<br>foreign presence in residential areas (retirees and<br>temporary residents).<br>Qualification and reputation of the doctors or<br>hospitals, gained through training or exchanges with<br>foreign universities and medical institutions, and<br>participation to networks with hospitals and research<br>centers abroad (in particular in France).|-<br>No statistics and sectoral strategy at the government<br>level.<br>-<br>Only individual initiatives and difficulty to finance<br>large scale projects.<br>-<br>Skill shortages: Insufficient number of doctors and<br>key health personnel (absolute terms), and lower<br>density of health personnel than Tunisia, Egypt,<br>Libya, and Algeria (relative terms).<br>-<br>Qualification of nurses and other medical staff.<br>-<br>Late in the race with Tunisia and other competitors.<br>-<br>Non application of international standards and<br>certifications (e.g. ISO).<br>-<br>Absence of a clear legal framework for medical<br>tourism that could result in malpractice with an<br>important reputation risk.<br>-<br>Strict<br>nationality<br>requirements<br>that<br>exclude<br>foreigners topractice(and invest).|
|**_Op_**<br>-<br>-<br>-<br>-<br>-<br>-<br>-<br>-|**_portunities_**<br>Booming market of seniors and retirees (ageing of<br>the population): residential programs, medical<br>accompaniment in Morocco and abroad, paramedical<br>services.<br>Booming<br>market<br>of<br>cosmetic<br>surgery,<br>thalassotherapy and other forms of health tourism at<br>large.<br>Booming market of dental surgery and prosthesis.<br>Specialization in some advanced surgical procedures<br>to treat patients in the region: cardiology, cancer<br>treatment, epidemiology, etc.<br>Expected shortages of certain medical personnel in<br>Europe.<br>Off-shoring of certain medical services – use of the<br>existing infrastructure.<br>Deterioration of the level of reimbursement of<br>treatments in Europe and development of the<br>portability of health insurance.<br>Increasing need for medical training in the region:<br>Mauritania,Mali.|**_Threats_**<br>-<br>Protectionist reaction of European countries and ban<br>of medical tourism.<br>-<br>Competition of emerging countries in Asia, Eastern<br>and Central Europe, and the region.<br>-<br>Loss of human resources through the permanent<br>establishment abroad of key health personnel.|

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