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Small isolated countries and islands face unique health care headaches

Costs tend to be far higher partly because of local monopolies enforced by the medical profession and business elites.

Then there is the thorny question of what should be done locally and what farmed out. Abu Dhabi faced these issues when it decided to spend billions on building its own Cleveland Clinic. At what stage is it better to send patients with rare or very acute conditions abroad?

Getting that balance right is not easy. Arguably Abu Dhabi built too big – we hear of empty pediatric beds sometimes filled by Lebanese orphan children in the absence of local need. That’s heartwarming and expensive in equal measure.

Bermuda whose healthcare costs are second only to the USA has the opposite problem. As our interview with Edward Fitzgerald reveals, it has a tendency to fly patients to New York for minor ailments that should be handled locally.

Fitzgerald spots plenty of opportunities in islands in the Americas and Europe, particularly for outsourcers. He also had a ringside seat on the roll-out of universal healthcare provision in countries as diverse as Jamaica and Bermuda.

Look hard and there are plenty of opportunities. Healthcare tourism is big business in the Cayman Islands, says Fitzgerald. And there are some intriguing business models like Spanish group Hospiten, a chain of 20 hospitals across the Canary Islands, Mexico, Jamaica and Mexico, focused on serving tourists who fall sick or have accidents.

It’s easy to ignore the islands but it is worth bearing in mind that the island practice of KPMG has a population of some 45m in the Caribbean and 750,000 in Gibraltar, Malta and the Isle of Man.

We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.