Global Health Care

The challenge for American hospitals is not competing with the hospital across town or with hospitals in the big city down the Interstate highway. The challenge is how American hospitals compete for patients, physicians, nurses and recognition in the global marketplace. 

Over forty years ago, David Brower, founder of Friends of the Earth, coined the term “Think globally, act locally.”  Today, among the most visionary American hospital CEOs, from large and small hospitals, the expression is “Think globally, act globally.”

Hundreds of thousands of foreigners, cash and insurance cards in hand, are traveling for consultation with American physicians and treatment using our hospitals’ advanced technology.¹   The perception of these foreign patients and foreign health insurance carriers is that, although the cost is high, America’s physicians, drugs, and technologies are the best in the world.

It is not just large hospital systems in the global market. Some small American hospitals are offering both high quality and low cost.  Galichia Heart Hospital in Wichita, Kansas, is targeting Canadian and British markets, offering coronary by-pass for patients without complications for a flat fee of $10,000.

The same Boeing 767 aircraft that bring people to America for treatment transport a growing number of residents, uninsured, underinsured and insured, from US communities to Istanbul, Dubai, Shanghai, Bangkok, and Krakow for treatment.  That, according to the Deloitte Center for Health Solutions, will amount to about $68 billion departing the US for foreign healthcare providers in 2010.

Travel to a foreign country for medical treatment is not new.  Patrician Romans and royalty traveled for weeks to soak in the healing waters of Bath in South West England.  Well-heeled foreigners joined President Franklin D. Roosevelt to bathe in the Warm Springs of Georgia.

In Krakow, Poland, the Wieliczka Salt Mine Underground Rehabilitation and Treatment Center treats Americans and other international visitors, as it has since 1826, for lower and upper tract respiratory system diseases, under the care of its physicians and therapists, in moist air saturated with sodium chloride. Insurance cards are welcome.

More American insurance carriers are actively enabling members to go abroad for healthcare treatment.  Companion Global Healthcare, Inc., affiliated with Blue Cross Blue Shield of South Carolina and headed by President and COO David Boucher, formerly with Quorum Health Group, offers its members a selection of procedures in Istanbul, Bangkok, Costa Rica, Dublin, India, San José, and Singapore.  Boucher says he regularly travels to evaluate these hospitals and searches for new ones to give his members the best choices.

Joint Commission International has accredited many hospitals abroad, including those in the Companion network, as meeting many of the basic standards of American hospitals. 

The most noticeable difference between having a procedure performed in the best hospital in Bangkok and having the same procedure performed in the best hospital in Baltimore is quality and hospitality, followed by cost.  Costs abroad are dramatically lower even with a weak US dollar. At Bangkok’s Bumrungrad International hospital, the median cost for a coronary artery by-pass graft (CABG) is about $22,000. The package price for an uncomplicated CABG is $15,000.  Follow-up care is provided by the patient’s US physician.  Bumrungrad is headed by an American CEO, Curtis Schroeder, formerly with Tenet Healthcare.

UnitedHealth International, headed by CEO Ori Karev, an American lawyer, has an international network of hospitals and healthcare providers available to US expatriates. Karev says UnitedHealth is bringing foreigners to the US for care, establishing third party administrators in foreign countries, and advising hospital systems such as the National Health Service in the United Kingdom.

The American Medical Association, recognizing the increase in patients leaving the US, approved its Guidelines on Medical Tourism in June 2008.

Calling this travel “medical tourism” belittles the fact that people going abroad are not on vacation but on a journey to get the best care they can, in a facility that treats them like royalty, and for a reasonable out-of-pocket price.  Instead of calling this phenomenon “medical tourism”, we should call it global medicine or medical travel..

While most major players in American healthcare, including insurance providers, pharmaceutical companies, technology equipment manufacturers, software developers, and others have long had global markets built into their strategic plans, most American hospitals have not. 

Three US hospital groups, Methodist International in Houston, Poudre Valley in Fort Collins, Colorado, and Providence Health & Services in Seattle, have created partnerships with foreign hospitals to exchange best practices, create facilities, and be positioned for global medicine.  Methodist is in the United Arab Emirates.  Poudre Valley and Providence work with Israeli hospitals.

Sisters of Charity Providence Hospitals in Columbia, South Carolina, exchanged physicians, nurses, and technicians with hospitals in Romania so that the hospital in Cluj Napoca could learn US practices. Today, as the quality of hospitals abroad improve their standards, American hospitals are learning from foreign hospitals – on building design, operations, patient safety, cost reduction, planning, marketing and public relations.

A growing number of American healthcare groups, such as International Hospital Corp. and Christus Health, both based in Dallas, are looking at how they can get foreigners to use their hospitals, physicians, and high-tech equipment and, at the same time, how they can collaborate with foreign hospitals and insurance providers.  They benefit, coming and going: when their patients choose to go abroad for high quality affordable care or when foreigners come to their facilities in America.

Other American hospital groups need to be looking for strategic collaboration abroad, so that they won’t be behind as the healthcare market goes global and they’re acting local.   Hospitals in the US that want a share in patients from abroad will need collaboration with physicians and health systems abroad.

More attention is being given to the international healthcare issues by American media, including NPR.  

Many Americans have only heard about horror stories, especially from politicians, about healthcare in Canada and in the United Kingdom and contend that the American healthcare system is the best in the world.  But when we have asked random Americans about their experience or that of relatives or friends in American hospitals, nearly every one, including hospital employees and physicians, has a horror story about a hospital experience and medical errors. 

It is clear that health care in the US and around the world needs improvement.  The ideal would be a standard for health care quality that not only standardizes quality and outcomes among the states in the US but also comparable quality and outcomes among countries.

International health care is not just limited to patients from one country going to another country to get care.  It also involves health care professionals, including surgeons, other physicians, nurses, pharmacists and others, working together to solve health care problems, create new treatments, and improve patient outcomes.  One example is the first successful transplantation of a trachea using the patient's stem cells, conducted by Paolo Macchiarini MD and an international team at the Hospital Clinic in Barcelona, Spain.

The Association of periOperative Registered Nurses has incorporated a new feature in its peer-reviewed journal , called Global Perspectives, to report on international involvement with organizations such as the International Council of Nurses and the International Federation of  Perioperative Nursing.  

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1. Modern Healthcare, July 7, 2008, Breaking Barriers, by Jean DerGurahian