Cross-Border Health Care:Flash in the Pan or Our Future?: Cross-Border Health Care: Flash in the Pan or Our Future?


TONIGHT: TONIGHT International Patients Seeking Care in the US Defining the phenomenon Understanding the demand Assessing the prospects for growth Americans Seeking Care Abroad Defining the phenomenon Understanding the demand Assessing the prospects for growth Cross-Border Care in the New Millennium


Who’s Traveling Where? : Who’s Traveling Where? Two Distinct Populations, Differing Motivators: Well-heeled international patients – all nationalities Looking for the best that money can buy US Patients – middle-income level Looking for value Looking for non-FDA approved treatments


International Patients Searching for American Quality: : International Patients Searching for American Quality: 1960s – mid-1990s: US enjoyed unrivaled technological superiority, modern clinical facilities, well publicized outcomes Non-medical factors also drove phenomenon: business, educational and cultural ties draw the affluent to consider the US for care Patients drawn to US for tertiary/quaternary services – primary and secondary care services less common


Tapping the International Market: : Tapping the International Market: Big name US centers begin to establish formal programs for foreign patients late 1980s Cleveland Clinic – Johns Hopkins – Mayo Clinic – MGH –Stanford Growing prevalence of managed care makes this population look like gold Cash pay full charges Even when discounted, this is finest reimbursement in any providers’ payer mix International insurance products still not widely used Services catering to these patients: Interpreters Travel assistance Visa assistance Financial estimating & Global Billing Dedicated facilities, VIP amenities


International Contributions to the US Bottom Line:: International Contributions to the US Bottom Line: International derived profits have not been a “silver bullet” for budget woes at any major center International patients represent only 2 – 5% of any center’s total patient population in the most mature international programs International program costs are offset by reimbursements, with a few possible exceptions… On the other hand, if patients are there anyway …accommodating them is prudent


Outreach: Let’s Market to Them!: Outreach: Let’s Market to Them! Word-of-mouth drives 70%+ of international patients to US Without benefit of referring MD participation Nonetheless, domestic HC marketing tactics are used: Print ads CME conferences Referral liaisons Foreign MD training A hospital in Bali to call our own Second Opinion Services


Setting Up Shop Overseas: : Setting Up Shop Overseas: Many have tried… Johns Hopkins Oncology Center – Singapore Harvard Management International – global Stanford Advanced Radiology Center – Singapore Inhibitors: Capital requirements Diversion of resources Quality and brand controls Virtual Presence: A higher calling


Second Opinion – Remote Consultations: : Second Opinion – Remote Consultations: Increasingly important international referral channel for tertiary centers Allows patients access to expertise without travel Correctly promoted: becomes an effective marketing tool Operationalizing service is complicated… New telemedicine legislation has helped to minimize liability concerns for US providers Physician culture change is the biggest challenge Operationalizing service is essential… for tertiary/quaternary services Leveraging your market advantage – subspecialty expertise Domestic and international market applications


Prospects for Increasing InternationalPatient Volume in the US:: US pricing Remote consultation services Vastly improved capabilities of local or regional physicians and facilities Negative word-of-mouth US State/Territory   Country Prospects for Increasing International Patient Volume in the US: Information access Positive word-of-mouth Remote consultation services Growth in international insurance products Continued global leadership in medical research and clinical infrastructure Enablers Inhibitors


 “Were you on vacation!? You look terrific!”: “Were you on vacation!? You look terrific!”


US Patients Take to the Skies: : US Patients Take to the Skies: Trend begins in mid-1990s Maturing economies with money/need to invest in healthcare – new clinical facilities built, rivaling US/Europe Proliferation of sub-specialty expertise – foreign MDs acquiring skills from US/Europe and bringing them home Increasing US costs & 43.4 million uninsured More globally-aware American populace with access to the WEB!!!


HospitalSoup.com: HospitalSoup.com


PlanetHospital.com: PlanetHospital.com


PhuketHealthTravel.com: PhuketHealthTravel.com


CosmeticSurgeryTravel.com: CosmeticSurgeryTravel.com


HealthcareTourist.com: HealthcareTourist.com


What are Americans seeking?: What are Americans seeking? Cosmetic Surgery Elective procedures (joint replacement) Cardiac procedures…and more Consumers looking for value & service “The un-insured are among us!” Clear from review of recent literature that the target for medical tourism marketing is the uninsured AMERICAN MIDDLE CLASS


Which Countries are Calling? : Which Countries are Calling? Thailand JCAHO-accredited hospitals Bumrungrad International – poster child for medical tourism Estimate international patient visits increasing 30% annually Leading provider of sex change surgeries; top 10 reason foreigners go to Thailand for care! India Top-notch physicians, rapidly improving clinical infrastructure Estimate ~500,000 international patients in 2006 Excellent Outcomes – higher chance of surviving surgery in India, than in the US! Experts estimate $2.2 billion a year by 2012 ENGLISH! Mexico Best known for providing alternative cancer care Cosmetic surgery lags in reputation relative to other sites Promotions emphasize low cost as primary benefit Dubai, Germany, Singapore South Africa, Malaysia


The Prices!!: The Prices!! Add the price of the “vacation” and care is still less costly abroad!


Beautiful New Buildings Soften Cultural Differences: Beautiful New Buildings Soften Cultural Differences Apollo Hospitals & Clinics Chennai, India Bumrumgrad International Phuket, Thailand


Prospects for Increased US Exodus for Care :   Prospects for Increased US Exodus for Care Information access Positive word-of-mouth US pricing; affordable insurance Foreign investment in research and clinical infrastructure US Board Certification of foreign MDs; relationships with US Hospitals Reticence to leave home Negative word-of-mouth Reduced accountability Enablers Inhibitors


The Millennium Ahead…: The Millennium Ahead… America’s Comparative Advantages: A medical culture based on transparency and patient rights – patients feel this difference Federal funding for medical research that preserves US scientific leadership – our leadership is in jeopardy Leadership in patient-targeted health and wellness information


Thank you, WHCE!: Thank you, WHCE!