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Economics & Investments
While the distribution of healthcare as a global service is a reality in many countries, the US lags in development because there are gaps in industry rules, ill-defined dispute resolution mechanisms, billing transparency concerns, and other significant issues that create unknown business risks.  As a result of these structural issues, national reputations and international business brands are nnecessarily jeopardized.

The case study below highlights critical issues for businesses and countries exporting healthcare to consumers.  It is a real case. The events occur commonly, but to varying degrees, during the normal delivery of medical care. They are not unique to medical tourism patients. What is unique in the case is the risk and powerful consequences assumed by businesses and countries attempting to build brands within the US.

The Case

The fictitious patient, Tom, seeks the best price possible online for a medical procedure.  Tom accepts care in Country ‘Z’ after email exchanges and an online interview.  No local facilitator assists him. Tom arrives without a complete assessment. The receiving doctor requires additional tests costing Tom more than planned.

He has a complication at home and is dissatisfied.  His medical care options at home are limited.  Unable to find a solution, he goes to a radio station and presents a biased story to a large audience undermining the destination country’s brand, the hospital’s reputation and value provided to patients seeking international healthcare.

From a business perspective, any country lacking an organized market approach will collect a few hundred dollars in tax receipts and forfeit millions of dollars in revenue.  In 2007 the US spent $2.26 trillion dollars on healthcare, while $4.1 trillion was spent worldwide , , .

The construction of an orderly, process-driven, and seamless Global Healthcare Services Distribution market could favorably shift the consumer’s spending patterns. A movement of 0.01% in market share represents a tremendous revenue opportunity.

Countries bear the greatest risk to the brand(s) they are building. International companies and hospital brands entering the global healthcare services market carry a significant amount of risk as well. Decades have been spent building premium brands in corporate portfolios. Entering a relatively unstructured industry and marketplace carries undefined and potentially unmanageable risk. Brand damage can propagate to other businesses units.

Proactive coordination, development, and management of these healthcare export services are in the best interests of all the participating countries and their domestic companies. The exportation of healthcare deserves, the same, if not more attention, than other export industries.  

There is greater oversight, quality assurance, process control, and compatibility standards established in semiconductor chip manufacturing. The standards in that industry developed with the realization that the size of the organized market grew larger with collaboration and shrunk with parochial disorder. The shared collaborative reward of a Global Healthcare Services Distribution market exceeds any singular market share acquisition.

Requirements to Stabilize and Ensure Market Growth

  • National standards to define how facilities accept patients
  • Patient care delivery and control systems
  • Dispute prevention and resolution mechanisms
  • Billing transparency processes

National Standards for Patient Entry and Exit

Countries with businesses sending and accepting patients should consider having a locally managed authorized list of facilitators, physicians, and insurers. There is a compelling interest in limiting the number and types of businesses allowed to send and receive patients. Specific entry and exit processes for patients should be defined and agreed upon.

From both a national and a medical facility brand perspective, the risk is greatest when there are few or no controls to access facilities.  When a poorly managed case occurs, the outcome reflects most heavily on the country and the facilities within that country.

The provider(s) typically fade out of the story line. Unknown business risk exists to both country and facility brands when there are no controlled access and exits points for the provision of services.

Patient Care Delivery and Control Systems

We do not advocate for the imposition of a US-centric patient care system. But a reasonable sense of comparable and enforceable quality across borders protects everyone’s interests. Medical centers and national certification bodies can use existing processes to qualify their doctors and related licensed providers. Existing credentialing processes typically include a specific scope of practice with limits and definitions.

A new scope of practice: International Provider can organize efforts in an aligned manner. A physician interested in providing elective care to international patients can select that credentialing option. Existing credentialing systems can be vertically integrated to a national level in order to build a manageable, enforceable equitable process that allows medical centers and nations to allow participation, but protect their brand(s).

The credentialed position: International Provider can be revoked locally or at a national level for legitimate practice pattern concerns, licensure lapses, or quality issues.

A systematic categorization of problems and complaints can create an organized quality improvement approach.  As problems arise, categorize and track them under different subject headings and the types of events. Over time as undesirable events occur, patterns will emerge, problems will be identified and solutions developed.

These events may be classified within, but separate from, routine quality improvement systems. This separation allows for relatively rapid and accurate risk identification, mitigation and quality improvement specific to this industry and its collective development.

Dispute Prevention and Resolution Mechanisms

These systems should be initiated and managed locally. Valuable customer service tools designed for healthcare providers can improve doctor-patient relationships. There are techniques with proven results that can reduce the likelihood of a poor medical outcome from becoming a negative customer service experience.  

Some costumer satisfaction issues will not be resolved with these techniques. These cases can be addressed by hospital leadership, or by local ombudsmen, to reduce the negative impact. Extraordinary customer service is one of the key differentiators offered by international service providers to US consumers. It merits the same protections that all essential brand components deserve.

Avenues to arbitration already exist and may be preferred to control costs. Contractual language can help to control risk and reduce disputes, but jurisdictional issues are difficult to overcome leading to enforcement issues. Initially, it may not appear to be in the interest of an individual facility or country to yield power and authority to outside parties.

But, a collaborative standardized consensus based agreement and mechanism for dispute resolution is essential.  Sharing best practices here makes tremendous sense as it encourages the overall market to learn and grow.

Billing Transparency

Before the patient arrives there should be a clear bill set out for the services to be rendered. Hidden and undeclared additional fees and charges are a bad practice. There is a valid reason to charge for additional mandatory or unexpected legitimate services. Infections, complications and operative recovery issues are all legitimate services to bill for when rendered. This point helps explain why the limitation of access points is important to your reputation.

Message consistency begins and ends with your ability to enforce how the message is delivered. Accepting referrals through resources unfamiliar with your terms, conditions and charges allows for the potential patient to misunderstand what the obligations are and where additional charges may be added on.  

When qualified referral services are in place, the business and medical risk to the patient, facility and country can be controlled or minimized. The entire process assures the consumer receives a clearly defined fee structure and the potential for additional charges. These issues can be addressed prior to departure to receive the care. Options for aftercare insurance and other gaps can be closed prior to departing for services.


The days of the “gold rush” approach to medical tourism will end. There is room for more participants, additional talent and new entrepreneurs, but a more structured mature industry lies ahead.  Competing for healthcare consumers across borders and into domestic territories is a complex and challenging goal, but appears rewarding and worthwhile in the end.

International Centers of Excellence that are worth traveling to for health care can exist in the consumers’ minds. To establish them, we must move away from unmanaged participants, underdeveloped policies and ill-defined rules.  A comprehensive strategic approach is necessary to accomplish these goals.

Each dissatisfied person that leaves a country carries a powerfully negative brand message. Domestic advocates, lobbyists, providers and insurers who characterize this industry as a threat will actively publicize these cases. They seize the stories like Tom above and use their negative value. The physician(s) and the facility involved are almost unimportant. The strategic use of a bad outcome and/or dissatisfied customer is to broadly paint the country negatively.

This simple stroke destroys the quality and pricing power that exists in the collective brand. The Toms that return are given the ability to tell their stories to thousands, perhaps more, of empathetic audiences that are more likely to believe his word of mouth story. A priority must be established early on to defuse and disarm the dissatisfied consumers before they vent publically.

In the end, each country’s reputation and their domestic corporate brands are also placed in harm’s way. Patients rarely lose public battles.

About the Author

Dr. McCormick, originally from New York, is a practicing Emergency Medicine physician in Los Angeles and has remained Board Certified for the last 10 years. Prior to that, he served for over 20 years in pre-hospital emergency services, both ground and air based operations. Dr. McCormick graduated from medical school at the State University of New York Downstate in 1993 and completed his residency in Emergency Medicine at the prestigious LAC+USC Medical Center in 1997.

Dr McCormick is a founding member and co-inventor of the NuMask IntraOral Mask, a breakthrough medical device for ventilating patients. His next direction is a more strategic solution to the US healthcare challenges with the launch of a medical tourism business called Premier Medical Travel this fall. He is convinced that combining his MD and MBA will help to unleash the tremendous benefits this industry has to offer: our patients, our payers, our country and our future generations. He may be reached at

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