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Economics & Investments

Compare and Contrast ~ Inbound vs. Outbound Healthcare

Economics & Investments

For years, non-U.S. residents have traveled into the U.S. for healthcare, many travelling from third-world countries every year for their annual check-ups, second opinions, diagnosis or treatment of a wide array of medical conditions. If you Google the topic, you’ll find records of wealthy and/or affluent travelers from other countries visiting the U.S. as far back as 2000 for everything from difficult-pregnancy childbirths to cancer diagnosis.

The 2008 Deloitte Report on Medical Tourism gives a decent state-of-the-union report on inbound medical tourism. Inbound Medical Tourism is described as patients from other countries traveling to the U.S. to receive medical care. Outbound Medical Tourism is the opposite of inbound; it is described as patients from the U.S. traveling to other countries to receive medical care.

The main commercial feature of that report is that inbound medical tourism is expected to be essentially stagnant into the foreseeable future. However this doesn’t mean that we can’t glean some meaningful comparisons between inbound and outbound healthcare.

Industry Drivers

First, for both inbound and outbound medical tourism, there are underlying industry drivers. For inbound, proximity is a driver. The bordering countries of Canada and Mexico offer proximity. In addition, there are domestic issues that render travel as an attractive option. Canadian visitors seek to avoid long waiting times in their country.  

Mexican visitors may seek better access to quality than they can find locally. For outbound, the overwhelming industry driving force is cost savings for the payer, be it employer, insurance company or government, as well as the individual.

Beyond the industry drivers that essentially create and establish the industry, there is the issue of quality. For inbound, there is the notion that the U.S. hospitals provide a standard of quality that provides sufficient assurance that they will be able to secure quality healthcare. In addition, the affluent inbound patient seeks specific hospitals, clinics and other healthcare providers of international renown in their field of expertise.

Both those examples are indicators of the desire for quality. For outbound patients there is the similar desire for quality. In the industry, such quality assurance has become exemplified by accreditation of the foreign-based healthcare provider by a renowned accreditation organization.

The Patient Experience

Patient treatment begins with patient reception; how a healthcare facility prepares for, and receives, its patients – specifically, how it receives its non-resident patients. Consideration of the obvious differences between resident and non-resident patients suggests that this area of treatment (reception) should be specific to each patient type. Language considerations, food considerations, cultural considerations and ethnic considerations are a few of the relevant factors that must be addressed.

How a hospital or clinic incorporates these considerations into their overall business model is of particular interest to a marketing specialist like me. The reason that this holds special appeal for marketing types is because the patient experience is one of the major marketing tools that a healthcare facility has.

The patient experience translates directly into word-of-mouth marketing. Word-of-mouth marketing has been and continues to be the strongest influencer in the buying decision of ALL products and services in our world.

Results of the strictest and most disciplined research that includes websites, marketing material review and phone calls, are completely overwhelmed by direct rendition of personal experience. Hurricane ravaged hotels have experienced immediate full occupancy based on one tour’s worth of satisfied visitors who spread their satisfaction by word of mouth.

High quality restaurants have experienced business-ending public relations as a result of an article by a dissatisfied restaurant critic.  And, trust me on this one, hospitals and clinics can be permanently (or almost permanently) erased from industry consideration on the basis of one major bad patient experience.

Hospitals that are major players in the medical tourism industry are taking bold, well-thought-out steps to make sure that they own, manage and control the complete patient experience. Hospitals have dedicated entire floors of patient rooms to serve as hotel rooms for patient companions, to retain control of as much of the patient travel and experience as possible.

Other hospitals control the tourism experience by hiring and using their own, or favored, tour operators. If you visit world-class hospitals and take a look at their lobby areas, you’ll see another example of how hospitals manage the patient experience. The types of food vendors, product vendors and services vendors are indicative of the international patients that they attract.

You may see a Starbucks or other coffee vendor, snack outlets, convenience store areas and other “comforts of home” accessories that hospitals use to enhance the patient experience. All of these amenities and activities are intended to manage and achieve positive results for the patient experience.

Let’s go back to how hospitals and clinics incorporate these considerations into their overall business model and how this is of particular interest to a marketing specialist such as myself. Specifically, let’s take a look at the patient reception step and let’s observe international patient departments.

These departments are becoming the industry standard of how a healthcare provider positions itself in the international patient component of medical tourism. In reality, the creation, maintenance and operation of an international patient department says a lot about how motivated a hospital and clinic might be in attracting non-resident patients.

Pre-patient marketing design targets the patients’ country of origin. The hospital or clinic’s international patient department has established marketing plans in the countries from which they wish to attract patients. Some of these plans include specific niche marketing. For example, a hospital or clinic that wishes to attract orthopedic patients might have agreements with physical therapists in a particular market, to refer their orthopedic clients to the hospital or clinic for treatment consideration.

For U.S.-based hospitals, they may achieve the same objective by setting up partnerships or affiliations with foreign-based hospitals to refer their affluent or wealthy clients to the U.S. hospital.  Keep in mind that the objectives are similar – namely to achieve specific niche effective marketing directed to the source of patients and directly connected to the healthcare facility for treatment.

Similarities continue in the pre-patient phase. Hospital international patient departments will offer services such as visa assistance, travel planning, lodging reservations, tours and other travel and patient amenities. They will also finalize payment options and offer payment plans.

I have found that these services are common to both inbound U.S. hospital international patient departments and foreign-based hospital international patient departments. However, I must point out that the similarity is limited to the “good” foreign-based hospitals – not all of them offer these services.

Facility-based marketing plans for foreign-based hospitals include onsite amenities, such as specific reception offices, rooms or cubicles attended to by employees who are proficient in the expected patient’s language. In addition, they include use of pre-patient paperwork and patient registration forms in the patient’s language.

Nurses and doctors who are fluent in the patient’s language may also be always on staff, or be specially scheduled to be working when specific patients arrive. One country has even implemented a medical interpreter program designed for all its hospitals, and monitors participation of its member hospitals through it.

Host-related services include transportation of patients upon arrival. This is an industry-wide standard service. However, excellent hospitals make sure that the transportation includes a language-proficient attendant, and perhaps a review of the patients’ upcoming schedules. Inbound hospital international patient departments will include an orientation with the attending physician to make sure the patient is at ease.

Outbound hospital international patient departments do not always include this service. Inbound hospital international patient departments have the business luxury of being able to build specific accommodation into their price structure, so that their patients experience complete comfort.

For outbound hospitals, they can take a page out of their inbound counterparts’ books and achieve the same satisfaction levels, by enforcing standards on the lodging providers that they select for their patients and their families.

The concept of enforcing standards can be duplicated throughout the patient experience value chain and can include tour operators, hotels, personal assistants, facilitators, concierge services, car rentals and any other service provider that impacts the patient experience.

As I’ve illustrated, there are similarities and differences between inbound and outbound facilities and the services they offer, including their international patient departments. It’s important for hospitals, clinics and governments to assess their complete patient experience value chain from Step One: Thinking, to Step Eight: After Glow (from OneWorld Global Healthcare Solutions services’ “Create Positive Word-of-Mouth Marketing Campaigns”).

They must identify the ownership of each step and how they can influence that owner to guarantee a positive outcome. They will find that the patient is at least part owner of every step, but also that they can manage the patients’ assessment of each step so that they will eventually attract and multiply international patients.

With over 17 years experience in Insurance, Marketing and Employee Benefits Management, Alex Piper possesses extensive knowledge of the U.S. Healthcare Market and the influence that Insurance Carriers, U.S. Employers, Hospitals, Physicians, Physician Groups, Healthcare Professional Organizations and Government will have on the next generation of global healthcare.

He is the President of OneWorld Global Healthcare Solutions, a consulting company committed to creating a worldwide healthcare solution. He can be reached at: or

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