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Domestic Medical Tourism: Establishing U.S. Centers of Medical Excellence

Destination Spotlight

For years, American medical centers have welcomed patients from around the world who are in search of advanced technology, innovative surgical procedures and specialized research which may not be available in their home countries.

On the other hand, domestic medical tourism within the U.S. – where patients seek care across state lines or outside of their local hospitals – is still in the nascent stages, but the bottom line is, when it comes to health- related travel, higher quality care and lower costs tend to be the driving factors.

Facilities such as the MD Anderson Cancer Center at the University of Texas and the Cleveland Clinic – have long since recognized the essentiality of such factors, making them attractive medical tourism destinations for both domestic and international patients.

A Specialty Perspective on Cancer

Located in Houston, Texas, the MD Anderson Cancer Center is home to the largest cancer clinical trial program in the nation. Situated within the sprawling Texas Medical Center, which is the largest medical center in the world with 49 not-for profit medicine-related institutions, this degree-granting and cancer treatment research establishment has ranked as one of the top two hospitals in cancer care every year since U.S News & World Report began its annual “America’s Best Hospitals” survey in 1990.

“The market for oncology care is growing throughout the world as health systems advance and the ability to diagnose cancer in early stages increases,” said Congress speaker Martha Coleman, nurse manager of the International Center at the MD Anderson Cancer Center.

The 571-bed clinic, which maintains a staff of 18,000 and has served more than 105,000 patients worldwide as of 2010, is one of only three nationwide comprehensive cancer centers as established by the National Cancer Act of 1971.

It has garnered recognition for developing and implementing cancer treatment services such as frontline diagnostic technology, allowing physicians to pinpoint each patient’s unique cancer and tailor therapy for the best possible outcomes. Other specialty tools such as BrainSUITE and the robotic-based Da Vinci Surgical System provide cutting-edge treatment options not widely available.

As a foremost cancer care provider, MD Anderson offers extensive international services to a clientele base representing more than 90 countries, where international patients comprise 3 percent to 4 percent of new registrations and mostly come from Mexico, Kuwait, Qatar, the United Arab Emirates and Saudi Arabia.

In order to meet growing global demand, the hospital’s International Center provides each foreign patient with a representative who acts as an interpreter and serves not only as the primary source of contact, but assists with tasks such as travel arrangement, financial counseling and liaising with embassies and government payers.

“MD Anderson displays a strong commitment to international care giving in order to stay true to its mission, maintain its internationally-recognized reputation, support research and remain financially beneficial,” said Coleman.

Although many of the benefits such as medical record transcription, free language assistance and representative services outweigh the disadvantages of planning a long medical trip, the process is still not without its challenges. Securing visas and gaining access to the U.S. along with the financial commitment for initial visit and treatment are just some of the detractors which make it problematic for international patients to seek inbound domestic care.

While cognizant of these difficulties, MD Anderson’s newest marketing campaign has its sights set on Mexico, given the close proximity, and plans to emphasize treatments not available there in addition to employing web and social media tactics as a way to further capitalize on the global presence right in its backyard.

Bridging the Gap between Care and Consumer

The Cleveland Clinic, which resides in the lakeshore capital of Cleveland, Ohio, sees more than 3 million outpatient visitors and at least 2,600 new international clients from 80 different nations each year – and it continues to grow.

Ranked No. 1 in heart care and one of four top hospitals in the United States by U.S. News & World Report, the multispecialty academic medical institution caters to more than 120 specialties and sub-specialties such as heart, digestive, neurology and urology/kidney care – all for which it ranks No. 1 in Ohio and within the top six nationwide for high volume specialties.

With more than 25 percent of Cleveland Clinic in-patients coming from outside of the state of Ohio, the hospital has largely embraced domestic medical tourism from all sides and has even established partnerships.

A Kaiser Health News report from 2010 stated that Lowe’s, the home-improvement retailer, has a three-year contract with the Cleveland Clinic where willing employees and their dependents can go to the hospital for procedures such as open-heart surgeries, valve repairs and pacemakers.

By waiving deductibles and covering travel and hotel costs, the domestic travel contract can save both the patient and employer anywhere from 20 percent to 40 percent in costs.

Congress speaker Dr. William Ruschhaupt, chairman of the Global Health Center at the Cleveland Clinic, cited that many consumers travel more than 100 miles for medical care, seeking specialized procedures and better outcomes. “Easy-to-find electronic outcomes books allow consumers to compare Cleveland Clinic’s results to other institutions,” said Dr. Ruschhaupt.

As such, the Cleveland Clinic has recognized the increasing healthcare consumerism trend and now offers tools such as “Find-A-Doctor” and the online second opinion program “MyConsult.”

While domestic medical travel shows no signs of slowing down, the hospital has been keen to meet the needs of its international patients as well. The Global Patient Services division opened in 1975 provides assistance for both domestic and transnational visitors when it comes to hotels, reservations, medical planning and cultural assistance from the more than 13 different language interpreters.

As one of the more high-traffic medical tourism destinations in the U.S. with 40,000 unique national clients every year in addition to its average yearly 3 million outpatients, the Cleveland Clinic has established itself as not only a regional, but an international competitor in the medical tourism market.

Home Sweet Home – Drawbacks of Domestic Travel

While there are countless advantages to being a healthcare “consumer”, for some, the risk is not worth the price of comfort. For those that don’t want to travel for medical reasons, drawbacks such as the possibility of not being able to bring (or afford to bring if the cost is too high) loved ones puts a damper on a higher quality deal if there’s the prospect of traveling alone.

Some practitioners are reluctant to follow up on a case or attend to a complication if that patient received care at another facility, especially for international patients as liability becomes an issue.

The Choice is up to you

Domestic medical travel may not be for everyone, but for those that do opt in, compromising on quality care is not an option, and thus, medical providers such as MD Anderson Cancer Center and the Cleveland Clinic strive to maintain standards of what they deem as medical “excellence.”

“ Centers of medical excellence maximize coordination of care, improve patient access to multiple disciplines, allow experts to act as a dynamic team and earn results in optimal treatment for patients,” said Dr. Ruschhaupt.

Whether its patients are traveling within or into the U.S. for healthcare treatment, the benefits for the patient widen the scope of advantage for everyone involved by stimulating the economy of the community in which the healthcare facility is located, which not only helps to boost funding for research and technological advancement, but ultimately benefits the healthcare system as a whole.

About the Authors

Renée-Marie Stephano is the President of the Medical Tourism Association™. Ms. Stephano is also the Editor-in-Chief of the Medical Tourism Magazine, Health Tourism Magazine and Healthcare Development Magazine. Having a background in international marketing and relations, health law and litigation, she provides a valuable service to the Medical Tourism Association™ in these fields. She may be reached at

Brandon Samuels is a graduate of Northwestern University’s Medill School of Journalism and is a contributor to the editorial staff for the Medical Tourism AssociationTM. Developing an early interest in health, Brandon completed a four-year Medical Magnet Careers program, which led to experience working in areas of nursing, radiology and dermatology.

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