The following was originally published in the October 2019 special print edition of Medical Tourism Magazine, which was initially available at the 12th annual World Medical Tourism & Global Healthcare Congress in Abu Dhabi.
The development of medical travel throughout the last two decades provides an excellent vision for the decade ahead. The industry’s maturation and the incremental growth of the number of impacted and participating stakeholders provide valuable lessons, as well as a plethora of best practices to build upon. Yet, while innovation is seen in the art and science of healthcare, the business of health needs transformation, reframing a vision with more revolutionary ideas and collective execution.
Public and private leadership should see the shift in referral patterns of patients as a sign that we could do better; each one of us has an obligation to come together to do more to facilitate greater collaboration, partnership, and contribution to building up healthcare services worldwide. Long gone are the days of inbound patient referral from emerging markets without more two-way street dealing to justify these relationships. Insurance companies and providers must contribute to population health strategies not only from an ethical perspective, but also to develop a sustainable business model moving forward.
Physician training, advisory and capacity building services, academic exchange, and philanthropic ventures focusing on population health management goals are becoming the underlying requisite investment a provider or health system must offer to continue to receive inbound patient referrals.
This intersection across business units is often ignored, leaving global programs fragmented, difficult to expand, and otherwise unsustainable.
For example, there are leading hospitals in the United States collecting millions of dollars from a Caribbean government in physician training fees in areas of clinical expertise the provider offers due to its own program capacity, yet a waiting period for a mammogram can be up to two years because women’s health is not a top focus of the affiliation program. Not only does this fail to meet the needs identified in the national healthcare assessment report, but it results in inpatient referrals inbound to the U.S. for services that could and should be delivered locally with the right advisory and training programs in place. The cost to the local government far outweighs the value received because complex and minor clinical services must still be outsourced. Memorandums of Understanding, hospital affiliations, and consulting agreements are executed between governments and providers to supply a variety of services not linked to inbound patient services sought, or even to the surgeries performed in other destinations as part of philanthropic ventures. Why is there such a disconnect? Generally, the internal departments responsible for these various business development activities are not talking to each other. The result is a complete lack of continuity and lost opportunity to really generate an impact in the markets entered.
Many health systems have been working with governments for years without a defined strategy for global health and, as a result, the global health program lacks leadership support. Philanthropic programs generate funding for research and development, and advisory contracts and inbound patient flow generates revenue, but rarely do all of these activities link to one regional purpose and global health mission statement.
Moreover, physicians more often than not maintain their own relationships with referring physicians and global connections and fail to pull these relationships into the global health department, leaving systems without good data about the source of referrals. Worse yet, the international program loses revenue generation opportunities. Physician training programs, residencies, observerships, and other physician- and nursing-based programs are not organized in a way to leverage visiting or trained medical professionals as brand ambassadors for future referrals. This represents a significant disconnect.
Other critical areas involved in the business of health are being neglected. Price transparency and sensitivity, superb clinical outcomes, low complications rates, as well as a high priority focus on end-to-end care continuum for optimal patient experience are the now the norm. A new door is open, affording smaller or less well-known brands the opportunity to step in and acquire business relationships from embassies, insurance companies, and corporate referrers, defying years of historical patient referral patterns.
Trending New Industry Goals
One of the biggest areas in need of innovation is in the delivery of the patient experience. Too often patients, are just an identification number, a medical record, or a claims number on an insurance form.
This does not refer to the delivered care by nurses or physicians, per se; in failing to prioritize the transformation of the business of health, we often forget the human side of it.
We forget empathy. We forget that empathy and attention to detail in the patient care continuum is good business. The single most valuable change in the medical tourism industry has been the ‘silent pause’ taken by stakeholders all over the world to accept that riding big brands and prior patient experience alone is not enough to sustain long term business models and justify the major investment. New models of healthcare delivery urgently provide not only better quality and delivery of healthcare services, but also the better value of services built upon bundled pricing and a patient experience that all contribute to lower complications.
More employers, insurance companies, and governments direct contract with hospitals and steer patients across state borders and, in some cases, across country borders. Why? Let’s suppose perhaps they have woken out of a dream previously focused on cost-reduction strategies, only to find that the best cost-reduction strategies are based in high quality, reduced complications, and more affordable care . Providing covered patients with the right diagnosis and right treatment plan the first time around is the best care. This dream also rests upon the need to treat individuals as human beings, with the element of choice a necessity and decisions resting upon true transparency of quality and pricing. Steering individuals to centers of excellence for the right diagnosis the first time around supports putting the individual first above all else.
There is a huge disparity in healthcare delivery worldwide. But medical travel supports breaking down this disparity through clarity and universally delivered expectations. Organizations like Global Healthcare Accreditation are focused on systematizing these expectations and building standards to hold organizations and people responsible .
Accreditation for hospitals in medical travel is truly disruptive in a world of consumers requiring more personalized service and clinical excellence.
"It’s crucial to ensure patients’ needs are met, especially those who travel for medical care," said Dr. Nizar Zein, Chairman of Global Patient Services at Cleveland Clinic (Ohio). Each year we receive patients from all 50 states and more than 125 countries. We chose Global Healthcare Accreditation as it conducts a deep review of the entire Medical Travel Care Continuum, beginning when the patient first enquires about our services all the way through their arrival back home, including the patient experience at all touchpoints. Additionally, GHA reviews those sustainable business processes and practices related to medical travel that has helped us identify areas of opportunity to enhance patient experience and improve operational performance.”
The patient experience is just as important to medical travel because it’s inextricably linked to better clinical outcomes .
Healthcare is more personalized than ever, and the hospitals that are winning over the patients and referrers of care are those that ‘get it’ and give it. It’s about the individualized story for each patient, the healthcare experience, and the personalized relationship between patients and their healthcare providers .
Expanding the Metrics
Healthcare is late to globalization compared to most other industries. We can see various important trends impacting the patients who travel for care, whether they are travelers from developed countries seeking more affordable care in developing countries due to lack of insurance (or being underinsured), or patients in developing markets seeking access to better quality or avoiding long queues.
Celebrating twelve years since its inception, Medical Tourism Association has provided the industry an opportunity to reflect on some other great changes, as evidenced through the dialogues shared by leading buyers and providers of care at the live and virtual events offered by HEALTHCARE REVOLUTION and the World Medical Tourism & Global Healthcare Congress (WMTC) each year.
We are experiencing an expansion of the terminology, the scope of the industry, and the adoption of good metrics in measuring the true economic impact of worldwide access to health and wellness services, truly transforming the business of health. Many earlier professional dialogues involved heated debates about using the term ‘medical tourism’ based upon an unwillingness to connect serious medical care with tourism.
How likely was it that someone receiving a knee replacement would be found zip lining in Costa Rica? That all depends on your definition of ‘tourism’. Whether a medical travel program is even needed is also a big topic of debate, primarily by stakeholders resisting investment in technology and tools used to measure or improve efficiency and effectiveness of healthcare delivery. There has been a ‘wild west’ approach to maintaining status quo and avoiding accountability.In fact, the European Parliament released a Policy Report defining medical tourism as a subset of health tourism and spa-related wellness. They are interrelated without a doubt, yet the impact on tourism is prominent for a medical traveler with extended stays and daily in-destination spending. These days, much of the funding for medical travel programs emanates from tourism dollars allocated in the public sector. We now see the economic impact of patient mobility as one of the best measurements to utilize in determining investment policy. First, we can recognize the important link between various public sectors in health, hospitality, tourism, and economic development. Second, we can drive economic impact from one sector into the other for investment to create greater impact and fund programs that previously were not viable. Global Healthcare Resources developed a Medical Travel Calculator for planners and stakeholders to look at their health and tourism services and estimate total economic impact through job creation, taxes, and delivery of health and hospitality services.
Accountability is Key
Increasingly, payers such as insurers, employers and governments are using criteria that impact medical travelers and international patients in order to determine which hospitals will be included in their global medical networks . Factors such as quick access to treatments, international office efficiency, medical center dedication to international patients and servicing their medical needs, cultural competency, and ability to coordinate logistical support are becoming nearly as important as the quality of the medical outcomes when choosing where to send patients.
Healthcare providers who neglect these areas will find themselves gradually relegated to the sidelines by payers seeking to provide a high-quality patient experience as well as a positive medical outcome.
While accrediting bodies such as Accreditation Canada and Joint Commission International have assisted medical travel destination sites to achieve a standard of care comparable to that found in accredited hospitals within those countries, the scope of the standards does not encompass all of the significant dimensions required for medical travel.
Competencies such as cultural sensibility, financial transactions, marketing and tourism, and travel, for example, directly impact medical travelers and must be addressed in order to ensure the delivery of a high-quality patient experience at each touchpoint along the care continuum.
National accreditation bodies like the National Accreditation Board for Hospitals & Health Care Providers (NABH) in India, the Malaysian Society for Quality in Health, the Korean Health Industry Development Institute, and others are taking strides to engage their stakeholders in medical travel accreditation and certification as valued-added investment in their health sectors.
Disrupting the Status Quo
The Global Healthcare Accreditation Program (GHA) was founded in 2016 to address these gaps. GHA is an independent accrediting body that seeks to improve the patient experience and excellence of care received by patients who travel for their medical care and treatment, whether within their own country or internationally.
The GHA Program, with its independent board and Regional Advisory Committees comprised of a broad representation of key experts and stakeholders, seeks to bring clarity, and consensus around important issues facing medical travel, improving the patient experience and excellence of care.
In the 2019 Medical Tourism Pulse Survey by the Medical Tourism Association®, 100% of the respondents agreed that the experience and credentials of the medical practitioner are among the most important components to the growth of the industry. At 91 percent, accreditation and certification are almost equal in importance.
Public and Private Engagement
Strong cooperation between the public and private sector in positioning a destination as a desirable medical tourism destination is extremely important. Proponents of public-private partnerships see that sustainability relies upon having a public policy and private engagement. In the United Arab Emirates, along with Thailand, Malaysia, Jordan, and South Korea, great partnerships between the public and private sectors are seeing tremendous growth.
In Global Healthcare Resources’ Global Buyers Report, safety and security was a number one concern and decisive factor on where buyers of healthcare refer their patients for care. Nations and organizations not addressing these concerns will fall short of success without addressing it with prospective patients.
For a nation or city with safety issues promoting itself in medical tourism, it is essential to conduct a survey of public opinion on what is being done to assure the safety of visitors. There are real threats to security such as terrorism, crime, et cetera, and then potential risks like mosquito-borne viruses.
All of this should be addressed transparently the discussion should be held right from the onset to assure confidence that visitor safety is a top priority. The International Healthcare Research Center and Global Healthcare Resources partnered to launch the Medical Tourism Index (MTI) which is now a peer-reviewed, academically-validated tool to measure the perception of a destination for medical tourism.
While the MTI has just begun to explore its application in destination development strategic planning, IHRC plans to release the MTI every two to three years, expanding the consumer survey pool to targeted groups such as Chinese, Middle Easterners, Russians, and CIS nations for comparison. Currently, MTI highlights the top 41 destinations for medical travel from the perspective of Americans.
Since then several regional surveys developed including an Arabic and MENA survey to confirm the MTI destinations were valid from the perspective of other continents. Framed properly, medical travel from a government perspective has the capacity to fund population health management and national health equity programs currently underfunded and underutilized.
Global partners can serve as instigators of population health change and inspiration towards advancing global healthcare concerns such as obesity, diabetes and other lifestyle diseases. Additionally, advancements in prevention and personalized medicine through genomics should become the norm while curative care becomes more advanced through the same science.
We have not yet measured the long term impact of medical travel programs on improving access to improved quality of care and improving population health. This is our next decade of work.
If medical travel programs inbound can truly raise the standard of healthcare for local populations, every nation should be looking at the policy to develop and facilitate it.
Tools and Technology
Technology and tools that provide greater access to care and enhance the patient experience are now the requisite, yet not quite the norm.
Increasingly, traveling patients are becoming more informed and demanding more data in order to make decisions about their care. Current estimates for medical travel place the size of the industry at approximately USD $100 billion and growing, yet uniform definitions and data regarding the exact number of patients who travel, and their outcomes of care, including both clinical and patient satisfaction, do not exist.
In the 2019 Medical Tourism Pulse Survey, almost 40% of medical travel professionals say they lack the technology necessary to grow their business or organization. 43% believe adequate medical record transfer is not available to protect the privacy of the patient.
In an age of developing cures for cancer, how is it possible we are unable to protect patient privacy or find a transfer solution for a universally accepted medical record?Even worse, there is no consensus on how to define a medical traveler. Should a medical traveler be defined as only a patient who travels outside his/her country for care? Or should we also include tourists who get sick or injured and require medical care? What about foreign residents, employees, and expatriates? We cannot even begin to answer these questions or gather accurate data without agreement on this basic point. When some nations use the term ‘international patients’ and others ‘medical tourists’, the disparity of information generates a lack of trust in the underlying data.
Accessing the Patients
While cash-paying patients may be secured through search engine optimization and marketing, it is hugely unreliable from an investment perspective as the primary source of referral; each new competitor comes into the market with similar marketing and taps the same target markets.
About 86% of the professionals surveyed in the Medical Tourism Pulse Survey believe the information on their website is important when comparing healthcare providers, but only 51% of companies receive their inquiries direct from consumers.
Business to business (B2B) and business to government (B2G) potential provides for direct contracting opportunities to grow the medical travel business and really advance healthcare worldwide through strategic partnerships, affiliations, and capacity-building joint ventures that are developing.
The Medical Tourism Association® saw an opportunity to position itself as the voice of the medical tourism industry, with a primary goal to grow awareness of the business to business opportunities in medical travel. Our focus has been on building an immense buyer network to connect businesses together and grow opportunities for everyone. This is quickly becoming the MTA’s most successful niche, as no other company does this on a remotely similar scale.
The B2B space includes an employer or insurer who is incentivizing a plan member to travel to a center of excellence or an organization that they have contracted with for value-based purchasing. This may be domestic (within cities in a country), regional (like within the European Union for example), or international.
The needs of the traveling patient are immense, and yet not enough attention is spent assuring that the care continuum is safe and secure and leveraging that experience as a means of generating more patient volume. After all, the patient is our highest priority and humanity needs a far greater motivation to combine the art, the science and the business of health.
After years of bringing innovation and disruption to healthcare, wellness, medical travel, benefits, and insurance, a lot of things have come full circle to reframe our thinking. We are innovating by convening the change agents from all over the world. ‘Healthcare Revolutionaries’ are people committed to innovation, disrupting the space and the status quo.
Our world is not operating at its full potential because human beings are not operating at theirs. We’re currently in the middle of a silent cultural revolution. It’s a revolution we’re only just beginning to recognize, affecting every single living person.
This revolution is transforming our society to everyone’s benefit. It’s a call to every woman and man to rise to a new definition of leadership and create change in the world regarding health. Humanity needs far greater motivations that transcend our limited, precious time on earth to truly contribute our best while we are here.
How do we do this as part of a digital health transformation? The global healthcare industry is rapidly advancing into new areas of technology and innovation, but there are a few basic needs that remain critical cornerstones. The need to provide a top patient experience and price-sensitive, value-based specialized care continues to dominate our market. Collaborative, consensus-based industry growth must be tethered to both public policy and private sector engagement.
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 Z. Abdulhak. Strategies for Building a Quality Global Medical Network. Presentation at 6th Medical Director Summit, World Medical Tourism Congress. October 2nd, 2017.