In the aftermath of last month's 12th annual World Medical Tourism & Global Healthcare Congress in Abu Dhabi, Medical Tourism Association Co-Founder Jonathan Edelheit had the opportunity to sit down with Ran Yang-Chawla, Founder & CEO of SeeHealth LLC.
Jonathan Edelheit: We want to talk about the Chinese market a little bit, but first, we want to find out more about you. What's your background, how did you come to medical travel, and why did you create SeeHealth?
Ran Yang-Chawla: I was born in China and moved to the United States to pursue higher education. During my undergraduate career at the University of Miami, I was a member of the National Society of Collegiate Scholars for exceptional academic performance in three academic disciplines: neuroscience, psychology, and art. As a graduate student at Columbia University in New York, I was awarded a scholarship for scientific research in the field of human brain mapping. After receiving my Master’s in clinical psychology, I worked as researcher at New York Presbyterian-Columbia University Medical Center. I published scientific articles in various peer-reviewed journals and presented my work at both national and international conferences.
During my time in New York, before SeeHealth’s formation, I was often asked to arrange medical appointments and physical examinations for my family and my friends’ parents when they traveled to the United States. Their lack of familiarity with specific hospital specializations and with the healthcare appointment system, coupled with the language barrier, meant that they needed a facilitator to make the arrangements for them. I was happy to step in and felt very gratified by my ability to make such a difference in their lives. With my assistance, they received the highest level of healthcare—not only were they able to enjoy access to the best hospitals, but also the top experts in the medical field and a superior overall patient experience. The differences between the US and China healthcare systems were stark. In the US, they did not have to wait long to see a doctor, they were offered better service and more treatment options, and they were given the attention, time, and empathetic focus that multi-specialist teams can provide to a single patient. This type and level of care was completely absent in China, and I recognized this as a formative moment in my personal and professional life. I came to see that my passion for helping others could be channeled into a career to facilitate access to superior healthcare. Coupled with my experience doing research and training with psychiatric patients, I learned how vital excellent healthcare is to a person’s quality of life. I was searching for a way to make such services a necessity, rather than a luxury. And thus, SeeHealth LLC was born.
In my current role, I assist clients who have reached a critical juncture in their health journey. Many are very sick and facing an uncertain future. Despite this adversity, they are fighting with all their might to live. Their courage, commitment, and tenacity continue to inspire my work. I meet with clients who face multiple barriers in their fight for survival and wellness, but I work tirelessly to mitigate the factors that can be attended to, such as language, lack of information, geography, and cultural differences. SeeHealth’s primary mission is to show people who think they don’t have any options left that indeed they do. As opposed to my position as a clinical researcher, at SeeHealth, I spend far more time directly communicating with patients and their families and witness immediate and continual positive growth and benefits for my clients.
JE: From your perspective, can you give us a little background on the current Chinese healthcare market? Where does it stand now?
RYC: After years of closed doors, China’s healthcare market is now open for private investment, and businesses are stepping in to fill the gaps in its medical system. The deficits in China’s current model include overcrowded public hospitals; ill-prepared physicians; understaffed facilities; and outdated treatments, technologies, and medications. There is an overall negative consumer experience throughout the healthcare system. Patients seeking routine care are flooding the top-tier public hospitals, eschewing community clinics and doctors’ offices to see specialists. Lines form before midnight, and appointments are booked to capacity by dawn. Those with the means buy slots from scalpers, while most grow frustrated and angry. In addition, health insurance is inadequate, and most medical care requires substantive out-of-pocket payment, leaving many without the ability to afford even basic services, let alone critical care.
There are numerous factors driving substantive changes in China’s healthcare market: a rapidly aging population, a rising middle and affluent upper class, increasing rural-to-urban migration, and a rise in chronic and critical illnesses. Here are some supporting statistics. By 2030, it’s expected that almost 25% of China’s population will be over the age of sixty, up to 30% or more by 2050. According to McKinsey & Company, in 2012, China’s upper middle class accounted for just 14% of urban households. By 2022, they estimate, the upper class will account for 54% of urban households and 56% of urban private consumption. Approximately 230 million Chinese currently suffer from cardiovascular disease, and annual cardiovascular events are projected to increase by 50% between 2010 and 2030, based on population aging and growth alone. There are currently nearly 300 million Chinese with chronic disease, accounting for the overwhelming majority of deaths in China. This fact means that China has reached a point where chronic conditions have surpassed infectious diseases as the leading cause of early deaths.
All of these factors drive the need for more effective, diverse, and innovative healthcare solutions. The current system is simply inadequate to serve the country’s shifting demographics and health profile, and the necessity for critical care and monitoring is only expected to grow. This gap creates a unique opportunity for alternative and innovative solutions. The technology is present, government support is strong, and members of the middle and upper classes are willing to pay for better service and more effective healthcare solutions.
JE: Can you give us some more details on the outbound Chinese Traveler's Profile? What procedures are they looking for, and where do they like to go?
RYC: China’s healthcare system is mired in bureaucracy, and a myriad of obstacles confront citizens who are looking for adequate routine, preventative, or critical care. In terms of primary care, the first line of defense for illness and injury, China lags woefully behind other nations, with one general practitioner for every 6,666 people, compared with the international standard of one for every 1,500 to 2,000 people, according to the World Health Organization. China’s top hospitals (those that receive the highest international rankings) represent only 7.7% of the country’s medical centers but handle 50% of outpatient care. A 2015 study by The Lancet found that based on the United Nations’ criteria, China ranked 92 out of 188 countries in healthcare, after Cuba and Mexico.
Overcrowding, substandard medical training, rampant physician bribery, outdated technologies and facilities, and poor patient outcomes are drawing those with the financial means toward new markets that can serve their needs and provide specialized care. China’s largest travel platform, Ctrip, maintains that 500,000 citizens took medical-related trips in 2016, a number that represents a fivefold increase from the previous year. That figure is expected to grow to one million by 2020. Based on a survey of middle class citizens in Beijing , Shanghai, and Chengdu, the ideal Chinese hospital would feature the following common characteristics: specialized services, respect for patient privacy (including single rooms), location in a residential area, superior customer service and patient-centered care, and attractive physical surroundings.
Most Chinese medical travel is to Europe and Japan. Japan is geographically the easiest option, and its citizens enjoy the longest lifespan of any nation. Japanese physicians have access to the latest medical technologies, practice in sleek and clean facilities, and are perceived by Chinese as a model of modern and effective healthcare. Although India also represents a large portion of the medical tourism market overall, it is not an attractive option for many Chinese consumers because of their negative and ill-informed perceptions of the country and its healthcare infrastructure. Perhaps this will change in the future with increased patient education and as more Chinese citizens are looking for alternatives to their stagnant system.
Most of those who travel abroad do so for relatively simple procedures like plastic surgery or routine examinations. And the initial impetus for medical tourism was to find cheaper treatment and surgical options. That is a reversing trend. The rise in critical and chronic illnesses alongside an increasingly affluent middle and upper class has opened up another market sector. China lacks the latest treatment options, specialized care, and medications targeted toward cancers and other rare illnesses. For those who are desperate to find solutions, these interventions represent their greatest hope for remission and survival, and their chance to leave the country for medical care represents the choice between life or death. To illustrate this point: the five-year survival rate of Chinese cancer patients is around 30%, compared with about 70% in the United States, according to China’s National Cancer Prevention and Research Center.
The medical tourism industry represents a key intervention and alternative for Chinese citizens. There is a pervasive sense of mistrust of public institutions and the medical profession among Chinese citizens. There is good reason for this: aside from physician bribery, apathy, and insufficient training, misdiagnosis, and inadequate treatment are hallmarks of the Chinese healthcare system. This is a barrier and an opening for foreign healthcare markets to attract Chinese patients, and other countries have stepped in to fill the gaps and provide a more satisfactory experience to those who can afford to take advantage of the opportunity. For many Chinese citizens, these trips are not only life-saving; they are emotionally uplifting and psychologically revitalizing.
JE: How is the Chinese healthcare market evolving over the next five years?
RYC: China is recognizing that it needs to revamp and revitalize its medical care. There are several ways the country is pursuing this objective. It is encouraging more private investment and hospital facilities to potentially lighten the load on the country’s public hospitals. Whereas foreign ownership of healthcare facilities was formerly not permitted, this is now being hailed as one solution to its overburdened system. In addition, the government plans to increase the level of insurance coverage through the New Cooperative Medical Scheme and URBMI. This can hopefully help to cover the gap between patients’ medical expenses and their ability to pay for them.
One of the key ways in which China’s healthcare market is evolving is through greater incorporation of digital technologies, known as “fingertip medical treatment.” Some of this is already in place, such as online payments, digital communication tools, remote patient monitoring, and online scheduling. Other initiatives are on the horizon, many of these targeted toward seniors, given the rise in China’s aging population. These include home wellness kits that can provide monitoring and assessment. Other medical devices and wearables are beginning to saturate the market as well.
In terms of numbers, McKinsey & Company estimates that healthcare spending in China will reach $1 trillion in 2020, up from $350 billion in 2011. Looking beyond the scope of five years, the development of the Boao Lecheng Medical Travel Pilot Zone reflects large-scale future ambitions. The Hainan government and private sectors have injected $7 billion USD into the project, seeking to attract collaboration from international healthcare and hospitality firms to develop China’s first “Healthcare City.” The pilot zone already boasts 14 high-profile projects in the areas of acute medical care, stem cell therapy, and rehabilitation. Other plans include luxury hotel and resort developments. All of these goals are set to be achieved by 2030.
JE: Will the Chinese outbound medical tourism market decline as China invests more in healthcare?
RYC: That is a tough question to answer. It's hard to imagine that China’s investment in healthcare — either through increased government spending, more comprehensive insurance coverage, or private investment — will fill all the gaps in the current system, particularly given an aging and increasingly affluent population who need and/or want a more personalized medical experience and efficient, specialized service. Thus, it is unlikely that medical tourism will decline. On the contrary, I think that efforts such as SeeHealth’s to promote awareness of medical and treatment alternatives amongst Chinese citizens and our efforts to build solid and enduring partnerships with top doctors and hospitals around the world will lead to a rise in medical tourism, as recent upward trends reflect.
JE: Yes, all of this ties nicely back into what SeeHealth is doing. Can you tell us a little bit more about what it is you guys do over at SeeHealth?
RYC: SeeHealth is a New York-based medical tourism company that helps US and Chinese patients access top-notch treatment and care around the world. We specialize in serving patients with chronic diseases like cancer, cardiac and neuro-related conditions, and rare diseases. SeeHealth locates global healthcare providers and delivers A-Z solutions for its clients. We liaise and collaborate with internationally accredited and certified hospitals in different countries, including the US, Singapore, India, Thailand, and Japan. We facilitate clients’ receipt of a remote medical second opinion, and then compare different hospitals according to their treatment options, location and price to find the superior healthcare plan matched to each client’s financial and cultural background.
SeeHealth serves as a guide for those navigating an incredibly turbulent time of their lives and a complex and overwhelming healthcare system. We offer options and education. We understand that every client has a unique financial profile, so we provide a list of tiered services, presenting multiple treatment options and enumerating the pros and cons of each choice.
Every patient is different, as is every disease presentation. American doctors specialize in diagnosis and treatment and have access to the best and most current regimen of treatment protocols. In China, all patients with lung cancer are treated with the same, often outdated, medications. In the US, patients receive a personalized treatment plan that takes into account multiple factors regarding their overall health profile, the stage and type of cancer, and numerous other criteria for assessing care. SeeHealth performs extensive research and outreach to stay on top of medical trends and to keep pace with which hospitals and doctors are best suited to treat specific types of cancer or conduct clinical trials that may be of interest to patients. We are confident when we tell our clients that, although we cannot guarantee they will be cured of all disease after their treatment, at least in the United States, it is regarded as “curable.” Thus, an overseas treatment regimen truly represents their best option, provided they match our screening criteria.
SeeHealth performs screening for American hospitals in its selection of clients to seek overseas treatment. Components of our screening process include requiring the treating Chinese doctor to provide medical clearance indicating that the patient is physically well enough to fly. We also collect all of the client’s most recent medical records to make sure physicians in the US receive the most updated medical information about each patient whose case they review. Our emphasis is on building and maintaining relationships with the top hospitals and doctors, and part of that derives from our commitment to ensuring that patients are well-suited to travel and overseas treatment and well-educated about how it will be conducted once they arrive there. In addition, we retain both medical and daily interpreters to help patients navigate an unfamiliar environment and manage communication with hospital and medical staff once they arrive in the United States.
Our “all-in-one” services include:
- sending medical records in accordance with HIPAA regulations
- researching and communicating with the best doctors and hospitals related to specific clients’ disease presentation
- facilitating case review by 2-3 top-tier hospitals to maximize the chance of obtaining a successful treatment plan
- presenting a scaffolded treatment option plan
- negotiating with hospitals for out-of-pocket discounts
- conducting comprehensive patient education and support
- making all travel arrangements
- securing visas
- booking lodging
- scheduling all appointments
- creating a full itinerary for the duration of your stay
- maintaining ongoing communication after clients’ return to China
- facilitating patient follow-up with US doctors following patients’ return to China. This usually takes the form of remote follow-up, such as sending current lab results, images, and physical examination notes
- Arranging (per client request) aftercare in China for those who have undergone surgery, chemotherapy, or immunotherapy abroad. This may include physical therapy, Traditional Chinese Medicine, or continuing care in one of our partnering Chinese hospitals
JE: What is See Health specializing in now?
RYC: SeeHealth specializes in the treatment of critical conditions like cancer and cardiac and neuro-related diseases, and rare diseases. We work with the top-ranked hospitals in patient care around the world and monitor ratings and hospital performance closely to keep on top of current listings. We have offices in Beijing, Tokyo, and Walnut Creek, California, and on-site staff in Los Angeles, New York, Rochester, Minnesota, and Walnut Creek. We pride ourselves on maintaining a stable core of excellent and well-qualified employees.
JE: SeeHealth has created some fairly valuable strategic partnerships with leading institutions in China. Who are those partners, and why are they important?
RYC: We partner with the two best hospitals in China: the 301 Hospital, better known as the People’s Liberation Army General Hospital, and the Peking Union Medical Hospital. SeeHealth plays a role in arranging grand round for the medical staff at these hospitals with top US physicians. We hold patient gathering events, during which chief physicians from the US travel to China to lecture, consult with Chinese patients, particularly those who Chinese physicians are having a harder time treating, and tour Chinese medical facilities. These are key partnerships that we are looking forward to building and sustaining as we move forward.
JE: How many patients is SeeHealth assisting each year, and what is your growth rate over the next few years?
RYC: We conduct around 400 consultations per year now. Out of this number, about 300 clients are willing and eligible to move ahead to a full case review. Of that 300, only around 120 end up receiving treatment abroad. The remainder either obtain a remote second opinion or travel to other countries for treatment. The reasons for this alternative outcome include visa issuance problems, or a mitigating factor, such as physical condition or financial issues. Our extensive screening process also plays a role in these figures, as our criteria for treatment ensures that patients receive the care they need and that hospitals receive patients who they can actually treat successfully.
JE: What were some of the initial mistakes or challenges you encountered when launching See Health?
RYC: Many of our clients possess high and/or inflated expectations and a sense of urgency. Both of those can often be tempered with screening and education. It is a constant challenge to establish and maintain credibility with both sides of our business, Chinese patients and US physicians and hospitals. Doing so requires thorough patient education, rigorous screening, and transparent and consistent communication amongst all key players. We need to provide our clients with realistic expectations, and the hospitals have to extend their trust that we will send patients who fit their criteria for care. Over the years, we have tightened up our screening protocols and criteria.
Past mistakes include “overtrusting” patients. At times, patients may present a healthier picture than the reality of their situation. This can lead to invalid assessment of their compatibility with overseas travel and medical care. We have also been in the position where we have gotten overly attached to clients, blurring personal and professional boundaries. This has resulted in an inability to say no, and the subsequent creation of an overburdened workload with minimal profit. We have learned to be better judges of character and to maintain stricter professional standards and relationships with all of our clients as a result.
Another challenge has to do with the pervasive Chinese belief that only the top clinics, such as Mayo Clinic-Rochester, can treat them successfully. To counter this perception, SeeHealth performs due diligence on all top hospitals and learns which institutes have the highest success rates with specific types of cancer, are conducting relevant clinical trials, and offer treatment plans/packages that match clients’ budgets. We share the fruits of that research with our clients to show them that they have far more options than they think they do.
In the medical tourism field as a whole, the common challenge all companies face is how to establish patient trust. Many who come to us have seen media reports about malpractice suits targeted toward inexperienced companies or related to incidents that occurred while Chinese citizens traveled abroad for medical treatment. This instills negative and pre-conceived notions about who we are and what we do. We need to navigate these fears and misconceptions with sensitivity and care to convince patients that we have their best interests in mind and will deliver on our promises.
Yet another challenge we face is ensuring continuity of care once our clients return to China, and we are constantly working to ensure that this process goes more smoothly. Also, due to the country’s current trade war with the US, it has become far more difficult for clients to obtain a travel visa.
JE: Why do American Hospitals need partners like SeeHealth? How would you recommend US hospitals approach the Chinese market?
RYC: Physicians from Japan and Europe are already aggressively pursuing the Chinese market. Doctors from these countries travel frequently to China to see patients, and to recruit them for medical care in the physician’s respective home country. They are thus highly visible and present an attractive alternative to Chinese patients looking for superior care and a more positive overall experience. Media attention has highlighted the advanced facilities and technologies and the high patient satisfaction rate of those who undergo treatment in these countries. American physicians and hospitals need to capitalize on and intervene in this high-interest market and begin to establish on-the-ground networks with Chinese physicians and patients. This effort will require persistence, given that it is a long-term investment and the outcome is uncertain. But the business is there for American physicians and hospitals willing to invest the resources and time to recruit Chinese patients.
Though many Chinese consumers view the US as a beacon of top-notch care, they also rightly perceive its healthcare system as bloated and far more costly than that of other countries. On average, treatment in the US can cost upwards of three times the price of the same package in Japan. This is a clear barrier to US penetration in the Chinese market. And yet, through its extensive network of top US physicians and hospitals, SeeHealth is well-positioned to educate its clients about the unique quality of care available in the United States. They can also often negotiate costs for clients to yield savings, which Chinese patients, with an eye to value, appreciate.
American hospitals can increase their representation by implementing more tenacious marketing strategies and pursuing more partnerships with Chinese physicians and hospitals. SeeHealth can help to facilitate and maximize these efforts. Our company is already conducting outreach efforts to pool intellectual and clinical resources between US and Chinese doctors, such as arranging for US physicians to consult and perform grand rounds with Chinese doctors and holding “meet and greet” events for patients, Chinese doctors, and US physicians. Many Chinese hospitals want training in specific western medicine specialties, such as cardiology, oncology, women’s and children’s health and orthopedics. Also, SeeHealth plays a vital role in partnering medical staff at the best Chinese hospitals with top US physicians. We hold patient gathering events, during which chief physicians from the US travel to China to lecture, tour medical facilities, and consult with Chinese patients, particularly those whom Chinese physicians are having a harder time treating. These are key partnerships that we look forward to building and sustaining as we move forward.
Our rigorous selection criteria and post-treatment follow-up set us apart from market competitors and place us in an unparalleled position to assist US hospitals in recruiting eligible Chinese patients. We screen and monitor all patients very carefully, following these steps:
- communicate with their primary doctor to ascertain the full scope of each patient’s medical condition
- attain medical clearance for travel
- assess their financial situation to ensure that the payment process will go smoothly
- collect as many medical records as possible, including the latest images
- educate all patients in advance of their treatment, so that clients do not have unrealistic expectations or misleading information
- provide follow-up services after they return to China, such as nutrition counseling and other ongoing lifestyle support
SeeHealth has an excellent reputation and distinctive record in the field. We do not spend a great deal of time on active marketing, and our clients come to us as referred by top Chinese hospitals or past patients. We have just been honored with the International Medical Health Tourism’s awards for best patient referral and best patient experience.
American hospitals can also rely on SeeHealth to help navigate the cultural differences between US doctors and their Chinese patients, something that has become a burden to overtaxed international patient departments at US hospitals. Furthermore, over the last few years, US hospitals have faced losses accruing from international patients refusing to pay their medical bills. They want to see those cases mitigated and their finances managed more seamlessly. As a US-based company, SeeHealth is governed by the same legal regulations and obligations as the hospitals and can ensure payment and legal protections for its medical partners, a component of our comprehensive screening process outlined earlier.
Lastly, our WeChat account represents a major social media outlet for Chinese citizens. This platform offers multiple functionalities similar to a combination of Facebook, Twitter, and PayPal/Venmo. Through this extensive network, we share news articles related to wellness and health, patient stories, and the latest clinical and research news coming from our partner hospitals. We also use it to announce patient gathering events. It is a vital and vibrant information source for a majority of Chinese.
JE: Thank you so much for your time.
Looking for more information on SeeHealth? You can visit their corporate website here.
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