Despite difficulties since Sept. 11, healthcare providers are not shying away from the business of international healthcare.
The goals and challenges remain the same: provide high-quality care and know the market. These basic tenets apply when tapping into the international arena whether it's in bringing patients to the U.S. or in expanding a presence overseas, several speakers reiterated at a recent international healthcare conference.
"The international market is dominated by a significant few," said Janet George, manager of international managed care at the 1,003-bed Cleveland Clinic Foundation. "The revenue potential makes it a sound business."
George spoke at a session on global market strategies at the Sixth Annual International Summit on the Private Health Sector. The conference, sponsored by 80 healthcare organizations including Modern Healthcare, was held in Miami earlier this month. Despite efforts by conference organizers to make the meeting more timely by adding a session on bioterrorism, attendance was down by a third this year to about 400 people from 600 last year.
Some of the conference's sessions and workshops focused on cross-border relationships, telemedicine and private health sector trends in Europe and Africa. The underlying theme was how sharing knowledge and forming networks among the international healthcare community can forge better public-private relationships that improve the quality of care.
In attracting the "tiny percentage of patients (who) can afford international care," George said, hospitals must exceed those patients' expectations. When patients come to the U.S. from other countries, they expect to get the best quality of care.
International patients are among the best educated about their choices and demand the most from their care, George said. Often they've come to see a particular physician or to undergo a specific procedure. They want to see that physician right away, they want follow-up visits and they want something in writing that they can take back with them, she said.
The challenges of attracting elite patients have always been great, but the income they provide can help offset the costs of dealing with managed-care companies, she said.
George said there have been fewer international patients at the Cleveland Clinic-where 51% of the international patients hail from the Middle East-since Sept. 11. Embassy closings in the region are one possible reason, she said, as well as the possibility that Middle Eastern patients might think twice about coming here given the ongoing conflict in Afghanistan.
In attracting more international business, the strategies providers use must be customer-driven, George said. New programs at the Cleveland Clinic are aimed at providing better service, such as "one-stop shopping" and customized escort and travel services. Knowledge of markets overseas also is essential for building relationships "to entice people to come here," she said.
While the Cleveland Clinic tries to attract patients to come to the U.S., another medical center that participated in the conference is building its overseas presence. Martyn Howgill, vice president of international business development at 437-bed University of Texas M.D. Anderson Cancer Center, spoke at the same session about how he works to "export intellectual capital."
M.D. Anderson International EspaÃ±a, a 20-bed cancer hospital in Madrid, opened in November 2000. It is the first such project undertaken by the Houston-based center.
At the hospital, Spanish patients are treated according to M.D. Anderson's regimens of care without having to go to the expense and trouble of traveling to Houston.
In its presence overseas, Howgill said M.D. Anderson is expanding its brand of "evidence-based coordination of care," which encourages greater coordination by clinicians and differs from traditional care that is based on a series of referrals.
As for the role of telemedicine in treating international patients, Howgill said physicians at M.D. Anderson are concerned that clinical quality might suffer when doctors are not able to be in the same room with the patient. Although telemedicine is a hot market for second opinions internationally, it still isn't profitable right now, he said.
The income that international patients generate can help defray other areas of patient revenue. In addition to its budding program overseas, M.D. Anderson counts on international patients-and the revenue they bring-at its Houston facility. Almost 22% of M.D. Anderson's patients are residents of Harris County, where the medical center is located, while 35% are from the rest of Texas and 37% are from other parts of the U.S. International patients represented just 6% of new patients at M.D. Anderson, but they accounted for 8% of its $1.2 billion in gross revenue in 2000, according to its annual report (See chart).
Because by state law M.D. Anderson must accept patients from Texas regardless of their ability to pay, the income that international patients bring to the Houston hospital is particularly attractive, Howgill said.