Health care providers supply medical services to patients, so they are essential players in the medical tourism trend. In most cases, hospital groups form “international divisions,” which specialize in treating an international clientele, and many affiliate with prestigious global medical groups such as Harvard Medical School and Mayo Clinic. They recruit physicians who have often been educated and trained in western medical schools and hospitals. They design facilities to appeal to the expectations of international patients. Providers may be government owned or private enterprises, but their growth always depends on government involvement.

The provider market gets more competitive every year, as governments fund investment in their medical capacity. Economists have long predicted that rich countries’ aging populations would strain demand on their health systems, and lower costs in provider countries offer a critical extra incentive. They all want to profit from these trends.

There are leading medical tourism providers on every continent. One example is Apollo Hospitals in India (Wikipedia), which is the largest private medical provider in Asia and the third largest in the world. It has 60 departments and over 1,000 beds in hospitals in India, Sri Lanka, Bangladesh, Ghana, Nigeria, Qatar, Mauritius and Kuwait. The Chennai hospital was one of the first in Asia to earn JCI accreditation. It is also ISO 9002 and 14001 certified. It has won numerous awards. Physicians have pioneered many procedures, having performed the first Total Knee Replacement surgery as well as Birmingham Hip Resurfacing, Liver Transplant, Coronary Angioplasty, and Radio surgeries in India. Its Cardiology and Cardiothoracic Surgery Center has performed 27,000 open-heart surgeries with a success rate of 99.6%.

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Bumrungrad International Hospital in Bangkok, Thailand (Wikipedia) is a poster child for the globalization of health care because it is so successful. It is regularly cited by reporters as a representative medical tourism site. It features 554 beds, 33 specialty centers and over 1,000 doctors. A large portion of its physicians was trained in the U.K. or the U.S. Many are board certified in the U.S., the U.K., Germany, Japan or Australia. 210 are board certified in the U.S. Bumrungrad treats 1.2 million patients per year, and conducts business in 26 languages.

Mount Elizabeth Hospital in Singapore (Parkway Health) is another medical tourism pioneer. Opened in 1979, it was the first hospital in Asia to earn JCI accreditation and ISO 2000 accreditation. it is known for cardiology, cancer treatment, and neuroscience and for minimally invasive surgeries (important in medical tourism since it shortens recovery time). Today it is owned by the U.S. medical corporation, Parkway Holdings, which has hospitals in Singapore, India, United Arab Emirates, Malaysia, Brunei and China.

Hospital Clinica Biblica in Costa Rica (official website) is the first hospital in Central America to earn JCI accreditation. It is affiliated with several U.S. medical centers, including Ochsner Medical Institutions and Mount Sinai, Florida and Tulane Medical Center, New Orleans. Although private, Hospital Clinica Biblica is not for profit. It has more than 200 physicians on staff and is expanding rapidly due to medical tourism. Today it has 65 beds, and 80 are under construction. It specializes in plastic surgery, orthopedics, dentistry, bariatric surgery, ophthalmology and dermatology.

These examples show that leading medical tourism providers combine several strengths: dedicated international departments that understand the needs of international patients. Physicians that are trained and certified in the home countries of the medical tourists (U.S. patients will be drawn to hospitals with U.S.-trained doctors). International accreditation to ensure standards for quality of care. Large modern facilities feature the most modern equipment and technology. Most broaden their appeal by offering appropriate tourism options through the international division.

However, the above examples only show one side of how the globalization of health care is affecting providers. Another dimension is the international expansion of recognized “Academic Health Centers” (AHCs) such as Harvard Medical International, Mayo Clinic, Johns Hopkins and Cleveland Clinic. These renowned institutions are expanding their presences in countries with favorable medical travel infrastructures. Their professors are researching how medical tourism will affect the practice of medicine (Harvard Business School Working Knowledge). This shows that medical tourism provides opportunities for many types of participants in health care; it is not only about low-cost country emergent competition for patients in rich countries.

As detailed in Involvement Abroad of U.S. Academic Health Centers and Major Teaching Hospitals: The Developing Landscape (Academic Medicine), leading AHCs typically follow a four-stage process when expanding abroad. Although they had long had collegial relationships with other leading medical centers, September 11, 2001 served as a catalyst to increase their activities abroad. Due to security reasons, an important portion of their international clientele was curtailed, increasing the attractiveness of international expansion.

These institutions begin international expansion by advising foreign medical schools and health centers and offering training. In certain cases, their involvement deepens when they begin offering consulting and advisory services to stage one clients. In the third stage, they offer management services, and the last stage is their ownership and direct delivery of patient care, education or research. The authors identified a small group that had been in stages three and four for several years: Cleveland Clinic, Duke University School of Medicine, Harvard Medical International (Wikipedia), Johns Hopkins International, University of Pittsburgh Medical Center, University of Texas-M.D. Anderson Cancer Center and Weill Cornell Medical College. Other leading AHCs that were in earlier stages included: Jackson Memorial Hospital, Mayo Clinic, Memorial Sloan-Kettering Cancer Center and New York Presbyterian Hospital.

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