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America’s New Export: Hospitals And Medical Schools

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I often cringe when I see charts displaying parallel growth lines of these two variables: the number of American fast food restaurants in a given country and local obesity rates. The bad news is that our unhealthy eating habits have been exported successfully to foreign countries. The good news is that we’re going to export hospitals and health services next.

I spoke with Emme Deland, Senior Vice President of Strategy at New York Presbyterian Hospital, about the globalization of healthcare and the exportation of American health technology and expertise. You may read my summary of our discussion, or listen to the podcast here:

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Dr. Val: Where does New York Presbyterian Hospital stand in terms of the global marketplace for medical tourism?

Deland: We’ve spent the last couple of years reviewing our strategy regarding medical tourism because we want to be a part of the global healthcare economy. There is a growing market for hospital development overseas, particularly in India, the Middle East, Eastern Europe, and China. The US offers the most advanced medical care in the world, and it’s only natural that other countries want to begin importing it. Whether it’s minimally invasive surgery, infertility techniques, or prenatal diagnostics and care – America is among the global leaders in health technology and services.

Dr. Val: What do these countries want to import exactly? Providers, infrastructure, physical plants, data systems, consultants who can advise on ways of doing things to reduce errors and improve quality?

Deland: I think there is a great need for infrastructure. Middle Eastern countries, for example, spend as little as 1.5% of their GDP on healthcare. Compare that to the United States where we spend about 16% of our GDP on healthcare. There is a tremendous amount of wealth in Middle Eastern countries that could be spent on building hospitals and developing systems of care for their citizens. Right now, when Middle Eastern nationals require advanced medical care, their government pays for them to be treated in the UK or the United States. That’s not a sustainable model. In addition, since 9/11, visa restrictions have made travel to the United states increasingly difficult – so there is great interest in developing the infrastructure to handle complex medical issues locally.

Dr. Val: When you say that there’s a need for “infrastructure” do you also mean academic centers with physician and nursing schools and so on?

Deland: Absolutely. The Weill Cornell Medical College – which is affiliated with New York Presbyterian Hospital – has a medical branch in Doha, Qatar already and the first class of physicians graduated in May 2008. Johns Hopkins manages hospitals in Abu Dhabi, UAE too.

Columbia University has many scientific affiliations globally, and New York Presbyterian will begin offering management services internationally in 2009.

Dr. Val: What are management services exactly?

Deland: They come in two forms: 1) “Green field” opportunities where we send a team of experts to help to design a hospital from scratch, and then we also help to staff it and manage it with a “c-suite” of administrators (CEO, CIO, COO) who will initiate training in hospital quality, safety, and patient-centered care. 2) We also can help improve the quality and efficiency of current facilities – providing assistance with IT, human resources, tele-radiology, teleconferencing, and physician collaboration and oversight.

We’re not trying to be a franchise, though – because we’re very cautious about our brand and how we utilize it and we’re aware of the time and travel limitations of our medical staff and management teams. If we decide to put our name on a hospital abroad, we must be absolutely confident that the quality will be equivalent to our flagship hospital in New York City. Our standards reach beyond the Joint Commission minimums.

Dr. Val: Who are the other players in this global health franchise space?

Deland: They are all the ones you’d expect: Johns Hopkins, Harvard, the Cleveland Clinic, the University of Pittsburgh, and Methodist Hospital in Houston. Duke does some educational work overseas and there are a couple of hospitals in California who are thinking about branching out into the Asian markets.

Dr. Val: Are you worried about the current economic downturn and that it might slow your efforts?

Deland: The good news is that there is still a huge global demand for healthcare services. The challenge is that if the respective governments of these countries is sponsoring the importation of U.S. healthcare systems, it could slow down the process. However, in a down economy, healthcare is still considered to be an essential commodity and private equity firms will often consider investing in healthcare if they invest in anything. Short term, the economy will slow our progress, but long term there’s still a great need for healthcare infrastructure in many developing nations.

Dr. Val: Where do you think New York Presbyterian will be in 20 years in this new global economy? What’s their “end game?”

:  Unfortunately I don’t have a crystal ball, but I can tell you that the greatest challenge is to get enough quality medical staff (nurses, doctors, administrators, and so on) to run tertiary and quaternary healthcare systems. I think it will take at least 20 years to train the necessary staff to globalize healthcare on a large scale and make sure that quality standards are met.

The opportunity for expanding clinical research efforts through global collaborations is really exciting to me. Imagine all the advances that we could make with shared data, tissue banks, and pooled resources.

I think we’ll find that India and China will develop strong healthcare infrastructures in the next 20 years. I think that development in the Middle East may be slower because of their climate (it’s over 130 degrees for several months of the year) and staffing (most of their work force is imported from other countries) challenges. However, some of these countries (particularly in the Gulf region) certainly have the financial ability to move their healthcare forward despite adversity.

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