Medical Travel: Exporting Patients

A few weeks ago, the Los Angeles Times ran an inauspicious feature in its business section. Several articles told readers how they can save money by seeking medical treatment in foreign countries. The problem? In a time of consumer-driven healthcare, that healthcare might very well be driven to other countries.
- The Deloitte Center for Health Solutions reports that 750,000 Americans traveled abroad for medical care in 2007 and projects the number will reach 6 million by 2010.
- Nearly 200 healthcare institutions outside the U.S. have been certified by the Joint Commission International.
-  Patients Beyond Borders, Josef Woodman's complete guide to "affordable, world-class medical tourism" is now in its second edition. It lists 40 destinations outside the U.S. that provide quality and innovation at a much lower cost.
The cost comparisons provided by Woodman are mind boggling. A heart valve replacement with bypass that costs $75,000 to $140,000 in the United States is just $9,500 in India or $25,000 in Israel or $50,600 in the United Arab Emirates. If quality is equal, we're in trouble. 
Deloitte estimates that domestic healthcare providers lost $16 billion to medical travel in 2007. Compared to $2.4 trillion in domestic healthcare spending, it's not much. But the upward trend promises to continue. Much will depend on what happens as the new administration tackles healthcare reform.
Now more than ever, the mighty U.S. healthcare industry is facing global competition. Few, if any, would argue that we provide the best medical treatment for those who can afford to pay. Will we succumb to competition and begin exporting patients—and jobs—in large numbers? Possibly.
The challenge for the U.S. healthcare industry is to compete globally on quality, cost and patient satisfaction. The opportunity for entrepreneurs is to get into the patient export business. By building high-quality global networks and making travel easy, they could deliver excellent outcomes at costs that open-minded payors, employers and individuals can't resist.

—Tom DeSanto 

The Truth Abut Blogging

After six months and 25 posts, I've learned some harsh realities abut blogging.

A blog is a tumbleweed. It lives in a vast, uncharted wilderness. You must provide the moisture to sustain it and the wind to keep it moving. A blog can easily become dry, lifeless and still.

A blog is a spouse. You will not find fulfillment and joy in blogging unless you love it, are committed fully to it and have realistic expectations for it. A blog can easily end from boredom and neglect.

A blog is a lottery. You play it regularly and hope to hit it big. You check the numbers and shake your head. 30 hits one day; none the next. It makes no sense. But you don't want to stop.

A blog is a drill sergeant. It demands the discipline to go beyond reading, thinking and sharing to obeying the regimentation, schedule and protocols of blogging. Duty calls and you must hop to it.

A blog is a personality inventory. You can learn a lot about yourself and readers can learn more about you than you could ever imagine. A blog can reveal everything from narcissism to altruism.   

A blog is a reservoir. If you love to write and have something to say, a blog collects and stores a wellspring of ideas that quench your thirst to share and hopefully serve to refresh others. (At least that's my ideal.)

To tell the truth, there are a great many things I'd rather do than blogging. For now, I'm choosing to make it a part of my life. Will other commitments crowd it out? Only time will tell.

—Tom DeSanto

Image: www.pierce.ctc.edu

Obama elected. Reform expected.

Americans went to the polls and cast their vote for "change" and "hope."

But how much change can we hope for? 

For our healthcare system, not too much, not too soon.

The problem? We all know the numbers: double-digit cost inflation and premium hikes; $2 trillion annual spending with questionable results; and 71 million Americans either uninsured or underinsured.

Obama's proposed solution? Three more numbers: $2,500, how much the plan is slated to save the typical family each year; $50 to $65 billion , the annual cost of the plan when fully phased in; and $100 billion, the upfront cost expected for bringing coverage to most of the uninsured.

And how about those other numbers? A 25% loss in value of the U.S. stock market; 5% inflation; and possible double-digit unemployment.

Beyond the numbers, how about words? Quality, affordability and universal coverage. I'm not sure the American people agree on what they truly mean or realize how difficult it will be to bring them into satisfactory equilibrium.

Bob Blendon from the Harvard School of Public Health offers the final word on numbers: 60 percent. That's the majority of Obama voters who expect him to do something major to improve healthcare.

Of all the factors influencing the success of healthcare reform, overinflated expectations may be the most difficult to control.

Our country voted for "change" and "hope." Let's be real. Let's look forward to even the most incremental of change and not lose hope.

— Tom DeSanto

Rx for Falling Hospital Philanthropy

Giving to U.S. hospitals fell 50 percent between 2005 and 2007 according to a study recently released by the Association for Healthcare Philanthropy. Fewer available dollars require more effective methods.

My prescription: Optimize the internal relationships that drive fundraising campaigns.

Running a campaign, particularly a capital campaign, involves a huge cast of characters, on the inside and outside. It demands Herculean amounts of energy, strict management of expectations and endless endurance. Myriad decisions must be made in short order to meet sequential goals for creating communications. Much too often, fundraising and marketing/media/PR people are left scurrying to meet impossible deadlines.

To avert anxiety and do the best work possible, people in fundraising and communications must break down silos and proceed with one accord from the very beginning. This requires mutual respect for the invaluable experience and talent each group offers—and demands the graceful surrender and sharing of power. (And that can make it a difficult challenge.)

Early in the planning stages, get to know each other well—beyond the cursory meetings—and establish free-flowing channels of communication. Create a process that works efficiently for everyone involved. Define objectives and assign very specific tasks. Designate shared responsibilities that cross silos. Set clear deadlines and hold each other accountable. Proceed with transparency, honesty and a singular sense of purpose. Avoid an "us" and "them" mentality at all costs.

Too many times I've seen fundraising campaigns lose their momentum and mojo because the internal relationships were dysfunctional. With hospital philanthropy falling, all of us must rise to the occasion.

—Tom DeSanto