Inbound International Patient Program Issues to Contemplate

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As President Obama’s healthcare reform legislation is implemented, organizations will seek alternative income streams to increase their bottom line. One alternative is to establish an International Patient Program (IPP), which could provide a lucrative source of revenue from foreign travelers who may need care when visiting the United States.

According to Rush University researchers, for every American healthcare dollar spent abroad, international patients spend $5.64 within the United States. Because of the potential severity of illness and complexity of cases, an international patient’s length of stay is likely to be 28 percent longer than a domestic patient.


Many international patients who visit the United States have the ability to pay out-of-pocket for care even though they may have international insurance for treatments. International patients seek treatment in the United States for advanced technology and special attention, shorter wait times and for procedures unavailable at home.


Furthermore, they have become more selective when selecting a U.S. healthcare facility, seeking instead quality, high safety standards, access to treatments and impressive physician credentials not unlike a domestic patient.

Globally, healthcare organizations attempting to attract international patients have become more competitive. Governments and foreign healthcare organizations in Singapore, Thailand, Turkey, United Arab Emirates, India and South Korea have invested heavily in infrastructure and technology to meet the needs of international patients. If U.S. healthcare organizations choose to attract international patients, it is extremely important to provide the services to meet patients’ needs.

Know Your Patient

Prior to working in international healthcare, my career was focused in international private banking. Due to legislative changes post 9/11, bankers were required to “know your customer” for risk assessment with extensive due diligence conducted prior to establishing a client relationship. This same approach is highly recommended and should be put into

For every American healthcare dollar spent abroad, international patients spend $5.64 within the United States

practice as part of an IPP’s standard practice. The “know your patient” approach allows the IPP team and the physician to assess the needs of an international patient to determine preexisting medical issues and identify potential complications prior to their arrival from abroad and certainly, prior to their procedure.


A complete case management approach is necessary and should be utilized.

Total Patient Care

Focus should never stray from the patient’s medical needs. Many international patients are accustomed to a higher level of care and personal attention. In addition, the higher level of care is also a necessity due to the potential complexity of a patient’s health.


International patients entrust care to a healthcare organization and a medical team in a foreign country with a different culture from the host population. The high-level of attention to which they are accustomed requires a complete work-up prior to arrival, and questions should be asked:

  • What is the medical reason for travel to the United States?
  • What does the patient need? • What is the country of origin?
  • Does the patient need a consultation, second opinion or treatment?
  • Is the home physician available for consultation with the organization’s medical team?
  • Will an interpreter be required?
  • Who is traveling with the patient and are they the decision-maker regarding their healthcare?
  • Logistically, what is necessary for the patient’s arrival, i.e. lodging, transportation, special needs (ambulance, wheelchair), coordination at the hospital, consultation with the physician, etc.
  • Who is paying the bill — the patient, an insurer, government, a corporation, another family member, etc.?

These are just a few questions an IPP team should ask before the patient travels to the United States. Therefore, the initial work-up before the patient arrives is critically important.

Medical History

Studies have shown some of the highest patient volume involved oncology, cardiovascular and neurological specialties with medical and other surgical specialties in high demand as well. The potential complexity of a case is high when dealing with an international patient; therefore, it is important to obtain a complete medical history from a home physician when possible.


Most likely, the home physician will provide a brief history and immediate diagnosis without a complete picture of the patient’s overall health. At home, many international patients may have several sub specialists caring for them with no one coordinating care.


Without a complete picture of the patient’s overall health and the focus on their specialty needs at the moment, complications can arise after the procedure or upon their return home.

Cultural Sensitivity and Communication

Due to potential language barriers, an IPP team should provide interpreters and avoid the risk of poor communication between medical team and the patient and/or the family. There are nuances to every culture and language including colloquialisms particular to a patient’s country and even city or region of origin.


A patient requires transparency and understanding regarding a diagnosis, a thorough review of the necessary treatment or procedure and next steps in a native language. Otherwise, the patient’s understanding of the complexity of a particular case raises an element of risk and causes issues between the patient and/or family members and attending physician(s.)


In addition, a family member may be the decision-maker for the patient, a cultural issue that must be delicately, managed. In the unlikelihood of an adverse outcome, it is important that the patient and the family clearly understand potential risks and complications involved.

Other Issues to Contemplate

  • Changes in climate (cold/hot, dry/humid) and how that may affect the patient;
  • Pre-existing illnesses (diabetes, respiratory disease, renal failure, HIV, cardiovascular deficiency, special needs) should be disclosed;
  • Availability of medications vary from country to country and equivalent medications in United States should be identified;
  • With the rise of global travel, the possibility of rapid transmission of an emerging or new communicable disease, such as SARS or MERS, is a real possibility.

Continuum of Care

A sustainable IPP model requires an infrastructure that provides a continuum of care with a closed loop of communication for the patient from pre-arrival, while they’re in a country before and after treatment or procedure, post discharge and, eventually, upon a return home.

Primary Focus: The Patient

When the decision is made to establish an inbound IPP due to the potential lucrative income stream, the healthcare organization should never deviate from the primary focus — the patient. An IPP team must “know their patient” and prepare for any issues that may arise including complications related or completely unrelated to the treatment or procedure.


The patient’s overall health should be evaluated before and assessed upon arrival of the physician. Ultimately, the success of an inbound international patient program requires the necessary infrastructure to care for and meet the needs of the international patient.

About the Author

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Rosanna Gomez Moreno is a Texas licensed attorney and Partner at McMains & Moreno Global Consultants, L.L.C., a consulting and project developer providing advisory services to companies, developers and governments focused on the Latin American market. Moreno participates in global healthcare and medical tourism conferences around the world. She has a B.A. from the University of Texas at San Antonio, an M.A. in International Relations from St. Mary’s University and a J.D. from South Texas College of Law in Houston. rmoreno@mcmainsmoreno.com