U.S. Inbound Medical Tourism Competitiveness

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Global challenges exist and a growing trend in healthcare competitiveness abroad will affect U.S. inbound medical tourism programs in the future. The U.S. is no longer the only kid on the global stage in specialty healthcare nor is it the sole beneficiary of medical travelers looking for quality care, accessibility and affordability. Over 270 hospitals have been accredited by Joint Commission International in Europe, Asia, Africa and Latin America.


During my tenure at the Texas Medical Center, I found that the U.S. continues to serve as a beacon for specialty care and a destination for medical travelers looking for the best medical procedures and treatment due to the unavailability or accessibility of treatment or procedures at home.


Realistically, however, medical travel has become quite competitive over the past decade and certainly, in the past five years due to the availability of web-based information, the creation of international organizations dedicated to the medical travel industry and research conducted on the global industry as a whole.


While there are established inbound international patient/medical tourist/medical travel (these terms are used interchangeably and for purposes of this article medical travel will be used) programs at many leading healthcare institutions throughout the U.S., any facility or institution contemplating the creation of a program should consider what the Texas Medical Center and member institutions have done quite successfully over six decades and what challenges exist today.

A Case Study: Texas Medical Center

The Texas Medical Center in Houston is the largest medical center in the world and is comprised of 49 member institutions. As Houston grew, so did the Texas Medical Center. The Texas Medical Center Corporation (TMC) oversees the development of the medical center and provides the infrastructure similar to a municipal government. In addition, member institutions sit on the governing committees.

Over the years, many member institutions have gained global stature for the first-class specialty healthcare and state-of-the-art procedures provided such as The University of Texas M.D. Anderson Cancer Center, the Methodist Hospital/Methodist International, Texas Heart Institute at St. Luke’s Episcopal Hospital and one of the largest pediatric hospitals in the U.S., Texas Children’s Hospital.

In order to compete globally, these institutions created strategic plans with the following key points:

  • The Creation of In-House Concierge Programs for Medical Travelers from Abroad
  • Collaborative Relationships with Internationally Recognized Staff Physicians for Receiving Patients and Referring Physicians from Abroad
  • Strong Academic and Raining Programs with Local Medical Schools
  • Budgets to Support Their Strategic Global Efforts
  • Affiliation agreements with foreign institutions for academic exchange and operational support, including support with the international accreditation process, collaborative research programs with protocols to U.S. standards and additional training for medical students, residents and physicians at the U.S. affiliate facilities.
  • Foreign Representative Offices Opened in Strategic Countries for Market Positioning and Referral of Patients

In support of member institutions strategic plans and to facilitate the entry of medical travelers arriving from abroad, the TMC negotiated an agreement in 2005 with the Houston Airport System and the Houston Greater Convention and Visitor’s Bureau.


An airport liaison program was established at Bush Intercontinental Airport providing the public infrastructure support necessary with financial support for the program from the participating TMC member institutions. The multilingual airport liaisons welcome and facilitate the entry of a medical traveler and accompanying family members to the U.S.


The medical traveler is greeted upon arrival at the gate of the plane, navigated through immigration and customs with a medical visitor center outside customs for weary medical travelers and their guests to relax until transportation arrives. This program serves as a model of how public and private institutions can work together providing the infrastructure for strong medical travel programs.

The TMC has had its share of challenges, however, due to events outside its control. Prior to 9/11, the TMC received more than 40,000 medical travelers annually. Although some of the member institutions international programs continue to grow due to their strategic efforts, the overall number of medical travelers to the TMC has declined.


In 2009, the number rose to 18,000, but in 2010, the number declined to a little over 15,000. According to Suzanne Suarez with Marketing and External Affairs at the TMC, there was a decline of 12% in 2010.


In a recent article in the Houston Business Journal (May 6, 2011), Cathy Easter, president and CEO of Methodist International at The Methodist Hospital in Houston, stated that medical travel volume had increased by 20% from 2009 to 2010 with a 16% increase in revenue during the same period.


According to Easter, Methodist International relies on collaborative relationships with their physicians, a diverse multilingual and international staff with an office in Dubai for patient referrals with a strategic focus in the Middle East.


The programs with the strongest strategic plans continue to grow due to their concerted efforts in global outreach and affiliations regardless of the overall decline in patient volume at the TMC.

Some countries are elevating their national hospital certification program to U.S. standards such as Mexico adopting U.S. hospital standards in 2007 and the first in the world to do so. Should other countries follow the Mexico model of adopting U.S. hospital standards with Joint Commission for national hospital certification, the individual hospital international accreditation process will be much stronger elevating the competitiveness of the medical travel programs within those countries and in direct competition with U.S. facilities.


In addition, U.S. Department of State requirements for obtaining visas for travel to the U.S. for pleasure, business or medical reasons are stringent post 9/11 requiring for the presumption of the intent to stay in the U.S. to be overcome.


With the difficulty in obtaining a visa for entry into the U.S., many countries have created a specific visa for medical travelers in order to facilitate their entry for medical treatment. Korea created a medical visa due to the number of medical travelers arriving daily.


The post 9/11 difficulty entering the U.S. spurred countries, such as Singapore, Malaysia, Thailand and Korea to fill in the gap with accredited hospitals and the creation of medical travel programs. In light of the global competition, the competitive advantage U.S. institutions have had, should not be squandered.

Informed Patients

The world has changed and an important factor in the global medical travel industry lies with the informed patient. An informed medical traveler traveling to the U.S. or another country for medical treatment expects the following:

  • Accessibility to Medical Procedures Not Available in the Country Where They Reside
  • Availability of Medical Procedures Thereby Circum-venting the Wait Times in Their Country of Origin
  • Affordability and Value for Quality Care

Accessibility and Availability

Access to medical procedures requires priority for the medical traveler in light of their limited time in the U.S. Hospitals planning to enter the medical travel program business must plan strategically with a diverse multilingual staff and internal administrative support to provide the necessary concierge services the medical traveler expects upon arrival.


The services required to attract the medical traveler must make accessibility to those procedures in a timely manner, including but not limited to access to the attending physician and their staff, a dialogue with the physician in country and the physician in the U.S. for follow-up care, assisting the medical traveler with their family, lodging, and other needs they may require for their stay.


The decision to enter the medical travel industry requires long-term strategy and budget to provide the services necessary for the medical traveler and their families. In addition, a strong medical travel program can prove quite lucrative and profitable to any institution with strategic global outreach.


Affordability and Price Differentials

With the internet, medical travelers are savvier with regard to cost of procedures; physician’s certifications and licensing; hospital ranking; and if part of an academic center or academic setting, the state-of-the-art medical breakthroughs and procedures provided.


In today’s global economy, pricing is important and the cost savings is considerable in other countries where similar procedures or treatment could be provided at a fraction of the cost with savings of 60-80% outside the U.S.


While visiting several facilities in Mexico City last year, the programs provided in neurosurgery, cardiovascular surgery and oncology were at least 60% less than the U.S. Two of the facilities were JCI accredited and part of the same hospital system with a long-term affiliation agreement with a healthcare institution in Houston.


Other facilities visited were in the process of obtaining their JCI accreditation, conducting clinical trials under the supervision of U.S. institutions with Mexican physicians and with a large percentage of their medical staff residency and/or fellowship trained in the U.S., Canada or Europe.

Affordability of quality care comes into question when the cost of that care is double or triple the cost in the U.S. It must be acknowledged that advances in medicine are being reached every day in other parts of the world at an affordable cost to the medical traveler.


If we are to remain competitive and retain our global strategic position in specialty healthcare not just for Americans but also for the medical traveler, affordability will be a decision-making factor in years to come.

Today’s medical traveler is informed whether they rely on information from the internet and social media, a friend, a recommendation from their family physician, health insurance plan, employer or direct contact with the facility where treatment is received. The issue of transparency with regard to pricing and availability of medical packages is essential for a medical traveler to make an informed decision.


In the Deloitte 2009 Medical Tourism Report, the U.S. will receive a slight increase to 561,000 by 2017.

With cost savings abroad for treatment, inbound medical tourism programs must become more competitive and not expect to fill costly empty beds with medical travelers. In order to make up for a shortfall in reimbursement, it has been common practice to charge a premium for procedures provided to medical travelers with little or no discount for gross charges.


Today’s medical traveler knows U.S. institutions discount charges thus the medical traveler expects a discount for services provided or treatment; if not, they will go elsewhere where they will receive similar medical treatment at an affordable cost.

Suggestions for U.S. Inbound Programs

U.S. hospitals must be competitive in pricing due to the significant cost savings to the medical traveler in other countries and the information disseminated globally today. Medical travel programs and global outreach programs should be focused on specialties, centers of excellence and medical breakthroughs.


In addition, the global outreach programs should include strategic representative referral offices, affiliate and operational support agreements and with budgets to support those programs. The strongest advertising campaign is usually through word of mouth from a satisfied medical traveler and their families.


Strategic positioning is important and what market is natural to the healthcare institution. TMC member institutions have strategically positioned themselves in Latin America due to Houston’s geographic position and in the Middle East due to Houston’s oil and gas industry position in that part of the world.


The most important suggestion, I believe, begins with the hospital’s administrative decision to enter the medical travel industry. The focus for a global outreach program should be long-term not short-term with an emphasis in quality and accessible care at an affordable cost. Any program established under these guidelines should prove to be quite lucrative for the hospital’s bottom line, while providing the best-of-the-best medical care to the global community.

About the Author

Rosanna Gomez Moreno is a Texas licensed attorney and CEO of RGM Global, L.L.C., a consulting company advising local and state governments, hospitals and clinics. Ms. Moreno’s educational presentations provide an in-depth view of successful medical tourism programs for hospitals and clinics, global marketing and positioning, the travel and insurance industries impact on medical tourism and in-depth case studies of existing health care clusters globally.


As a partner in Global3, she and her partners provide consulting, project development and logistical services to companies, developers and governments focused on the Latin American market. In addition, Ms. Moreno is a partner in Blue Marble Healthcare, a healthcare cluster consulting and design company.

Ms. Moreno participates in global healthcare and medical tourism conferences around the world. Most recently, Ms. Moreno participated as a plenary speaker at the April 2011 Texas Public Health Association Annual Conference in Houston. In November 2010, Ms. Moreno was a speaker on global health clusters at the University of Incarnate Word’s Center for Medical Tourism and Research in San Antonio.


In October 2010, Ms. Moreno was a featured speaker and faculty member of the “Advanced Medical Tourism Executive Course” in Cairo, Egypt. In addition, Ms. Moreno presented an overview of medical tourism before the Whitehall Club of Houston. Ms. Moreno was a speaker at the International Tourism Fair of the Americas in Mexico City in September 2010.


Ms. Moreno presented at the first “Seminar on Health Tourism in Mexico City” and was featured as an expert on medical tourism with a discussion on the medical tourism industry in Houston on the New York-based Peter Greenberg Travel Talk Show broadcast live from Houston in August.


In April 2010, Ms. Moreno participated as a featured speaker at the “Global Healthcare and Medical Tourism Conference” in Seoul, Korea. In October 2009, she participated as a speaker in the second “World Medical Tourism and Global Health Congress” in Los Angeles.

Ms. Moreno attended the University of Texas at San Antonio earning her B.A. in 1983 and earned an M.A. in International Relations from St. Mary’s University in 1994. In 1996, Ms. Moreno attended South Texas College of Law in Houston receiving her Juris Doctorate in 1999.