PART 3: States of Competition

11 Feb

The continuous loss of medical revenue to overseas destinations pushes more U.S. hospitals to match the low foreign prices in different ways.

World Health - Infographic courtesy of

Late in 2008, with the U.S. dollar still down over 13% against other foreign currencies over the last three years, foreigners were benefiting when they sought elective medical care in the U.S. This benefited clinics and hospitals that cater to medical tourists.

“You don’t have to look any further than this spa and cosmetic surgery center in West Palm Beach, Florida. From the waiting rooms to the treatment rooms, international patients come here from Europe, Asia, and Latin America,” said Yastine.

Innovative state legislators in West Virginia and Colorado have introduced bills to their respective state legislatures that would offer incentives to state employees to take advantage of the costs savings available through overseas medical care. Other states are joining the parade.


Dental Tourism - Infographic courtesy of

The Methodist Healthcare System in Texas has been marketing to recruit rich Mexicans to for medical procedures. Texas Medical Center recorded some 5.5 million total patient visits in 2008, including domestic and international patients.

The Anderson Cancer Center in Houston treated more than 79,000 patients who traveled there for care, 9,000 of which come from outside the Houston area.


Several hospitals in the Chicago area extend substantial price breaks automatically to anyone without medical coverage. Others will give them to anyone who asks.

Under the Knife - Infographic courtesy of

Rush University Medical Center, for instance, will reduce hospital bills by 50 percent for any uninsured patient, regardless of their income or assets. Loyola University Medical Center for poor and low-income patients are typically much more generous. The Illinois-based Healthplace America helps self-insured employers to save money via medical tourism within the U.S.

The company works with employers, teachers’ unions and large corporations. The company provides each patient with a care manager to collect medical records, schedule appointments, make travel and lodging arrangements and organize post-procedure follow-ups.

As well, the patient saves money as travel and associated expenses are covered, there are no deductibles, no co-pays, and no co-insurance. Patients choose from a network of 15 U.S. hospitals for hip and knee replacements, coronary artery bypasses and spine surgery. Insurers used to pay for service after surgery but the company helps them save up to 50% by paying cash up front.


The Philadelphia International Medicine (PIM), a medical consortium to attract foreign patients, includes the University of Pennsylvania Medical Center, Temple University Hospital and Children’s Hospital of Philadelphia, which treated some 5,000 patients from the Caribbean, Middle East and Brazil in 2006.

Affluent patients pay cash upfront for surgery and routine health checkups in large medical centers with concierge services that cater to traveling families banking, dining and shopping desires.

Also contributing to Philadelphia’s medical tourism are nine medical facilities – including Mayo Clinic, Johns Hopkins, Cleveland Clinic and Texas Medical Center – which treated over 30,000 patients from more than 100 countries in Europe, Latin America and the Caribbean.

These patients brought over US$60 million into Philadelphia’s economy in 2005 alone.

Johns Hopkins Medicine International has 40 full-time and 45 on-call interpreters. Cleveland Clinic has 35 staff interpreters and Texas Medical Center has at least 10 full-time interpreters and 25 bilingual staffers. Johns Hopkins Hospital recorded over half a million total patient visits, including domestic and international patients, and the Cleveland Clinic over 3 million in 2008.

The University of Pittsburgh Medical Center recorded over 3 million total patient visits in 2008, including domestic and international patients.


Mayo Clinic in Minnesota has at least 38 fulltime interpreters and 25 on-call employees. Mayo Clinic recorded around 150,000 total patient visits in 2008, including domestic and international patients.

New York

Cornell Medical School recorded some 2 million total patient visits, including domestic and international patients in 2008, while the Memorial Sloan-Kettering Cancer Center recorded around half a million total.

North Carolina

The 2008 Deloitte report shows that Duke University School of Medicine recorded almost 1.5 million total patient visits, including domestic and international patients.


The Greater Miami Convention and Visitors Bureau promotes Florida as a medical tourism destination. Although most foreign patients are charged higher rates than U.S. patients, business was good.

In 2008, Miami treated 12,000 foreign patients from 100 foreign countries. Florida International University Medical School, Baptist Health, Jackson Memorial, the University of Miami Hospital and Mercy hospital are among those who compete with foreign medical tourism destinations, each with their own marketing programs, live webcasts from operating rooms, and regional medical conference representatives.

Orlando, which hosted over 200 medical meetings with 170,000 attendees in 2008, now promoting medical facilities such as Medical City, a 7,000-acre medical complex at the University of Central Florida Medical School.

The Center for Natural & Integrative Medicine includes an 87,000-square foot, 126-room hotel with health screening, spa, and detoxification services, one of the several clinics that offer alternative and integrative procedures such as Vitamin IVs, Hyperbaric Oxygen Therapy, and Ozone Therapy among other alternative wellness programs.

Each year, thousands of international patients go to Jacksonville’s Mayo Clinic and the University of Florida Proton Therapy Institute at Shands. Florida Hospital offers cash-paying patients better rates than most HMOs and managed care plans would offer.

According to Miami Herald: “Many hospitals offer international patients discounts off the gross charges, but foreigners generally still pay more than Americans with private insurance, which generally negotiates rates of discounts of 50 to 70 percent off gross rates.”

In addition to direct discounts, some hospitals team up with banks and lenders to give patients better rates and copayments, such as the Bank of Bahamas Visa card, which gives cardholders up to 60% discounts at several hospitals.


The Shady Grove Fertility Center in Washington gave IVF treatment to over five dozen British patients in 2008, a 350% increase from 2007, according to Economic Report: Inbound Medical Tourism in the United States by said Erika Valdez and David G. Vequist IV. The IVF center teamed up with three fertility clinics and held seminars for potential donor egg patients in the UK.

Taking advantage of long wait times and the lack of anonymity and donor eggs in the UK, Brits also enjoy Shady Grove’s payments to donors and the reduced the three-year waiting time, the report said.


In January, the Maine-based company Hannaford Bros. Co. offered hip and knee replacements in Singapore to its employees.

The upfront price, a low-priced package for hip replacement is $9,000 compared to $43,000 in the U.S. Reverse medical tourism began when several U.S. hospitals offered to match the Singapore prices.

Hannaford has signed a contract with a Boston hospital for hip, knee and spine surgery, said Victoria Knight in a report in the Wall Street Journal.


Harvard Medicine in Boston recorded over 2 million total patient visits in 2008, including domestic and international patients.

Massachusetts General and Brigham & Women’s Hospital received at least 4,200 medical tourists, which is 16% more than their combined figures in the past six years.

A McKinsey study estimated that 87% of Latin Americans seeking medical care abroad came to the U.S., along with 33% of Europeans seeking care outside of the European Union.

Adopting the infrastructure cosmetics used by the foreign-market oriented hospitals of Thailand, some hospitals now target their marketing programs specifically to international clients, as well as build special facilities for the treatment of international visitors.


Since 2004, The University of Michigan Health System, Detroit Medical Center, Henry Ford Health System and St. John Health System attracted foreign patients from 11 countries via website advertising. In 2008, they engaged in more aggressive marketing, in response to foreign hospitals that heavily advertise in the U.S. to offer patients lower-cost medical care, said the Valdez-Vequist report.

NOTE: This Part 3 of a three-part article by Jaime Cabrera was first published in the international magazine Medica Tourism in December 2010.
SOURCES: Andi Atwater can be reached at The Wichita Eagle website is at For more details about Richard Miller’s The Healthcare Business Market Research Handbook, see For Hilary Abramson’s full report, visit http://news. The Greater Miami Chamber of Commerce website is John Dorschner can be contacted at jdorschner@MiamiHerald. com, his full report is at The press archive at contains Jeff Yastine’s report, Medical Tourists Flock to U.S. The has John Goodman’s full report, Medical Tourism Reversing Course. For Medical Tourism ~ An Economic Boost to the United States by Dr. Jose Quesada, visit http://www.medicaltourismassociation. com or contact him at Dale Van Demark’s report, How will the medical tourism industry in the United States develop? is at For information about Economic Report: Inbound Medical Tourism in the United States, contact authors Dr. David G. Vequist IV at or Erika Valdez at For Victoria Stagg Elliott’s More Hospitals Looking to Merge, Buy Physician Groups, visit For Judy Dugan’s full report, see Medical tourism: Outsourcing your health at For the full report An Overview of Medical Tourism and Its Effects on US Providers” by Dr. Maria K. Todd, visit

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