1. The Rise of Domestic Medical Tourism and Effective Panel
Use for Tourism Research
Rudly Raphael – President, qSample
Dr. Christine Oschell – University of Montana
Dr. Simon Hudson – University of South Carolina
The Rise of Domestic Medical Tourism and
Effective Panel Use for Tourism Research
2. Text
The Role of Research Panels in
Montana Tourism Research
Christine Oschell, PhD
Director of Survey Research
Institute for Tourism and Recreation Research (ITRR)
University of Montana
3. Background
• How does my institute work?
• Why a panel?
• Recruiting panel members.
• Benefits of a panel.
4. Case Study 1: Gas Prices and
Travel: What will happen?
• Panel survey of previous visitors to Montana
and those interested in Montana
• Survey administered March 19- 27, 2012
• 627 respondents
• http://surveyanalytics.com/s/1-1442120-
2964638
5. Any
Trip
MT
Trip
Would spend less on discretionary
items
85% 65%
Do less costly activities 83% 64%
Would eat out less 71% 54%
Stay fewer nights in hotel/motels 65% 45%
Change mode of transportation to MT 55% 17%
Eliminate trips? 34% 14%
How might rising gas prices affect
your upcoming pleasure trips?
6. Case Study 2: Flexibility
in Montana Travel
• Panel survey done in February 2013.
• Yielded 1,363 responses.
• Informed major decisions for the Montana
Office of Tourism.
• Ease of sharing results.
http://surveyanalytics.com/s/1-1442120-
3111942
8. 8
Agenda
• What is domestic medical travel?
• Who are the key players?
• Why the growth?
9. 9
What is domestic medical travel?
• “Domestic tourism for the primary purpose of
invasive, diagnostic, or lifestyle medical treatments.”
10. Who are the key players?
Medical Tourists
Motivated By:
Affordability
Availability
Opportunity to vacation
Privacy and anonymity
Advanced technology
Better quality care
Quicker access
Medical Brokers
Travel Agents
Online Agents
Employers
Insurance
Companies
Direct Channel
Hotels
And
Resorts
Medical
Medical Facilities
-Invasive
-Diagnostic
- Lifestyle
Demand Intermediaries Supply
Source Market
Externalities
Economy
Health System
Political System
Destination
Externalities
Destination brand
Political Stability
Accreditation
Accessibility
11. Demand
• Influenced by:
– Affordability
– Availability
– Opportunity to vacation
– Privacy and anonymity
– Advanced technology
– Better quality care
– Quicker access 11
16. Boeing Co. has a similar arrangement for heart
surgery at Cleveland Clinic for the company’s
83,000 nonunion employees, dependents and
retirees.
16
17. PepsiCo employees covered by its health insurance
plan can travel to Johns Hopkins Medicine in
Baltimore for heart surgery and joint replacements
with no out-of-pocket costs.
17
18. Lowe’s have a deal with Cleveland Clinic
making its cardiac care available to
employees.
18
20. • After conducting medical tourism research in
other countries, Galichia Heart Hospital decided
to challenge itself to see if it could offer
comparable prices on heart procedures and other
services.
• By cutting prices, the hospital found it was
attracting an additional two medical tourism
cases a week, or approximately 100 a year,
which generates $1million in incremental
revenue per year. 20
21. • Oklahoma is positioning itself as the medical
tourism destination for oncology care in the U.S.
21
22. 22
Why the growth?
• 1. Growth in health and wellness
• 2. A reaction to outbound medical tourism
• 3. More employers and insurers are offering financial
incentives to encourage workers to consider domestic
medical
• 4. The aging population and the baby boomer cohort
• 5. Consumer trends
• 6. Destinations see the health sector as an opportunity
• 7. A recognition of the economic impacts
• 8. Technology (e.g. Fresenius Medical Care)
27. 3. Financial incentives
• In 2009, a supermarket chain in Maine, with
27,000 employees, offered to send its staff
needing knee or hip replacements to Singapore.
The medical costs would be so low that the
company would pay the employee’s insurance co-
payment of about $2,500 and the travel expenses
for the employee and a spouse or companion.
• The move attracted the attention of hospitals in
Maine and Boston, who offered to match the
Singapore prices. In the following two years, ten
employees had the surgery, but all elected to stay
in the U.S. 27
All trips84% will change the number of trips73% will stay closer to home73% will change trip destination55% will change length of trips35% will eliminate at least one pleasure tripMT trips37% would reduce distance traveled within MT36% would camp more35% would stay more with friends and relatives16% would change destination within MT15% would reduce LOS in MT12% would eliminate their trip to Montana12% would increase LOS in MT 6% would increase distance traveled within MT
ISTANBUL—Turkey's economy is getting hairier, as a booming medical sector profits from a growth spurt: mustache transplants.Long favored as a destination for the follicly challenged, Turkey's cosmetic surgeons have for years offered hair implants to those who are balding on top. Now hair transplants for the face are growing in popularity, cosmetic surgeons and tourism agencies say, with men from the Middle East, Europe and Asia coming to Istanbul seeking a virile addition for the upper lip.
There is evidence, however, that domestic medical tourism is becoming more organized. Healthplace America, for example, offers a travel-for-care benefit directly to health plans that offer discounts including travel and lodging on surgeries performed in 35 locations throughout the U.S. Likewise, Healthbase, a medical tourism company based in Newton, Mass., works with healthcare providers in California, Florida, Kansas and Nevada helping them fill beds for certain discounted surgeries (Lubell, 2009). The company has found that for hospitals, the medical tourism business is an especially useful way to fill beds at weekends.
One Denver company, BridgeHealth Medical, specializes in negotiating discount rates with hospitals and extends those rates to big businesses. In the future, it seems domestic medical tourism will reshape the way healthcare is delivered, making quality, cost, and efficiency crucial for hospitals and physicians to compete in the marketplace.
Medical tourism, while still in its infancy, continues to expand beyond plastic surgery in Las Vegas.“I know it’s hard to believe, but it’s about $20,000 cheaper to come here and have this done –– even when you figure in the cost of the airplane flight for me and my wife and staying in a hotel for a week,” Kimberly said. “Everybody in medicine in Alaska figures they’ve got a captive market so they can make more money, charge more than $40,000 for knee and hip work in the hospital. I would have had to pay thousands of dollars in deductibles and this way the insurance is taking care of everything.”Kimberly was able to take advantage of BridgeHealth Medical Inc. in Denver, one of a handful of companies in the United States that assists employers, insurers and patients with the logistics of surgery shopping, becoming part of his new insurance plan.The company has negotiated bundled fixed rates for procedures with dozens of surgical centers across the country, including Crovetti’s. Sometimes the rates are as low as $19,000 for hip and knee replacements that often cost more than twice that at many hospitals. Under such an arrangement, all services, including physician, anesthesiologist and hospital or facility charges, are covered by a flat fee that is generally far lower than the sum of the individual charges.“The plan member generally ends up not having to pay deductibles or co-pays,” said Cade Ross, a Bridge account manager who noted that her company contracts only with facilities that are in the top 25 percent when it comes to performance measures that include infection rates and patient outcomes.To Kimberly, the opportunity to come to Las Vegas “where the price is right and the medical care outstanding,” seems like a miracle. For years, well past the time his knee started to hurt, he continued his work regimen for a wastewater treatment system, painfully walking up rocky, steep inclines on Alaska’s north slope in the dead of winter, putting off surgical intervention because he knew he’d have a hard time even meeting his insurance deductible for what is often a $50,000 operation in Alaska.
A small but growing number of U.S. corporations are offering their insured employees the option of undergoing certain procedures at highly ranked health systems across America at almost no out-of-pocket cost to them — travel included.The companies believe sending heart and spine patients elsewhere would result in improved care for patients and lower costs for employers. These programs usually involve a large company negotiating a bundled rate from a health system for certain services. The procedures are then offered to employees who need them, with no co-pays or deductibles. Travel expenses for the patient and a caregiver are usually thrown in. Employees still have the option of receiving these services in their hometown, but co-pays and deductibles apply. For example:Wal-Mart Stores announced Oct. 12 that, as of Jan. 1, 2013, 1.1 million people covered under its employee health insurance will have access to heart and spine surgeries at one of six health systems identified as “Centers of Excellence.” The health systems are Cleveland Clinic; Geisinger Medical Center in Danville, Pa.; Mayo Clinic sites in Rochester, Minn., Scottsdale, Ariz., and Jacksonville, Fla.; Scott & White Memorial Hospital in Temple, Texas; Virginia Mason Medical Center in Seattle; and Mercy Hospital Springfield in Springfield, Mo. The latter hospital is the closest to Wal-Mart’s corporate headquarters in Bentonville, Ark.
As of Oct. 1, 2012 Boeing Co. had a similar arrangement for heart surgery at Cleveland Clinic for the company’s 83,000 nonunion employees, dependents and retirees.
brand new Methodist Stone Oak Hospital that had opened in San Antonio, Texas in Spring of 2009. The hospital has apparently declared itself the “hospital of the future” featuring state of the art design and architecture, accompanied by a level of service that goes above and beyond what one typically finds in health care.Hospitals in Washington State are relying on innovative, hotel-like design elements to attract insured patients and generate better outcomes and profits.For example, Swedish Medical Center's new Issaquah campus and St. Elizabeth in Enumclaw look more like spa and wellness centers, rather than traditional hospital facilities
Deloitte Center for Health Solutions estimated that the U.S. lost $15.9 billion in domestic consumer spending to medical tourism in 2008, and 900,000 American traveled overseas last year for medical treatment.
Some of the biggest brand names in health care delivery are deciding that it's not enough to be a prestigious place in the distance.Places like Mayo Clinic in Rochester, Minn., Cleveland Clinic and MD Anderson Cancer Center in Houston have established affiliate programs that put their names on systems far afield from their main campuses. Duke University Health System in Durham, N.C., is working with LifePoint Hospitals, a large chain of for-profit community hospitals based in Brentwood, Tenn., to set up joint ventures to buy hospitals. Generally, the prominent organizations are partnering with local institutions that are established, but are often not considered the biggest or most prestigious names in their home area.The motivation by both sides in these deals is stronger branding as a way to increase revenue, marketing experts say. For the name-brand institutions, affiliating with, or buying, a local hospital can formalize existing clinical relationships and allow them to capture revenue from patients who might not otherwise go to the home base. For the local institutions, their hope is that by putting the Mayo or MD Anderson name on their buildings, they can attract patients who might otherwise have passed them by for a better-known facility.
the Bucksbaums are donating $42 million to the university of Chicago to create an institute devoted to improving medical students’ handling of the doctor-patient relationship. The Bucksbaum Institute for Clinical Excellence will be led by Dr. Mark Siegler
Missouri’s Hospital Association recently commissioned a study into domestic medical travel, suggesting that it created over 3,000 jobs and generated $124 million in non-medical travel expenditures in 2009 (Southeast Missouri Hospitals, 2010).The report suggests that the tourism industry should work with the healthcare community to inform potential patients about the opportunities Missouri offers in the state’s largest cities – St. Louis, Kansas City and Springfield.