JULY / AUGUST 2007

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Flat Medicine

There is a long-standing tradition of diseases and individual providers crossing borders, primarily from developing to developed countries. Now well trained and experienced expatriate providers are returning home or staying home to work in newly developed corporate health care delivery systems that can compete quite favorably with less-than-perfect providers in Europe and North America. In turn, these health care systems are attracting patients from around the world who are interested in exploring high-quality, lower-cost health care alternatives. Trailing nearly every other industry, health care is finally globalizing.

Globalization was the central theme of a recent seminar organized by HMI at the New Research Building on the Harvard Medical School campus. Robert K. Crone, MD, HMI President and Chief Executive Officer, chaired a series of presentations illustrating developments in the global health care community, as viewed through the lens of HMI’s work with its institutional partners. Crone was joined by a cadre of HMI team members who discussed initiatives ongoing in India, Turkey, and the United Arab Emirates.

The term global health has long referred to public health interventions in the developing world. But as Crone explained, those efforts, combined with economic growth, have helped narrow the health care quality gap between the most advanced countries and the developing world. Today global health means not only programs to combat HIV or reduce child mortality, but also growth, innovation, and wider access to high-quality care.   

Much of the growth in health care systems development, said Crone, is occurring in the emerging economies, home to around 4.5 billion people (70 percent of the world’s population). A demographic shift is underway in many populous countries in Southeast Asia, South and Central America, and the Middle East, where life expectancy is increasing (and with it, the prevalence of chronic disease) as well as the numbers of health consumers with the means and willingness to pay out-of-pocket for one-time interventions like joint replacement and cardiac surgery. These health consumers are better informed, less willing to wait for treatment, and beginning to demand that these interventions be available close to home.

Medical tourism, an industry worth an estimated $60 billion and growing, is another driver of change. High costs and long waiting lists have thousands of patients in the U.S. and Europe looking abroad for life-altering care at an affordable price. An estimated 500,000 patients will travel to India for care this year; thousands more will turn to hospitals in Thailand, Malaysia, and Singapore. Half a million Americans are expected to leave the country for treatment.

Many of them will visit one of the new privately-run specialty hospitals catering both to international patients and the emerging native middle class. “These hospitals are able to operate cost-efficiently due to labor costs, and as greenfield developments are willing and able to institute a culture of quality from day one,” said Crone. “Many are expanding regionally and competing globally.”

HMI head Robert K. Crone: Political will and mechanisms for pooling risk are critical to health care systems development in emerging economies.

Building a health care system
A growing number of organizations around the globe have formalized collaborations with world-class academic medical institutions like HMS in order to build and enhance their expertise. HMI put a number of those collaborations on display during the seminar, including Dubai Healthcare City (DHCC), a large-scale initiative for which HMI has developed new models of governance and created two powerful entities to provide infrastructure to support postgraduate education and research: the Harvard Medical School Dubai Center (HMSDC) and the Harvard-based Dubai Harvard Foundation for Medical Research. All of this has been accomplished within a designated “free zone” wherein HMI and DHCC have a blank canvas on which to create an essentially new health care system. Presenter Mehul Mehta, MBBS, HMI’s Chief Strategy Officer, called the free zone concept “one of the dominant models of transformation in health care today.”

Underlying the challenges being addressed through the creation of DHCC is the need for high-quality postgraduate education and biomedical research systems. That’s where HMSDC and the Foundation come in. These two entities have the most promising minds in the region looking homeward as they chart their future course.

“The Harvard Medical School Dubai Center functions as a ministry of education for DHCC,” said the Robert L. Thurer, MD, the Chief Academic Officer of HMSDC and Executive Director of the Foundation. “We have to build a governance infrastructure and bring instructors in from all over the world.”

Since December 2003, HMSDC has conducted 32 education programs for nearly 6,000 Gulf Region health care professionals, taught by around 150 faculty (half of whom are from HMS). A state-of-the-art home for HMSDC is under construction. “We are using the presence of education and research to create a center of inquiry and knowledge transfer to recreate an HMS-like environment and provide healthcare informed by research and education,” said Thurer.  

The presentation of “soft” infrastructure provided by Drs. Mehta and Thurer was followed by a look at brick-and-mortar efforts currently underway in Dubai Healthcare City. Bruce Solomon, MBA, MPH, an HMI Senior Consultant, joined HMI Director of Planning Judy Mitchell, AIA in providing a glimpse of ongoing hospital design planning. (Check back with HMI World in future issues to learn more about how HMI is playing a major role in DHCC’s physical expansion, including hospital planning and design.)

Developing new centers of excellence
State-of-the-art medical centers are on the rise, but the human resource challenge remains: how to recruit and retain qualified health care professionals. When Istanbul-based Acibadem Healthcare Group first partnered with HMI, the network’s nurse turnover rate was around 33 percent. Acibadem teamed with HMI and faculty from Beth Israel Deaconess Medical Center on an extensive nursing leadership initiative designed to redefine organizational development and build the capabilities of Acibadem’s nurse managers. Two years into this initiative, reported HMI’s Elizabeth Brown, RN, MSN, MBA, Director of Clinical Services, nurse turnover is down to between 15 and 17 percent across the network. Exit interviews with those that leave show that “relationship with direct supervisor” has dropped significantly among the reasons for departure.

Wockhardt’s growing network of hospitals is at the center of South Asia’s medical tourism boom. The second largest hospital chain in India is emblematic of the new wave of high-tech corporate health care networks that are helping to reveres the medical brain drain in the developing world. Wockhardt staked its claim to regional leadership when it received accreditation from Joint Commission International in 2005, a distinction that followed an intensive quality management and performance improvement initiative with HMI.

But beyond giving international patients a choice when it comes to hip replacements, Wockhardt is operating at the leading edge of interventional cardiology, according to HMI Senior Consultant Regis de Silva, MD, MPA. Wockhardt’s Bangalore heart center regularly performs such state-of-the-art procedures as awake minimally invasive cardiac surgery, operates a state-of-the-art catheterization lab, and has achieved a phenomenal 30-minute door-to-balloon time.

Seminar attendees got a look at recent progress in HMI’s major Dubai initiatives

Copyright 2007 Harvard Medical International