Reconstructing Healthcare in a Global Marketplace
America's $1.5 trillion dollar healthcare system is in the midst of volume growth that many hospitals haven't seen since the mid-80s. Coile predicts "That tomorrow's challenges will be consumerism, competition, and capital." 1 Today the increased demand for inpatient care is staggering and is a significant change from the 1990s, which was characterized by rightsizing, downsizing, and consolidation of services. In addition, the bottlenecks today in emergency rooms, surgery, and critical care units are widespread and that does not include emergency room diversions, which is becoming a national issue. Meanwhile the healthcare industry continues to be transformed by a bombardment of major forces that include but are not limited to the aging population, the Internet, continued biological and technological advances, and the population growth from other countries.
From a global perspective, the availability of cutting edge healthcare services such as diagnostic imaging and noninvasive interventions continues to increase demand by the global populations at a time when international health systems are facing significant fiscal, demographic, and consumer pressures. Some of the emerging healthcare trends such as advancements in pharmaceuticals and technology are dramatically impacting the provision of care in every illness and with those advances comes a disparity in access that is recognized around the globe. A 2-tiered health system may emerge as consumers are seeking more convenient, timely access to perceived higher quality of care services, even if it means paying more out of pocket. 2
WHAT'S DRIVING ALL OF THIS?
Hagland states, "There are several broad markets driving technology-based competition which will shape effective marketing strategies, for example: intensifying intra-market competition, including the expansion of community hospitals into specialized, tertiary care services such as open heart programs, whereby previously, these programs were solely dominated by academic healthcare organizations." 3 There is also an increase in self-pay-based services such as full body scans, wellness assessments, and other complementary medical services to attract the affluent consumer. To date, I believe the single, strongest force that is driving healthcare is the continuous increase in cost. One example is skyrocketing malpractice insurance. It continues to escalate, forcing physicians to either strike or leave their practices and where there are increases in insurance costs, you can be sure that they get passed on to the consumer.
GLOBAL IMPACTS
Global healthcare structures vary significantly from country to country by macroeconomic conditions as well as the standard of living. Poverty is the most pressing global health issue. Models of healthcare services include variations of public-private, private, and charity. Insurance is available through employers and/or for self-purchase, and is creating a new consumer class for private healthcare. Stanfill believes, "That health services are moving from centralized control to decentralized control in many countries, allowing local communities to make more focused healthcare provisions." 2
Healthcare reform is a prevalent issue in all developed countries as services continue to increase in cost. The cost and demand is outpacing realistic expense allocation. The United States is at the forefront of healthcare reform initiatives with diminishing government reimbursements for care, such as Medicare reimbursement, commercial health plans, managed care, and other legislative mandates related to healthcare. The bottom line with all these reductions in reimbursement is to control costs.
Globally the standard of healthcare is inconsistent and uneven from country to country and economy to economy. One of the widely recognized benefits of globalization is improved access to information. While the World Health Organization has an ongoing program to increase dialogue between countries on the type of health and healthcare reform, we must realize that there is no global strategy for healthcare. However, as communication levels increase through technology and shared research, the global economy will eventually become seamless and comparable levels of healthcare will be realized regardless of the country, thus opening up opportunities for new providers to enter the market. 4
There are some major healthcare procedures performed in the United States that recruit patients internationally, which assist to diminish some of the barriers of entering a foreign market to provide services. Some of the facilities in the United States who recruit internationally include the Cleveland Clinic, Sloan Kettering, MD Anderson, and the Mayo Clinic to name a few. Canada also has begun sending cancer patients to the United States for radiation therapy treatments because of a shortage in specialty physicians.
From the insurance perspective, Blue Card World Wide, affiliated with Blue Cross and Blue Shield, is an international hospital network of 115 facilities in 37 countries. With more countries encouraging privatization efforts, a mechanism is needed to pay for the care, other than by out of pocket cash. If a structure can be established, future healthcare plans may replace government-sponsored healthcare and/or supplement shortages in coverage such as vision, dental, or drug benefits. 2
NEW TRENDS
"Boutique" healthcare programs that charge premium prices for first-class service such as quicker appointments, attractive waiting rooms, and special attention to patients represents a definite trend. MacStravic states, "That with the new consumerism many patients are looking for more than coddling; they are demanding new ways to make a positive difference in their life and achieve better control of their own health and healthcare program." 5 Examples of boutique healthcare programs include the following:
* The Dare Center, a "retail boutique" at Virginia Mason Healthcare in Seattle, Wash, offers members-only service where patients receive unlimited 24/7 physician access, home or office consultation, and specialist referral service-for an annual fee of $3000 for a single person.
* Marburg-Pavilion at Johns Hopkins Hospital in Baltimore, Md, charges $200 to $650 a day over the insurance rate for secluded private rooms that feature wood furnishings, private baths, TVs with VCRs, premium channels, and in-room computer hookups and fax machines.
Niche services continue to diversify and expand. Some of the newer ideas include the following:
* Quick Medx: Care sites that are offered in some of Minnesota's grocery stores. These provide medical care with a limited menu of diagnostic tests and treatments.
* Gait/Biometrics Lab: Frazier Rehabilitation Center in Louisville, Kentucky, offers services for golfers that feature "Swings in motion" analysis and recommendations for self-improvement.
The strategies of boutique healthcare range from "retail boutiques" providing low-cost tests to "executive house call" services offered in hotels in more than 250 US cities. Many physicians also have added or switched to retainer services, or cash-only arrangements where patients pay out of pocket and file their own insurance claims. Although many of these services may be limited to the affluent, their success highlights the opportunities that are found when unmet consumer needs are examined. 5
In this issue of Nursing Administration Quarterly (NAQ), I certainly appreciate the healthcare professionals who have taken the time to articulate and share their unique perspectives on controversial issues and questions that may impact healthcare in a global marketplace. Some of the topics that they have addressed include consumer distrust, global licensure, culture diversity, a mobile workforce, and financial reform, to name a few. From the journal articles that I have read, there is definitely an underlying assumption that the shift from local to a global marketplace appears to be irreversible and is gaining momentum.
Moving into the healthcare global marketplace requires careful deliberation and a well-prepared, market researched, strategic plan that addresses available markets. It is critical for the healthcare organization (HCO) to know the capabilities of healthcare providers within each country to narrow down potential markets. Customer surveys and surveys of the medical personnel will also prove to be beneficial. In addition, the marketing program must also be customized to the culture of the country and the marketing materials should also reflect the language spoken in that country. Staff in the United States must also be educated to the culture and to the expectations that will be anticipated. Hospitality services will also require a high level of attention.
The HCOs to be truly successful in the global markets must first address their own profitable growth and physician alignment to the facility's service growth strategies. Once there is consensus, then the HCO should actively involve internal and external stakeholders in all aspects of developing the global strategic marketing plan. The HCOs must also be cautious, focused, deliberate, and analytical in their planning, implementation, and evaluation of their strategic plan on an ongoing basis. The global health markets are and will continue to be a compelling challenge for the US healthcare industry in the 21st century.
REFERENCES