Visioning 2026 Blog
Health Care Focus Group Comments
We have had a very active group with the health care topic as one of our focus groups. We had great dialogue and follow up and would like to hear from you if you are interested in contributing to the discussion. This particular subject is based on a concept presented by Dr. Marv Cetron at the September symposium on medical tourism. Please read the posts and add your own.
Jennifer
Diane Blinn November 21st, 2006 10:17 am
FROM: Diane Blinn
TO: Chamber of Commerce Visioning Committee
RE: Study proposal from Marvin Cetron
DATE: 11/16/06
The Cetron report discusses three different potential markets for such a clinic.
1. A clinic which would serve foreign visitors seeking medical care in the US
2. A clinic which would try to capture a segment of the US “medical tourist” market
3. A clinic which would serve US companies trying to contract for cheaper medical care for employees
The report does not recommend one approach over the other and mixes the discussion of all three together leaving a rather confused impression on the reader and making it difficult to examine the viability of the three separate items.
As best I can infer, the preliminary proposal for the center includes these components:
• Medical activities could be housed in a refitted warehouse (equipped with the latest technology).
• Patients would be housed in a hotel and treated primarily as outpatients.
• Physician staffing would primarily be foreign “post docs” working under the supervision of experienced, expert physicians.
• Nursing staff would be locally-trained nurses (motivated by incentives to pay off their student loans) assisted by elderly volunteers.
So let’s examine these ideas
Foreign visitors seeking medical care in the US have, as the report acknowledges, tended to be the wealthy able to pay to travel wherever the best, cutting edge medical care is; this can be true even in a small town, Rochester MN. Yes, this is absolutely so, there are commonalities between our situation and theirs. Mayo Clinic is indeed in a small Midwestern town, Rochester, MN which did not have a university of its own and which had a hospital built by a religious order as its starting point.
The report however, fails to identify what it is that makes people willing to overlook the difficulty of getting to a small town in the Midwest even in the winter. If you go to Mayo, and I do, what is significant in both my experience and in Mayo’s telling of its own story is that the Mayo brothers (both surgeons) “believed in collaboration and provided the resources and time required to foster what was then a revolutionary way to practice medicine.”
By 1914 Mayo Clinic had established two of the principles that have since guided it—and not coincidentally provided it with the reputation that makes it attract people from all over the world:
(1) Serving the best interests of the patients—which involved treating the patient as a whole person: “Dr. William J. Mayo repeatedly said that a sick person was not like a wagon, to be taken apart and repaired in pieces, but should be examined and treated as a whole.
(2) Group collaboration as a means of treating a person as a whole while also providing specialized services “He believed specialists should function as a unit in relation to the patient.” The facilities at Mayo are designed to encourage group collaboration—which today means not only the physical design but also the accessibility of patient data and test results.
(3) As the clinic became well known (Dr. William J. Mayo was president of the American College of Surgeons) it became widely visited and Mayo began teaching. Accumulated data from the clinical practices, with consent, was available for research as well. (In 1950 two Mayo doctors won the Novel Prize for the discovery of Cortisone.) In turn advances in knowledge and treatments were swiftly incorporated into clinical practice.
Mayo’s growth into a premier teaching and research institute (which consequently made it attractive to people in dire medical straits all over the world) grew organically out of a desire to cure patients with illnesses that were difficult to diagnose or for which there was no known treatment and out of the skill, creativity and leadership provided by the Mayo family. It was an organic growth that flowed from the attractiveness of excellence.
I believe that there are ideas that can be gleaned from studying Mayo’s success—indeed several ideas that came up spontaneously at our committee meeting strongly resonate with the success factors echoed in Mayo’s history:
• An attitude which values the role and encourages the collaboration of all health, wellness and education professionals is critical to health care in the coming decades;
• Clinical and patient data needs to be stored accessibly to facilitate collaboration and since information technology is expensive it is important to keep abreast of developing industry software and hardware standards for data transmission;
• Norfolk may be well advised to develop “centers of excellence” that is to define and capitalize on specific procedures and areas where they do considerable volume (thus acquiring experience and expertise as well as potential economies of scale.) This idea ties together discussion at our focus group with the most feasible avenue in the report
At the same time, it seems to me an unrealistic leap from where we are (beginning to really develop collaborative practices, teaching, supervision and research roles and setting benchmarks at nationally competitive levels) to what is required to offer world class patrons (cutting edge medical technology, diagnostic and surgical expertise). The facility described—a converted warehouse and a hotel with elderly volunteer—and its access (no local airport etc.) seems at odds with the intended patron profile. The idea of picking off centers of expertise where costs could be controlled also differs from that of a center where the whole person with any and all ailments and complications could be treated.
American citizens seeking “medical tourism” destinations
This market has several components and they need to be differentiated.
• Some people have the means to pay for heath care and would rather skip the complicated and controlling insurance system in the US, the high cost of voluntary surgery. They may also wish to pursue preventative measures and testing not covered by insurance while avoiding the unpleasantness of a hospital stay or the awareness of others that they are having a procedure done. These people patronize destination spas in the US that offers diagnostic services in housing with full exercise or pampering amenities and gourmet diet menus as well as a location which has natural wonders. Such facilities either require considerable investment or a location where cost of living is so much cheaper it compensates for travel. As the report acknowledges we cannot compete with the costs of third world countries. We do not appear to have an awesome natural endowment such as Zion Canyons or Colorado mountains & forests to capitalize upon. The healthcare focus group didn’t focus on either luxury markets or preventative care, nonetheless the diagnostic/spa facility is an interesting idea if liability was not an issue and there was a source of funding for an investment in an industry (spa care) in which we do not have much local expertise.
• There are people who go outside the US to get treatments prohibited in the US. This is clearly not our market.
• There are people who make the decision to cross the border strictly on the basis of economics. The border tens to be physically accessible to them so they don’t incur significant travel expenses. Across the border, the standard of living allows for significantly lower wages for service providers across the border and the costs of compliance with a regulatory environment is lower. As Cetron himself concedes, the Midwest may have a cost of living lower than the costs but the differential is not as great as US to Mexico, therefore we are unlikely to attract such individuals.
• An allied idea that I have heard my husband express at a state level, which would require changes in state law/policy is for the state of NE to consider positioning itself so that it had a liability strategy that attracted industry to the state be it in sport jumpers or manufacturers of hunting weapons as in my husband’s ideas or in spa/diagnostic services such as those offered in Bangkok and in the US. This idea involves NE putting a price/liability cap on accidental death, dismemberment etc. which equaled whatever the military pays the widow or provides for the injured soldier. The service must be received instate or the buyer must come to the state to purchase the equipment and in both cases must sign a waiver aligning themselves with the state’s insurance and suit settlement policy.
Outsourcing of corporate health plans
Cetron identifies a possible trend still in small numbers of US corporations outsourcing contracts for health care services for their employees. Here, there is some potential and there are a lot of ifs and issues, including liability issues, regularity issues (for the kind of facility built) and uncertainties regarding where group health care plans really will go, how much would need to be invested to place ourselves competitively in this stream, whether corporations seek separate sources for different procedures or more generalized outsourcing, how we connect with corporations likely to do this. I would suspect if we want to pursue this option, we need further study by a specialist in health care not a futurist in general. I note in passing that this category is not medical tourism but corporate group health plans and multiple outsourcing.
In closing, I would also note that the group at the very end of the meeting brought up three important healthcare issues but did not have time remaining to go to any depth with them:
• The proposal for a joint training program for nursing with University of Nebraska
• Faith Regional Hospital’s need to find a source of funding to replace that which came from the Benedictine order
• The future of citizen health in the community (as opposed to the economics of the healthcare industry, our charge for the day) in which preventative care and the role of education looms large.
• We hoped these topics are addressed subsequently or by some other group.