While I attended a health care conference last month in Kuala Lumpur, halfway across the planet from the hallowed hallways of Harvard Medical School, my trusty newsfeed treated me to an item that starkly underscored some of the large competitive challenges confronting the U.S. health care system and its stakeholders.
Turns out Miguel Forbes, grandson of Malcolm Forbes, had voluntarily checked into a hospital in Asia for a full health checkup, having heard from a friend that he could receive better care than in the U.S. at "five times the speed" and a fraction of the price. In brief, all went well; the hospital (Bumrungrad International in Bangkok) delivered everything Mr. Forbes' friend had promised. He sang its praises, proclaiming, "I would go back without question," and citing medical tourism as a "positive evolution toward truly global health care."
This isn't news. While Bumrungrad was the first Asian hospital to gain international accreditation (in 2002 by the prestigious U.S.-based Joint Commission International [JCI]), since then more than 350 hospitals have been awarded JCI accreditation, among them some of the largest, most profitable in the world -- often more modern and innovative than their counterparts in the U.S. Indeed, many of these hospitals have contributed significant clinical, research, and academic achievements, to the good of all patients worldwide.
Yet nearly everywhere I travel in the U.S., I continue to encounter a prevailing, defensive consumer attitude of "the United States is number one in health care." In a similar vein, I am often accused by executives within the U.S. health care sector of sending U.S. patients overseas to uncertain outcomes, or to "the competition."
This in spite of the fact that most developed nations offering equal or superior medical services tend to now do so at a lower economic and social burden than here. Health care costs represent 11.6 percent of Germany's GDP, 11.3 percent of Canada's. Upstarts such as Singapore, Thailand, and Turkey maintain health care costs at 4.0 percent, 3.9 percent, and 6.7 percent, respectively, while expanding services, including consumer health care coverage. As most of us in the U.S. are painfully aware, health care costs are now a crippling 17.9 percent of our GDP -- and rising -- while nearly 50 million Americans remain uninsured.
Does this sound familiar? Think about the outcry 40 years ago when overseas manufacturers introduced their automobiles into the U.S. While Toyota was on the way to creating affordable cars that could travel 70,000 miles without a major checkup, Detroit was busy perfecting planned obsolescence. The "Japanese invasion" turned U.S. auto manufacturing on its ear and forced change -- unwanted as it was by U.S. automakers -- that benefited millions of Americans with access to reasonably priced, high-performance consumer products.
While much of the health care "GDP gap" between the U.S. and other nations can be attributed to cost of living, it's undeniable there's plenty of room for reimagining our approach to health care, not simply in terms of reform, but in market-driven innovation that reflects achievements in other corners of the world. Singapore for example, in 2005, completely overhauled its health care infrastructure with a public/private model, organized by medical specialties and specialist care versus our antiquated general hospital model. Similarly, Singapore's MediSave program (the equivalent of our Social Security program, except it's for health care) now allows Singaporeans to travel to neighboring Malaysia for medical care, saving money for patients as well as providers up and down the health care value chain.
Yet, make the mere suggestion of sending Medicare or Medicaid patients to neighboring Mexico, and be prepared to be run out of town or dismissed as a wingnut. I should not be surprised; an entrenched status quo as large and monolithic -- and lucrative -- as health care mightily resists change even in the face of defeat. True reform will arrive with innovative approaches in telemedicine (EHR's, remote monitoring), technology (minimally invasive surgeries), and of course online applications (think ZocDoc, Castlight, PatientsLikeMe). Much of this innovation is already happening on U.S. soil, only to be adopted more nimbly and efficiently by other nations.
In these times of endless political and corporate posturing and little action, it would be refreshing to see fewer cautionary tales about the risks of health care in far-flung lands and more genuine cross-border dialogue amongst U.S. health care leaders, as so much knowledge can be gained about to bring affordable, quality medical care to citizens on our shores. Yet when lecturing at international health care conferences and workshops, I still see far too little representation from the U.S. The IMTEC conference in Monaco next year might be a good start, where I hope to see some fresh faces from U.S. health care gracing the hallways.
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