News at NCH
"What is Global Healthcare?" by Allen Weiss, MD, CEO & President

Dr. ALlen Weiss, MD, MBA, FACP, FACR

Ever consider going abroad for elective surgery? Is this a scary thought? Evidently not for the 55,000 Americans who were treated in Bangkok's Bumrungard hospital in 2005, according to a New England Journal of Medicine article published in October, 2006. The statistics are probably growing but most agree that the actual numbers of Americans going abroad for open heart surgery, joint replacements, and aesthetic surgery are almost impossible to obtain.

Why do people leave this country, with arguably the best care in the world, to seek medical services far away from home? The answer is cost. Open heart surgery in India costs about $9,000, Thailand $15,000, Mexico $20,000, and California $60,000.

Currently, there are an estimated 47 million Americans without healthcare insurance. Add to these folks the multitude of people who are offered plans that have large deductibles, co-pays, or Health Savings Accounts (HSAs). These potential patients are “price sensitive,” which is why 75% of workers who are eligible for benefits turn down employer-provided health insurance, according to the California HealthCare Foundation.

As healthcare costs increase, people (e.g. the middle class) who have assets they want to protect from creditors will be more likely to shop for healthcare than the unemployed. The most common cause of bankruptcy has been related to unforeseen illnesses and either no insurance or being underinsured. Going abroad can mitigate the expense. Additionally, some national insurance companies are now offering to pay for medical care obtained abroad, and have expert case managers trained to assist in the process.

What about quality? You can save money but it won't do you any good if you are not around to spend it. Singapore boasts the most hospitals accredited by the Joint Commission International (JCI) in the region, which may be one reason why they attracted 374,000 visitors in 2005 purely seeking healthcare. The JCI is an offshoot of the Joint Commission on Accreditation of Healthcare Organizations which sanctions most U.S. hospitals, including the NCH Healthcare System. Both organizations have similar standards.

Many of these Singapore hospitals boast a documented mortality rate of less than 1% for open heart surgery, which is comparable to excellent hospitals in the United States, such as NCH. To be fair, it is unclear if the patients who are able to travel abroad are as sick as the patients who need urgent care in their own communities.

On the other hand, there are patients who come from abroad to have their care in the U.S. NCH has had patients from Europe and Canada for treatment of prostate cancer. and more than a few from around the country who, having “shopped” for quality, come to us for treatment with either the DaVinci Robot or the Cyberknife. For years, we have had patients come to NCH for hip and knee replacements, making us the second busiest joint replacement center in Florida and seventh in the entire nation. Other technologies in the U.S. are, and will be, attracting patients from abroad.

What does this all mean of an individual, our medical community, the community at large and the rest of the world? In As the Future Captures You, author Juan Enriquez shares the uncomfortable thought that the world is becoming more topsy-turvy. Healthcare is now being recognized as part of this evolution. Is healthcare abroad good or bad for an individual? How does one deal with delayed complications or other problems that do occur even in the best of circumstances. The uncomfortable but true answer is that no one knows for sure.

Can we control costs, care for all Americans, and improve quality? That is the challenge which America has always met. I think we can meet it again.




Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.