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Tricia Johnson, Ph.D., Rush University

Editor’s Note: As the director of the Center for Health Management & Policy Research at Rush University, Tricia Johnson, Ph.D., has been studying the economic impacts of medical travel for the past six years. A recent speaker at the Center for Medical Tourism Research conference, Dr. Johnson was kind enough to speak to us about her research and share some highlights from her talk about medical travel and about the future of healthcare.

Medical Travel Today (MTT): If you don’t mind, let’s start with your background and how you came to study medical travel.

Tricia Johnson (TJ): Certainly. I originally earned my masters in hospital and health administration at the University of Iowa. For a time after that, I worked in healthcare on the provider side. I then went on to get my Ph.D. in economics. After completing my degree, I took a position as a faculty member at Rush University in the Department of Health Systems Management, a graduate program training future leaders in healthcare. 

I started to work with my colleague, Andy Garman, on a research effort funded by the Alfred P. Sloan Foundation in 2007. Our goal was to look at current and future trends related to inbound and outbound medical travel, as well as the implications of those trends for US providers and other industries. The impetus for the research came from what we were hearing from providers that inbound medical travel was becoming important.

MTT: And how did you conduct your research?
TJ: We did a number of things, including interviews with domestic providers, intermediaries and other stakeholders, and site visits with providers abroad. Our goal was to get a sense of the size of the inbound market.

MTT: How did you determine the focus of your survey or interview?
TJ: We first identified 26 hospitals with U.S. News and World Report national rankings in service lines that we knew were active areas for medical travel. Some of our preliminary evidence had suggested that reputation was a key issue for inbound patients choosing where to go for care. We originally focused on cardiology, orthopedics, cancer, and neurology. In addition, we identified other hospitals with international patient programs through our literature review and contact with various stakeholders.

Through interviews with 22 hospitals, we gained insight into the number of international patients they cared for, where the patients came from, and the infrastructure of their international program. It was a very high level study. Our study found that an estimated 43,000 to 103,000 foreigners came into the U.S. for medical care, and between 50,000 and 121,000 U.S. residents traveled abroad for necessary care in 2007.

As we’re looking at this data from an economic perspective, the big takeaway was this: While a slight net outflow of patients leaving the US for medical care existed, the resulting impact on exports was still positive for the US, due to the higher patient complexity and higher average spending per patient coming to the US. We estimate that for every $1 spent by Americans on healthcare abroad, $5.64 is spent by international patients on medical care within the US.

The balance of patients coming in and patients going out is really critical. We need reliable, and regular, mechanisms to track the balance of mobility and trade for medical care to better understand the impact of international patients on the US economy.

MTT: The numbers you cite are from 2007. What’s your sense of how things have or haven’t changed since then?
TJ: Since the original research we have met a lot of people who oversee international patient programs, and in 2010 we started collaborating with UHC (previously known as University HealthSystem Consortium) on work related to international patients.

UHC is an alliance of 116 academic medical centers and their affiliate hospitals. Through collaboration and the sharing of data, UHC aims to help members become national leaders in healthcare by achieving excellence in quality, safety, and cost-effectiveness. They provide a lot of valuable benchmarking for improvement.

We’re also working with the U.S. Department of Commerce on an important project through its Market Development Cooperator Program. The goal of the project is to stimulate growth in the number of international patients coming to the US for medical care through better data, networking and implementing best strategic business development practices. As part of this project, we are also developing better means to systematically measure the number of patients coming here for care and the associated revenue. That kind of data simply doesn’t exist now.

Toward this end, we conducted our first survey in December 2010 and January 2011. It has been interesting. Historically there’s been competition among US providers but there is a realization that competition from abroad is equally important. This is clearly felt and appreciated among the 30 to 35 providers we worked with nationwide.

MTT: Is that data available yet?
TJ: At this point we’ve only been sharing the data with participants, primarily to aid them in improving their practices.

Much of our effort over the last six months has been to promote the US as an international healthcare destination.

The US Cooperative for International Patient Programs (USCIPP) was recently launched as a means to increase the global competitiveness of US healthcare providers and to improve access to healthcare in the US for patients from around the world. USCIPP is a partnership of the International Trade Administration of the U.S. Department of Commerce, UHC, and Rush University.

It’s a truly great way for domestic providers catering to international patients to share best practices and potentially grow their business collectively. It is an exciting time – the first annual USCIPP meeting will be held in Houston in April.

Editor’s Note: A growing and highly provider-centric organization, USCIPP welcomes hospitals and hospital systems to join in its efforts. To learn more about participating email Molly Allen atUSCIPP@uhc.edu

MTT: I know you operate in a university setting. I’m just wondering if medical travel has crept into your curriculum at all.
TJ: I teach two courses to graduate students in health systems management (HSM). The first is health economics and the other is an applied research project course. This year, I integrated a module on globalization and innovation into the health economics course. It is a multi-faceted topic that brings in a number of economic concepts that relate to patients, providers, and the economy overall.

In addition, we have had students in the past three or so years pursue master’s projects on a topic related to medical travel. A current HSM student is developing a macro-level of model of medical travel to identify health and healthcare system regulatory, economic, and social factors that are associated with the number of patients coming into the country, and where they come from. Another student examined whether the length of stay for international patients seen at academic medical centers was longer than domestic patients. She found that the sickest international patients stayed longer than otherwise similar domestic patients.

MTT: Any closing thoughts on your experience as a speaker at the recent Center for Medical Tourism Research Conference you’d like to share?
TJ: Sure, while at the conference I had the opportunity to talk with graduate students in the University of the Incarnate Word’s Health Care Administration Program about some of the global trends likely to shape the future of healthcare. We had quite a bit of discussion about growing price and quality transparency, growth in the global mobility of the healthcare workforce, and the unsustainable growth in education costs. These trends are expected to further encourage providers to deliver high-value care and will influence the overall balance of patient mobility for the US.

About Tricia Johnson
Tricia Johnson, Ph.D., is associate professor and acting associate chair in the Department of Health Systems Management at Rush University in Chicago. She is also the director of the Rush’s Center for Health Management & Policy Research. As an economist, Johnson was a 2009 Fulbright Scholar to Austria. Her research interests focus on innovation and globalization from an economic perspective. She has regularly been recognized, by both students and fellow faculty, for her excellence in teaching.

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