Hospitals Worth the Trip

Medical travel, popularly referred to as medical tourism, usually means foreigners coming to a hospital in the United States for a procedure or US citizens going to hospitals abroad.

However, when someone in Fort Worth drives fifty miles to Dallas' Baylor University Medical Center, that is medical travel as well.

Medical travel happens when a woman leaves her own neighborhood, where there is an acute care hospital, and goes to another hospital outside her neighborhood. It can be travel within a community, city, county, state, or country -- or outside the country.

People are medical travelers when they pass by a local hospital that offers the same procedure as the hospital to which they travel. It is understandable when people pass by a local hospital that does not offer a procedure, treatment or test that the distant hospital provides. That is medical travel too.

A hospital in Orangeburg, South Carolina that offers maternity services is concerned when a healthy woman from Orangeburg travels to Columbia, South Carolina for what is expected to be an uncomplicated and normal vaginal delivery. If the woman expects to have a difficult delivery or the mother or fetus has health problems, then it is understandable if an Orangeburg resident travels to a hospital in Columbia where there is a neonatal intensive care unit.

What makes travel to a hospital outside your neighborhood worth the trip?

The status of "worth a special journey" (***) has been used for years by the Michelin Guide to characterize the very best restaurants. Their next lower rating is "worth a detour" (**). This is followed by "very good" (*). The lowest rating, with no asterisks but recommended, is "good at moderate prices". While some may disagree with the ratings, the person in search of a dining experience, in a city in which he or she is unfamiliar, is likely to have a pleasant meal when they go to any Michelin-rated restaurant at any rating level.

Michelin may someday rate hospitals worth a special journey. In the meantime, the hospital industry has a variety of rating services to help us find our way to that one hospital out of many that is worth a special journey.

Recently Thomson Reuters released its list of the 100 Top Hospitals for 2009. Last year, US News & World Report published its list of top hospitals. Some hospitals, like the Mayo Clinic, appear in nearly every list, regardless of the source of the list. Sometimes there are surprises, hospitals that are not known to be exceptional either within a region or within the country.

Who are we to trust? What about our local hospital that is not on either of these lists? Should a man travel to a top one-hundred hospital that specializes in prostate surgery to get his prostate removed? Or take a chance at a local hospital that just installed the latest robotic prostate removal device? Each list-maker has its own criteria and valid reasons for using either hard data such as infection rates and costs or soft data such as physician opinion. Many hospitals not on the list are quick to challenge the list's validity. Hospitals making the list are quick to get the rating posted on their web sites.

Are these top 100, regardless of which list we are looking at, really worth the trip? Is your local hospital worth the trip?

I am asking hospital marketing and public relations directors to tell me why their hospital is worth the trip.

The public relations director at a rural hospital with less than 100 beds tells me that her hospital is not worth the trip. It exists, she says, just for the people in the community. She notes, however, that she is concerned that people from the small town where her hospital is located are going to a hospital in a nearby city. The city hospital is, apparently, worth the trip.

A hospital in a mid-sized city says it offers many services and really cares about its patients, making this hospital worth the trip for most nearly everyone.

A large tertiary teaching hospital's President tells me that his hospital is worth the trip for specialized procedures that are not offered at smaller hospitals. He advises residents in other towns to use their local hospital's services for less specialized procedures.

A well-known hospital in Bangkok, Thailand says the hospital is worth the trip because of the specialized treatments, board certified physicians, American administrators, high volume of procedures performed, good outcomes, low infection rates, short recovery times, high patient satisfaction, excellent customer service, and costs lower than those in the US and other countries.

What, if anything, makes the hospital you work for, have worked for, are affiliated with, or have used -- worth the trip?

Shouldn't every hospital have at least one carefully documented quality that makes it worth the trip?

One rural hospital, unremarkable in most respects, has a celebrated lunch buffet in its cafeteria that packs in local residents and those from nearby towns every Sunday. Another hospital has a museum of surgical devices in its lobby. Still another exclusively serves American Indians but welcomes visitors to view its exhibits of one tribe's art, artifacts and culture. Another hospital has a convention center and retail shopping mall that serves the community.

Let's hear the viewpoints of patients, hospital staff, volunteers, doctors, nurses, techs, administrators, attorneys, board members, public relations and marketing directors, people whose relatives and friends who have been in a hospital, employers, insurers, pharmacists, and other who have had experience with the hospital.

Can you make a compelling argument, with documented evidence or just platitudes, for your hospital as a destination for the medical traveler? Except for the most frail and poorest among us, travel to a hospital across town, across the country or across the ocean is an option. Insurance companies are promoting travel and will assist their members in making the trip.

Comment below about why your hospital is worth the trip or, if you prefer, simply email me. If you include your phone number, I'll call you. I'll compile the results from all sources and let you know what I hear.

What makes your hospital worth the trip?

An American Dilemma

Americans are faced with taking sides on either of two models of what roles Americans can select.

One model is what I and others have characterized as the American Cowboy. The Cowboy is independent, self-sufficient, dislikes government and taxes, and believes in personal responsibility. The Cowboy, although generous on his own terms and kind to animals and children, doesn't want to see any of his tax dollars going to support people who aren't like him. The Cowboy is happiest when he can have his own house and property isolated from the bother of neighbors.

The other model is the American Liberal. The Liberal believes that he has a responsibility to take care of the needs of others as well as himself. Government and taxes exist to support the social and economic structure of which everyone is a part. The Liberal pays taxes so that all can share in services to provide, if needed, government supported transportation, housing, food, clothing, education and job training, employment, preventive health care, hospital and physician services. The Liberal likes to work with his neighbors and cooperate to improve the community.

Of course, these are extreme examples. Many Americans move from one role to the other over time.

Looking Ahead

The world's got financial problems, public health problems, and people are openly fighting one another in Pakistan, Afghanistan, Iraq, and elsewhere.

I saw a story several weeks ago out of the UK. Someone found a sign from World War II that was prepared in case the Germans ("the enemy" as the WWII Germans are referred to in the UK today) marched into the UK. The 1939 sign had one short sentence: Keep calm and carry on.

Having lived in the UK, in Exeter in Devonshire, I can appreciate the sentiment in this sentence from a British perspective.

Going Outside the US for Healthcare

We hear about people going out of the US to get prostate treatment, heart bypass and joint replacements -- and getting their US insurance companies to pay.

Now the City of Myrtle Beach, South Carolina, had an employee who was in Thailand anyway get a colonoscopy there. A colonoscopy locally costs $3,500. In Thailand, it is $700. Quality of care was good, the employee reports.

The City is now considering sending employees who need angioplasty surgery to Thailand. The procedure costs "up to $50,000" in the US and $15,000 in Thailand. A report in The State newspaper says it will save the City money to pay for the employee to go to Thailand, have the procedure, spend a few days in Thailand, and return to work.

For most hospital CEOs, marketers and doctors in the US, the issue of their patients choosing to go outside of the US for treatment isn't on their memo pads. Most see it as an aberration, something that won't have an impact on their patient base. Some hospitals, however, are setting up operations overseas where the costs are lower for their patients and others who wish to leave the US for treatment.

Some treatments, like the high intensity focused ultrasound (HIFU) procedure for prostate cancer, are now in clinical trials in the US, but promising enough that US physicians are taking their patients abroad, to Canada, Mexico and the Bahamas, for the $25,000 treatment. This is an outpatient procedure, walk in and walk out.

Let me know if you have had experience in getting treatment outside of the US. Tell us about it.

South West England

My wife and I lived in South West England while I was a Leverhulme Fellow at the University of Exeter in Devonshire.

This part of England consists of the counties of Somerset, Gloucestershire, Wiltshire, Dorset, Devon, and Cornwall. The South West also includes the port City of Bristol,in between Somerset and Gloucestershire. Bristol is on the River Avon which pours into the River Severn. One of the great men of this area was Isambard Kingdom Brunel, the builder of the first iron ocean-going ship, the SS Great Britain, launched in 1843, carrying many British to live in Australia. The ship is on display in Bristol.

Since we were based in Exeter, we traveled often in Cornwall and to the Isles of Scilly to the west of Exeter and to Dorset and Somerset to the east. These counties are tourist destinations for the English and Europeans and have their share of sheep and cows. The counties of Wiltshire and Gloucestershire, being close to London, are more urbanized.

The economic development office for this part of England, the South West of England Regional Development Agency (SWRDA) is divided into seven sub-regions: Cornwall, Devon, Somerset, Dorset, Wiltshire, South West England (containing Bristol), and Gloucestershire.

The South West is looking for knowledge-based, high tech companies. I know it's a great place to live, with excellent transportation to get around Europe or around the world. I'm looking for comments on companies that may have looked at South West England to get their feedback on this area.

Fear of Foreigners

I'm a member of a national organization that has about 1,000 members. I sent an email to a staffer and asked how many members were from outside of the US. She wrote back that there were 7 non-US members, 5 in Canada, 1 in the Bahamas, and 1 in Puerto Rico.

I went to the organization's blog site and asked a question: Should the organization actively recruit members from outside the US? Although there isn't much activity on this blog, it took several weeks for the blog moderator to read my blog. But when she did, she called me on the phone and said that I must remove my question. She said that it was up to the Board and the executive director to make such decisions and that the members should not discuss the issue. I complied and removed the offending question.

I haven't been back to contribute to the blog site since. And when my membership comes up for renewal, I'll decline to renew. There are other such organizations that I can join that have open minds and actively seek members from the US and abroad.

Curiously, the parent organization to the one that didn't like my question had learned of my interest in global issues from other sources and asked me to send them more information and references to be a part of a speaker's bureau they operated. They said they didn't have any speakers on global issues.

So here is an organization with one its offspring fearing international relationships and the parent willing to promote international relationships.

The fear of foreigners, of course, is evident in some of our political leaders who really feel that foreigners like the ones who flew into the World Trade Center are trying to get into the US to kill more Americans. That may be true, but all foreigners are treated by the immigration people in the US, on Congress' direction, as if they have bad intentions toward US buildings and people living in the US. On a recent trip from Australia to Hawaii, a video was shown by Qantas Airlines alerting non-US citizens that they would be photographed and fingerprinted upon arrival and that certain nationalities would need a valid visa or they would be denied entry.

I talked with one Australian immigration officer who said he never intended to visit the US as long as all non-US citizens were presumed to be criminals.

For many in the US, there is a problem with foreigners as members of an organization, just as some organizations in our history had a fear of having blacks in the organization. The biggest issue is that the communication between those in the US and those in other countries is effectively blocked and we do not have an opportunity to learn from one another things that would benefit both Americans and foreigners.

There is one organization, called Rotary International that advocates world friendships to achieve world peace. This organization was started in Chicago at the turn of the 20th Century by a lawyer, Paul Harris, and has millions of members and thousands of meetings all over the world every day of the work week.

I can go to Sofia, Paris, Auckland, Tokyo, Quito, Warsaw, Moscow, or virtually any city of any size and find a welcoming group of fellow Rotarians willing to have breakfast, lunch or dinner with me. Members can talk about any topic without fear of reprimand from the head office. It is an open forum. We take "banners", like little flags, with us from our home club and exchange it at another club for their banner. Then when we return to our home club, we present the other club's banner to our members.

Rotarians give millions of dollars to help people in developing countries drill water wells for washing or for irrigating their crops. One Rotary group in Cornwall, England has "shelter boxes" that contain a tent, water containers, cooking implements and other items that can be used in these temporary shelters for people who have lost their homes due to wind, fire, landslides, or flooding.

Rotary has existed and thrives after over 100 years of promoting international exchange and world peace. Rotary will still be around long after the organization I mentioned in the beginning of this blog.

International Health Care

American healthcare is sophisticated in that we have the latest technology, a variety of new drugs, and medical professionals that are dedicated, highly trained, and respected all over the world. However, our total healthcare system, in terms of outcomes, is not ranked as the world's best. In fact, some say it is rated as about the 25th best in the world.

We have the technology and the people that could make us the best in the world, but the system, when all the pieces of the puzzle are put together to show the big picture, doesn't produce the best outcomes for the people who seek care from the American health care system.

We have nearly 50 million people who, for one reason or another, can't afford, can't get, or just don't have health insurance. Having some kind of insurance, whether it is commercial, Medicare, Medicaid, military, veterans, or something else, is the golden key that opens the door to preventive care, procedures on demand, being able to see a primary care or specialty physician on demand, and getting needed medications and durable medical equipment.

Anyone, whether a citizen, resident or visitor in the USA, can get seen for care to stabilize health problems at any hospital emergency department, regardless of whether the person has insurance or cash to pay for the service. That doesn't mean they won't be billed for the service. It does mean that they will get the immediate care they need to stop the bleeding, mend the bones, or otherwise intervene when a health problem arises.

If you ask people in the US which country has the best health care, most are likely to say that country is the USA. However, when we look at infant mortality rates and other indicators of health care quality, the USA is not the best in the world. And, the USA is one of the highest cost systems. We spend more than other countries on health care, but don't get the best outcomes.

That's why many are looking at other national health care programs, such as those of France, Sweden, the United Kingdom, and our neighbor to the north, Canada, where we see higher levels of preventive care, lower expenditure on health care per capita, and more access for everyone to the total healthcare system. What we also see are best practices that we can import to the USA.

That's why I am starting a wiki on international healthcare, based on the Joint Commission web called WikiHealthCare. The address of the international healthcare wiki is at WikiHealthCareGlobal.com. The wiki is in its infancy, basically many pages that are awaiting contributors to fill in the blanks. I'm inviting contributors to report on any country in the world to provide information on what the country's healthcare system is like and what best practices and quality indicators there are in that system. Best practices can be in clinical services as well as in support services, such as marketing, public relations, planning and administration.

Anyone can read the wiki web site and anyone who registers can contribute information to the site. You can contribute.