The Globalization of Healthcare: Why Americans and Canadians Travel For Care

1. The Globalization of Healthcare: Why Americans and Canadians Travel For Care David Boucher, MPH, FACHE, CPO President and Chief Operating Officer

4. Medial Tourism Medical tourism is the practice of traveling outside one’s national country to obtain medical or surgical care “As medical costs in the United States continue to rise, many patients, doctors, and employers are looking to exotic locations for first class service at third world prices. Everyday folks are realizing that for a fraction of the cost, they can have heart surgery, hip replacement and other procedures done in other countries, do a little sightseeing while they recuperate, and come home to have their insurance company foot the bill--for the surgery only of course. And in spite of the associated travel costs, the savings are still substantial.” eHow.com

5. Thailand India Costa Rica Turkey Korea Orthopaedic Cardiac General Surgery Dental Cosmetic IVF Countries & Procedures Of Choice For Americans Patients in Different Countries Travel for Different Reasons: Americans for Price Canadians for Access Russians for Quality

6. Regardless of The Supreme Court’s Decision on PPACA Costs Increasing 3x Inflation Diminishing Quality Increasing Queues Increased Demand Decreased Supply Increased Consumerism Increased Price & Quality Transparency

7. Safety, Service, & Savings

8. Safety • 2000 IOM Report, “To Err Is Human” ~ 98,000 patients die in America’s hospitals yearly as result of patient safety. Goal was to cut number in half in 5 years • 2009 Hearst News ~ The death toll from hospital-related deaths approached 200,000 The Number Doubled Rather Than Halved

9. Safety • The Equivalent To More Than One Fully-Loaded 747 Crash Each Day For a Year

10. Safety • Pneumonia and Sepsis (the leading cause of death in U.S. hospitals) killed 48,000 patients and cost $8.1 billion in 2006 (Reuters, 2/22/2010) • HHS released data from 2008: ~Rates of bloodstream infections after surgery increased 8% ~Urinary infections from catheter after surgery up 3.6% • Feds estimate that 180,000 Medicare recipients die each year from hospital mistakes.

11. Report Finds Most Errors at Hospitals Go Unreported Hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized, federal investigators say in a new report.

12. Arnold Milstein, MDStanford University “We doubt that the average U.S. hospital can offer better outcomes for common complex operations such as coronary-artery bypass grafting, for which several JCI-accredited offshore hospitals report gross mortality rates of less than 1%.” New England Journal of Medicine October 19, 2006

13. “It is politically correct, and widely believed, to say American health care is the best in the world. It is not.” Business Week, January 24, 2011 Donald Berwick, MDPrior Administrator of CMS

14. The Best Exotic Marigold Hotel…for the Elderly and Beautiful

15. The Missing Link In Consumer Transparency?

16. Have We Become Accustomed To Mediocre Service? • Patients Met at The Jet Ramp • Hospital Staff Handles Baggage • 5-Star Hospitals • Robust Nurse : Patient Ratios • Physicians Take Time to Listen • All Employees Make Eye Contact and Genuinely Smile! • Flavorful Food, 24/7 • In-Room Massages & Other Wellness Services

17. Savings Procedure Averages for Six Major Surgical Procedures CABG, Heart Valve Replacement, Vaginal Hysterectomy, Spinal Fusion, Total Hip & Total Knee Replacements Procedure Averages for Four Major Dental Procedures Crowns, Implants, Porcelain Veneers & Root Canals

18. Domestic Medical Travel • Blue Distinction Centers for Cardiac, Spine, Knee, Hip Replacement, Bariatric Surgery, Rare Cancers, & Transplants • Mobile Apps Now Available via GeoBlue for U.S. Distinction Centers • Self-Insured Employers Embracing Medical Travel Now Contracting DIRECTLY With Notable Hospitals Like The Cleveland Clinic & Johns Hopkins • Wal-Mart 1.1million employees • Kroger 334,000 employees • Lowes 161,000 employees • Pepsico 297,000 employees

19. Business Models of MT Facilitators, International Hospitals, Travel Agents Directly With Employers (Medical & Dental) Directly With Consumers Through Health & Dental Insurers

20. Why Highlight The Three S’s ? • Because With Increased Transparency, Educated Consumers Will Be Select Hospitals’ Best Customers • Sadly, The More American Consumers Know About Care Locally, The More Likely They Will Become To Seek Out Higher Quality, Safer Care – Whether At Johns Hopkins in Baltimore…..or In Istanbul • Employers Will Continue To Provide Employee Incentives To Seek Out The Best Providers

21. Questions? David Boucher, President & COO David.Boucher@CompanionGroup.com 803-758-2626