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MEDICAL CARE OUTSIDE THE UNITED STATES.

Change and challenge is in the wind that 2008 comes to an end. The same is true when examining this month's ReachMD XM 160 special series - Focus on Global Medicine. We take a look at both the changes and the challenges impacting global medicine.

The rising number of uninsured is leading 10s of 1000s of Americans each year to seek medical care outside the United States. But what kind of care are they getting and how can you as doctors get involved. Welcome to The Clinician's Roundtable on ReachMD, The Channel for Medical Professionals. I am Bruce Japsen, the healthcare reporter of the Chicago Tribune and with me today is Alex Marxer. Alex is the Chief Operating Officer of Health Travel Guides. Mr. Marxer is a Cofounder of California-based Health Travel Guide and specializes in building bridges between technology and business, which he has done for the last 15 years. In Health Travel Guides, patients are linked to everything from elective procedure such as LASIK eye surgery and breast augmentation to more specialized operation such as hip replacement, heart surgery, and cancer treatment among many, many other things these days and so please do welcome Alex Marxer from Health Travel Office in San Diego.

BRUCE JAPSEN:

Mr. Marxer, welcome to ReachMD XM 157, The Channel for Medical Professionals.

MR. ALEX MARXER:

Thank you for having me.

BRUCE JAPSEN:

This is an interesting phenomenon and I think we are still seeing thousands of people who are leaving this country to get medical care and it is not just cosmetic procedures. Tell us about Health Travel Guides and what kind of a market is there out there for this and where is this headed?

MR. ALEX MARXER:

You know, interestingly enough, we found that the company because my partner Herbs Stevens had an issue himself, he had a very bad snow-boarding accident and what happened was he developed a spinal fluid leak and the physician in Stanford unfortunately did not do a good job and after the second surgery, he dropped from his insurance and he had to have another 2 surgeries and since he, you know, didn't have insurance anymore, he got stuck with the 150,000 dollar bill and that prompted him to start looking into, you know, other options and what he had found is that in other places such as Singapore, he could have had the same thing done for 20,000 dollars and he then decided that perhaps this is a very interesting business to get into and he then approached me, we had done business previously in the Bay area and we incorporated the company in 2006 and we have seen an amazing influx of increase as you say into all kinds of different procedures, both on the elective side and on the rather complex side as well and it has been a while wild ride ever since.

BRUCE JAPSEN:

Well, that is very interesting and you tell us about like how many patients are now coming, I mean because I was recently at the American Medical Association, there was statistics on the order of 150,000 or more US citizens are going abroad and also we could talk a little bit about the kind of care people are getting, because we know that the US Healthcare System is a good one and people would like to stay, there certainly are people out there when you talk about going abroad and making a bucket, it kind of make some people nervous, but if you could tell a little bit about just how many people are doing this, why they are doing it, and what kind of care are people getting?

MR. ALEX MARXER:

In terms of volume, I believe were somewhere in the middle, you know, there has been a lot of hype in the press on this phenomenon for a while and then McKinsey, I believe came out with a report that said well, it is not real. The truth typically in an early market like this always lies in the middle. The reliable statistics that we see is from a hospital such as Bumrungrad who has reported that they serviced the 150,000 US people by themselves

BRUCE JAPSEN:

And where is this?

MR. ALEX MARXER:

That is in Thailand.

BRUCE JAPSEN:

Okay.

MR. ALEX MARXER:

And so those guys would cover the 150,000 all by themselves. They do about 500,000 for inpatients a year all together. Numbers probably much closer to 700,000 to a million and that is if you count the scores of people who actually cross the border into Mexico. Many people don't report on that so much because it is not as exotic as talking about the Asian countries and people flying all the way to Thailand, Singapore, but the fact is that the people who cross the border make up a very, very large number, in fact to such a degree that certain hospitals right close to the border reported to me that their revenue is, you know, up to 70% from US people. So, they specifically cater to that market.

BRUCE JAPSEN:

And are these elderly folks or they are uninsured folks or who are these people?

MR. ALEX MARXER:

You know, it has been a surprise to us just how diverge that group is, I will tell you 1 person that I know on care and she has a house in Delmore and very well off, but she is self employed and, you know, insurance premiums to the self employed have risen to such a degree that she just decided to drop her insurance altogether and she is, you know, upper middle class person who is looking for a better deal and so she and her friends had approached us on both dental and plastic surgery and just regular treatment options across the border and they are loving it because you had asked the question of what kind of treatments do people receive, the interesting factors that specially in Latin America where the culture is very relationship based, those systems have been pressured the doctors so much to turn people into numbers. People get amazing attention, you know, I was surprised myself. I put myself through this and just the level of attention and care that you get is a totally different level that I had experienced in the US myself.

BRUCE JAPSEN:

Bringing the idea of the quality up and even in the United Stated, I mean the measurement of quality is depending on who you talk to, but some of the concerns of the American Medical Association or other groups is like what kind of a seal of approval do these companies such as yours give to people when they go for care and I know that the joint commission as joint commission international accreditation, I mean what kind of quality assurance can you provide people, because I know you go into website and did you see these things and what can you tell us about that?

MR. ALEX MARXER:

We go through an extensive 9-step credentialing process, you know, what typically happens is that a lot of the providers that we choose to invite through our network actually have US training and the US system has a big advantage in terms of transparency and our culture here is also much more open to, you know, documenting things on paperwork and again, you know, that is not something as in green, say in Latin America because much of it is based on trust and relationships there, but many of them now strive for JCI accreditation just to put that additional stamp of approval.

BRUCE JAPSEN:

This is the joint commission?

MR. ALEX MARXER:

Yes, the joint commission. At the same time, the way we are trying to create transparency, perhaps where it is not systemically available is by applying a lot of web to all technologies in terms of incorporating testimonials and referrals on a community website where people can contact each other directly and talk about their experiences. And I have seen statistics that it is about 70 to 80% of the decision making process for people to elect to do medical tourism is based on somebody told them, I had a great experience and I got a great service for the amount of money I paid and it is all based on recommendation.

BRUCE JAPSEN:

If I could shift gears a little bit, could you also let's just say there are doctors that want to be involved, I know that on your website, you talk about ways that providers would possibly be one of part of your networks and that they are in the US, how do they do that?

MR. ALEX MARXER:

We go through this in a very face to face, slow organic approach through the involvement in the other company, I mentioned ResortCom, I have been doing business for 7 years in Mexico, so you build a lot of networks and relationships and the way we identify the providers is we identify people, we call connectors in the communities, you know, there might be emergency room physicians that we get referred to through our friends and then very quickly the top doctors in each community rise to the top, that is in the smaller towns. Because you hear the same names over and over, then we go through our 9-step credentialing process. We see whether they are really qualified to talk to US people, they need to obviously be fluent in English and so on. In the larger towns, we go through the main hospitals and many of those hospitals actually have alliances with US hospitals as well and there is about 10 major private hospitals in Mexico and so we have approached 8 of them already and a number of them have joined our network as well and then through those hospitals, all of them already pursuing the joint commission accreditation as well, they already make sure that their doctors are, you know, cream of the crop and, you know, high quality, so we are trying to do this very organically and slow rather than trying to do too many countries at the same time and build, you know, very strong relationships with the doctors.

BRUCE JAPSEN:

Give us a range of, you know, where you think this is, is headed if you think it will continue and how many patients are you guys linking up just in your company?

MR. ALEX MARXER:

I will give you an example of just one campaign that we have recently launched and that campaign is focusing on obesity surgery, a lap band, gastric sleeve, and gastric bypass and we launched that campaign on Google and within the first 5 hours, we got over 100,000 hits on just the search term that we chose and over 4500 impressions which means people actually looking at our add and then the click through was amazing, so just on that campaign alone, we get about 20 to 30 increase a week with people who are actually actively looking for doing surgery in other countries, specifically for obesity and that is just one campaign, 1 specific procedure. Where we believe that this is going is that just like in many other industries, we believe that the potential for globalizing choices for the consumer will have a hugely beneficial effect, you know, it is a win for the consumers, it will put pressure on the US Medical System which I think by all intense and purposes is facing severe challenges to get better and more efficient and it is just going to, you know, make medical choices affordable again.

BRUCE JAPSEN:

Walk me through this, I go online, I discover health travel guides and you then link me up with a provider in another country depending on what I need.

MR. ALEX MARXER:

Yeah. What we do is we actually take the entry anonymously and then we bid it out to the provider network, so that we give the patient options. Some people who have a very clear preference of where they want to go, they tell us, I only want to do this in Brazil or I only want to do it in Costa Rica or I only want to consider Thailand, so we narrow the network to those specific selection criteria and then we present to the patient a number of options and those options are then supported by the providers testimonials, the credentials, you know, previous outcomes and then the patient makes the choice and we arrange from A to Z everything that pertains that travel. We prep the people give them detailed itineraries, we pick him up from the airport, make sure that, you know, they have a guide there locally to alleviate any scary, any issues, any language barriers and we are just kind of handhold him through the whole process all the way back into the US.

BRUCE JAPSEN:

Well, with that I would like to thank Alex Marxer who has been our guest. He is with Health Travel Guides and he is out of San Diego California which is one of the companies that are forming to address healthcare needs to folks who are going abroad for medical care for variety of reasons.

I am Bruce Japsen of the Chicago Tribune. I have been your host. You have been listening to The Clinician's Roundtable on ReachMD, The Channel for Medical Professionals. To listen to our on-demand library including this show, visit us at www.reachmd.com. Register with promo code radio and receive 6 months free streaming for your home or office and I would like to thank you today for listening.

Thank you for listening to our special series - Focus on Global Medicine as we celebrate this annual holiday season, everyone at ReachMD wishes you and your family a happy holiday and a successful new year.

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