Healthcare is growing as a global phenomenon: more patients are engaging in medical travel for reasons related to cost, accessibility, quality, and experience of care.
Healthcare providers are also moving and collaborating across borders at an unprecedented level. Cedars-Sinai International is the global extension of Cedars-Sinai, a top medical center and health system in Los Angeles which collaborates with partners in key regions outside of the U.S. to provide top quality medical services to international patients and raises the standard of healthcare globally. Through building regional offices/clinics in medical travel hubs, engaging in hospital affiliations, or strategic collaborations, CSI is addressing important medical needs of these regions' populations. A large attractor for traveling patients is the availability of cutting-edge technology at a healthcare institution. These technological advances can improve patient care quality, communication, knowledge transfer, and even address global challenges. However, in the face of growing innovations, we recognize the regulatory barriers and the importance of creating and applying a global method of technology and service accreditation to make the future of healthcare safer and even more impactful.
Medical Travel
Healthcare is increasingly growing as a global service and phenomenon. Patients have long traveled to premier healthcare institutions in Europe and the U.S. for complex clinical care and cutting-edge treatments that are not readily accessible in their home country. Additionally, healthcare professionals have a history of moving from one country to another for employment opportunities or education and training purposes — a trend that is likely to continue.1 Furthermore, U.S. academic medical centers are engaging more and more in global collaborative healthcare.2 The COVID-19 pandemic revealed that while healthcare delivery may be a local resource to certain environments, the supply chain of medical knowledge and goods is global. Due to the pandemic, public and private sectors worldwide have invested more resources into all aspects of healthcare, promoting growth and collaboration in the global healthcare industry.
Medical travel, the act of traveling to another country to receive medical services, is recognized as a form of global trade in healthcare. This is distinct from unplanned emergencies that may happen while traveling to another country. Other terms used interchangeably to describe this phenomenon include medical tourism, health tourism, and destination healthcare, to name a few. In this paper, we use the phrase "medical travel" as it lacks negative connotations associated with tourism. Reasons for medical travel are variable but are usually related to medical care cost, accessibility, quality, and experience — including wait time. Recently, there has been a trend of patients from richer countries traveling to less-developed countries to access lower cost treatments and services. However, it's important to note that drivers behind medical travel depend on home country-specific factors; for example, healthcare coverage is universal in Canada, so cost is not so much of a driver for medical travel as is wait time.
Shifting Landscape: From Local to Global
In the past, the U.S. stood out as a medical travel destination for high-quality healthcare. However, there exist several challenges for patients overseas accessing care in the U.S., including visa requirements, high cost of care, and cultural or language barriers. Patients have, therefore, been turning to regions other than the U.S. to access the desired high-quality care with fewer barriers to access. Thus, while Los Angeles is one of the most global cities of the U.S., Cedars-Sinai has looked overseas to serve a larger population of medical travel patients. Cedars-Sinai International is the global extension of Cedars-Sinai's mission, vision, and values. To achieve our purpose, we supply two main lines of service at CSI: 1) providing personalized, culturally appropriate care for patients traveling to Cedars-Sinai from outside the U.S., and 2) developing sustainable international collaborations to share medical knowledge around the world. CSI has collaborations in key regions, including Central and South America, the Gulf Cooperation Council, East and Southeast Asia.
Regions such as East and Southeast Asia are important for CSI as these areas have become regional medical hubs due to countries' political stability, government support, vibrant economies, and talented workforces. Recently, Asia-Pacific accounted for around 40% of the global medical travel market.3 In Southeast Asia, Thailand, Singapore, and Malaysia have become major destinations for medical travel. These locations draw many medical travel patients due to the competitive cost of care, technological advancements, expert medical providers, and high quality of care. Singapore attracts an estimated 500,000 overseas patients yearly; most medical travel patients to Singapore are from Indonesia. Although Singapore is currently ranked the most expensive city in the world, the costs of healthcare services are still competitive when compared to the U.S.
In addition to developing multiple Global Strategic Collaborations and Academic Collaborations in East and Southeast Asia, CSI maintains regional offices in Shanghai, China, and in Singapore. These regional offices collaborate with the Los Angeles headquarter office to bring high-quality, high-touch medical services closer to local communities. CSI aims to extend operational excellence through regional offices to provide patients continuity of care, raise the standard of global healthcare, and build knowledge-sharing means. Considering the number of patients traveling to and from countries such as China and Singapore, these CSI regional offices are a critical step towards providing these regions with access to the best patient care modern medicine has to offer.
Technological Advances at Cedars-Sinai
Cedars-Sinai Medical Center is at the forefront of research and technological innovation, advancing medicine and bringing cures to patients around the globe. As the world witnesses the growth of virtual reality technologies, our experts have been focused on using VR capabilities to help mitigate and control pain in patients. Recent studies at Cedars-Sinai have investigated utilizing VR as a non-drug approach to manage lower back pain by combining the psychological technique of cognitive behavioral therapy with VR headsets.4 Previous studies have found success in VR use to reduce pain in coordination with traditional medicines.5 Furthermore, VR simulations are explored as a tool to help physicians better empathize and relate to patients with specific health conditions. Other areas of exploration with VR at Cedars-Sinai include patient education and disease prevention, and mental health relief.
Artificial intelligence technologies are also explored widely in healthcare settings. Cedars-Sinai experts envision utilizing AI to improve clinical care of patients by researching mechanisms of AI intervention and support in various clinical settings, including the prediction, prevention, and management of sudden cardiac arrest.6 Current methods of exploration for AI tools to enhance the prevention of sudden cardiac arrest include combining machine learning and deep learning with population-based health systems and digital 12-lead electrocardiogram test readings. Discoveries thus far have shown the potential of AI to enhance primary prevention of cardiac arrest; amazingly, some AI algorithms can accurately predict heart attack risk within five years.
Regenerative medicine and induced pluripotent stem cell research at Cedars-Sinai has generated opportunities to provide groundbreaking care to patients with devastating diseases such as amyotrophic lateral sclerosis. Clive Svendsen, PhD, director of the Cedars-Sinai Board of Governors Regenerative Medicine Institute, and his lab were honored for their work on stem cells which produce a protective protein, GDNF; together, these can promote the survival of motor neurons in the spinal cord of patients with ALS.7 Scientists at Cedars-Sinai have also partnered with Space Tango to send iPSCs to the International Space Station, where they research how zero gravity influences the production of stem cells.
Going Global with Technology
Beyond supporting cutting-edge quality of care and medical treatments, technological advancements increase the globalization of healthcare. Technology makes patient mobility possible by opening the doors for easier travel, allowing seamless communication, and empowering patients to compare providers' healthcare costs and quality. In some cases, the availability of cutting-edge medical technology such as medical devices or surgical procedures increases the number of inbound medical patients in certain countries. Furthermore, the increased prevalence of telemedicine and telehealth technologies since the COVID-19 pandemic has allowed patients to communicate and consult with healthcare providers around the world. Telemedicine and telehealth are generally used interchangeably; however, the U.S. Federal Communications Commission clarifies that telehealth includes a wider variety of remote healthcare services beyond the doctor-patient relationship, including services provided by nurses, pharmacists, and others who support patient health education and medical adherence.
Telehealth has provided medical travel with significant improvements, as it allows patients and family members to experience quality and continuous pre- and postoperative care. Today, 10% to 15% of CSI's patient encounters are through virtual means. Healthcare providers can gather patient baseline data, perform preoperative examinations, and educate their patient all while the patient is still in their home country. Following treatment or procedures overseas, patients can leave the destination country and maintain care through telehealth visits from the comfort of their own home. Furthermore, patients' support networks can attend virtual telehealth appointments and be included in the patient's care, even if they are unable to travel overseas. Additionally, overseas providers and home country providers can communicate with each other about follow-up care measures or additional care concerns if necessary.
Addressing Global Challenges
Technological advances, like telemedicine and telehealth, represent a possible solution to the global shortage of healthcare workers. Many countries have experienced difficulties retaining and recruiting healthcare workers after the COVID-19 pandemic. As a result, the WHO estimates a shortage of 10 million healthcare workers by 2030.8 The shortage's distribution is unlikely to be equal; low to lower-middle income countries are likely to suffer more losses. The WHO predicts that rural sub-Saharan Africa and Asia will experience the greatest gap in healthcare workers.
Particularly, telehealth consults offer remote populations access to healthcare providers. For example, rural areas in the U.S. have experienced a greater specialty physician shortage than urban areas. But thanks to telehealth, patients can still consult with and access medical experts in specialty fields from their own homes prior to traveling for care if necessary. Because the WHO predicts serious healthcare worker shortages in Asia, the development of CSI Regional Offices in China and Singapore are even more important. These offices can address health worker shortages by connecting regional urban and rural populations in East and Southeast Asia to experts at Cedars-Sinai in Los Angeles.
The Future of Technology in Global Healthcare
Technology is always advancing. In fact, technology advances far quicker than global policies and standards of healthcare technology assessment. Unlike drug and medical device development, which are under strict regulation by federal organizations such as the FDA and the European Union's EMA, healthcare technology is more decentralized and left to free market forces. As technologies interact more frequently in the global healthcare sphere, we must be aware of standard outcome measures for utilization of novel technologies. Hospitals and healthcare organizations nationally and globally are held to a standard of accreditation. This establishes the baseline delivery of safe and quality healthcare.
Hospital accreditation has changed hospital standards across the world. In addition to Joint Commission International accreditation, which establishes global standards for hospital performances, Global Healthcare Accreditation is an accreditation authority for medical travel hospitals. Standardization of hospital procedures for medical travel through GHA improves the experiences of all patients who travel to receive care. As the role of technology increases in health services and medicine everywhere, we need to hold technology to the same accreditation standards as the rest of global healthcare and medical travel. Beyond creating standards of technology implementation and development in healthcare, accreditation processes for technology would promote international collaboration and data outcome sharing. While we celebrate the advances and adoption of technology in global healthcare, we recognize the importance of creating and applying international accreditation standards to make the future of healthcare technology even more tremendous.
Concluding Thoughts
In a continuously global healthcare landscape, Cedars-Sinai is fully engaged in bringing top quality healthcare closer to patients around the world through building Regional Offices and clinics in medical travel hubs, engaging in hospital affiliations, and creating strategic collaborations. And as technology in healthcare advances, Cedars-Sinai is not only at the forefront of developing the cutting-edge: we are actively involved in knowledge-sharing and awareness-building with collaborative partners around the globe. Through these activities, Cedars-Sinai and Cedars-Sinai International provide the best care quality, communication practices, and novel treatments to patients worldwide. By being active in global healthcare delivery and technology advancement, Cedars-Sinai acknowledges the importance of regulatory bodies for accreditation in pushing this field to the last mile.
References
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3. Medical Tourism Singapore 2023 report available from https://www.budgetdirect.com.sg/travel-insurance/research/medical-tourism-singapore.
4. Virtual Reality for Chronic Lower Back Pain Reduction Study available from https://virtualmedicine.org/research/current/vr4backpain.
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7. Baloh RH, Johnson JP, Avalos P, et al. Transplantation of human neural progenitor cells secreting GDNF into the spinal cord of patients with ALS: a phase 1/2a trial. Nat Med 2022;28:1813-1822.
8. World Health Organization (WHO) data available from https://www.who.int/health-topics/health-workforce#tab=tab_1.