Editor’s Note: Earlier this year Dr. Simon Hudson and his colleague Xiang (Robert) Li published a research report entitled, Domestic Medical Tourism: A Neglected Dimension of Medical Tourism Research. Since then Hudson has presented at several medical travel events where his findings and ideas have been both challenged and lauded. Medical Travel Today caught up with Hudson to learn more about the findings in the report and the cause of the mixed reception. Medical Travel Today (MTT): Let’s start with what prompted you to pursue this area of research.

Simon Hudson (SH): Medical travel is something I’ve been looking at for a while. A number of years ago I wrote a case study called “Safari and a Facelift: The Rise of Medical Tourism” about the trend of people going to South Africa for the purported purpose of safari, which they did, but also managed to squeeze in a bit of plastic surgery while they were there. The length of the safari permitted them to be gone long enough to recover and come back looking better than ever. So while I originally looked at it from an overseas or international perspective my view shifted when I moved to South Carolina. Here I was looking for economic and tourism opportunities for South Carolina and recognized that the state is actually very strong in certain areas such as cardiology, orthopedic surgery and plastic surgery, and has an established tourism infrastructure. But we’re not really known as a place one would travel for medical reasons. I then set about researching how to position South Carolina as a medical tourism destination. I quickly found that almost all the research done on medical travel has focused solely on the international aspects of the industry. In my view this is a big miss. With economic times such as they are, people, Americans in particular, just aren’t traveling abroad the way they used to, and yet the population of aging Americans is growing. The need for care is also growing. And the truth is, Americans would prefer to stay home for major surgery if there was a feasible, reasonable option. India or Thailand is a long way to go in the best of circumstance, but when traveling for care there’s a greater risk of something going wrong. When you get your care here, it’s easier to respond when things go wrong. A revisit abroad just isn’t as easy. MTT: What did your research bear out in terms of the challenges to developing domestic medical travel? SH: I’ll address the issue of challenges, but I want to touch on the motivation first. Back in 2009, Deloitte Center for Health Solutions issued a report stating that in the preceding year the United States lost around $16 billion in domestic consumer spending to medical tourism abroad. That number certainly got a lot of people’s attention, but not a lot of hospitals responded. At least not right away. The reason for that is that attracting medical travel requires making some significant changes in the way you do business. The whole idea of here’s your all-inclusive price for a new hip, well, that’s just not the way it’s done in US hospitals. You know here you can’t figure out what something costs before a procedure and, frankly, even after it’s all done and paid for you can’t quite be sure how much you paid and exactly what it was all for. So, in my view, American hospitals were slow to respond but they’re on it now. And so are the cities and regions they’re based in. There’s now a movement to collaborate on regional promotion with healthcare options as a component. MTT: What kind of actions are you seeing healthcare providers make to promote domestic travel and what do they need to do? SH: Well, number one is creating fixed and visible pricing that’s competitive. For many people who go abroad, cost is a key consideration. And, again, it’s extremely hard to figure out what the true cost of care in the States is. Even so, by most accounts, it’s way out of line with what other countries are charging to provide the same care. There are quite a number of companies in the US that have started posting fixed prices for a variety of procedures. Both Travel Surgery USA and Healthbase post prices, as do a few hospitals. But the costs have to be competitive, and there’s a strong argument for making them so. For example, Galichia Heart Hospital in Kansas decided to try out some competitive pricing on certain heart procedures. They thought they’d just do a test to see what happened. Well, what happened was they added two cases per week and $100 million in revenue. That’s pretty compelling. The other area where changes need to be made in terms of perception and reality is patient care. Everybody knows that the typical care you get in a US hospital looks nothing like the personalized care you get in Thailand or Costa Rica or many other foreign destinations. There, it’s limos delivering the patient to the door of the hospital, Starbucks in the lobby and so on. Some might argue that customer service should be second or third to quality/safety issues and cost, but I think they’re on par. And I’m not alone. In fact there’s a very wealthy couple in Chicago that agrees. The Matthew and Carolyn Bucksbaum Family Foundation has just donated $42 million to the University of Chicago Medical Center (UCMC) to create the Bucksbaum Institute for Clinical Excellence. The Bucksbaum Institute will work to improve doctor-patient communication by providing support and training for doctors from the beginning of medical school through their clinical work. This emphasis on a doctor’s bedside manner is novel in medical education, but is critical, I believe. But these things, the price issues and customer care, are really second to asking some of the most basic marketing questions. Things like what’s our area of strength in care, how far will patients travel to receive it, what are they willing to pay, and is there enough demand to support an initiative. I also think that cooperation in the area of medical tourism promotion is key to success. Creating appeal for your destination, be it Las Vegas or Charleston, S.C., will only add to the appeal of medical travel. Healthcare providers should seek to align themselves with the people heading up the destination marketing for their area or region. A good example is Las Vegas’ new Health & Wellness Destination Guidebook, designed to educate consumers and take them through their medical tourism decision-making process. Part Two of this interview will appear in Issue 11. About Simon Hudson The endowed chair for the South Carolina Center of Economic Excellence in Tourism and Economic Development, Dr. Simon Hudson joined the University of South Carolina in January 2010. He has held previous academic positions at universities in Canada and England, and has worked as a visiting professor in Austria, Switzerland, Spain, Fiji, New Zealand, the United States and Australia. Prior to working in academia, Dr. Hudson spent several years working in the tourism industry in Europe. Dr. Hudson has written five books: Snow Business; Sports and Adventure Tourism; Marketing for Tourism and Hospitality: A Canadian Perspective; Tourism and Hospitality Marketing: A Global Perspective; and Golf Tourism. His next book on customer service will be published in January 2013. The marketing of tourism is the focus of his research and, in addition to the books, he has published more than 45 journal articles from his work. Dr. Hudson is frequently invited to international tourism conferences as a keynote speaker. His personal website address is www.tourismgurus.com.