The concept of modern medical cities has been in place for some time, but has gained renewed interest, particularly in rapidly developing economies. The implementation of these cities varies, but they share several fundamental characteristics. Let us examine these shared characteristics, challenges in the current model, what the future may hold and the potential implications on medical tourism.
Medical cities have been designed to be comprehensive in scope and incorporate advanced technologies and medical practices. The services provided are comprehensive of most, if not all, clinical service lines and include the full spectrum of diagnostics and therapeutic treatments.
The scale and scope of medical cities usually demands an advanced level of care – both in technology and approaches – to create an attractive destination for care. This attractiveness is necessary to ensure the high level of patient volumes required to support such a large operation.
What Makes Medical Cities
Often, medical cities will also incorporate substantial non-medical services to support the staff, patients and visitors. These include retail, hotel and transportation systems. More often than not, medical cities also include academic and research activities that draw upon the large numbers of patients, the mix of learning opportunities and the access to high-tech facilities.
Where medical cities have tended to fall short, particularly in light of current and future realities in healthcare delivery, are in their hospital-centric model and their relative isolation from their surrounding communities. Not unlike most of the healthcare delivery system in the developed world, medical cities tend to develop around a major hospital and as a result, their care delivery model and the path of development tend to orient to highly acute transactional care. Additionally, this model tends to miss opportunities to optimally support the continuum of care and as a result the health and wellness of their communities.
While there will always be a market for transactional based medicine, for example elective knee surgery, there is an increasing emphasis on overall wellness and long-term outcomes. This is particularly true where governments or insurers are involved in the funding of healthcare services.
The implications of the changing funding and emphasis for healthcare is an increase in shared risk (bundled payments) and reimbursement that is tied to outcomes (pay for performance). These are two areas that medical cities are well positioned to excel in. With the consolidation of services, including the co-location of diagnostic and physician activities, medical cities create the opportunity for ‘one stop shopping’ and the ability to coordinate care and offer package pricing.
This creates an interesting and opportunistic intersection with medical tourism providers. Medical tourism organizations are accustomed to bundling and offering package pricing. They are the most experienced in aligning the necessary components and determining the appropriate all-inclusive price. For these reasons, many of the exemplar medical cities we would cite today also have substantial medical tourism operations.
What we are likely to see and, some would say, need to see in future medical city developments is a much stronger integration with the community. For those organizations providing medical tourism services, this integration extends beyond the immediate community into the global healthcare delivery system.
The stronger integration into the local or global community is required to strengthen the clinical outcomes and provide a much stronger infrastructure for prevention, wellness and the management of chronic disease. Integration will also help reduce the cost of care by enabling the care to be provided in the most appropriate and cost-effective setting.
The stronger integration within the community will also serve to break down the physical barriers between the medical city and the community to the point where many will no longer be considered separate entities. We are seeing this in several new developments around the world – the medical city without boundaries.
Carrying the integration idea even further, virtual technologies, including telemedicine, will enable health care to be nearly ubiquitous and strengthen the push for wellness. The primary challenge in this scenario will be more about how care is reimbursed than how it is enabled.
Destination Healthcare
Medical cities are currently not common practice, nor are they likely to be in the future. In certain circumstances, they do make sense. One of the factors that support the development of a medical city is the support and placement within a larger urban setting.
Medical cities will always require a significant amount of patient volume from the local population in addition to needing the human resources and community infrastructure that a city setting provides. The dependence on local patient volume is another reason the integration of the future medical city into the community is important.
Specifically related to medical tourism, medical cities offer several attractive attributes in support of attracting foreign or ‘non-local’ patients. First, they have the ability to support advanced medicine and high technology services. As medical cities are of a larger scale and better represent the full continuum of care, they have the ability to support services that are highly specialized – services that often struggle to see sufficient volume to support a business case.
These can be sub specialized services within larger services lines, such as heart transplants or highly focused technology items such as robotic surgery systems or image guidance in the operating room. These advanced services in term provide excellent marketing support for those organizations looking to capitalize on patients seeking this type of care.
The second area where medical cities can strongly support a medical tourism initiative is in the ability to create a true destination healthcare experience. Family accommodations, more expansive retail services and convenient pre and post acute care resources create an environment where the patient and the family needs can be fully met – especially for services that might normally be more involved and time consuming such as cancer care or operations with long recovery periods.
Beyond the scope of services and access to advanced care, medical cities might offer additional medical tourism benefits in the increased research opportunities and the ability to support information technology investment for the provision of virtual services such as telemedicine.
There are significant risks and challenges to developing a medical city, especially in a greenfield scenario. The amount of capital and human resources needed are significant and beyond the reach of most organizations. Additionally, properly developed medical cities require the alignment of many different entities, often having conflicting objectives.
Given the reliance on local patients to provide a significant portion of revenue, the business plan needs to be carefully evaluated to ensure this foundation volume is realistic given the market demographics and competitive influences.
The markets that will be most supportive of medical city developments will be urban with a rapidly rising economy and a healthcare system that is developed, but not advanced. Additionally, cities having a strong higher and medical educational system and complete and stable infrastructure also characterize ideal locations.
Those organizations that can bring together the necessary resources, align the objectives of all the key stakeholders and find a location that supports the foundation volume needs will be able to find success in medical city development.
We will continue to see the selective development of medical cities around the world. The organization and operation of these developments will continue to evolve to have a higher focus on health and wellness – deemphasizing the hospital aspect in favor of other components of the continuum of care, the integration of spa and alternative therapy centers and stronger integration into the communities in which the medical cities are based.
The destination healthcare services will still be important, but patients, referring physicians, insurers and local communities will expect longer term results and more seamless communication and coordination of care benefiting health and wellness. Organizations that develop stronger pre and post acute care services, expand the portfolio to include alternative and wellness and implement the necessary technology solutions to become part of a global system of care will be best positioned for success.
About the Author
Todd Fitz is a Principal at HOK and the Director of Healthcare Consulting. In this role, he is responsible for developing and implementing HOK’s global healthcare consulting strategy. In his 14+ years of healthcare experience, Todd has developed expertise in finance, strategy and operations and worked in a variety of settings, including academic medical centers, community hospitals, insurance organizations, government agencies, physician groups and medical device companies. He may be reached at Todd.Fitz@hok.com.
HOK’s Health Care planning and design services create patient care innovations. Our work with clients including academic medical centers, hospitals and other healthcare organizations, redefines modern care environments that support fast-changing requirements while anticipating future needs. With the largest team of LEED Accredited Professionals globally, HOK’s healthcare team emphasizes the need for healthcare facilities that are expertly functioning, sustainable or regenerative, and to be spaces that promote health while remaining aesthetically pleasing. Our teams have extensive experience in the delivery of P3 projects and are global leader in this area. Our design process is sophisticated, community-oriented, partnership-driven, and we commit to the satisfaction of patients, families and staff. To learn more about health care at HOK, visit: www.hok.com/healthcare.
