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Rush University System for Health

Medical Travel as DiplomacyAndrew N. Garman; Tricia J. Johnson

2 December 2019 Department of Health Systems Management

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 3

Why Diplomacy? Diplomacy(/dəˈplōməsē/) n.

The profession, activity, or skill of managing international relations, typically by a country's representatives abroad.

The art of dealing with people in a sensitive and effective way.

Nationalism (/ˈnaSH(ə)nəˌlizəm/) n.

Identification with one's own nation and support for its interests, especially to the exclusion or detriment of the interests of other nations.

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 4

Social, political and economic events have led to expansions and contractions of the international travel market.

Have these world events had similar effects on overall international air travel and international medical travel?

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 5

Inbound medical travel has grown at a faster rate than overall air travel since 2013

*Author calculations from In-Flight Survey of International Air Travelers, U.S. Department of Commerce, Office of Travel & Tourism Industries

Inbound Medical Travel

Outbound Medical Travel

Total Inbound Air Travel

-

10

20

30

40

0

50,000

100,000

150,000

200,000

250,000

300,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Total InboundAir Travelers in Millions

Medical Travelers

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 6

Medical travelers to the US are more equally distributed across geographic regions

0%

20%

40%

60%

80%

100%

2000 05 06 07 08 09 10 11 12 13 14 15 16

All Inbound Air Travel

AfricaOceaniaAsiaEuropeS AmerMiddle EastCaribbeanC Amer

0%

20%

40%

60%

80%

100%

2000 05 06 07 08 09 10 11 12 13 14 15 16

Inbound Medical Travel

*Author calculations from In-Flight Survey of International Air Travelers, U.S. Department of Commerce, Office of Travel & Tourism Industries

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 7

2009 Real GDP growth rates: The effects of the Great Recession were uneven

https://en.wikipedia.org/wiki/Great_Recession#/media/File:GDP_Real_Growth.svg

Despite the global downturn, the Chinese and Indian economies

continued to grow

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 8

*Author calculations from In-Flight Survey of International Air Travelers, U.S. Department of Commerce, Office of Travel & Tourism Industries

Inbound Medical Travel

Total Inbound

-

3

6

9

12

0

5,000

10,000

15,000

20,000

25,000

30,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Total InboundAir Travelers in Millions

Inbound Medical Travel

Inbound medical travel from Asia increased during the Great Recession and continued to increase

Great Recession

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 9

*Author calculations from In-Flight Survey of International Air Travelers, U.S. Department of Commerce, Office of Travel & Tourism Industries

Inbound Medical Travel

Crude Oil Price

$0

$20

$40

$60

$80

$100

0

5,000

10,000

15,000

20,000

25,000

Crude Oil Price

per Barrel

Inbound Medical Travel

Inbound Air Travel

Crude Oil Price

$0

$20

$40

$60

$80

$100

0

200,000

400,000

600,000

800,000

1,000,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Crude Oil Price

per Barrel

Inbound Air Travel

What about OPEC crude oil prices and travel from the Middle East?

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 10

Economic and political events may have less of an effect on medical travel than on travel and

tourism overall

What does this say about medical travel as diplomacy?

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 11

Why Diplomacy?

Diplomacy(/dəˈplōməsē/) n.

The profession, activity, or skill of managing international relations, typically by a country's representatives abroad.

The art of dealing with people in a sensitive and effective way.

Nationalism (/ˈnaSH(ə)nəˌlizəm/) n.

Identification with one's own nation and support for its interests, especially to the exclusion or detriment of the interests of other nations.

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 12

Contrasting Narratives

Stock photo / Getty Images Photo courtesy USCIPP

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 13

The ‘Long View’ - Socio-political cycles

Turchin, 2012

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 14

The ‘Even Longer’ View – A great story for humanity…

Rosling et al., 2018

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… a potentially catastrophic one for humans

Google. 2017

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 16

More changes to come

Sources: https://asia.nikkei.com; UK Department for Work & Pensions; Sisodia 2019; USCIPP; reliefweb.org

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Thinking More Broadly About our Roles

1. How is my organization’s mission currently defined? 2. Does this mission fully capture all of the good my organization might

do in the world? 3. To what extent is mission reflected by all of my organization’s

actions?

Sources: American Hospital Association; Moody’s; Rush Center for Health System Leadership

Case example: a typical U.S. hospital:• Net operating margin: 3%• Payroll expense: 60%• Supplies / procurement: 20%

• Cash reserves: 55%

Medical Travel as Diplomacy | Rush University System for Health | 12/02/2019 18

Additional Resources & Contact InformationAnchor Mission Playbook:Rush’s journey implementing an ‘anchor strategy’

Healthcare Anchor NetworkNational collaboration of 45+ US healthcare systems building more inclusive and sustainable local economies

https://democracycollaborative.org/sites/clone.community-wealth.org/files/downloads/Playbook-Web.pdf

Andy GarmanAndy_N_Garman@rush.edu

http:/www.healthcareanchor.network

Tricia JohnsonTricia_J_Johnson@rush.edu

References

In-Flight Survey of International Air Travelers, U.S. Department of Commerce, Office of Travel & Tourism Industries