Feature articles by: Bruce J. Fried, PhD, Dean M. Harris, JD, Lynn Schroth, DrPH and Ruthy Khawaja

EDITORIAL

Historically, we who are involved in healthcare delivery in the United States have enjoyed the trek of the well-heeled from other countries coming to seek medical care from our sophisticated medical centers. We have welcomed foreign medical students into our medical schools and residencies in the hope that they return to their home countries to practice medicine and refer patients to us for tertiary-level treatment. We have recruited nurses and other clinicians from other countries to meet our burgeoning workforce demand. We have offered our management expertise to healthcare providers in other countries. Some of us have invested in, built, and operate facilities in other countries. In short, we have a long history of deep entrenchment in global healthcare delivery.

But now, a new phenomenon is occurring: U.S. citizens are seeking medical care in other countries. Additionally, some observers are suggesting that recruitment of nurses and other clinicians from other countries is causing workforce deprivation there while assuaging our problems in the United States. After all, they suggest, if a country invests in training someone, that person should stay and meet healthcare needs at home. To top it all, we see world-class hospitals and specialists in other countries reaching out to American patients with the lure of treatments and top quality care at much less cost than they would pay in the United States (with a luxurious stay during recovery at a lush resort tossed in for “good measure”!)

In a further twist of the “globalization of healthcare,” we find ourselves, in some instances, impaled by our own laws and regulations. EMTALA, for one, requires that we serve all persons who come to our emergency rooms, whether or not they can pay for care. So, when the illegal immigrant appears at our ER door, or the legal, uninsured immigrant brings a family member into the country to get care at our emergency rooms, we are required to provide that care at our own expense. Our national conscience would not let us see that person suffer when our outreached hand can help.

From the sublime of our incredible tertiary services and our highly skilled clinicians, to the front lines of “on the ground” emergency medicine, to the collaboration for medical research across borders, to the provision of care in underdeveloped countries, to massive investments in countries such as Dubai, healthcare delivery is truly a global enterprise. It is a phenomenon that adds to all the possibilities and complications of a U.S. healthcare system in need of change.

The question is, will we learn from our experience in the United States, and be part of effectively shaping the global healthcare delivery arena with vision and wisdom? Or will our participation be fragmented and lacking that global vision?

This issue of Frontiers has brought together a number of perspectives on how global healthcare delivery is shaping up, the drivers of it, the focus areas in which it is developing, and the challenges it places on us. Here you’ll read about how one healthcare system has carved out and is continuing to carve out it global collaborations; you’ll learn of the various models under which we function in the global arena, and you’ll read the practical insights on what the “globalization of heathcare” means to a health system CEO, an employer who has taken what might be considered a controversial strategy to reducing healthcare costs for his company, and a global healthcare consultant.