Author: Dr. Amado Alejandro Báez , From Medical Tourism

“Caribbean” can be defined in terms of geography, politics and cultures. The United Nations defines the Caribbean as a chain of islands surrounding the Caribbean Sea — 13 sovereign states and 17 dependent territories. Tourism represented 14 percent of total Gross Domestic Product, in 2013.

Certain Caribbean countries possess developing healthcare systems with variable service lines, human resources and technology. Modern medicine relies on a combination of excellent clinicians and advanced technologies; emergency medicine and critical care are modern multidisciplinary specialties that have been purposefully developed to respond to the medical challenges presented in economic and public health transitions. In times of integrating markets and economies, the globalization of healthcare is a driving force for economic and social development.

About the Caribbean

More than 25 million visitors contributed $49 billion toward the Caribbean GDP in 2013, and 11.3 percent of the jobs in the region are dependent on related services. Caribbean tourism has always had health-related components. Early seaside resorts were developed primarily for medical and the curative benefits. Historians believe the first Caribbean hotel — The Bath Hotel and Spring House — was built on the island of Nevis in 1778, and appealed to travelers seeking mineral hot springs and better health.

Healthcare and Politics

The political framework is changing due to an appreciation of synergies, stronger collaboration and the free movement of people in the Caribbean. Established in 1973, the Caribbean Community (CARICOM) is an organization of 15 Caribbean nations and dependencies promoting economic integration and cooperation among members, ensuring that those benefits are equitably shared and coordinating foreign policy. The development of the Caribbean Single Market and Economy (CSME) created new challenges. In the CARICOM 2001 Nassau Declaration, the health became an important component of for creating wealth and provided a framework for regionalization and synergistic healthcare efforts.

From a public health perspective, the economic transition to a tourism and industry base has rushed non-communicable diseases to the forefront of overall mortality discussions. Cardiovascular disease — hypertension, coronary artery disease, and stroke– diabetes mellitus and cancer accounted for 51 percent of the deaths in the late 1990s. Violence and injuries are a leading cause of death and disability, affecting young and economically productive individuals. Homicide and motor vehicle accidents account for 9.3 percent of the years of productive-life lost and, combined, are second only to HIV/AIDS. The picture is similar in all countries: emergency departments are filled with violence-related trauma, accidents and injuries, highlighting the need to further develop regional standards of care and investments in human capacity and infrastructure in emergency, trauma and critical-care services.

The World Health Organization believes health conditions in the Caribbean are critical to the tourism product and destination brand. The Pan-American Health Organization evaluated clear opportunities and options that could enhance public revenue by making greater use of taxes and social security contributions to increase health sector financing in the Caribbean. With a country average often lower than 4 percent, Caribbean countries should aim for health expenditures of at least 6 percent GDP. Accessing the global medical tourism platform by creating a Regional Medical Travel Network will address existing health financing in most Caribbean countries.

A Value Based Proposal

“The only way to truly reform health care is to reform the nature of competition itself.” — ‘Michael E. Porter, Redefining Health Care: Creating Value-based Competition on Results’
To improve medical care in the Caribbean, standardization, clear quality metrics and a framework for positive-sum competition must be achieved. We propose reorienting healthcare around patient value, rather than current drivers like geography or the discounts negotiated by insurers. This way, a system will be developed that delivers sustained improvements in quality and efficiency.

Value defined as the health outcomes achieved per dollar spent, in reality, is the true measure of efficiency. A regional system needs to achieve high value for patients. If value improves, patients, payers, providers, and suppliers can all benefit. The economic sustainability of the healthcare system, in turn, will increase as well. Cost reduction without regard to outcomes is dangerous and self-defeating, leading to false “savings” and limits on effective care.

Value should always be based on the customer and — in a well-functioning healthcare system — patient benefits should define rewards for all participants in the process. Since value depends on results, not inputs, healthcare value is measured by outcomes achieved, not volume of services delivered. Shifting focus from volume to value is a central challenge. Value is not measured by the process of care offered; process measurement and improvement are important tactics, but are not substitutes for measuring outcomes and costs.

A regional Emergency and Critical Care Network must focus on a patient-centered and value-based philosophy. This way, the system will generate important positive-sum competition, improved outcomes and enhanced revenue. Also, if focused with a social responsibility character, important growth can be achieved in a multi-country healthcare system.

Need for Pan-Caribbean Emergency Medicine and Critical Care Network Modern medicine relies on a combination of excellent clinicians and advanced technologies. Emergency Medicine and Critical Care are modern multidisciplinary specialties purposefully developed to respond to the medical challenges presented in economic and public health transitions.

Healthcare systems in some Caribbean nations possess variable service lines, human resources and technology. Since the 1990s, the United Nations World Tourism Organization (UNWTO) has focused on strengthening the safety and security of regional tourism efforts. Health/medicine is an important component of this platform.

This regional EMC2 network complements local medical capacity, and creates a multi-institutional, multidisciplinary “Medical Bridge,” by harvesting the collective expertise and technology of all participating providers, institutions and countries in the existing medical infra- structure. This network will work within an existing political framework that enhances existing trade agreements and asserts medicine not just as a service, but as a public good.

Case Study

Centers for Global Health and International Medicine EMC2-Net The Centers for Global Health & International Medicine (CGHIM), a full-service independent international organization in the city of Santo Domingo, allows patients to benefit from the best medicine in the Dominican Republic. CGHIM operates under a value-based, patient-centered philosophy with personalized assistance provided by an internationally certified professional team that ensures success in all aspects of the patient’s experience. CGHIM developed a nation-wide comprehensive acute care network that integrates the best medical facilities in the Dominican Republic. The program uses advanced technologies, outstanding services and excellent medical doctors.

CGHIM EMC2-net covers various Caribbean medical travel initiatives originating from Haiti, Trinidad and Tobago, Martinique, Antigua and Saint Marten among other Caribbean-basin countries. The system has direct U.S. oversight, trained and certified medical doctors and adherence to the highest international standards. Clients include maritime and cruise ship companies, diplomatic missions, non-governmental organizations, independent providers and regional health centers, and local governments. EMC2-Net includes:
• 24/7 triage call center with access to U.S. board-certified physicians;
• Medevac with helicopter and fixed wing capacity;
• Advanced diagnostics and laboratory medicine;
• Telemedicine services by U.S. board-certified emergency and critical-care physicians;
• Top inpatient facilities and advanced procedures;
• Full spectrum of surgical, pediatric, neonatal, medical, neurosciences, trauma and cardio-vascular care services;
• Tele-education and capacity building.

Conclusions

The development of a Patient-Centered/ Value-based Caribbean Regional Emergency and Critical Care Network creates an important framework for generating scale, quality of care and revenue to participating members; and creates a “safety net” for local tourism and smaller limited health infrastructures.

About the Author:

Dr. Amado Alejandro Báez, M.D., MSc, MPH, FAAEM, FCCP, FCCM, is director for the Centers for Global Health and International Medicine in the Dominican Republic. He is a Mayo Clinic and Harvard-trained and a U.S. board certified physician with graduate degrees in public health and healthcare management. Dr. Báez holds faculty appointments at Harvard University, the University of Barcelona and the University of Miami. His vision of patient-centered /social responsibility is redefining the landscape of the medical travel industry. www.cghim.com
References:

1. World Bank Group: Latin America and the Caribbean Country Profiles; http://web.world-bank. org/WBSITE/EXTERNAL/COUNTRIES/LACEXT; Accessed July 24, 2015. 2. Caribbean Community (CARI-COM) Secretar- iat;Caribbean Free Trade Association (CARIFTA); http://www.caricom.org/jsp/community/carifta. jsp?menu=community; 3. Accessed July 24, 2015. 4. TOURIST SAFETY AND SECURITY/Practical Measures for Destinations; WTO; http://sete.gr/files/ Media/Ebook/110301_Tourist%20Safety%20and%20 Security.pdf; Accessed July 24, 2015. 5. Theodore-Gandi, B, Barclay, G.; “Protect- ing and Improving Health of the Caribbean People”; American Journal of Public Health; April 2008; 98(4):586-8; doi:10.2105/AJPH.2007.131086; Epub 2008, Feb 28.

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