That said, investors are still clinging to the promise of big returns fueled by patients losing their health benefits because of high unemployment, the aging population requiring more units of care and exploding costs of healthcare. If you think the medical travel industry is set to explode, there are some areas of investment to consider:

Foreign Healthcare infrastructure

Foreign Travel and hospitality infrastructure

Tools and support companies

Supporting global healthcare insurance and travel products

Firms in the medical travel supply chain

Expatriate retirement health cities and communities

Like other industry sectors, gold, for example, you can invest in the product itself, the people who create the product, or investments that pools risks, like mutual funds or exchange traded funds.

Look for companies in markets where the supply of care does not meet the demands of a growing middle class, that provide products and services delivering low, cost high volume care, and that provide platforms and infrastructure designed to reduce transaction costs for billing and collecting and value-based information.

Leaving home for care is nothing new. People have been traveling around the world for treatment since the beginning of time. Now we call it medical tourism, and it is growing quickly.

Patients seek care away from home because it is cheaper, unavailable in their home location, can be accessed without waiting for a long time, can be combined with a travel experience and can be kept secret. Despite the talk of healthcare reform, patients and employers are paying more for care with no forseeable decreases and they are looking for safe, affordable alternatives to care in the US.

There are several serious barriers to adoption and penetration of the notion of leaving home for care. In fact, we’re not even sure what to call it these days. “Medical tourism” has morphed into global healthcare referral or medical travel, underlying the fact that we are talking about healthcare in a different place, not sipping Margueritas by the pool. The growth of the industry is being fueled by mostly medical outsiders who see the commercial potential of opportunities that have resulted from medical cost inflation, globalization and cheap information and communications technologies.

There are lots of opportunties for physicians in the medical travel industry. Substantial challenges to the traditional notions of face-to-face care, continuity of care, itinerant surgery and global healthcare information exchange are but a few of the issues that the medical provider establishment will have to confront as medical travel continues to grow around the world.

1. The person sitting next to you on the plane is your surgeon-off-shore health communities are looking for US- based surgeons to participate in foreign offices to do surgery, and bring their patients, for less cost in the host country. Grumpy doctors in the US are interested.

2. The person you see on your computer is your doctor- information and communications technologies are providing a way to deliver follow up care at minimal cost

3. Click to see your record anywhere in the world- global healthcare information exchanges are growing as more doctors around the world adopt and connect electronic medical records.

BOTTOM LINE: Global healthcare referral coordination is more about moving information than moving people.

Large deductibles mean that patient will pay out-of-pocket for many of their medical expensive. As more and more Americans are tightening their belts, they will be looking elsewhere to lower their medical cost. This will raise demand for diagnostic tests (colonoscopies, endoscopies, CT scans, MRI), overall health screenings (Executive Wellness Exams) as well as other procedures, such as orthopedics, ophthalmology and others. Global healthcare can help to fill in the gaps to provide solutions to help families struggling with rising healthcare costs.

(Source KHIDI/ December 2010)

For example, take continuity of care. By providing global information and communcation technology networks, patients can now get a preoperative consultation and postoperative tele-care wherever and whenever they need it. While in some cases this does not meet the standard of care, in several instances, like cosmetic surgery or procedures that involve mostly postoperative wound care, telemedicine image and data devices are perfectly acceptable to monitor wounds and healing.

BOTTOM LINE: Entrepreneurs will rapidly fill markets in global healthcare referrals and care where there is an unmet need.

BOTTOM LINE: The globalized, interconnected healthcare infrastructure is putting more power in the hands of patients to make choices about the value of care they receive.

In my view, five things will need to happen before medical tourism and global healthcare referrals get real traction: 1) the creation of a sustainable business model, 2)global healthcare IT connectivity and integration, 3) a physician generated global healthcare referral network, 4) a global regulatory, legal and socioeconomic ecosystem, and 5) patient awareness and acceptance.

The creation of a sustainable business model
Industry players including payors, providers, partners and facilitators are still looking for the the most successful way to make a profit and scale the business. With an eye towards what happened when Expedia disrupted the travel agency business, participants understand that margins for travel arrangement services are thin and that there is high price elasticity for global medical care. Few have found the magic key that fits the lock that opens the doors to profits. Payors and employers are hesitant to accept the value proposition without a better way to reduce their risk and demonstrate tangible, meaningful cost savings to their insureds and employees.

Global healthcare IT connectivity and integration

The US national healthcare information architecture is evolving. Eventually, the network will be a portal to the world and will allow for seemless, secure, confidential transfer of personal health information thus assuring some continuity of care and quality improvement. Similarly, it will take a while for health information systems to evolve in host countries that can talk to non-host systems. Short term solutions, like personal health records or mobile health applications, might fill the void temporarily.

A physician generated global healthcare referral network

Most medical tourism models connect patients to healthcare facilities, bypassing doctors in the initial stages. Doctors will get in the game when the model feels better, and they have the resources and ability to make referrals to consultants directly, like they do now. Since MedVoy was founded by an American doctor, MedVoy connects patients directly to doctors which is unlike other facilitators. Given the rise of international members, professional medical societies should be more proactive in building global referral networks, rather than seeing them as threats to existing domestic members.

A global regulatory, legal and socioeconomic ecosystem

The barriers to adoption and penetration of medical travel are many and include liability, reimbursement, quality assurance and impediments to continuity of care. As healthcare goes global, so will the rules and regulations that facilitate or obstruct its use. How about a World Trade Organization Treaty on Medical Travel?

Patient awareness and acceptance

According to the most recent polls, 50% of consumers understand the meaning of the term “medical tourism”, leaving home for care. Social network buzz and media stories find the medical travel story sexy, particularly given all the noise about escalating healthcare costs and consumers, employers and payors are hungry for more information. Moving patients from awareness to intention to decision to action, however, will take more time and use innovative marketing approaches directed towards granular market segments.

Global medical travel is projected to be a $1B industry by 2012. While the bones are in place, it will take more time to add the flesh. Until then, to quote Karl Mauldin, people won’t leave home without it.

Using global information and telecommunications technologies to perform clinical (e. g. follow up care, second opinions, telemedicine, consultations for medical tourism) and business processes (e.g.billing and collection, making appointments, transferring documents) will eliminate waste and reduce costs of care.

BOTTOM LINE: Healthcare power is continual shifting to the patient. Look for an Office of Online Medicine to come to your hospital soon.