Feasibility report by Tercy U. Toussaint

GHR

Global Healthcare Resources

GHR

Global Healthcare Resources

University Health Network International Program Expansion Feasibility Study May 30, 2014 Feasibility Study 5-2014 ÂŠ UHNI and GHR All Rights Reserved. Distribution without Permission Strictly Prohibited by Law.

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Global Healthcare Resources

GHR

Global Healthcare Resources

“Philanthropy Provides Access to Advanced Healthcare.”

GHR

University Health Network International (UHNI)

Global Healthcare Resources

Abbreviations ACA

GHR

Affordable Care Act

ACHSI Healthcare Australian Council on Healthcare Global Resources

CANY

The Canadian Association of New York

CAP

College of American Pathologists

CapEx

Capital Expense

CARE

Creating Access to Residency Education

Standards International

ACI

Accreditation Canada International

ACL

Anterior Cruciate Ligament

ACS

American Community Survey

ADA

Americans with Disabilities Act

CBAHI

Central Board of Accreditation for Healthcare Institutions

ADRPBF

Abu Dhabi Retirement Pensions and Benefits Fund

CCHI

Cooperative Council for Health Insurance

ADX

Abu Dhabi Securities Exchange

CCHSA Canadian Council on Health Services Accreditation

AQAP

Al-Qa’ida in the Arabian Peninsula

Communicable Disease

ASO

Administrative Services Only

CDAP

Chronic Disease Assistance Programme

ASTM

American Society for Testing and Materials

CHA

Canada Health Act

CHIREC

Centre Hospitalier Interrégional Edith Cavell

CHWS

Center for Health Workforce Studies

CIHI

Canadian Institute for Health Information

CIHSA

Cayman Islands Health Services Authority

CIMA

Cayman Islands Monetary Authority

CINICO

Cayman Islands National Insurance Company

CLT

Charlotte Douglas International Airport

CMA

Capital Market Authority of Saudi Arabia

CMGS

Continuous Glucose Monitoring System

CMN

Care Management Network

CMS

Centers for Medicare & Medicaid Services

COBRA

Consolidated Omnibus Budget Reconciliation Act

CPQ

Center for Healthcare Planning and Quality

CRT

Cardiac Resynchronization Therapy

CSH

Canadian Specialist Hospital

CTC

Central Tender Committee

ATL Hartsfield-Jackson Atlanta International Airport

CARICOM Caribbean Community

AUH

Abu Dhabi International Airport

AWH

Al Wakra Hospital

BCBS

Blue Cross Blue Shield

BEA

US Bureau of Economic Analysis

BFC

Barbados Fertility Clinic

BHB

Bermuda Hospital Board

BHB Act

Bermuda Hospitals Board Act 1970

BHeC

Bermuda Health Council

BHeC Act

Bermuda Health Council Act 2004

BLS

Bureau of Labor Statistics

BMD

Bermudian Dollar

BMI

Business Monitor International

BMI

Body Mass Index

BMT

Bone Marrow Transplant

BOS

Boston - Logan Airport

BPS

Bermuda Police Service

BSC

British Safety Council

CVG

Cincinnati/Northern Kentucky International Airport

CAGR

Compound Annual Growth Rate

DBFM

Design, Build, Finance and Maintain

University Health Network International (UHNI)

Global Healthc FLL

Fort Lauderdale-Hollywood International Airport

FSC

Financial Services Commission

FTA

Free Trade Association

FTE

Full-time Equivalent

GAHS

General Authority of Health Services

GATS

General Agreement on Trade in Services

GCC

Gulf Cooperation Council

GDP

Gross Dometic Product

GDPR

General Data Protection Regulation

General Electric

GHTF

Global Harmonization Task Force

GII

Gender Inequality Index

GLIC

Gulf Life Insurance Co

GME

Graduate Medical Education

ECG Electrocardiograph

GNRD

General Directorate of Residency and Foreigners Affairs ...

Erectile Dysfunction

GOSI

General Organization of Social Insurance

EFTA

European Free Trade Association

GPSSA

General Pensions and Social Security Authority

EHA

Emirates Health Authority

GRE

Government-Related Entities

EHB

Essential Health Benefit

GSEC

General Secretariat of the Executive Council

EMG Electrophysiology

GWP

Gross Written Premium

ENT

Ear, Nose & Throat

HAAD

Health Authority Abu Dhabi

Eastern Province

EPF

Established Programs Financing

HART Hospitality Associates for Research and Training

EPF

Established Programs Financing

ERISA

Employee Retirement Income Security Act

ERTA

Economic Recovery Tax Act

ESO

Economics and Statistics Office

ESWL

Extracorporeal Shock Wave Lithotripsy

ESWL

Extracorporeal Shock Wave Lithotripsy

EWR

New Yory - Newark Liberty International Airport

FDI FISIM

DCA

Washington D.C. - Reagan National Airport

DEFRA

Deficit Reduction Act

DFW

Dallas/Fort Worth International Airport

DHA

Dubai Health Authority

DHCC

Dubai Healthcare City

DIFC

Dubai International Financial Centre

DIFC

Dubai International Financial Centre

DMC

Destination Medical Center

DMO

Domestic Marketing Organization

DOH

Department of Health

DPM

Department of Preventive Medicine

DSE

Dobutamine Stress Test

DTW

Detroit Metro Airport

DXB

Dubai International Airport

E.U.

European Union

Global Healthc

HDI

Human Development Index

HI Act

Health Insurance Act

HIP

Health Insurance Plan

HIPAA

Health Insurance Portability and Accountability Act

HIPCAR

Harmonized Policies for the ICT Market in the ACP Countries

HMC

Hamad Medical Center

Insurance Authority

Foregin Direct Investment

IABP

Intra-Aortic Balloon Pump

Financial Services Indirectly Measured

IAEA

International Atomic Energy Agency

GHR

University Health Network International (UHNI)

Global Healthcare Resources IAH IAIS ICD Global

Houston - George Bush Intercontinental Airport

GHR

ICT

International Association of Insurance Supervisors

Implantable Cardioverter Defibrillator Healthcare Resources

Qatar’s Supreme Council of Information and Communication Technology

MCO

Orlando International Airport

MDP&S

Ministry of Development Planning and Statistics

MHC

Mowasat Healthcare Company

Myocardial Infarction

MIA

Miami International Airport

ICU

Intensive Care Unit

MLR

Medical Loss Ratio

Insurance Department

MoCI

Ministry of Commerce and Industry

IFRC

The International Federation of Red Cross and Red Crescent Societies

MOD

Ministry of Defense

IHR

International Health Regulations

MoE

Ministry of Education

IMAC

Insurance Manager Association of the Cayman

MoH

Ministry of Health

IMG

International Medical Graduate

MOI

Ministry of Interior

Intellectual Property

MoU

Memorandum of Understanding

ISMS

Information Security Management System

MPI

Migration Policy Institute

ISO

International Organization for Standardization

MSP

Minneapolis - St. Paul International Airport

Information Technology

MTA

Medical Tourism Association

JCI

Joint Commission International

MVA

Motor Vehicle Accidents

JFK

New York - John F. Kennedy International Airport

NAFTA

North American Free Trade Agreement

NCCCR

National Center for Cancer Care & Research

JHMI

John Hopkins Medicine International

NCCI

National Company for Cooperative Insurance

KACCH

Kuwait Association for the Care of Children in Hospital

NCD

Non-communicable Disease

KAMC

King Abdulaziz Medical City

NHIC

National Health Insurance Company

KEMH

King Edward VII Memorial Hospital

NHIS

National Health Insurance Scheme

KHAC

Kuwait Health Assurance Company

NHS

National Health Strategy

KHAC

Kuwait Health Assurance Company

NIB

National Insurance Board

KIPCO

Kuwait Projects Company

NISSS

Barbados National Insurance and Social Security Scheme

KOC

Kuwait Oil Company

Nurse Practitioner

KSA

Kingdom of Saudi Arabia

KYD

Cayman Islands Dollar

NPMRH

New Rehabilitation and Physical Medicine Hospital

LAS

Las Vegas - McCarran International Airport

NWRHA

North West Regional Health Authority

LAX

Los Angeles International Airport

OCR

Office for Civil Rights

LEADC

Los Angeles Economic Development Corporation

OECD

Organisation for Economic Co-operation and Development

Medical Commission

OGIS

Offshore Group of Insurance Supervisors

University Health Network International (UHNI)

Global Healthc OpEx

Operational Expense

RHA

Regional Health Authority

Operating Room

RSS

Regional Security System

ORD

Chicago - O’Hare International Airport

RTA

Road Traffic Accident

PAHO

Pan American Health Organization

SAICO

Saudi Arabian Insurance Company Ltd

PCNL

Percutaneous Nephro Lithotomy

SAMA

Saudi Arabian Monetary Agency

PCNL

Percutaneous Nephrolithotomy

SAN

San Diego International Airport

PCP

Primary Care Physicians

SANG-HA Saudi Arabia National Guard Health Affairs

PEMF

Pulsed Electromagnetic Field Therapy

SCH

Supreme Council of Health

PHCC

Primary Health Care Corporation

SCPC

Society of Chest Pain Centers

PHCSPC

Primary Health Care Services Promotion Committee

SCTA

Saudi Commission for Tourism and Antiquities

PHI

Private Health Insurance

SDEA

Saudi Diabetes & Endocrine Association

PHICKN

Private Health Insurance Company for Kuwaiti Nationals

SDEC

Specialized Diabetes and Endocrinology Centre

SEHA

Abu Dhabi Health Services Company

PHL

Philadelphia International Airport

sEMG

Surface Electromyography

PMI

Private Medical Information

SFDA

Saudi Food & Drug Authority

PPACA

Patient Protection and Affordable Care Act

SFO

San Francisco International Airport

PPP

Public-Private Partnership

SHB

Standard Hospital Benefit

Public Relations

SHI

Social Health Insurance

PRTD

Premier-ranked Tourist Destination

SIH

Al Salam International Hospital

PSCC

Prince Sultan Heart Center

SKMC

Sheik Khalifa Medical Center

QCB

Qatar Central Bank

SoE

State of Emergency

QDA

Qatar Diabetes Association

SPR

Standard Premium Rate

QEH

Queen Elizabeth Hospital

QFC

Qatar Financial Centre

SWOT

Strengths, Weaknesses, Opportunities and Threats

QFCRA

Qatar Financial Centre Regulatory Authority

TAVI

Transcutaneous Aortic Valve Implantation

QGIRCO

Qatar General Insurance & Reinsurance Company

TEE

Transesophageal Echocardiography Test

TEFRA

Tax Equity and Fiscal Responsibility Act

QIC SAQ

Qatar Insurance Company

TENS

Transcutaneous Electrical Nerve Stimulation

QIIC

Qatar Islamic Insurance Company

TIAO

Tourism Industry Association of Ontario

QNV

Qatar National Vision

TIEA

Tax Information Exchange Agreement

QRCR

Quality Respiratory Care Recognition

TIFA

Trade and Investment Framework Agreement

QSA

Qatar Statistics Authority

TPA

Third Party Administrator

QUATRO

Quality Assurance in Radiation Therapy

Tourism Toronto

R&D

Research & Development

TTD

Trinidad and Tobago Dollar

Global Healthca

GHR

University Health Network International (UHNI)

Global Healthcare Resources TTE U.S. UAE UHNI

Transthoracic Echocardiography Test

GHR

United States of America United Arab Emirates University Health Network International

Global Healthcare Resources UI

Urinary Incontinence

United Nations

UNCTAD UN Conference on Trade and Development UNDP

United Nations Development Program

URS

Ureteric Stones

USD

United States Dollar

WBEY

We’ve Been Expecting You

WHO

World Health Organization

WTO

World Trade Organization

University Health Network International (UHNI)

Global Healthc

Global Healthca

GHR

Global Healthcare Resources

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Global Healthcare Resources

GHR

University Health Network International (UHNI)

Global Healthcare Resources

UHNI Feasibility - Table of Contents

GHR

A. Executive Summary Global Healthcare Resources Purpose. .............................................................................................................................................................................................. 1

Goals and objectives......................................................................................................................................................................... 1 Pre-Study Conclusions Results and Recommendations Prioritization of Markets

Objectives and Context of the Study

Methodology

Stage I - Foreign Experience Evaluation Stage II - Target Market Evaluation Stage III - Development of Target Market Selection Criteria Stage IV - Target Market Selection Stage V - Feasibility Study Key Data Selection Tools

D. Current Situation at UHN International UHN Strategic Planning Directives The Key Themes International Patient Flow in UHN International International Experience Internationalization of Specialists Marketing Development of Expertise Patient Networks Changes in Leadership Political Motivation Achievements

Canadian Infrastructure Overview and Impediments

Healthcare Delivery Challenges and Opportunities Canadian Health Insurance Market

UHNI Competitiveness and Recommended Strategic Direction

Results of the Analysis Competitiveness Indicators and Constraints Analysis of Increased Competition Cost and Price Sensitivity

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Feasibility Study 5-2014 ÂŠ UHNI andand GHR AllAll Rights Distribution without Permission Strictly Prohibited Feasibility Study 5-2014 ÂŠ UHNI GHR RightsReserved. Reserved. Distribution without Permission Strictly Prohibited by Law. by Law.

University Health Network International (UHNI)

Global Healthc Capacity and Capability Channels of Trade Convenience Culture Confidentiality

G. Gaps, Barriers & Opportunities in Canada

Global Healthc

Current Status Build & Execute Brand Strategy Expand Existing & Building New Channels of Service Revenue Consulting & Advisory Services Capacity Allocation System Global Referral Network Targeted Marketing in Domestic & Current Global Market

H. Hospitality & Tourism Capacity in Toronto Recommendations for Inbound International Patients in Toronto Hospitality and Tourism Capacity in Toronto Destinations Core Attractions Quality of Services Visitor Satisfaction and Value Proposition Accessibility Performance Dimensions SWOT Analysis Recommendations

UHNI’s Strategic Path to a World Renowned Destination Medical Center

Significance of the Program Developing a Comprehensive Plan Program Goals and Guiding Principles

Canadian Diaspora Opportunities

Canadian Population in the US Economic Activity and Education Migration Canadian Communities Canadians and Medical Tourism Advantages and Disadvantages of Canadian Diaspora as a Target Market

U.S. Market Opportunities

Healthcare Expenditures in California Healthcare Expenditures in Florida Healthcare Expenditures in New York Physician Shortages in California

Feasibility Study 5-2014 © UHNI andand GHR AllAll Rights Distribution without Permission Strictly Prohibited Feasibility Study 5-2014 © UHNI GHR RightsReserved. Reserved. Distribution without Permission Strictly Prohibited by Law. by Law.

GHR

University Health Network International (UHNI)

Global Healthcare Resources Physician Shortages in Florida Physician Shortages in New York Connectivity and Airlift to the U.S. Canadian American Associations U.S. Healthcare Reform PPACA Global Self-Funded Plans HealthcareMedical Resources The Self-Insurance Loophole

GHR

U.S. Market Opportunities (Continued)

Canadians and Medical Tourism U.S. Medical Tourism for Employers Implementing Medical Travel in a Fully Insured or Self-Funded Health Plan

International Patient Programs in the World

Definition of a International Patient Factors and Drivers Size of Sector and Players Emerging, Developing & Foreign Markets Legal & Regulatory Matters Popular Treatments Brokers Best Practices & Key Success Factors International Recognition The US Bureau of Economic Analysis The Interagency Task Force on Service Statistics Health at a Glance – OECD Indicators

M. Ethical Considerations in International Patient Programs N. International Patient Management at UHNI

Lead Management and Conversions Continuum of Care, Business Processes and Efficiency The Cost of Automation – or the Lack Thereof Compliance with Data Privacy Regulations UHNI Patient Management SWOT Analysis

O. Medical Second Opinions

The Case for Second Opinions The Incidence of Misdiagnosis The Costs of Misdiagnosis Estimate of Population Seeking Second Opinions Self-funded Employers Encourage Second Opinions Insurance Plans Cover the Cost of Second Opinions The Growth of Telemedicine

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University Health Network International (UHNI)

Global Healthc

Experiences of Hospitals/Institutions Offering Remote Medical Second Opinion Second Opinions SWOT Analysis

Health Challenges in the Middle East & GCC Region

Future of Healthcare in the GCC Region Expatriate Healthcare Workforce in the GCC Developments in the GCC Healthcare Sector Healthcare Demand in the GCC Region Public Private Partnerships (PPS’s), the Private Sector and Health Regulation Healthcare Delivery

Health Challenges in the Middle East & GCC Region (Continued)

GCC Outbound Healthcare Trends Providing Personalized Care for Muslim Patients

Global Healthc

Q. Trends in Healthcare and New Opportunities for UHNI in the GCC

Market Penetration Strategy

Target Market Analysis and Prioritization - UAE

UHNI market entry into UAE – SWOT Analysis

Target Market Analysis and Prioritization – Saudi Arabia

UHNI market entry into Saudi Arabia – SWOT Analysis

Target Market Analysis and Prioritization - Qatar

UHNI market entry into Qatar – SWOT Analysis

Target Market Analysis and Prioritization - Kuwait

UHNI market entry into Kuwait – SWOT Analysis

Trends in Healthcare and New Opportunities for UHNI in the Caribbean

Overview Key Market Entry Steps Strategy & Service Priority Matrix UHNI Strategy & Service Description for Caribbean Region

W. Target Market Analysis and Prioritization - Barbados

UHNI market entry into Barbados – SWOT Analysis

GHR

University Health Network International (UHNI)

Global Healthcare Resources

Target Market Analysis and Prioritization - Bermuda

UHNI market entry into Bermuda – SWOT Analysis

Target Market Analysis and Prioritization – Cayman Islands

UHNI market entry into Cayman Islands – SWOT Analysis

Target Market Analysis and Prioritization – Trinidad & Tobago

UHNI market entry into Trinidad & Tobago – SWOT Analysis

GHR

Global Healthcare Resources

AA. Recommendations & Conclusion

Competitiveness and Transparency Affordability and Price Differentials Global Insurance Results and Recommendations Prioritization of Markets

BB. Appendix

Appendix 1: Financial Projections and Recommended Investment Appendix 2: List of Interviews Conducted at UHNI Appendix 3: International Patient Destination Survey Appendix 4: Global Healthcare Resources Benchmarking Results Appendix 5: Global Healthcare Resources “Global Decisionz” Market Selection Exercise Appendix 6: Global Healthcare Resources April 9, 2014 Presentation Appendix 7: Public Relations: Altum Health April 9, 2014 Presentation Appendix 8: Business Case for Growth: Altum Health April 9, 2014 Presentation Appendix 9: UHNI Program Expansion: Altum Health April 9, 2014 Presentation

CC. Endnotes DD. Bibliography

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University Health Network International (UHNI)

Global Healthc

GHR

Global Healthcare Resources

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Global Healthcare Resources

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University Health Network International (UHNI)

Global Healthcare Resources

Executive Summary

GHR

The private healthcare sector is growing rapidly in emerging market countries. All across the developing world, there is an increased reliance on private healthcare organizations to address the needs of already overburdened public systems. This is a Global Healthcare Resources trend that will continue as the public sector battles to provide adequate services to the population not currently being serviced or underserviced in appropriate time frames. Capacity issues continue to face all nations and developing countries seek partnerships to address such issue with capacity building contracts and human resource mobilization and training. As fundamental survival issues drive the demand for service – increased life expectancy, growing disease burdens and non-communicable disease growth, population growth and patients’ demand for treatment, health management becomes increasingly challenging. Although there is significant growth in the health sector, it is not without its challenges. As a result many financial institutions, often unfamiliar with the dynamics of the healthcare sector, perceive it as risky and many healthcare organizations in developing countries remain underfinanced. It is for this reason exchanges are being developed between hospitals in the developed world and those in the developing world to meet the needs of patients and at the same time elevate the standard of care being offered. These relationships take many forms and are explained in this Study as it relates to existing trends at University Health Network International (UHNI) and proposed methods of market penetration. Inbound and outbound US medical travel is on the rise with consumer driven healthcare decisions precipitated by the collection of data from the Internet and hospital branding through word of mouth sharing of success stories. Deloitte estimates the growth of outbound medical travel at 35% per year with numbers of patients traveling for care at 1.6 million, however the basis of this estimate has been challenged and no new study has been conducted to replace it. Global insurance carriers are currently producing medical networks for centers of excellence. This trend towards adopting super specialization offers UHNI a position of good bargaining with global insurers. Domestic medical travel in the United States, also referred to as employer direct contracting, provides value added benefits for employers seeking to offer centers which will provide proper diagnosis and better outcomes. One quarter of employers surveyed by Towers Perrin have an interest in contracting with providers directly to achieve better outcomes and higher volume utilization discounts. Florida, New York and California self-funded employers surveyed by Global Healthcare Resources ranked higher than other states at an average of forty-two percent interest. The value proposition for UHNI in penetrating the U.S. employer market will be in offering to employers the right diagnosis and right treatment plan for patient the first time around with better outcomes, thereby returning employees to work quicker with lower risk of complications.

Purpose This Feasibility Study and recommendations for expanding the international healthcare program development at University Health Network International (UHNI) was commissioned by the International Program Executives of UHNI and Altum Health. The advisory and consultancy services offered are primarily capacity building in the area of oncology which has been most successful in the Middle East / Gulf Coast Countries, yet inbound patient volumes at UHNI have not increased significantly. The scope of this study is to understand the pull and pull factors of the target markets identified to penetrate and to determine market selection and prioritization as well as market penetration strategies most efficient in the selected markets.

“We must manage the social dynamic complex in Canada. Customer service elements within service delivery are a challenge for Canadians, because the system does not force this.”

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Goals and Objectives The objective of the analysis to be carried out and the recommendations to be provided in the Feasibility Study is an evaluation of the current the future exportation of medical services and development of new models of collaboration with overseas referral centers. The Feasibility Study examines the past experience of UHNI in providing and promoting global services, analyzes the international competitive environment for services in the context of the global international healthcare sector, and evaluates the current situation in the field of international healthcare provision at UHNI. Based on the conducted analysis, the following goals set for the Feasibility Study were implemented: • Identify the potential of organized direct “export” of UHNI health services (increased inbound patient volume) and its strategic development direction; • Define and substantiate the most appropriate measures for UHNI international healthcare development and promotion of export of medical services; and • Provide detailed and accurate information and recommendations on destinations, upon which UHNI could make the most appropriate decisions on international healthcare development and promotion of export of medical services in the short five-year term and the long term.

Pre-Study Conclusions During the interview process, consultations for the Study were drawn essential to determination of target markets and prioritization. It was generally agreed by all stakeholders and by senior management and division heads that international expansion was desirable and the potential was high, however the challenges include public perception, government intervention and staff engagement. It was further determined that despite the efforts of UHNI to centralize international communications and manage international patient flow, there currently exists no accepted consolidated strategy to drive or manage international expansion without greater collaboration, standardization of methodology and improvement of technology solutions to support all efforts. The inbound patient experience at UHNI until now has been premised upon a mix of efforts and relationships established by individual specialists within their respective division. These efforts include direct contracting such as the Libya Wounded Warriors Program, capacity building in oncology through Princess Margaret Hospital, international speaking opportunities, occasional referral from former residents or fellows, service provision abroad, and philanthropic work. The efforts of leading specialists should be combined into a system of best practices and utilized by all divisions for entry into new markets. Specifically noted is the need to centralize ongoing communications with residents, fellows and observers and to manage these relationships through the international program and the International Center for Education (ICE) collectively. Based upon this experience, the work established in the Middle East has been deemed successful and lends to the interest in further developing Middle Eastern relations and entering into countries in a more variegated fashion outside of capacity building. The Caribbean was also deemed to be of large potential, but existing market saturation, lower population volume, minimal academic medical infrastructure and lower profit margins present barriers making these countries more difficult to tap into with unpredictable financial overall impact. Specific opportunities have been identified to pursue in this region.

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University Health Network International (UHNI)

Global Healthcare Resources When working with higher specialized services such as oncology, cardiology and neurosciences, the concern for continuum of care necessitates that any target market selection would require a combination of care provided in Toronto and in the consumer market for follow up and patient monitoring over potentially long periods of time. Also to be determined is whether the collection of records and the use of telemedicine and second opinions will improve foreign relations, allow for proper diagnosis of the patient and ultimately better outcomes, raising issues of ethics and risk management worthy of Global Healthcare Resources conclusion.

GHR

Criteria were developed for the selection of destinations and services. Some of these criteria included: • The current patient volume was evaluated to determine (1) whether UHNI has the capacity to provide this service, and/or (2) UHNI specialists have accumulated enough international experience, potential and willingness to grow it. • The likelihood of the service being available abroad being low such that patients would be willing to travel great distances to receive it in Toronto. • High cost of service delivery criteria was used for assistance in selecting the most profitable and meaningful services. • Capacity of service was evaluated generally; however a capacity allocation system will need to be developed to assure continued capacity as the program develops. • Availability and quality comparison with other countries and other providers of services helps to assess the potential attractiveness of UHNI versus other providers in the region. • Existing relationships either through residents and fellows or existing advisory and consultancy services was used to determine prioritization.

• Cultural barriers were considered in the determination of priority.

Services were selected based upon the criteria established during the kick-off meeting and are as follows:

• Oncology

• Cardiology

• Neurosciences

• Orthopedics

• Rehabilitation

• Spinal Surgery

• Transplantation (Bone Marrow & Live Liver)

• General Surgery

“My opinion of medical tourism is that it is coming; it’s here...We need to embrace it or we will be left behind”

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Results and Recommendations The results of this Feasibility Study have revealed that UHNI has potential to attract a significant number of international patients from each of the markets as first and second priority in Kuwait, Qatar, United Arab Emirates, Bermuda, Trinidad & Tobago, Cayman Islands, Barbados and United States self-funded employers in California, New York and Florida. We evaluated long-term strategies as well as potential one-off opportunities which may lead to long term market penetration. Each market shows a dilineation of opportunities in the first and second prioritization. In order to realize this potential, UHNI should allocate sufficient resources and systematically implement the following initiatives. International program initiatives that are recommended in the Feasibility Study:

• Development of Physician Engagement and Staff Engagement Program

• Staff training of international patient services and cultural competency training

• Implementation of a public relations campaign and domestic brand awareness

• Validation of “Center of Excellence” model for international service lines

• Development of a digital patient management system; international patient volumes

• Ensuring and enhancing the quality of medical services to meet increased inbound international patients

• Implementation of changes in the logistical base to manage patient inquiries and continuum of care

• Development of physical infrastructure and competence at UHNI

• Development of multidisciplinary program for care in all target markets through digital platforms;

• Redefinition of brand including tag line and webpage

• Implementation of marketing measures in each market

• Development of existing and new sales channels and promotion of cooperation in each market

• Creation of peer networks and digital alumni platform

• Development of internet based second opinions program for all service lines

• Look for local teleheath connection centers/partners in target markets and consider investment in technology to support UHNI referral centers

• Implementation of patient engagement program and patient satisfaction tools

• Exploration and execution of immediate opportunities in identified first priority markets

Prioritization of Markets It is recommended UHNI begin with a strategy for the Middle East and Gulf Coast Countries, Caribbean countries and the U.S. market simultaneously, however with varying levels of prioritization. Each has distinctive methods of market penetration which shall allow for diversification of services and limit large financial investment to the extent that investment shall be made in developing processes and tools which may be utilized in all markets as opposed to just one or two. Due to cost of market penetration, the United States self-funded employer market suggestions are limited to three states (Florida, New York and California) to allow for ongoing monitoring and iterations to be made without overburdening financial resources.

GHR

University Health Network International (UHNI)

Global Healthcare Resources Additionally, the U.S. market will require outsourcing marketing efforts such as telemarketing, also uncommon with the other market penetration methods established. It therefore was determined to lower the priority of the U.S. market effort and monitor cost effectiveness. Canadian diaspora ineligible to receive Canadian health benefits by law shall also serve as a source of inbound patient flow; however this should be monitored against public relations campaign development to avoid the perception that such care encourages emigration. The Saudi Arabian market was recommended as the lowest priority due to cultural Global barriers Healthcare and should beResources developed organically through existing relationships and educational initiatives.

GHR

Kuwait Kuwait provides a good opportunity for growth due to the general awareness of the need for improvement of the quality of services as well as the trend towards furthering education and training. There are few language barriers as English is becoming more prominently utilized for international business. The existing advisory and consultancy relationships provide for open doors to communication of service line expansion but preexisting referral relationships and commission based referrals create a barrier to expansion of inbound international patient referral. The improvement of clinical guidelines and implementation of international standards for patient safety and quality of care will be essential to the provision of good continuity of care and many services in oncology being performed locally by UHNI specialists provides for training of clinicians for follow up care. These relationships will also allow for patient referral of more complex cases to UHNI if preexisting referral patterns can be overcome. Branding and name recognition is an important requirement for Middle East and GCC regional generally because physicians will typically refer to where patients want to go. Balancing brand awareness creation with management of referring physician relations are the crux of market penetration in Kuwait. As Kuwait also seeks to develop its healthcare services to retain its residents and also seek other GCC patient inbound, UHNI can uniquely utilize medical tourism development in Kuwait to serve as a trusted capacity building resource, education and training provider, but also as a “triage” unit for the GCC region. UHNI center of operations in Kuwait may serve the region in developing telehealth services and second opinions. The new government initiatives supporting public private partnerships as well as the trend towards “Kuwaitization” make such inbound patient referral options contingent upon specific contractual requirements to establish milestones, which are measured against deliverables. To wit, UHNI should counter deliverable schedules with patient IPP volume and service diversification. Existing initiatives to improve care in the public and private sectors and the advancement of medical tourism initiatives in the health and tourism sectors will foster increased demand for academic partnerships raising healthcare standards and services as has been seen with oncology and yet to be realized in other service lines. Relationship building requires face-to-face discussions with hospitals and clinicians; however brand recognition ultimately will drive referral. Meetings with families in large groups would be also beneficial to encourage triage relationships, brand recognition, understanding of the value of multidisciplinary care, and trust. The focus of these initiatives will provide clinical revenue, clinical research, educational opportunities and philanthropic goals while at the same time assuring growth of the international program and particularly inbound patient volume. Cost, while not a primary driver of referral, should be monitored comparatively with European and American competitors, which are increasingly becoming more price sensitive. Opportunities exist in the growing population and increased instance of disease that will also open the door to more opportunity and other research programs. As a result of improved coordination of care and therefore better outcomes, UHNI will recognize better brand visibility and increased inbound patient flow. It is well known in all markets that turnaround time, access to patient-physician communication channels, brand recognition, streamlined patient transfer and cultural sensitivity at UHNI will further enhance likelihood of referral, measuring continuum of care and managing patient expectations. In the case of Kuwait, ongoing patient follow up will have a greater impact on brand equity and awareness and referral.

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Qatar Similar to Kuwait, Qatar is a valuable market as the healthcare sector also is improving in the areas of financial concern as increased wealth allows for a stronger self-pay private market for services. The timing therefore is good for finding providers open to collaboration and broadening the scope of lines of service while at the same time maintaining university based capacity development. Relationship building requires face-to-face discussions with relevant stakeholders, contractual relations with deliverables and expiration period clearly outlined as with Kuwait. These initiatives will provide clinical revenue, clinical research, educational opportunities and philanthropic goals. The international program shall be best developed similarly as with Kuwait, however there is a stronger desire for the government to maintain “Qatarization” for personnel. Therefore training should be the crux of capacity building projects and further, immediate implementation of a strong second opinions program will have the largest impact in a nation which places great value on second and third opinions for care. This will improve brand equity in Qatar, where American and European competitor influence is less strong than in Kuwait. Established MOU’s executed by the government indicate a commitment to improving quality and building services for local population, particularly in the area of oncology, cardiology, neurology and rehabilitation services. Due to the drive towards competiveness and cost reduction measures, Thailand, Malaysia and Singapore have also become attractive to Qataris and therefore value for service and negotiated price points based upon volume should be considered as a market penetration technique. The key to success in the regions will be the negotiation of strong contractual relationships that provides for coordination of patient care, diagnosis and treatment referrals in exchange for education, training and knowledge to a greater degree than what has already been achieved in Kuwait. UHNI’s existing proposal with Qatar indicates a willingness to diversify services and operate on a year to year basis. It is recommended that long-term contracts are sought after first two successful years.

United Arab Emirates Dubai Health Authority (DHA) is at a pivotal time in developing inbound medical tourism and reducing outbound patient flow through its relationship with Dubai Healthcare City (DHCC). As the first healthcare free trade zone, there are many benefits to building an office in DHCC as a center for referral. Taiwan and Korea have utilized this method to build brands for their centers and also to execute ongoing MOU’s for education and knowledge transfer. DHA has as one of its top goals to reduce overall cost and is most challenged to overcome the culture of outbound patient flow whereby a lack of trust in local health services drives patients to well-known brands in Europe, U.S. and Asia. Combined with Saudi Arabia, the UAE spending represents 75% of all GCC spending in health expenditures making these regions the largest in terms of inbound patient opportunity for UHNI. Positive perception of Canadian healthcare in the region allows for new impressions to be made and likely a driver in the success of UHNI in the region to obtain MOU’s for services. However, important to note that the region is rife with competition from U.S., European and Asian competitors. DHCC is challenged to bring in health expertise of top surgeons without necessarily resulting in an increased cost of service.

GHR

University Health Network International (UHNI)

Global Healthcare Resources This provides a good opportunity for UHNI to consider obtaining experience through its newly established MOU’s, build brand and also take advantage of the sense of urgency at the DHA and DHCC level to raise the level of care and reduce cost. Non-communicable disease management and chronic condition management is not effectively delivered in the local system. Therefore UHNI could also benefit from a second opinion programs which could be integrated with the DHCC website allowing patients to access second opinions from the same portal as accessing the over 150 providers in the DHCC network. The existing agreement with Abu Dhabi for rehabilitation and other services shall serve as the launch of a rehabilitation Global Healthcare Resources program in the region and establish more consisting branding with larger numbers of patients.

GHR

“We can’t have an international reputation if we’re stuck in Canada.” The new MOU executed with Sharjah indicates further willingness to diversify services and commit to Canadian care. Sharjah Healthcare City (SHCC), like DHCC offers excellent economic opportunities under the free trade zone rules. UNHI will benefit from putting an office in SHCC with local representation to encourage ongoing referral as it would at DHCC. This would be seen as a five year strategy after attempting to establish the existing Kuwait office as such a referral center. It is important to keep in mind that in the region, the drive towards exclusivity and overall pride of the development of their nations may hinder the ability to seek mutiple relationships successfully with numerous regions. For example, it does not benefit development to discuss SHCC and DHCC collaboration with each party as the territorial nation and competition internally in the UAE may prevent UHNI from achieving its goals of expansion. It is recommened therefore that if such discussions ensue, these discussions center around value added service UHNI can provide which differentiates the service UHNI is providing to the other country. Bringing the “unique value proposition” to each nation will be beneficial over the presumption a group will contract for the same services another group has contracted for. This concept is firmly rooted in the competition being raised through each health authority’s own drive for medical tourism development. The value to be added through UHNI relationships is capacity build to improve structure for local population and retain patients as well as to attracts patients from around the region to generate health export. UHNI program can provide both.

Saudi Arabia Saudi Arabia will generate revenue for UHNI that can subsidize some of the costs for some of the international expansion efforts. However, this second priority market should be approached with caution. Lack of facilities and training of specialists has created a demand for services particularly for complex cases. The penetration of this market requires an on the ground agent to be developing relationships and negotiating contracts. Government requirements for international accreditation of facilities make the environment prime for collaboration. However, cultural competency and differences remain a large concern for physicians and staff. As such, GHR recommends Saudi Arabia be developed organically, utilizing residents, fellows and preexisting relationships to generate patient referral as opposed to feet on the ground market development and marketing. Low physician and staff buy-in may render large efforts innefective and may challenge the physician and staff engagement program as the international rogram expands.

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It would be beneficial to develop the Kuwait office into a regional hub for referral with appointed physicians performing triage evaluation, insurance contracts and patient concierge services such a medical record collection, preparation of families and establishing a communication liaison between provider and family. Clear contracts should be established as well through the embassies as well. Typically, the government entities will not contract with deliverables. However preferential payment terms may be negotiated. Outcomes information is a strong determinant in attracting patient flow and this is often communicated at the health attaché level. Goals to be achieved are clinical research and revenue as well as philanthropy. The Saudi market is in great demand by other U.S. hospitals that is why it is essential to have feet on the ground in the region and an advocate steering patient consultation, diagnosis and referral. It is recommended that as cultural competency becomes more developed at UHNI, and the international program expands, monitoring of the Saudi market opportunities through the embassy remains a goal but not a first priority. As stated, this market should serve as a secondary market consideration. As the healthcare sector develops and as the rush towards affiliation from U.S. and European providers wanes, UHNI will have further solidified its presence in the region and increased Saudi consumer brand awareness to make it more desirable for embassy referral and patient selection. The health attaché in Washington DC is the primary contact for all inbound referral and a relationship may be originated at international events and cultivated thereafter.

“If international programs are tried to capacity building, can we really do it? Sure they want us to come in and build capacity, but do we really have the capacity to do that?”

The Caribbean For the purpose of this Study, the Caribbean specifically refers to the markets of Trinidad & Tobago, Barbados, Bermuda and the Cayman Islands. The Caribbean Market presents various opportunities for UHNI Program development, and it is important to remember that the Caribbean as a whole versus a selected individual Caribbean country will provide UHNI greater traction and brand awareness. There is an economic and cultural intimacy within the region and although different stakeholders or policymakers exist within each country, the developmental and services delivery challenges are similar. These challenges can commonly include:

• • • • •

An absence of standardized best practices, clinical guidelines, and related operational protocols A lack of adequate infrastructure to facilitate ongoing professional development and educational training An accurate understanding regarding cost of care per person in the population An unaccountable governance structure A lack of performance management strategies and protocols within the healthcare delivery system

GHR

University Health Network International (UHNI)

Global Healthcare Resources The first step toward participating in the Caribbean opportunity mandates that healthcare service providers develop a deep understanding of each individual market, the competitors they will face and the consumers they will serve. As the individual markets are understood, UHNI leaders need to create a differentiated, attractive offering that takes into account the special nature of the Caribbean market segments.

GHR

For instance, because Resources of lower income levels, price remains the key consideration for the majority for consumers – a reality Global Healthcare all offerings must reflect. Alternatively, the Cayman Islands present a unique competitor due to the existence of Health City Cayman Islands due to the quality of expertise presence and overlap in service focus with UHNI. Additionally, unlike Barbados or Bermuda, Trinidad & Tobago have significant private health infrastructure that currently aids in the delivery of public services. The dynamics of the individual markets speak to a rapidly evolving healthcare system for the Caribbean landscape as well as a consumer market that will present rewarding opportunity for UHNI.

“This Study recommends several unique “one-off” opportunities, which if inneffective, would eliminate the prioritization of the market such as Bermuda, Barbados and Cayman Islands. Trinidad and Tobago has a greater opportunity and multi-faceted approach sustainable through the relationship with University of West Indies.”

While the Caribbean market has shown tremendous improvements as a healthcare consumer market, many barriers to entry still remain. System efficiency and the insurance industry create hurdles that has to be acknowledged and navigated to develop value-based relationships and positioning for revenue capture. To choose the right strategy for overcoming these hurdles, UHNI must assess risks and then decided how to establish the correct relationships. Each individual Caribbean market recommended has a private and public market segment to consider which will require simultaneous relationship building activities within the payor framework. All markets have refined distribution channels; thus, these relationships will be critical for advocacy and prioritized option among its beneficiary or consumer pools. Thus, UHNI can quickly be in a position to offer a multi-dimensional relationship that not only empowers to distributor but also builds in additional revenue streams outside of patient referrals. In the Caribbean, market knowledge, access to distribution channels and political connections must be obtained. UHNI will need to weigh the pros and cons along with the bandwidth of each relationship model to truly evaluate the merit in pursing market opportunities. In addition, community and family are strong elements of the Caribbean culture, and companies need to make sure their branding and promotional efforts resonate with these values. Marketing through these community and family channels is the only means of obtaining maximum support and brand awareness. A wide-variety of options exist in the Caribbean markets, including: Corporate Collaboration, Clinical Collaboration – Capacity Development, Academic Collaboration – Capacity Development, Project Management, Knowledge Transfer, Second Opinions, Subsidized Service Delivery, Specialized Referral Channels, Clinical Education Exchange and Telehealth Services.

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As each option is evaluated for feasibility and operationalized, it is important for UHNI to understand a few facts about the Caribbean that will not change in the near future. Those facts include:

1. Ageographic location will always require some dependence on expertise in another physical location 2. The individual economics are highly influenced by specific industries (i.e. financial services, tourism, natural resources) 3. Much time is required to create additional infrastructure to delivery services and/or educate individuals to deliver skills required for ongoing improvement 4. The scale of individual economies and associated vulnerabilities require outside investment and/or service collaborators to include factors for these margins to subsequently ensure sustainability of investment and/or service delivered

Marketing Efforts & Benchmarking UHNI has created inroads in a number of countries for advisory and consultancy, particularly Libya, Kuwait and now Qatar, Dubai, Abu Dhabi and Sharjah. By no means has the market opportunity been even remotely fully captured. There is little to no strategic international marketing efforts outside of personal connectivity of UHNI. Quite simply, it has not been in the nature of the organization to promote itself outside of fundraising activities for its respective medical specialty divisions. Yet, UHNI does commit to its relationships and it there is a consensus and commitment that marketing will be required to effectuate brand awareness even for the expansion of its advisory and consultancy services due to increased global competition. To date, the few marketing efforts made remain insufficient to attain or track measurable results. Few metrics are in place for international marketing and benchmarking at this time. A detailed study of effective marketing techniques of each facility within UHNI would be appropriate to develop best practices for each region and attain good results in each of the existing markets of origin of patients. It will be essential to identify the source of existing inbound patient flow to ascertain how to enhance existing volume and origins of patients. Detailed marketing information was not provided to the advisors from all facilities and was beyond the scope of the Study. However it is inferred that there is little to no marketing outside of fundraising. It should therefore be noted that in order for a successful international program to develop, a significant change of culture would be required to understand the importance of messaging and marketing. Once marketing measures are established, the inherent resistance to an international program by local providers amongst themselves must be shed through engagement programs and public relations campaigns supported by providers and staff in an effort to promote and support the whole. Development of centralized marketing and public relations division at UHNI specific to the international program to effectuate marketing initiatives would be more effective than attempts to market through the existing departments alone. Efforts to maret services currently undertaken by divisions should be brought to be aligned with the strategy developed by UHNI and not permitted to run without alignment of messaging. It is recommended UHNI develop a comprehensive, best practice marketing plan for the target markets specifically based upon the knowledge provided herein as to what drives international patient decisions, an understanding of the payor systems, development of a Unique Value Proposition (UVP) and competitive advantage. Additionally, the same could be done for each geographic region selected as a traget market. The goal shall be set to provide a clear, continuous message as to the UVP offered by UHNI.

â&#x20AC;&#x153;The Caribbean works.â&#x20AC;?

GHR

University Health Network International (UHNI)

Global Healthcare Resources Additionally, after the international program has been revised according to the recommendations and the program is ready for its offical “relaunch,” it is recommended to develop a bilingual Arabic/English web portal specifically for international patients to access all information about the program services and professionals in the program. Development of relationships with medical travel facilitators and other medical tourism companies should also be considered for international patients provided such companies are properly screened, risk managed assessed and best practices ensured. Insurance company relationships and relationships with self-funded employers and Third Party Administrators (TPAs) should be standardized to Global Healthcare Resources assure seamless patient flow and increased volume.

GHR

It would be further recommended that UHNI consider a Minimum Viable Product (MVP) approach in the early stages of health product development. This method would ensure the market desires the health product being offered before an investment of a tremendous amount of time, financial resources and effort is made. Since the demand and need in the Middle East and GCC regions is quite clear to UHNI through its ongoing relationships, this approach is more recommended for the target market recommendations of the Caribbean and United States for several reasons. Cayman Islands, Barbados, Trinidad & Tobago and Bermuda are focused at the present time on elevating the quality of care, reducing costs, as well as launching its own international healthcare initiatives through building new healthcare facilities. This would imply that the establishment of peer networks may be more challenging as providers seek to keep their own patients in country as opposed to exporting them for care. Alternatively, if UHNI deems it has the capacity to build some service lines in these locations, alignment would be established for UHNI to receive inbound patient flow for higher specialized services. The United States current adaptation to healthcare reform has left many insurers, agents, brokers, TPAs and employers left wondering how to cut costs, yet challenged with the ethical and logistic dilemmas proposed by “medical tourism.” Domestic medical tourism is on the rise particularly in the self-funded market, yet tapping into these employers will require outsourced telemarketing and campaigns to achieve consideration. Therefore it was recommended to run trials in areas of large Canadian diaspora and direct flights to Toronto, i.e. New York, California and Florida. In considering a MVP approach, UHNI’s international product is adapted during the lifecycle of the program through feedback from potential future patients. As an adaptable program, different approaches may be made without significant financial investment and/or loss. Then itteration can be made to add or remove services lines which are more or less profitable, more or less desireable and more or less price sensitive in comparison to U.S. competitors. All in all, UHNI will need to develop one complete package of services as selected herein, with the adaptability to offer some services to one market and other services to another market based upon the tolerance and risk management level established by the UHNI accounting and legal team.

“We need to land this plan, determine where we are going, what we are offering, what the metrics of success will be, how we will monitor it...and then just do it.”

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Cultural Competency Strategy Because UHNI is located in a culturally diverse area like Toronto, providing appropriate services for international patients would presumably be streamlined. A UHNI program for multinational cultural understanding and service delivery will enhance the patient experience and the reputation of UHNI as a truly international organization. While it is anticipated that there are few or little biases across all level of human resources, testing and evaluation will be beneficial to mitigate any potential issues in advance. In terms of infrastructure at UHNI, the overall feel of the buildings themselves is one of modernity as well as not suffering from over capacity of patients. UHNI provides a desireable location for international patients to seek care. Toronto is an international and well known city; as a whole, hotels and tourism areas are well-equipped to welcome international patients and families. However, in the healthcare facilities, medical interpreters are generally not kept on staff and translators are shared between patients, if available at all. It is recommended to build a cultural competency training program for all medical staff and within the hospitality sectors in UHNI which effecutates a reduction of biases and assists with the physicians and staff training programs at the same time.

Best Practices Guidelines It is recommended that all staff be trained in international patient services. This includes all services not related to patient safety and quality, but those services which are involved in the communication and education of the patient and the patient management process itself. Training programs are available for these services designed for all staff coming in contact with patients and their families. “Train the Trainer” programs should be developed to effectuate UHNI’s best practices for patients and to maintain the culture of engagement and accountability in each division. International efforts and opportunities arise continuously on a wide variety of fronts across UHNI. These take the form of patient referrals, second opinions, speaking opportunities, research and collaborative partnerships and other requests which are regularly emerging to the phones and computers of UHNI’s medical specialists. Currently, doctors and staff have little direction and few resources for how to pursue those opportunities and virtually no system to track them. This creates not only a slow process to comply with requests, but also inhibits good continuum of care and lost market opportunity. While the current international effort will help within the focus markets, UHNI needs best practice guidelines and protocols to help employees across the divisions within UHNI. Developing international metrics for gauging patient satisfaction combined with reporting requirements from all divisions regarding patient inquiries, management and patient experience should be regulated through the UHNI main office which will therefore be able to monitor success of efforts and streamline further initiatives in respective regions based upon trends in inquiries.

“We don’t have a brand, we are so confused as to what our brand is that people have no idea who we are. If we stop someone on the street and they don’t know, how is anyone else in the world supposed to know?”

GHR

University Health Network International (UHNI)

Global Healthcare Resources

Technology

GHR

UNHI has a need to develop a digital platform for managing patient inquiries for inbound care, second opinion inquiries from patients and from referring physcians, which protect medical records and expedites service deliveries. Health systems need enhancement. Residents, observers and fellows require an “alumni” platform to generate patient referral. Technology soGlobal Healthcare Resources lutions for all of these programs should be integrated with a video conferencing system to convert inquiries and meet patients for good continuum of care.

“The process needs to be clearly communicated. There is a concern about how the program has evolved and the rules have not been clearly enunciated.”

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Executive Summary Conclusion This Feasibility Study identified several key themes for development of the UHNI Program. Additionally, the culture of internationalization is essential to any global program and the same holds true for healthcare. Physicians engaging in speaking opportunities and training abroad will be well received into foreign markets as respected experts and as experienced to receive referral patients from referral centers abroad. UHNI should be promoting their renowned physicians as an integrated marketing approach with their marketing of the UHNI brand. These brands should be synonymous. It is essential that the hospitals, hotels and tour operators are integrated in a destination approach to establish best practices for developing international patient flow and measuring the success of the program. This would require a reliable and efficient communication system between all sectors to streamline case management and measure results. Training programs and establishment of “train the trainer” programs should be implemented at all levels of the patient and tourist experience to provide appropriate tourism and hospitality options for traveling health seekers and ensure good outcomes for patients and their families. This philospohy is completely in alignment with the UHN Strategic Directions 2016: Global Impact - Loacl Accountability. For projections of investment and outcome, patient flow potential was evaluated through metrics developed by Global Healthcare Resources and includes the following calculations: 1) rate of patient flow to UHNI over the last years; 2) valued brand awareness in target markets; 3) extrapolation of estimated volume of patient flow from target countries; 4) anticipated implementation of the recommendations herein and 5) anticipated commitment of collaboration expressed by stakeholder providers in target countries. Not included in this analysis is the value of research projects, education and training programs, investment projects or philanthropic programs. This analysis also does not consider unknown recession, political instability, legislative barriers or other crises which may impact patient flow. University Health Network International Program has a valuable opportunity for expansion; however, financial investment and service development in addition to enhanced brand awareness investment, local brand awareness and public relations will be required to achieve success in the long term and across multiple service lines. It is therefore recommended that a financial model be developed which includes an adequate mix of advisory / consultancy plus inbound patient care to assure sufficient human resource allocation and allow effective delivery of service.

“We need to have sophisticated and engaged partners.”

GHR

University Health Network International (UHNI)

Global Healthcare Resources

Objectives & Context of the Study

GHR

This Feasibility Study is designed to assess the potential of the UHNI’s international program, analysis of the target markets identified, and to identify UHNI’s opportunities for export of health services. Generally, the objective is to develop UHNI into a sustainable provider of specialized care abroad in the following service lines:

Global Healthcare Resources

• Oncology • Cardiology • Neurosciences • Orthopedics • Rehabilitation • Spinal Surgery • Transplantation (Bone Marrow & Live Liver)

One goal of expansion of the international program shall be to creating a growing steady stream of international patients. UHNI’s senior management is in agreement as to the methodology and quantification that support market prioritization.

The objectives of the Study are: • To evaluate UHNI’s health services export potential and the strategic direction of its development in target markets, taking into account the current situation in UHNI and foreign experience; • Define and justify the most appropriate target markets for development of healthcare services in UHNI and the incentives for export of services; and • Provide complete and accurate information and recommendations of destinations through SWOT analysis to make appropriate decisions on target markets.

This would require making the following assumptions on UHNI deliverables:

•

Increase the capacity of accessibility of international services available;

• Increase patients coming to UHNI annually;

• Increase the orientation of UHNI to high value-added services for patient experience;

• Increase the UHNI economic value added;

• Overcome local or governmental objections to offering international patient care;

• Maintenance of high level quality of care and patient safety for all patients; and

• Improvement of the clinical outcomes for services of patients through time.

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