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Andres Gibson

Good healthcare tips.


Great informative post.

Stephanie Sulger

Thanks for the article and a tip of the pen to the nurses and doctors at MTI who are very concerned about the medical appropriateness of overseas hospitals, the patients who travel there and sometimes those who facilitate the process.

And on a lighter note: isn't it called offshore if the procedure is procured far away and nearshoring if its close? So one could say that a patient traveling to Thailand is offshoring, unless they are traveling from India. And having a procedure in Costa Rica is nearsourcing only if you are from the US but offshoring if you are a traveling patient from Europe. No wonder they call it medical tourism.


Medical tourism has arrived in India and it is not just from the US. The fallout of this is the arrival of super speciality hospitals in India - and better facilities in general.

Hospitals can service the rich who are willing to pay and can also use some of it to cross subsidise the really poor - if they wish.

Som Karamchetty, PHD

1. As unchecked healthcare costs are expected to cause serious negative economic impacts on Western economies, medical offshoring has to be included in national economic planning.
2. As offshoring will not likely to provide relief to the middle class and poor in the Western countries, a new model of inshoring should be tried. This model envisages the creation of special economic zones (SEZ); let us call them Import Promotion Zones (IPZ), the opposite of Export Promotion Zones (EPZ). IPZ’s are specially designated geographic areas in Western countries where foreign medical practitioners are allowed to locate facilities and perform procedures at affordable rates. It is generally stated that middle class and poor people do not seek timely medical help as they cannot afford the high cost of medical care. By locating IPZ’s in easily accessible new immigrant neighborhoods, reasonable and good healthcare can be provided to the poor in the rich countries.
As the US government designs ways to legitimize the estimated eleven million illegal immigrants, the IPZ’s, with liberalized entry of medical practitioners, can keep them in good health and reduce costs, which would otherwise cripple the US and/or citizen budgets.

Nitin Goyal

This is a nice point. However for one moment consider the example of a service in which " face-to-face human contact" is necessary - hair cuts. Assuming that the consumer does not move to an offshore location (I wonder if one can in the near future be able to fly down to Shanghai for a hair cut), there are still parts of the service that can be outsourced:
- Making an appointment
- Deciding on what haristyle suits you best from available styles
- The total package - haircut, massgae, hair coloring etc you want to avail of.
- Advance payment
All these can be delivered seamlessly from an outsourced location over a phone call or the internet. In such a scenario, even though the consumer is captive, the service is fully commoditized. I wonder if there is any barber who will prefer this scenario. Even having a captive, immovable consumer base for your service does not necessarily mean that the service can be fully delivered onsite and there are no offshore components to it.

Just my 2 cents worth.


vinnie mirchandani

I am in the outsourcing advisory business - but I think your reaction and those of others to medical tourism is way too "wow". Somehow, we expect consumers as against corporations to be far more local rather than global in their sourcing. As we help our corporations globally source at an accelerated pace, we will also take advantage of global products and services for ourselves. In the 80s, there was a gray market as US residents used to pick up BMWs in Germany drive on a holiday there and ship it back. In my travels in the 90s I would try and buy most of my airline tickets in London as the bucket shops there and the rate of exchange made it 20 to 30% cheaper than getting them issued here. Hong Kong was known as the place to buy affordable electronics (and get tailored suits), Dubai (smack in the middle of the Muslim world) had a great duty free. There is no law that says consumers cannot take advantage of arbitrage, only corporations can. That does not mean it is one way - all hurting the US. Disney has known for a while that many UK residents prefer to come to Orlando rather than go to Euro Disney - it's cheaper, sunnier etc. There are plenty of stores in NYC that sell 220 v gadgets to tourists from around the world. There is a cottage industry of folks who help offshore staff from India find insurance, apartments etc in the US when they are here. As you know these things go in waves, though. I can no longer afford to buy tickets in London or that BMW there and have it shipped back.

John Maloney

Hi --

Thanks for the post. Not sure I agree that when a product or service is consumed proximately, i.e., in the location it was produced, that it is 'offshoring.' Getting a facelift with a nice vacation in Brazil is just good global development and competition.

Building a KIA in Korea and shipping to Long Beach is just import/export.

Geometry tutors in Mysore with 12-year old clients in Iowa is offshoring.

It important to elaborate the stunning corporate train wrecks in service offshoring. The picture is not very rosy. A lot of offshore service projects have been called back. Indian service firms are hiring like crazy in the USA.

For service offshoring success, the principle is to understand and lead intangibles. The technique is value network analysis. It allows mgmt to understand the real sources of value before making expensive geographical mistakes. See:



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