HEALTHY PRACTICE.

Behind aggressive new marketing, U.S. hospitals tap pool of well-heeled Latin Americans.

CARLOS VALENCIA, 72, TRAVELED FROM EL SALVADOR to Baptist Hospital almost in a coma, his blood vessels clogged and in danger of rupturing. He underwent state-of-the-art heart surgery to clean his arteries of plaque and, after 10 days at the Miami hospital, he was ready to go home. "Thanks to God and my family and to the doctors, nurses and the staff of Baptist Hospital that I am still alive," Valencia says.

Like Valencia, hundreds of thousands of Latin Americans turn to international hospitals for treatment every year. For decades, the region's well-heeled have checked into world-class facilities for cutting-edge medical care unavailable in their home countries. Often, the trips stemmed from referrals from family doctors who studied in the United States or Europe and recommended advanced treatment at their alma maters.

The difference now is that U.S. medical facilities are brazenly pitching

their services. Struggling with cost-cutting imposed by insurance companies and health maintenance organizations, hospitals target well-to-do Latins, who often pay cash for services, with slick marketing campaigns and high-tech outreach programs.

"These patients are a growing, increasingly important part of the revenue base of major blue chip hospitals in the United States," says Jonathan Lewis, president of the Academy for International Health Studies, a private clearinghouse for health care business issues. "What we have is a health care free trade zone."

Ever since the early 1980s when Brazil's then-President Joao Figueiredo was treated at the Cleveland Clinic for a heart ailment, the hospital has been a pioneer of international marketing. Former global pitchman John Hutchins built the business from US$7 million a year to $70 minion over an eight-year period, according to the specialized publication Medicine & Health. Hutchins moved on to Johns Hopkins in Baltimore, where international patients soared from 600 to more than 7,000 a year. And the boom was on.

Brazilians still seek cardiac services at the Cleveland Clinic, while they take their youngsters to the Boston Children's Hospital. An estimated 35,000 Latin American patients, primarily from Venezuela and Central America, checked into Miami hospitals last year. And half a million Mexicans are estimated to receive medical care in the United States annually, mainly in Texas and California.

"We get a lot of patients from Mexico because Houston is so close," explains Sara Rahman, administrative coordinator for international programs at the University of Texas M.D. Anderson Cancer Center, which touts its record number of grants from the National Cancer Institute and the American Cancer Society to potential patients.

Power in numbers. So intense has become the competition for cash-carrying Latin Americans that some health care facilities have joined forces for marketing. Philadelphia International Medicine handles marketing for an alliance of nine prominent research hospitals, including Children's Hospital of Philadelphia and the University of Pennsylvania Medical Center. "We market our hospitals internationally and we work with foreign patients from the moment of arrival until they return home," says alliance Chief Operating Officer Leonard Karp.

In 1998, nine Miami hospitals also decided big is better. They created Salud Miami, also known as the Miami Medical Alliance, to promote the city as a medical destination. Participating hospitals each contribute $65,000 annually to the nonprofit organization; the city of Miami chips in another $100,000.

"Our strategy is to emphasize that our doctors are bilingual and understand the cultures of foreign patients," says Victoria Brewer-Anderson, Salud Miami's executive director.

About 90% of all the contact work takes place via Salud Miami's Web site, which offers medical information, columns by health care specialists and well-being tips, although its principle goal is to link potential patients with Florida hospitals. Medical records are zipped to hospitals via e-mail, doctor's appointments are set up online and multilingual staff answer questions over the Internet.

Industry consultants say doctors' recommendations, more than marketing directly to the patient, have been the traditional route by which hospitals and foreign patients are connected. "The programs that are most successful are those where they market to the physician," says Joseph Davis, CEO of health industry consultant Medimetrix. Whether the Internet will change that remains to be seen.

Still, Miami's not the only city marketing medical services via the Web. Other U.S. hospitals have acknowledged that their target group overlaps with the small, but select, number of Latin Americans using the Internet. The Cleveland Clinic's Web site has an "International Center" link through which potential patients can look up services and physicians (in English and Spanish), make appointments online and arrange for interpreters to be present at meetings with doctors once they travel to the United States.

The site also contains local hotel information and airline phone numbers and Web addresses. Patients can even reserve transportation from the airport to the hospital; the fee is tucked into their hospital bill.

That's not to say everything is electronic. Salud Miami also pushes its message in Latin American newspapers and magazines. And it's making direct appeals to Latin American journalists, wining and dining small groups of them in Miami in hopes they'll spread the marketing message in their publications. Brewer-Anderson claims a $5,000 press trip can reap news coverage equivalent to $100,000 in advertising.

The push seems to be working. Maria-Ana Junquera, administrative director for the International Health Center at the University of Miami-Jackson Memorial Hospital, says the number of international patients at her facility has tripled during the past two-and-a-half years.

"We obtain all necessary medical information so the doctors know the condition of the patients. We also make sure the families know the cost of treatment," she says. "We have interpreters available. In effect, we offer foreign patients one-stop shopping."

Sticker shock. The United States' reputation for notoriously expensive health care might appear a deterrent to the marketing effort. But two factors are at play. The targeted patients are people for whom cost is not the first factor when seeking medical care. And some specialized treatment--thanks to economies of scale--sometimes end up more economical in the United States than in Latin America.

"There are certain diagnostic tests or, for example, the cost of MRIs, that can be less expensive in the United States," says Medimetrix's Davis, referring to the medical test known as magnetic resonance imaging. "You may pay more for something at the Mayo Clinic, but there are also diagnostic centers in the United States where you can just walk in and have things done cheaper."

Even though the final bill on complicated procedures may be appealing to Latin Americans, they're still shelling out more money than their U.S. counterparts with health insurance. "Think of it as 40% below retail. That's what insurance companies pay," Davis says. "The hospitals see foreign patients as a cash-and-carry market."

But Lewis at the Academy for International Health Studies says the push for foreign patients is not just a response to bottom-line pressure in the U.S. health care industry "There is also a global recognition that it's not sensible for every nation in the world to replicate very expensive, intensive health care, that the priority in most developing nations ought to be primary care, public health and community-based care," he says.

Moreover, to make the bills more palliative, some facilities offer one-price packages. Salud Miami offers $500 checkups for children. Marcia Dfaz de Villegas, spokesperson for Miami Children's Hospital, says Latin American parents typically bring youngsters suffering from cancer or those with cardiac, neurological and urological ailments.

"We had a patient in El Salvador with congenital heart disease who could not be treated in his native country," she recalls. "Through our network of doctors, the boy's family found us. They brought him to us. He was treated effectively."

Medimetrix's Davis says foreign patients are "a big deal" to hospitals and Latin America is getting vigorous marketing attention just because of the sheer size of the countries. Even if a fraction of Mexicans or Brazilians start looking north for health care, that could be millions of patients. Or more accurately, potential patients--for the hospitals are banking that economic improvements in the region will mean increasing numbers of Latin Americans will be able to afford health care at U.S. facilities. "They want to get in there early," Davis says.

Global treatment. There are already indications this is happening. Brewer-Anderson says while most Latin Americans come to Miami for cancer or cardiovascular care unavailable at home, they have also begun to seek knee, hip and spinal disc replacement, as well as brain surgery. More women are also arriving to deliver their babies. And some patients just want a second medical opinion or the latest medications.

That trend feeds off the notion that U.S. health care is superior to that of Latin America. Certainly, U.S. facilities have developed world-class reputations, and deservedly so. Technological advances, including expensive medical machines, are available. And stateside facilities excel at extremely specialized procedures, including some--like transplants--that register the highest success rates at the hospitals that do the greatest number of them. Practice makes perfect.

Still, Latin America boasts its own notable facilities that could be marketed globally--if only the region would be willing to pump some money into the effort. To be sure, the United States will continue to excel in heart and cancer care, infertility treatment, and the care of patients with degenerative diseases like multiple sclerosis and muscular dystrophy And patients who can afford it will seek out the very best facilities, regardless of national borders.

But reputation is not the only factor at play Some Latin Americans seek treatment in the United States, in part, for the cachet. That's where geography comes into play. While Houston and Miami are home to well-known medical facilities and are frequented by foreigners seeking health care, the most famous hospitals in certain specialty areas are not necessarily in those cities. "It's one of the rules of thumb in this kind of international marketing," says Medimetrix's Davis. "Will you fly over M.D. Anderson in Houston to get to the Mayo Clinic?"

Whether patients do or not has a lot to do with marketing. U.S. medical facilities allocate huge amounts to their marketing efforts. Top-rate Latin American facilities like the Albert Einstein Medical Center in Sao Paulo may be missing the opportunity to play at the same game.

Costa Rica has done some limited marketing for so-called medical tourism, touting its expertise in everything from transplants to dental care. Although the pitches are geared toward U.S. residents seeking discount prices for services, they have drawn other Central Americans. And Cuba is a well-known destination for certain treatments, including addiction problems. Argentine soccer star Diego Maradona spent months in Cuba recently trying to kick a cocaine habit. But these efforts aren't in the same big league with the U.S. players.

International Hospital Corp., working with Latin American investors, has opened high-quality private hospitals in Costa Rica, Mexico and Brazil. CEO Larry Meagher says marketing, although geared to local residents, has sparked some unusual results.

"We're currently negotiating with a major HMO in Arizona to provide coverage for their beneficiaries who want to come to Mexico for some of their care," he says. "A lot of the insured are Mexican-Americans, some of them first generation, and culturally they're more comfortable with a doctor who speaks Spanish. And Mexican doctors spend more time with their patients."

The insurance companies find the option appealing because health care costs are lower in Mexico. Meagher's company likes the idea because it expands its patient base across borders.

As private hospitals increasingly compete with public facilities in Latin America, U.S.-bound patients in Argentina, Brazil, Mexico and elsewhere in the region may begin to look closer to home for their hospital care. Meagher tells the story of a Mexican businessman who traveled with his wife to Arizona for the births of their first two children. The executive subsequently became an investor in the $30 million Cima Hermosillo, an International Hospital Corp. facility in Sonora, Mexico--where his next two children were born. "I joke that it cost him US$30 million to have those two children in Mexico," Meagher says.

Latin American facilities will need technology, strong management, cachet and aggressive marketing to join the global patient game. They'll also need to cultivate hospitals with stellar reputations and specialized services. "The challenge for Latin America is to develop its own expertise. Brazil would be an obvious one: it's a world-class center for plastic surgery," says Lewis at the Academy for International Health Studies. Even so, the United States has nothing to worry about.

"There are few places in the world that have the same quality, technology and resources that the American health care system has," Meagher says. "And some [Latin Americans] will always go to U.S. hospitals, no matter what alternatives you provide them."