Why are health systems pursuing this goal now?

Healthcare worker shortages are pushing health systems of all types to look beyond their domestic labor pools and recruit from abroad. Health systems may create international workforce pipelines by partnering with academic institutions to train and recruit student nurses and doctors.

Additionally, workforce shortages require health systems to create unique offerings and development opportunities to attract and retain talent. International partnerships can be mutually beneficial for participating institutions, as they allow staff to learn from each other, advance research and clinical education, and work at the top of their license.

What strategies are health systems employing to achieve this goal?

1. Creating international clinical exchange or “observership” programs

• How it works: Health systems welcome clinical staff and faculty from providers or universities from other countries to shadow their staff performing procedures and delivering treatments. Host organizations may also send their staff abroad to learn from partner organizations.
• What it looks like in practice: Since 2014, the University of Kansas Medical Center (KUMC) has partnered with the Chinese Ministry of Health on the Sino-U.S. Advanced Healthcare Professional Exchange Program. Through the three-month program, six to seven physicians from China participate in various clinical and administrative rotations and observations under the supervision of a KUMC clinician. The visiting physicians also participate in meetings, debriefings, and lectures and seminars on various topics, including leadership development, hospital management, and patient safety.
• Other goals it supports: Advancing research and innovation.

2. Launching international clinical placement programs

• How it works: Health systems, typically those affiliated with an academic institution, partner with an academic institution abroad to match students with clinical training programs (including rotations, fellowships, and residencies) across the two countries.
• What it looks like in practice: Since 2009, Oschner Health (Louisiana, United States) and University of Queensland (Australia) have partnered on the UQ-Oschner four-year MD program. Students spend their first two years at the University of Queensland’s campus in Brisbane, Australia, and the last two years at Oschner Clinical School in New Orleans, United States. The program boasts a 98% match rate in a range of specialties at leading hospitals across the United States, including Oschner Health sites.
• Other goals it supports: Cultural exchange and building a workforce pipeline.

Why are health systems pursuing this goal now? 

The Covid-19 pandemic highlighted healthcare disparities and elevated health equity as a global mandate. Health systems affiliated with religious groups and academic medical centers especially are keen to deliver on their mission to bridge quality and access gaps for patients who lack access to specialized services and expertise.

While there is an altruistic component to this strategy, helping other health systems or governments develop core capabilities abroad also builds brand recognition and can generate new revenue. Many of these partnerships are forged through consulting or advisory agreements, in which a government or health system contracts a (usually internationally recognized) health system for guidance and expertise. Additionally, in some jurisdictions, governments require certain kinds of organizations to re-invest their profits into philanthropic or community-building initiatives (e.g., nonprofits in the United States).

What strategies are health systems employing to achieve this goal?

1. Supporting other health systems in developing foundational competencies 

• How it works: Health systems provide training and coaching for staff, offer guidance on clinical and operational topics, and provide ongoing consultative support to enable partner organizations to improve and maintain services and quality of care for local populations.
• What it looks like in practice: In 2017, SickKids, a pediatric teaching hospital in Toronto, Canada, entered a five-year partnership agreement with the Nelson Mandela Children’s Hospital in Johannesburg, South Africa, to build a new hospital facility, with the goal of expanding children’s access to care in the region. The partnership expanded to provide ongoing support in several areas, including staff recruitment, governance and management structure, and sharing clinical and operational expertise.
• Other goals it supports: Generating new revenue and transfer of knowledge.

2. Implementing remote second-opinion programs

• How it works: Health systems provide virtual specialist consultations and support to clinicians and/or patients in regions without access to local expertise.
• What it looks like in practice: Since 2021, Memorial Sloan Kettering Cancer Center, a private nonprofit oncology provider and research institution in New York, United States, built an outpost in Chennai, India and partnered with iCliniq, an Indian telemedicine platform, to offer remote second-opinion services to patients in India.
• Other goals it supports: Generating new revenue and transfer of knowledge.

3. Opening Centers of Excellence or clinics

• How it works: Health systems partner with governments or local hospitals to open new clinics or specialty sites in areas where access to those services is limited.
• What it looks like in practice: In 2015, Brigham and Women's Hospital, an affiliate of Harvard Medical School and part of Partners Healthcare (Boston, United States), entered a five-year consulting agreement with Jiahui International Hospital (Shanghai, China). Through the partnership, Brigham and Women’s Hospital helped to develop a women's health center of excellence in Shanghai. The center includes obstetric, gynecology, and in vitro fertilization programs, as well as a neonatal ICU and integrated women's health.
• Other goals it supports: Generating new revenue and transfer of knowledge.

Why are health systems pursuing this goal now? 

All health systems — from for-profit to academic medical centers to government-run — are increasingly partnering to build their reputations as global leaders in research. Through these research agreements, health systems partner to deepen their clinical knowledge, codevelop treatments for specific conditions, and codevelop or accelerate acceptance of new practices and technologies.

Research and academic collaborations between health systems, medical schools, and research institutions are somewhat common. However, the Covid-19 pandemic highlighted the interdependencies between organizations around the globe and showed — to an unprecedented degree — the benefit of knowledge exchanges to patient care. Research and innovation partnerships also yield benefits to the workforce, as they can train, engage, and retain staff. As such, there is significant overlap between mission, research, and workforce goals.

Health systems may also leverage their research and innovation functions to diversify revenue streams as they develop and monetize intellectual property, proprietary care models, or new technology. Some progressive health systems run dedicated innovation or venture capital arms to identify partners with whom they can create, develop, scale, and market innovations.

What strategies are health systems employing to achieve this goal? 

1. Expanding and commercializing clinical research through joint ventures

• How it works: Health systems partner with Centers of Excellence, medical schools, or universities to advance medical research and education, typically on a specific condition or topic area.
• What it looks like in practice: Since 2007, UHN Princess Margaret Cancer Center in Toronto, Canada has partnered with the Italian Cancer Center Institute in Aviano, Italy, to share knowledge and best practices in cancer care, advance clinical trials, create innovative cancer education programs, and create opportunities for joint ventures.
• Other goals it supports: Knowledge exchange; workforce development and retention.

2. Developing and scaling innovative care models and practices

• How it works: Health systems partner with hospitals and health systems to codevelop new technologies and practices to improve patient care.
• What it looks like in practice: In 2012, Hospital Israelita Albert Einstein, a teaching hospital in São Paulo, Brazil, entered in a 10-year partnership with MD Anderson Cancer Institute in Houston, United States, to share knowledge and expertise, facilitate staff exchanges, advance oncological research, and improve treatment for oncology patients. The goal of the partnership was to implement a treatment program at Hospital Israelita Albert Einstein that emulates the one at MD Anderson’s campus in the United States.
• Other goals it supports: Improving patient care; workforce development and retention.

3. Codeveloping and marketing intellectual propriety

• How it works: Health systems partner with a private entity (such as venture capital and private equity firms, start-ups, and pharmaceutical companies) to codevelop, pilot, scale, and market new technologies or practices, or to launch and expand clinical trials for treatments.
• What it looks like in practice: Since 2021, Sheba Medical Center, an academic medical center in Ramat Gan, Israel, has partnered with Kaleidoscope Health Ventures, an American venture capital firm, to develop the Chicago branch of Sheba’s innovation arm, ARC (Accelerate, Redesign, and Collaborate). The Chicago ARC serves as the incubator for Sheba’s partners, which include health systems, start-ups, academic centers, and pharmaceutical companies from around the world, to further research and patent innovations in the fields of precision medicine, AI, virtual reality, telehealth, and medical technologies.
• Other goals it supports: Delivering on mission; generating new revenue.

Why are health systems pursuing this goal now? 

Global financial pressures brought on by rising costs of care and decreasing reimbursement rates and funding cuts are pushing health systems to chase new sources of revenue. One increasingly popular avenue for this type of revenue diversification is through establishing or expanding international presence. This trend is true not only for private, for-profit institutions, but also public, nonprofit, and even government-owned health systems looking for budgetary breathing room.

Health system executives may explore opportunities in other countries when they’ve determined that they’ve maxed out their growth potential domestically or where there are specific tailwinds that can facilitate quick growth in a new market. Competition with peer organizations that have international footprints is also leading health systems to expand overseas. As mentioned before, many opportunities highlighted in previous sections, particularly those related to advancing research and innovation, can also contribute to revenue growth. 

What strategies are health systems employing to achieve this goal? 

1. Acquiring or merging with other health systems or providers

• How it works: Health systems acquire or merge with providers to establish or expand their foothold in a market, capture more private or self-pay patient volumes, and/or augment their capabilities and service offerings.
• What it looks like in practice: In December 2021, Ramsay Healthcare, an Australian-based private healthcare provider operating in Australia, Europe, and Asia, acquired Elysium, the leading private provider of mental health services in the United Kingdom to grow its U.K. business by capturing volumes of behavioral health patients. Prior to the acquisition, Ramsay owned and operated 70+ behavioral health facilities across its global footprint.
• Other goals it supports: Establishing or expanding presence in new markets.

2. Monetizing internal capabilities and expertise

• How it works: Health systems license out proprietary knowledge or products to organizations, governments, and private companies through consulting or advisory agreements. Consulting and advisory services range from facility design to workforce training and education. The goals of these arrangements often overlap with an organization’s mission to expand access and improve quality of care.
• What it looks like in practice: In 2010, UHN’s Princess Margaret Cancer Centre in Toronto, Canada, entered a five-year consulting agreement with the Kuwait Cancer Control Centre to improve oncology services. The partnership leveraged UHN’s expertise to improve Kuwait’s cancer care infrastructure and improve quality of care.
• Other goals it supports: Delivering on mission and transfer of knowledge.

3. Taking management ownership of organizations abroad

• How it works: Health systems and hospitals in two different countries become affiliates through management agreements where one institution oversees the operations and administration of the other’s hospital or clinic(s).
• What it looks like in practice: In 2023, Aster DM Healthcare, a for-profit healthcare conglomerate operating in the Middle East, entered into a 15-year “operations and maintenance agreement” with Vritika Hospitals and Bharathi Education Trust, to assume operations and management of their super specialty hospital in India.
• Other goals it supports: Market proliferation.

4. Codeveloping and marketing intellectual property

• How it works: Health systems launch joint ventures with other health systems, private companies (including start-ups, private equity firms, venture capital firms, and conglomerates), or governments to co-own businesses.
• What it looks like in practice: Since 2015, Moorsfield Eye Hospital, a specialist National Health Service hospital in England, has partnered with Emirati holding company, United Eastern Medical Services, to operate a clinic in Abu Dhabi. The clinic is one of the few comprehensive specialist centers in the region. It offers services related to pediatric ophthalmology, strabismus, glaucoma, medical and surgical retina, oculoplastic surgery (cosmetic surgery around the eye), cornea repair, and refractive surgery (vision corrective surgery).
• Other goals it supports: Market proliferation and delivering on mission.

5. Bridging care or access gaps through government partnerships

• How it works: Health systems partner with a governmental organization to create or expand access to care. These agreements range in scope: they may target a specific demographic or need (such as government employees or children, or patients seeking specialty treatment) or involve large-scale projects or reforms (such as improving primary care services).
• What it looks like in practice: In 2013, Johns Hopkins, an academic medical center in Baltimore, United States, partnered with Saudi Aramco, the state-owned Saudi oil company, to launch and jointly own Johns Hopkins Aramco Healthcare Company (JHAH). JHAH provides healthcare to Saudi Aramco’s employees and their beneficiaries. JHAH has since expanded to provide care for patients across Saudi Arabia beyond Saudi Aramco employees.
• Other goals it supports: Delivering on mission and market proliferation.

6. Strengthening international referral networks

• How it works: Health systems strengthen ties with providers, life sciences companies, governments, payers, and third-party private companies abroad to grow inbound medical tourism volumes.
• What it looks like in practice: Since 2022, IHH Healthcare, the largest private healthcare provider in Asia, has partnered with Indonesian laboratory chain Prodia to refer patients to Malaysia for diagnostic services and examinations.
• Other goals it supports: Expanding access to care.

Why are health systems pursuing this goal now? 

Rising costs and supply chain disruptions due to natural disasters, worker shortages, and raw material scarcity are pushing health systems to reconsider their procurement strategy. While group purchasing organizations (GPOs) — which aggregate the purchasing power of its members — have long existed, they’re now facilitating domestic partnerships between member health systems and suppliers to increase domestic manufacturing or streamline operations.

However, partnerships that aim to increase domestic manufacturing are often limited in scope, financially burdensome, and have little impact on supply chain resilience. Some progressive health systems are looking to diversify their sourcing and aggregate purchasing power with partners abroad to improve supply chain resilience and reduce costs. Partnering internationally in this area remains a largely untapped opportunity. 

What strategies are health systems employing to achieve this goal? 

1. Launching global supply chain joint ventures

• How it works: Health systems partner with a non-competing health system beyond their national borders to combine purchasing power and codevelop procurement solutions.
• What it looks like in practice: Since 2018, Ramsay Healthcare, an Australian-based private healthcare provider operating in Australia, Europe, and Asia, has partnered with Ascension, the largest private nonprofit healthcare system in the United States, to operate a “global healthcare buying group.” The group, jointly owned by both organizations, seeks to improve efficiency and reduce costs associated with ordering, tracking, logistics, and fulfillment. Ramsay and Ascension can benefit without competitive tension as they do not compete in any markets.
• Other goals it supports: Supply chain resilience.