1. © Mobile Surgery International ™ Finding Affordable Health Care Arnon Krongrad, MD

2. © Mobile Surgery International ™ Consumer Attitudes About “Medical Tourism” Deloitte 2009 Survey: 8% sought health care services outside their community 43% would travel if they could save 50% The young are more receptive than the old How many are actually traveling?

3. © Mobile Surgery International ™ “Medical Tourism” Nothing New Not Medical Not Tourism

4. © Mobile Surgery International ™ Who Travels? Patients Travel Doctors Travel

5. © Mobile Surgery International ™ What Motivates Travel? Choice Quality Cost

6. © Mobile Surgery International ™  A 57-year-old uninsured, unemployed American  His father died of prostate cancer  He was diagnosed with prostate cancer on December 9, 2008  He is otherwise healthy  He chooses minimally invasive surgery  Offered unaffordable global package for US$50,000  Affordable options included open surgery Case Study 1: An Individual with Limited Means

7. © Mobile Surgery International ™ Meeting the Patient’s Needs  The patient’s priorities are – Treatment Choice – Treatment Quality – Cost containment – Risk management  He wants minimally invasive surgery – He cannot afford complications, so … – He needs a highly experienced surgeon – He needs the surgery at an affordable cost, and … – He needs insurance against post-op medical/surgical problems

8. © Mobile Surgery International ™ Addressing the Clinical Needs  MSI coordinated – A highly experienced and highly specialized American surgical team – High quality equipment sourced in an operating room in Trinidad – Transportation of specialized, complementary equipment – An experienced surgical support team

9. © Mobile Surgery International ™ Addressing the Non-Clinical Needs  MSI also coordinated – Transportation to Trinidad and back to the U.S. – Peri-operative accommodations for the patient and his wife – Cancer surgery travel complications insurance – A 60% discount

10. © Mobile Surgery International ™ The Surgical Practicalities  The patient arrived in Trinidad on March 3, 2009  Inpatient surgery was carried out on March 6  There were no peri-operative issues  The patient was discharged the next morning  The patient flew home on March 9

11. © Mobile Surgery International ™ Lessons of the Mobile Model Quality is mobile America is wasteful Reduce capital expenses Permits transparency Fill gaps in coverage Uninsured Self insured Under-insured Consumer Directed Plan Health Savings Accounts Government

12. © Mobile Surgery International ™ Potential Barriers to Mobile Surgery

13. © Mobile Surgery International ™ Latin America Caribbean Florida United States Traditional Model: Patient goes to surgeon Surgeon goes to patient Patient and surgeon meet at third place Models of Surgical Travel

14. © Mobile Surgery International ™ Domestic and Foreign Service Florida Kansas Trinidad

15. © Mobile Surgery International ™ Facilities and Services

16. © Mobile Surgery International ™ Who Are the Clients?

17. © Mobile Surgery International ™ Fridays Initiative: Service for Uninsured http://FridaysInitiative.com

18. © Mobile Surgery International ™ Fridays Initiative: Service for Uninsured http://FridaysInitiative.com

19. © Mobile Surgery International ™ Who We Are and What We Do Health care is about choice and quality Cost is a barrier to choice and quality Waste drives up cost Patients generally do not want to travel for health care A bundled, surgeon-driven model can partly optimize choice, quality, and cost