Managing healthcare for expatriates: quality assurance using a technology-based approach.

Cheek, Ronald G. ; Sale, Martha L. ; Hatfield, Robert D. 等

INTRODUCTION

The demand for international healthcare is being driven by the globalization of economies (Smith 1997). When organizations send employees from their home country to their international operations (expats), employees expectations of healthcare services, both in quality and access to, are similar to those they are accustomed to back in their home countries. If these acceptable healthcare services are not available, the overall effectiveness of these employees may be impacted. If organizations are going to compete in the global economy, they must provide a comprehensive, modern healthcare system for their employees (Plock 1996).

The failure to provide access to quality healthcare for expats can cause dissatisfaction and may result in poor productivity. Abraham Maslow in his "Hierarchy of Needs" addressed the basic issue managers had to address in order to motivate employees. He broke these into "lower-order" and "higher-order" needs (Robbins 1997). Healthcare can be considered a safety need and is addressed in Maslow's "lower-order" needs. Acceptable healthcare services must be satisfied if the employee is to be motivated. Frederick Herzberg in his "Two-Factor Theory of Work Motivation" described those things that made you feel good about your job and those things that made you feel bad about your job. He called these "motivators" and "hygiene" factors. The "motivators" lead to job satisfaction and motivate employees while the "hygiene" factors cause dissatisfaction when they are absent (Luthans & Hodgetts 1995). Quality healthcare for expats seems to qualify for Herzberg's definition of "hygiene" factors. It should be apparent that the absence of quality healthcare (hygiene) could possibly inhibit or limit the performance of expats. Organizations can resolve these issues associated Maslow's "lower-order needs" and Herzberg's "hygiene factors" through the provision of quality healthcare services for their expats.

The important roles that healthcare plays in human culture are a driving force for international organizations. Future healthcare systems must recognize, maintain, and value human culture while at the same time providing a high quality of healthcare (Kilman & Forslund 1997). International organizations must align themselves in healthcare issues with employees, between the physicians, healthcare providers and insurance companies to ensure the availability and quality of the expats' healthcare services. Merely depending on health insurance companies to provide adequate coverage for their expats will not suffice. In fact, organizations must play an active role in ensuring quality healthcare for their expats. This may include bringing in healthcare providers (managed care) which currently have the have the technology available to provide these healthcare services to their expats (Smith 1997).

Just as global communications has been transformed through the World-Wide Web and the Internet, efforts are being made to build an information infrastructure that will have similar impact on the provision of international healthcare. Clinicians are pioneering Web-enabled healthcare applications that will allow them to function locally, regionally, nationally, and internationally. Hagland (1998) reflects that these systems will provide crucial healthcare information in a manner that will "shrink the miles between the stakeholders in healthcare, while simultaneously improving health status and care delivery and cutting costs." As the use of the World-Wide Web increases dramatically, technology innovation in healthcare can be expected to increase exponentially.

Smith (1997) states that while "no healthcare system in the world is stable," information technology will transform healthcare worldwide. The integrated virtual system developed through technology innovation will allow patients, primary physicians, and healthcare providers to be linked regardless of their locations. Virtual patient records will dramatically impact the ability to provide healthcare in the global economy (Kilman & Forslund 1997). The challenge of this technology innovation is translating the research into innovative products and services (Poste 1997).

TECHNOLOGY INNOVATION

Technology innovation is streamlining the transmission of patient and clinical data (Hoffman 1996). The impact is that the patient can be positioned electronically between his/her primary care physicians and the healthcare provider at their international location. Physicians, nurses and other healthcare professionals are able to have ready access to patient records. As an example, Intermountain Health Care (IHC), a company that has built an integrated delivery system that allows physician systems outside their group (24 hospitals) access to patient data.

George Poste (1997), President, R&D, SmithKline Beecham recognizes "the challenge of translating the remarkable momentum of today's research into innovation products and services" for the healthcare industry. While incremental advances have historically been the routine, the global demands for healthcare require the dramatic advances available through technology innovation. These organizational linkages will require considerable managerial expertise to successfully deal with the varying organizational goals and objectives and cultural differences. Telemedicine

Magenau (1997) defines telemedicine as "a wide range of medical services delivered from a remote site via electronic networks. It uses telecommunications networks to transmit medical data (i.e., x-rays, high-resolution images, patient records, and videoconference consultations) from on location to another. Such transmission occurs on the Internet, on corporate Intranets, using videoconferencing equipment, and on ordinary telephone lines."

Telemedicine is in its infancy and the cost for its implementation may be expensive. However, technology is improving rapidly and primary care physicians in the near future can be expected to provide medical consultations from affordable and convenient multimedia desktop systems. For example, Sprint Healthcare Systems, Sprint's healthcare-dedicated business unit, recently provided all of Florida Hospital facilities with videoconferencing/telemedicine services. This service allows a cost-effective approach for physicians to perform remote diagnoses and consultations. Ralph Randall, regional client manager for Sprint says, "We will implement technology that changes the way healthcare is delivered and improves the lives of both patients and healthy individuals." This service allows radiologists to read X-rays and includes electronic storage and transmission of ultrasound, electrocardiograms, and other scanned images. It is interactive and allows patients and physicians to work simultaneously on their records to provide necessary treatment (Mycek, 1997).

The U.S. armed forces have effectively used teleconferencing applications to treat military personnel around the world. Through the use of satellites they have provided healthcare services to over seventy remote sites in such remote areas as Rwanda and Somalia. In their estimation, "the military has cut evacuation (of patients) by eighty-five percent because the personnel on the ground feel surer about their diagnoses" (Magenau 1997). While effective, it should be noted that the military does not necessarily operate under the same cost/budget constraints as private providers of healthcare services.

CHALLENGES & CONCERNS

Organizations offering healthcare services across country borders may encounter geographic and legal barriers to the implementation of their services. For example, in the U.S. there are concerns about physicians who regularly consult in states where they do not have a license to practice. Currently, 21 states require out-of-state physicians consulting across state lines to have a license in the state where the patient is located. In support of telemedicine, two years ago, the Federation of State Medical Boards offered legislation that would allow doctors holding an unrestricted medical license in one state to obtain a reciprocal license to provide electronic consultations in other states (Rose 1998). Healthcare attorney Robert Waters, counsel for the Washington, D.C. based Center for Telemedicine Law suggests "that some of the state bills are also projectionist driven as much by economic factors as by any quality concerns" (Anonymous, 1997). Similar medical licensing difficulties may be encountered when providing telemedicine healthcare services across country borders in the global economy.

Why has the implementation of telemedicine not progressed at a faster pace even though healthcare providers are willing to utilize it and patients will benefit from it? There seems to be two main obstacles:

1 the cost of this technology is extremely expensive, and

2 there has been some resistance to reimbursement from insurance providers (McCue 1997).

With the increased power and lower cost of multimedia software and personal computers, the overall cost to deliver telemedicine is expected to fall. Insurance providers are discussing this issue and are expected to consider its acceptance in the near future. Further innovative advances in the use of the Internet are also expected to support the delivery of telemedicine.

There are several other areas of concern. Many healthcare providers are uncomfortable with the privacy of patient information. Access controls and methods of authorization must be designed to limit electronic access to patient records (Kilman & Forslund 1997). As demand grows, there is a continuing shortage of trained network professionals (Janah 1998). Potential problems can also occur resulting from language barriers (Allen & Corcoran 1997). And finally, as with any activity in the global economy, cultural difficulties may be encountered when providing healthcare support throughout the world.

GENERAL DISCUSSION & CONCLUSIONS

Expats are empowered when provided with healthcare information and are given responsibility for their healthcare decisions. Innovations in technology will provide a strategic tool for solving the challenges of international healthcare (Allawi 1997). Organizations will have to play a major role in "unbundling" healthcare services for their expats. This role may include acting as an intermediary between insurance companies, healthcare providers, and their expats. The purpose of this new role of intermediary is to limit or eliminate expats healthcare concerns such as negotiating for coverage or reimbursement for healthcare services.

By establishing a diverse network of technical healthcare alliances, whose partners are both domestic and international, expats can be provided with the level and quality of healthcare services that they both expect and demand. An international effort based on virtual patient records that allows physicians, healthcare providers, and patients to work together offers the ability to provide quality healthcare services in an effective and efficient manner (Kilman & Forslund 1997).

In a global economy that stresses quality and cost, organizations must have motivated employees that are able to perform in an effective and efficient manner. Healthcare for expats represents, in the words of Maslow "a low-order" need that must be satisfied. Technology innovation can be expected to change the international provision of healthcare in a rapid and dramatic fashion. This work provides a mere introduction and should function as a solid theoretical foundation upon which to build future research.

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Ronald G. Cheek, University of Louisiana, Lafayette

Martha L. Sale, University of South Alabama

Robert D. Hatfield, Morehead State University