Abstract
Background: As medical tourism rises globally, healthcare leaders are required to make strategic decisions about accepting international patients, as a means to diversify income, increase access to cancer care, and optimize patient experience. Hospital Infantil Teletón de Oncología (HITO), a free-standing pediatric oncology hospital in Mexico, currently has no international patients. Aim: We posed a hypothetical case to a group of HITO's senior leaders to understand the strategic priorities, examine the decision-making process around allocating beds for self-paying patients, and explore how changes in hospital governance influence the healthcare system. Methods: A literature review and prediscussion interviews were conducted, and IRB exemption was obtained. Two facilitators led the discussion using a structured case guide. Participants (N=13) were randomly assigned to teams supporting or opposing the decision to accept international patients. Thirty minutes were allocated for team discussion, thirty minutes for team presentation and group discussion. Session was recorded and transcribed. Results: Four themes emerged around ethics and equity, finance, operations, and community. Ethical considerations included concerns that this possibility disrupted HITO's mission to serve the Mexican population. Financial considerations focused on the creation of a new billing system and cost-efficiency questions. Operational issues included new processes and systems in care delivery to accommodate international patients such as transfer of records and hiring of translators. Community topics covered HITO's reputation and the impact on local economy. Conclusion: Our study revealed the importance of a multidisciplinary approach to complex decision-making and the need for systematic strategic planning that lead to system strengthening and improvement of childhood cancer outcomes. The use of a hypothetical case as a learning and consensus-building tool in exploring team dynamics and mapping strategies was also highlighted. With medical tourism as a potentially realistic scenario, healthcare leaders must be prepared to evaluate its impact on their organization, healthcare system, and society.
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