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Involvement Abroad of U.S. Academic Health Centers and Major Teaching Hospitals: The Developing Landscape

Merritt, Michael G. Jr; Railey, Chris J. MFA; Levin, Steven A. MBA; Crone, Robert K. MD

doi: 10.1097/ACM.0b013e318172399e
Institutional Issues

Purpose: To compile information about major offshore clinical, education, and research programs and operations of U.S. academic health centers (AHCs) and major teaching hospitals, and to describe how these offshore activities relate to each institution’s underlying mission and to the organizational mechanisms that link the activities to the organization’s core mission while protecting the organization from potential risks.

Method: The authors collected information regarding the major offshore activities of 16 AHCs and major teaching hospitals from a variety of sources during the months of March to May 2007. The data sources included telephone interviews with leaders of each organization’s offshore activities, review of information on each organization’s Web site, and a review of the literature on this topic. A framework was then developed to distinguish the type and scale of offshore activities among these 16 organizations.

Results: The extent and nature of offshore activities varies widely across the studied institutions, ranging from a limited number of education and training programs to major commitments to deliver patient care, education, and research services offshore. Offshore activities seem to follow a four-stage development path, which the authors describe. There seem to be four reasons that US AHCs and major teaching hospitals are engaging in these offshore activities.

Conclusions: Development of offshore activities requires a major commitment and is only appropriate for those AHCs whose mission is to serve a global market and who are able to dedicate significant faculty, management, and staff resources. While some have achieved tangible benefits, the creation of truly global AHCs will require many years of development with uncertain results.

Mr. Merritt served as senior engagement manager, The chartis Group (a health care advisory services firm), New York, New York, until March 2008. He is currently executive director, International Business Development, New York-Presbyterian Hospital, New York, New York.

Mr. Railey is director of communications, Harvard Medical International, Boston, Massachusetts.

Mr. Levin is director, The Chartis Group (a health care advisory services firm), New York, New York.

Dr. Crone served as president and chief executive officer, Harvard Medical International, Boston, Massachusetts, from 1995 to November 2007. He is currently managing director, Academic Medical Center Practice, Huron Consulting Group, Inc., Boston, Massachusetts, and clinical professor of anaesthesia, Harvard Medical School, Boston, Massachusetts.

Correspondence should be addressed to Mr. Railey, One Renaissance Park, Suite 900, 1135 Tremont Street, Boston, MA 02120; e-mail: (

© 2008 Association of American Medical Colleges