There are no shortage of articles telling us about the scale and staggering growth of the ‘medical tourism market’. Deloitte has valued it at $60 billion, while a Research and Markets report estimates it at a lower, but still substantial, $40 billion. I have spent the last 3 years working in the field and after putting over 50,000 customers in contact with overseas healthcare providers, I have come to the conclusion that while there is a growing and vibrant international trade in healthcare services, it isn’t a market in the true sense of the word.
A market is defined as any structure where buyers and suppliers can exchange goods and services, in this instance, healthcare. Once you talk to a number of ’medical tourists’ it becomes abundantly clear that they don’t purchase their overseas healthcare from a ‘medical tourism marketplace’ at all. Instead they buy from a globalised healthcare market. In simple terms, when Annie Smith considers travelling to Thailand for a breast reduction procedure, she doesn’t compare Thailand’s cosmetic surgeons to other overseas cosmetic surgeons; she compares them to local practitioners. She doesn’t buy from the ‘medical tourism market’, she buys from the globalised healthcare market – she compares the price and quality offered by multiple clinics that carry out this procedure, both at home and abroad, and chooses her preferred option.
The fundamental mistake that analysts and pundits make is to assume that globalisation creates new markets – it does not. Globalisation combines many domestic markets into one larger market place. In the case of healthcare, the consumer is free to evaluate their options at a global marketplace and choose the clinic that meets their needs. While the location of the service provider might be a consideration for the consumer, or even a deciding factor, it does not change the fact that the services being consumed are available across multiple locations.
In some ways this globalisation of healthcare echoes that of other previously globalised markets. For example, parallels can be drawn between the healthcare industry and the automotive industry. When Carlos Ghosn became CEO of the Japanese Nissan company, he started purchasing car parts from factories in China and India. This decision was influenced by the price and quality offered, not by source location. In other ways the globalisation of healthcare is unique and some lessons will have to be learnt by trial and error, rather than by reference to historical market analysis.
One way in which healthcare is different to, for example, consumer product industries, is that the patient must be transported to the service. This has two major affects on medical tourism. Firstly, it makes it difficult for governments to apply trade barriers in the form of tariffs (effective trade barriers are already very much in place, in the form of subsidies or national insurance that apply only to domestic providers). Secondly, unlike intellectual property which can cross borders effortlessly, healthcare is not a frictionless product. The cost and time involved in travelling over large geographical distances presents a significant barrier to trade. This gives an inherent advantage to the local market. It is quality, availability of care, value for money and additional privacy that enable overseas clinics to overcome these barriers.
Healthcare suppliers who target overseas patients may regard themselves as constituting a ‘medical tourism marketplace’, but this is because they operate from a myopic, supplier-centric
view of the market. It is necessary to take a step back and view the market from the consumers’ perspective. After all it is they who define the market.
What this means for healthcare providers worldwide is that they must become aware of the options open to their patients, locally, nationally and internationally. Only then can consumers be expected to make educated decisions about their own healthcare.
All online enquiries deserve a personalized email response; however your business processes should also include an automated email that is sent immediately once the online enquiry has been submitted. A well thought out response should include the following five pieces of information:
Confirmation that you have received the enquiry. This reassures the consumer that their enquiry hasn’t fallen into a black hole and your systems are working correctly. An automated email is standard practice on the internet and the consumer expects it. If you don’t send one then you won’t be meeting their expectations and reducing the chance that they will ever visit your practice for treatment.
A time and date when they can expect a personalised response. This allows you to set the consumer’s expectations so that you can then subsequently meet them. If you don’t tell them when they can expect a response then they will create their own expectations, which will probably be unrealistic. If you say in the automated response that you will contact them within the next two days it is critical that you actually do contact them – even if it is only to apologize that there is a delay. If you do delay the response make sure you inform them of when they should expect the new response.
Some further information on the clinic. Give the consumer something to read and to think about. Focus on the best aspects of your clinic such as accreditations, specialities, equipment, training, etc.
Include two of three real testimonials with full names. Credibility is absolutely critical here and if your testimonials have been published on 3rd party sites you should include that fact.
Contact Information. A lot of people use email as a crude tool for organizing their life – when they want to contact you in the future they will remember that you emailed them and will search their email. Putting all of your contact information in this mail will maximise the chance that they will contact you in the future even if they don’t come for treatment immediately.
It is nice to be able to personalize the email response to include the patients name and the treatment that they are looking for. This is not critical but if your technology easily allows it then it is a good idea.
Sample Email
Dear [insert the patients name here]
Thanks for your enquiry regarding [insert treatment here] with [insert your clinic name here]
We are currently reviewing your enquiry and will contact you in the next two days.
Clinic Overview
Describe your doctors or dentists experience, qualifications and specialisations- Take this information from your staff listings and add more detail as you like.
Procedures.
Describe the procedures your clinic performs. You should let them know how long the procedure normally takes, the recovery time and the number of visits required. You can include before and after pictures if you have them.
Testimonial 1
“I was very pleased with the treatment and also I was very pleased with the way I was looked after on my visit to the clinic.” – Alison Benson, Surrey, UK (published on RevaHealth.com)
Testimonial 2
“Despite having been to the dentist every 6 months all my life, I discovered, when I had my first appointment in Budapest, that none of the caps and facades I’d had put on locally fitted properly and my teeth had been quietly rotting away for years (the dentist gave me a mirror so I could see for myself, and I was horrified to see that the teeth underneath were black). Consequently I needed a lot of work. I’d had an estimate in a local clinic of 8 hours and 1300 Euro for just one tooth. The dentist in Budapest did the preparation work on 19 teeth in six and a half hours and the whole thing, including the most expensive crowns available (which are metal-free and therefore look like real teeth) cost around 5000 Euro. The most impressive thing was that because the dentist was so gentle and sympathetic, six and a half hours in the dentist’s chair really wasn’t that bad. It was tiring though and I felt fragile afterwards so the fact that Access Smile then drove me back to where I was staying (and ferried me back and forth to all subsequent appointments) really made a huge difference.” – Daniel Smith, London, UK (published on RevaHealth.com)
Contact information.
The patient may wish to contact you. Give them email, phone and website information for your clinic. Tell them the hours of business for your clinic and don’t forget to include the time zone – tell them hours before or after GMT.
A lot of sales experts are going to tell you that the goal of any sales process should be to maximise the number of prospects you can move from one level of the sales funnel to the next. At RevaHealth.com we find that this goal can result in clinics using their limited resources inefficiently, and effort being wasted on enquiries that are never going to result in business.
At every stage of the sales funnel you are going to have prospects that are never going to convert into business. This could be for any number of reasons, including: they can’t afford the treatment, they aren’t suitable for the treatment, they are a competitor researching your clinic, they live too far away, etc. A clinic’s business process needs to maximise the number of prospects that can result in business while excluding the prospects that will never result in business.
There are three key ways in which to achieve this:
Exceed or meet the prospect expectations
Provide them with sufficient information to allow them to exclude themselves
Ask questions so that you can exclude unsuitable prospects
Converting Website Visitors into Online Enquiries
Visitors to your website are expecting to be able to find the information they are looking for quickly and easily. They are not expecting site originality or artistic flair, they have come for information; give it to them as quickly as possible without cluttering your site. You should try and follow standard web conventions in the design and structure of your website and make it easy for the visitor to get to the following information:
Phone number and contact form
Opening hours
Address
Map
Prices
Testimonials
Your goal is to give the visitor this information while also building trust. Trust can be built in two ways through a website: transparency and personal information. Transparency can be provided with clear pricing information and candid descriptions of your core specialities. It can also be useful to mention the services you do not provide to avoid any confusion. Personal information can be provided through staff profiles and the use of pictures.
If you meet the visitor’s expectations, the next stage is to channel them into creating an email enquiry. This will typically only ever be a small percentage of your visitors, but hopefully will include a large percentage of the visitors who are actually interesting in purchasing a treatment from your clinic.
A common question we are asked is what percentage of visitors you should expect to create an enquiry. Unfortunately this is an impossible question as the single biggest variable is how ‘qualified’ the visitors to your website are. In this instance ‘qualified’ means how interested your typical visitor is in purchasing one of your treatments.
An example we commonly quote is a clinic in London that has written exceptional descriptions of the health problem they treat. These descriptions attract hundreds of visitors per day, however most of these visitors are just looking for information – they are not interested in getting treatment. This clinic converts under 2% of all visitors into online enquiries.
However, as a general guide, if you are not converting at least 5% of your visitors into online enquiries you should look to your website for potential problems.
Email Enquiries
When consumers submit an online enquiry they expect two things. First of all, they expect an automated response that informs them that you have actually received their enquiry and tells them when they can expect a response. It is a good idea to take advantage of this email to highlight the key benefits of your clinic and include contact information. In this way a consumer will always have easy access to this information even if they can’t find your website again.
Secondly, they expect a personal email that directly addresses their query. This second email should be sent no later than one business day after the initial enquiry was received. If this is not possible then an additional email should be sent explaining the delay.
The email that you send to the customer is your first real chance to start building a relationship with them. The key elements in building that relationship are to personalize the email to the consumer (it is vital that you do not sent a stock email) and to be as transparent and candid as possible.
It is easy to enter into an email dialog with the customer at this stage but remember that the goal of this stage in the sales funnel is to get the customer to the next stage. You should always try and progress the email dialog into a phone call. The purpose of this stage is to give the customer sufficient information and trust in your clinic to move them to that stage. At the same time it gives you the opportunity to weed out the time wasters.
If the customer will not engage with you on the phone then there is very little chance that they will visit your clinic. Only in a rare case is it worth expending significant effort on a potential patient that will not schedule a phone conversation. Typically this means that they are not prepared to commit to the next level of relationship.
This could be for any number of reasons – perhaps they were just comparing prices, perhaps they can’t afford it, etc. All personal emails sent to a customer should either be asking for a suitable time to call or setting a time for when you will call.
A Note On Having The Consumer Phone You Directly
A common question that we are asked is: if the goal of an email enquiry is to get the customer to talk to us on the phone, why don’t we skip the email enquiry step and just publish our phone number on our website?
First of all, it is important to put your phone number on the website in case the visitor actually wants to call you. However, it is also vital that you have a contact form and we argue that this is the desired route that you want to encourage your visitors to follow.
The reason for this is that if a consumer calls you they have a reasonable expectation that they will talk to an informed person who will be able to answer their questions. However, the person best qualified to talk to the consumer may well be busy when they call. It is better that you agree a time with the consumer when the right person can speak to them.
In some cases the consumer will get an answering machine (don’t forget your visitors will be on your website 24 hours a day, 7 days a week). A contact form is always available. It allows you time to research the consumer’s query and be properly prepared to directly address their concerns in a way that exceeds their expectations.
Phone Call
The consumer expects you to call at the specified time, or if they are calling you they expect that the relevant person will be available. They expect the person that they talk to will be able to speak specifically to their personal enquiry. They do not necessarily expect that person to have all the answers, but they do expect them to be knowledgeable, friendly, polite, understanding and non-judgmental.
Once you have succeeded in getting someone to talk to you, you have a real opportunity to start building a relationship. While you might have spent a lot of effort on your website and with the email dialog, all that did was to get the customer on the phone. So, no matter how good your website is, if you don’t manage to build a relationship with them on the phone then they are simply not going to purchase treatment from your clinic.
Face to Face
This is now getting back to your core business. You have brought the potential customer from the online world to the physical world and it is now up to your normal business processes to close the sale.
However, like all of the previous stages of your pipeline, once you have got the person to this stage everything that went before matters very little. Even if you have exceeded the customer’s expectation in all of the previous stages, you must at least meet their expectations at this stage.
Repeat and Referral Business
This is the ultimate goal that you should have for ever visitor to your website. Nothing is more profitable for your business than having a customer return for future treatment. You have already built the relationship with them and do not have to bring them through the sales pipeline again.
Managing your finances is critical to every business and I think accountancy should be an effective tool for managing a business. However, for all too many SMEs accountancy is all about compliance, simply ensuring that accounts are filed correctly and taxes paid.
Now I’m not an accountant, however I have always been of the opinion that anyone in business has to be able to understand the finances of the business. So about a year ago I went and looked for the accountancy tools that would help me (a non-accountant) to manage my business. Eventually I settled on Xero, for its simplicity and because it was online giving me access no matter where in the world I was.
At that time Ulster Bank Anytime Banking supported the OFX format which was readily support by Xero, allowing me to easily import my bank statements each month. However about 2 months ago Ulster Bank stopped supporting Anytime Banking and move their customers to a new system called Bankline. Despite repeated reassurances from Ulster Bank that all features of Anytime would be supported in Bankline they dropped support for OFX and only supported CSV.
This was a disaster for Ulster Bank user who used the Xero system as it made reconciliation of your bank account slow and error prone. Last week, at the end of July 09 Xero started to support the import of CSV formatted bank statements. This post looks at the tweaks that you need to make in order to get your Ulster Bank statement into Xero.
Exporting your Ulster Bank Bankline CSV statement
Log into your Ulster Bank Bankline account as normal and navigate to the statement of the account that you want to import.
At the top of the page select the date range that you want to statement to be for and press the go button to the right of the date fields.
Click the ‘export statement’ link at the bottom of the page. This will save the statement onto your computer in CSV format. The fields in this file are different to the ones required by Xero, however the file is easily editable to make it compatible.
Open the file in Excel or Open Office.
Xero expects the following columns which are not in your CSV file – Cheque number, Transaction amount. Add these two columns into the spreadsheet.
Copy the amounts from the Debit and Credit columns into the transaction amount column. The transaction amount column should now be a solid list of numbers, positive numbers for Credits and negative numbers for Debits.
Save your spreadsheet ensuring you save it as a CSV file.
Bankline puts the cheque number into the Narrative #1 field. Whenever the type = ‘CHQ’ copy the number from the Narrative #1 field into the respective cell in the new Cheque number field.
Log into Xero as follows and from the account of the relevant bank account menu select ‘Import a statement’.
Click the ‘choose file’ button and select your CSV file and click the ‘Import’ button.
Mapping your CSV column to Xero
You are now presented with a page in Xero that allows you to map columns from the CSV file to Xero. Make the following mappings:
‘Date’ in the CSV to ‘Transaction Date’ in Xero
‘Narrative #1’ in the CSV to ‘Description’ in Xero
‘Narrative #2’ in the CSV to ‘Payee’ in Xero
‘Type’ in the CSV to ‘Transaction Type’ in Xero
‘Cheque Number’ in the CSV to ‘Cheque No.’ In Xero
‘Transaction Amount’ in the CSV to ‘Transaction Amount’ in Xero
Press the save button and you’re done. Xero will remember these mappings so you won’t have to do them again for subsequent imports.
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