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American academic medicine’s global role is changing. Instead of primarily bringing international patients to the United States for highly specialized care, major health systems are increasingly helping countries build that expertise closer to home.
David Duncan led Aaron Gerber MD, Heitham Hassoun MD and Bishoy Mikhail through that evolution. Gerber described Mass General Brigham’s growing emphasis on long-term partnerships, including work in the UAE that combines facility development, clinical operating models and a willingness to put the MGB brand behind care delivered locally. Hassoun emphasized that no single international business model fits all. Cedars-Sinai’s approach ranges from partnerships in Mexico City to a wholly owned London clinic, depending on what the market and relationship require. Mikhail traced Cleveland Clinic’s progression from international patient care and physician training to advisory relationships, managed facilities and major operations such as Cleveland Clinic Abu Dhabi.
Affordability, access and geopolitics remain major constraints, particularly as visa challenges and regional instability affect patient travel. But the panel saw those pressures as another reason to bring care closer to patients. International healthcare partnerships are becoming less about exporting an American hospital model and more about building sustainable local capability, with lessons that may eventually help US health systems deliver high-quality care more efficiently at home.
Session Focus
Duncan framed the session as covering a kind of innovation that gets lost alongside clinical and technological advances: infrastructure and policy work that is less immediately compelling than AI, which he noted virtually every other panel at the Forum was discussing.
The question he posed was how American medicine’s advances reach the rest of the world, while acknowledging the US has not managed to distribute them everywhere domestically either.
He described his own first exposure to this work in Saudi Arabia in the 1980s, when the infrastructure was only beginning, and framed the arc: what was once institutions sending doctors abroad while those countries sent patients to America for tertiary and specialty care has shifted dramatically toward building local systems through to highly specialized medicine.
The Evolutionary Arc
Aaron Gerber MD described the original mechanism plainly. For a long time the United States delivered a level of care few parts of the world could match, so the primary route to high-quality care for countries with limited capability and growing resources was sending patients to America. That flow consisted largely of royals, wealthy individuals, embassy-referred citizens and some international insurance patients, with insurance mattering differently by region.
What changed is that those countries increasingly recognized they need local capability. In response, US institutions leaned into advisory services, hospital creation, centers of excellence, improving existing facilities, and establishing research and education capabilities.
He identified COVID as a real turning point. Inbound patient numbers were already declining, and the pandemic accelerated that while driving a re-intensified push to build local capability.
His framing of the institutional response went to mission. Rather than being the place wealthy patients come, the goal is providing outstanding research-infused care to as many patients as possible throughout the world, which required changing models to do far more work in country. He noted it as the one thing that, regardless of politics, everyone can agree should be done.
Inflection Points and Regionalization
Heitham Hassoun MD, who was previously at Johns Hopkins, described the phenomenon as regionalization, and named the standing tension in healthcare between local and global, arguing the magic for international programs lies in bridging that space. Some leaders of major US academic centers think very locally and others more globally.
Across roughly twenty years in the field he identified three inflection points: September 11, the 2009 global financial crisis, and COVID.
His assessment of the present is that the industry sits in something like an extended COVID, given geopolitical tensions, with the countervailing force being exactly what the Forum was convened to discuss, namely rapid technological advancement of capabilities. Both pressures are reshaping the industry continuously.
Success Measured in Declining Patient Flow
Bishoy Mikhail traced Cleveland Clinic’s involvement to its founding era, with international patients arriving soon after 1921, and noted that international doctors coming to train and work in Cleveland built the reputation alongside patient care.
The result a century later is a globally minded organization with leaders arriving from and departing to everywhere, offering what he described as a continuum from unbranded advisory work through to managed and operated facilities such as Cleveland Clinic Abu Dhabi.
His account of declining inbound volume contained the session’s sharpest observation. Numbers have shrunk for two reasons: geopolitical factors, and the improvement of infrastructure and capability abroad. The second reason means the decline is evidence of success at what these institutions set out to do, achieved at the cost of their own patient flow.
What still travels is complexity. The cases arriving are the redos, the third or fourth attempt at a cardiac procedure, the situations where care available locally is not sufficient.
He was also careful about how this work begins. It was typically organic, with partners approaching Cleveland Clinic asking for help building specific capabilities, rather than the institution setting out to dominate a market.
What Partnership Looks Like Now
Gerber described a current partnership in the UAE with a large multi-industry organization based in Sharjah that decided to enter healthcare. Mass General Brigham entered the partnership alongside Dana-Farber to help develop, and ultimately to help manage and co-brand, both a hospital and an associated set of ambulatory sites.
Key Takeaways
1. The model inverted from exporting patients to building local capability, accelerated sharply by COVID.
2. Three inflection points shaped the field: September 11, the 2009 financial crisis and the pandemic.
3. Declining inbound international volume is partly a measure of success, since local capability improved.
4. What still travels is complexity, particularly redo procedures and cases local systems cannot resolve.
5. These partnerships begin organically, with local organizations requesting specific help rather than institutions expanding into markets.
6. Offerings span a continuum from unbranded advisory work to fully managed and co-branded facilities.
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