August 9, 2012Dear Sir,In Jonathan Bell’s article on tackling health care costs, BF&M president and CEO John Wight says, “For many groups wanting to reduce their healthcare premiums, one way is to reduce the number of facilities overseas that people go to. They don’t have the same cachet as Johns Hopkins, but they’re good providers.”This statement implies that one solution to reducing health care costs is to find overseas providers that are lower cost than Johns Hopkins. But we should be wary of blanket statements about cost being the most important factor to consider, especially for specialised procedures that only a handful of institutions excel at performing.In choosing the right overseas facility, consumers, managed care companies and providers should weigh several factors. Is the patient’s case a complex one? Does the facility see a large number of similar cases, enabling it to build expertise? Does it offer the sort of multidisciplinary care that complex cases typically demand? Is the centre highly ranked in the speciality of most relevance to the patient? Can the facility demonstrate a record of favourable clinical outcomes for similar cases? There is a strong body of research that demonstrates that medical centres that perform a high number of a particular medical procedure have significantly lower rates of adverse outcomes and complications.The article also stresses the importance of cutting down the use of overseas care. We couldn’t agree more that local access to affordable, high-quality health care should always be the goal. Johns Hopkins Medicine’s international division focuses on supporting partners around the world in advancing the level of care that is available locally. In fact, we’ve been facilitating knowledge exchange for many years between King Edward VII Memorial Hospital physicians and nurses and Johns Hopkins experts in a joint effort to advance the quality of local care.Still, the reality is that in some communities, not all patients’ health care needs can be met locally, especially complex cases, and travelling to get care will remain a necessity. The question, then, is how to be judicious about when travel is the right option, and about which overseas facility offers the highest level of expertise and the best outcomes. Focusing on outcomes is a win-win prospect — it’s the path that’s best for the patient’s health, and one that saves money down the road.As a top-tier academic health system, Johns Hopkins has a wide array of world-class physicians who not only treat the most complex cases, but also conduct leading-edge research that is rapidly translated into new diagnostic techniques and treatments. The main reason The Johns Hopkins Hospital has been ranked #1 by US News & World Report in far more specialities than any other US hospital is not because our name holds “cachet,” but because of outcomes and other quality measures related to patient care.We also agree that the absolute best way to reduce costs is to keep people from becoming sick in the first place. Johns Hopkins Medicine is working with dozens of countries, including Bermuda, to develop and implement better preventive medicine approaches, which include identifying and promoting lifestyle changes that can defend against expensive, chronic conditions such as diabetes and obesity, and establishing better primary care to head off potential problems as quickly as possible.Our century-long dedication to our mission of improving the health of the community and the world has never been stronger. And we’re proud that this mission extends to our friends and neighbours in Bermuda.STEVEN J THOMPSONCEO, Johns Hopkins Medicine InternationalSenior Vice President, Johns Hopkins Medicine