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Shanghai International Medical City

Small World

...families feel confident that they can care for their relatives and have a vacation at the same time. It’s drawing people in from around the world.

Medical tourism is an innovative medical practice taking place on an international stage. The Shanghai International Medical City master planning exercise integrates the functional requirements of a state-of-the-art medical tourism hospital with three facilities. The integration of two very different modalities is demonstrated in an international scheme that fully integrates the entire campus and a resort scheme that reduces the large building forms into small-scale expressions. The project further strengthens GS&P’s ability to compete on an international level and serves as an innovative example of a new form of healthcare delivery.

Medical tourism is a relatively new concept in healthcare. Describe your initial discussions with the client and their vision for the outcome.

Kevin Kim: Medical tourism is a big buzzword for many countries because the cost of medical treatment, particularly in the U.S., is skyrocketing. One of the ways to tackle that is through a global society, where you can go to other countries and get the same type of medical treatment at a much lower cost. It’s becoming a big revenue industry. Singapore, Thailand, and India are all doing it.

Greg Wieland: People are looking for alternatives because they can’t afford conventional services or their insurance won’t pay for it. Now insurance companies are looking at this because it could save them money compared to what they usually pay.

What are some of the associated challenges?

Greg: Medical tourism involves a collection of many programs located together, such as retail, entertainment, hospitality, cultural events, etc. The challenges will come with the logistics of how you move services around the site for all the various programs. We are talking about creating an underground highway system to connect all the different places.

What did the feasibility study include?

Kevin: We had to define medical tourism. Then we looked at other potential markets, one of which was an enormous Chinese community outside of China. For example, just in the United States, there are Chinese-Americans who are actually willing to go to Shanghai for treatment. That represents an incredible amount of healthcare expense when you consider that Chinese-Americans are spending $2 billion a year on healthcare. So we looked at the market, we looked at percentages, and we looked at terms of insurance.

Feasibility studies also look at potential problem areas such as follow-up service. They look at the different types of paperwork to put through a payment system because Chinese hospitals have to know how to get paid by U.S. insurance companies. And they look at other service lines to see what popular procedures, like cosmetic surgery, can be done in offices.

What types of treatment are proving to be the most popular for medical tourism, and what are the associated costs?

Kevin: Bypass surgery is very popular. It costs about $140,000 in the U.S. But if you go to China, certain insurance companies will provide two business class airline tickets, hotel accommodations, and food for you and a family member. On top of that, they give you $10,000 spending money. Plus, you get the procedure done at a cost of about $40,000. So the insurance company saves about $100,000 instead of paying $140,000 here. All of a sudden, this becomes a very viable option.

It sounds like medical tourism is potentially a movement toward global healthcare.

Greg: There is a difference in medical costs between the U.S. and other countries. Also, while you may have a three-day stay in the U.S. for some hospital procedures, in China it might be two weeks. The question becomes, “How do you make the patient and family comfortable for two weeks?” Medical tourism’s answer is to include everything you would find in the hospitality industry, such as a five-star hotel, bars, entertainment, and retail: families feel confident that they can care for their relatives and have a vacation at the same time. It’s drawing people in from around the world.

Kevin: It’s interesting that medical tourism probably started in the U.S. It used to be that people came here to get the best of healthcare. And people still come to places like M.D. Anderson or Johns Hopkins for treatment. However, now people can go to other countries — and pay less. It’s become a price war because the same quality healthcare is starting to emerge in other countries. In India, most of the doctors working in medical tourism hospitals have done some work in the United States — they either went to school or practiced here. Patients also have easier access to experimental treatments abroad because the United States requires FDA approval, which takes a long time.

This started as a competition project, and now we’ve done the feasibility study, the program, the plan, and created two very distinct options for site development. Where is the project right now?

Kevin: I’ve always thought this was a long shot. It is such an ambitious project that will involve a lot of people and investors. But Dr. Xu, our client, has already received commitment from two hospitals, and he indicated they may actually start developing the site fairly soon. It’s a three-hospital setup with one shared facility providing state-of-the-art technology. Such technology is expensive, so it makes sense for all three hospitals to share it.

What was the reasoning for the two Shanghai design concepts: the international and the resort?

Greg: We weren’t sure which design direction the client would value most, so we thought we’d better give them some options. They actually like both of them. The concept for the international scheme was driven by the notion of internet access and new technology, allowing us to connect with the world, like a circuit board. We actually used that as a metaphor for the building’s design, which has a tectonic, state-of-the-art look.

If you look down on the design from above, you can see that we made water trails on the roof gardens, which create visual pathways from the hospitals. If you think about a circuit board with everything plugged into a network, you can see the resemblance in the plans where the hospitals, hotels, and various structures are linked together. These visual trails create artistic features that lead visitors to destinations within the complex.

Another idea was to create a resort feel or scale by breaking down the large building masses into smaller, unique proportions. This creates more intimate outdoor spaces and more of a community feel.

Is it true that there is a requirement that all patient rooms must point to the south?

Kevin: The Chinese believe that in order for an environment to be healthy, it must have sunlight. There is a regulation stipulating that a percentage of rooms must have a certain amount of sunlight for two hours a day, and to achieve that, rooms must face the south. Even residential houses like to have southern exposure so that you get lots of low sunlight in the winter, and high sunlight in the summer that doesn’t come in as much.

Greg: The buildings and layouts become quite linear to allow maximum south exposure to most of the patient rooms. About 85 percent to 95 percent of the rooms face south or have access to southern light.

Why did the client ultimately choose GS&P?

Kevin: I think their basic goal was to engage international architects who specialize in healthcare. When you’re trying to appeal to international patients, you must have a facility with international standards. At the same time, they knew we understood certain requirements for the local population because we had done some hospital design in China, so it was a good combination.

Greg: And since a lot of their physicians are trained in the U.S. and are used to practicing a certain way, the client really likes the idea that you can help them develop their hospitals or facilities in a similar fashion. It is hard to explain to someone who has never been through that before, so it’s an advantage that we have.

What would it mean for us as a firm if this project goes through?

Greg: This is a new industry. If this moves forward, it gives us a foothold in becoming a medical tourism industry leader. There are other major architectural/engineering firms that are making great efforts to get involved in this new industry.

Kevin: We’ve already developed a lot of trust and can speak about it with some authority. Frank Swaans and Sheila Bosch speak at many of the healthcare forums on medical tourism. When I visit hospitals in Korea and China, the subject of medical tourism always comes up.

At this point, what part of this process and your design gives you the most pride?

Kevin: It was a good opportunity to meet this client and begin a potentially long-term relationship. It has also opened up a new opportunity for us in medical tourism, which we could market to many different countries and clients.

Greg: I am always interested in new ways of thinking about our current industry, so medical tourism sends us in a whole new direction. It’s pretty exciting to bring all of our experience and knowledge together for something like this. One of the great parts about working with Kevin in China is seeing him bring a lot of these new ideas and challenges to GS&P. We are challenged to think differently about healthcare, and we can carry that information to other projects. You learn through trying different approaches, and we are so fortunate to get those challenges here.

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Project Info

  • Client: People’s Republic of China
  • Location: Shanghai, CN
  • Market: Healthcare Design
  • Services: Architecture, Planning, Master Planning
  • Team:
    • Frank Swaans, AIA, EDAC, ACHA, FHFI, LEED AP Project Professional
    • Gregory J. Wieland, AIA Project Designer
    • J. Brent Hughes, AIA, NCARB, EDAC, LEED AP Project Professional
    • Kevin K. S. Kim, AIA Principal-in-Charge
    • Mack McCoy, AIA, NCARB, LEED AP Project Manager
  • Awards:

    Middle Tennessee AIA, Honor Award, Unbuilt Category

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