Perspectives on U.S. Patient Care from Global Health Care Practitioners

Abstract

Background Interest in the field of global health care has been rapidly growing over the last two decades, leading to the proliferation of academic medical institutions offering more opportunities for medical study, research, and patient care abroad. A growing body of literature looks at the impact of these initiatives on the locations in which they operate, however a gap remains in understanding how these programs influence long-term global health care physician perspectives on patient care practices, the U.S. health care system, and how in turn global health care physicians may impact the delivery of health care in the U.S. Objectives We conducted a qualitative study to identify global health care physician and global health care program leadership perspectives on how global health care work and research was understood to influence global health care physician perspectives on the U.S. health care system, patient care in the U.S., and in shaping their personal values. Methods This study consisted of an online questionnaire and semi-structured interviews with physicians and program staff affiliated with global health care programs in U.S. academic medical centers. The study recruited individuals to share their perspectives on how global health care experiences shaped values, perspectives on patient care, spending patterns, and more generally health care practices in the United States. Twelve participants completed online questionnaires, eight participants (four survey respondents and four additional participants) were interviewed in-person or by phone. Content analysis was used to derive relevant themes from questionnaire and interview data. Findings Six themes were identified in how participants perceived global health care physician work to shape their perspectives on health care and impact their U.S.-based medical practices: 1) improved patient care with low-income, refugee, and immigrant patients; 2) reduction in medical spending patterns; 3) improved care through more efficient and stronger patient advocacy; 4) greater awareness of the social determinants of health; 5) deeper understanding the U.S. health care system via comparisons; and 6) altruistic values motivated physicians to pursue work in global health, and were not significantly changed by their global health experiences. Conclusion Global health care physicians and global health care program leadership expressed that their global health care work either improved U.S. patient care or was inconsequential when compared to factors such as the social determinants of health or health care policy. Participants stated that their altruistic values had motivated them to pursue a career in global health care work, and that global health care work self-selected for people with similar values. Participants reported that their global health care work had brought a greater understanding of the strengths and weaknesses of the U.S. health care system but did not reported a perceived greater agency to bring about positive reforms. Future research is needed to understand the extent to which these experiences influence U.S. patient care and whether discontents with the U.S. health care system have contributed to increasing interests in global health care.