Cross the Dock
Healthcare: An Export Case Study — Part One
Healthcare: An Export Case Study — Part Two
Healthcare: An Export Case Study — Part Three
xports are commonly perceived to comprise goods that are carefully containerized for off-shore shipment accompanied with arcane customs documentation, letters of credit, and exchange rate guarantees. But "transparent exports" (known as "invisibles" in the UK) comprise an important part of international trade. "Transparent exports" are the delivery of services (and occasionally goods) within the United States to foreign purchasers — individuals or corporate entities. These "exports" represent a substantial portion of the positive component of our balance of payments; they also represent constructive opportunities for many smaller businesses and entrepreneurs.
The tourism industry is an excellent model of "transparent exports." Foreign tourists injected $80.0 billion into the US economy in 1995; the US Department of Commerce estimates a 4 to 5 percent annual growth in revenues from foreign tourists through the end of this decade. Hotels, resorts and a wide range of package tours serve the needs of visitors to the United States from other countries. A $2,500 hotel bill for a German family visiting Disney World is just as important to our balance of payments as the shipment of a $2,500 copier to Düsseldorf. Innumerable smaller businesses ranging from translation services to ethnic catering specialize in meeting the diverse necessities of foreign travelers. Thousands of modest bed-and-breakfast ventures focus almost exclusively upon serving guests from overseas; e.g., a tie-in with a Berlitz Language Center assures a constant clientele of adults engaged in intensive English-proficiency programs.
Trade shows and professional meetings are a primary dimension of tourism. For example, the Fourth Annual Internet World 97 at the Los Angeles Convention Center March 10th through the 14th attracted more than 50,000 technical and business professionals from all over the world. There were also hundreds of non-US exhibitors. Net foreign exchange generated by this one trade show alone was estimated to exceed $25.0 million; this does not include equipment, software and service sales consummated at or as a result of the exhibition. In addition to the mammoth trade shows, hundreds of professional and technical associations conduct meetings in the United States every year attracting thousands of attendees from all over the world. Each of these meetings offer dozens of "transparent export" opportunities for smaller businesses and entrepreneurs.
In fact, knowledge continues to be one of the largest exports of the United States. And most of this "transparent export" is delivered here at home. For the past 50 years, the preeminence of US universities and colleges as well as outstanding preparatory schools has drawn tens of thousands of students from all over the world. There is also a substantial secondary market among mid-level institutions that attract foreign students simply seeking the acculturation and cachet of an American college education. Again, smaller businesses and entrepreneurs can find a profusion of opportunities to participate in these "transparent exports" surrounding educational institutions.
Health care is another magnet luring large numbers of foreign patients to hospitals and medical centers in the United States. Of course, media attention has been focused upon members of prominent Middle Eastern royal families who have chosen US hospitals and clinics for surgery and other major therapeutic procedures. But the United States is the first choice for critical medical care among many wealthy Latin American, Asian, and even European families. Faced with the tumultuous changes occurring within health care here at home, American medical centers are now beginning to develop this market imaginatively and aggressively. The Johns Hopkins Medical Services Corporation (Johns Hopkins Hospital — Baltimore, MD), The Cleveland Clinic Foundation (Cleveland, OH), The Methodist Hospitals (Houston, TX), and the Mayo Clinic (Rochester, MN) are all placing glossy full-page advertisements in Middle Eastern periodicals. Johns Hopkins has secured government contracts to provide and train with new prostheses the severe casualties of border wars and regional conflicts.
Among the many attractions of "transparent exports" is the ease of payment. Almost all payments are made in US currency, either in cash or by wire transfer. It is not uncommon for payments to be made in advance of the delivery of services. Responsibility for currency exchange and conversion is assumed by the customer/student/patient. And there are no customs documentation, letters of credit, or commercial risks.
Many emerging businesses and entrepreneurs may be unaware they are already in the "transparent export" business. For others, some careful thought and inquiries may reveal attractive new opportunities "in our own backyard." It can be remarkably simple and lucrative. If Alice's Bed and Breakfast in Northfield derives most of her revenues from exports, why not you, too?
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Revised: May 31, 2021 TAF
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