International Data Need to Add Up

A useful analysis requires the understanding of data and a belief both in the data and their issuer. Companies, organizations, and scholars wary widely in their interpretation and use. International comparisons often differ substantially in data collection and quality control. This commentary eases comparisons of research across national borders. Here is an international perspective on research numbers, going beyond quantitative data aspects and embedding human warmth and insights. 

In an era of lengthy and diverse supply chains, investors need to transparently identify corporate action and its effect on the market place. Clear rules of origin are just like license plates. They identify ownership and assign responsibility. Labels cannot simply state “manufactured in the European Union.”

Information needs to be compatible across domains. For example, to compare medical information across nations, one has to segment patient differences by age, country, health patterns, variations in the access to medical care, prophylactic treatment, and pharmaceuticals.

Culture affects personal behavior. For example, research identified the wearing of face masks helpful to viral containment. In Asia, there was ongoing and rapid use of breathing masks. Particularly in wintertime, masks were encouraged both to protect oneself and others from contamination. No negative connotation is associated with the use of a mask. By contrast, in the United States, a mask reflects for many the existence of a medical problem by the wearer. In consequence, masks are not seen as protective but rather as an announcer of risk, which in turn negates their use. 

Social structure matters, particularly as it reflects differences in infrastructure and trust. Not all countries have the capability to fund and collect data within short time spans. The need to save face can then lead to the furnishing of poor data, delivered with elan. In consequence, ‘current’ information may really be old and may not even begin to alert users to important changes in one’s society or social conditions. 

Data work needs to recognize the emotional component of information. How will people feel about their direct exposure to hard and cold numbers alone? How can one systematically but honestly include emotions into one’s analysis? How to cope with self-fulfilling prophecies? What are the short –and long-term effects of optimism with data – particularly when insights can cover the entire range of a scale. For most people numbers are mere indicators of opportunities for action and change. 

Analyses and forecasts need to consider change. An evaluation based on the next quarter may reflect the next 25 years. Insufficient or incorrect reflection of change and innovation may lead to precariously wrong decisions. Imagine the decision-making process for countertrade, where the outcome and conclusion of an agreement may take decades.

Synchronicity is another important dimension. I am reminded of Ludwig Erhard, the second chancellor of the Federal Republic of Germany who was credited with Germany’s postwar “Wirtschaftswunder” or economic miracle. When Erhard concentrated expenditures on some sectors and called for a ‘tightening of belts’ for others, these steps were rapidly and fully implemented by government, firms, and society, leading to a powerful impact. The players actually cared.

On this dimension, President Trump will find his largest risk and opportunity. The coordinated development of a restructured economy accompanied by a synchronous response of all participants with their resources can turn into a wonderful economy that shakes off the problems of post coronavirus rebuilding like a duck shakes off water.   

Apart from human emotions, economic re-emergence requires measurement scales benefiting from recalibration and new benchmarks. For example, a scale measuring export controls which ranges from “no controls” to “tight controls” is only in part complete since it omits policy resulting from subsidies and voluntary restraints. Numbers are only snapshots of a current condition. These conditions are not frozen in salt, but they will change and with them their impact. In a dynamic and complex environment, even the efficacy of Aspirin benefits from review. 

Professor Michael Czinkota teaches International Marketing and Trade at the McDonough School of Business of Georgetown University. He served as Deputy Assistant Secretary for Trade Information and Analysis in the U.S. Department of Commerce in the Reagan and Bush Administrations. 

Book Foreword: IN MY OPINION

My colleague and former student Dr. Valbona Zeneli, recently, published her book IN MY OPINION. The book presents 39 short articles about the core issues of European security, international trade, and the Western Balkans. She also uses cartoons with each topic. All of which have been drawn by her 12 year old son.

I had the pleasure to write the Foreword of the book as follows:

Foreword

I like this book. The many articles of Dr. Zeneli provide a 360 degree view of the world. This collection of articles offers new decisions and policies that impact current events in our  turbulent times. Equally important, Dr. Zeneli recognizes the fact that even those interested in a topic may not have the time to read and reflect on many lengthy academic treatises. The subsequent risk for the world are decisions made by  policy makers, business executives, and researchers themselves, which are based on very limited information, fragmented insights, and very limited overall comprehension.

With the work presented here, Dr. Zeneli provides an answer to this problematic. She identifies core international policy and trade issues and addresses them with depth and parsimony, thus helping to create a new bedrock of understanding. Her answer is the new use of short and pertinent  commentary.

Her background provides unique strength and capabilities to Dr. Zeneli. She was born and raised in Albania, and educated at leading global institutions. Combined with her exposure to practice, she is  able to bring to her analysis and writing a rare combination of academic expertise and “real world experience”. Her training in economics and security studies took her from Italy, to the United States, and to Germany at the famous George C. Marshall European Center for Security Studie.

I  have known Valbona for 15 years, since  she was my students.  in  International Marketing class at Georgetown University in Washington D.C. she excelled then and ever since I have enjoyed working with her in researching and writing on current important in the fields of global trade, international marketing,  trade agreements, corruption, and international terrorism.  Her extensive exposure to and participation in policy, business, and academic research allows her to glide easily  between the three worlds, and to understand different perspectives. Her international experience at the Marshall Center, where she works with leaders from  all continents to discuss current  security issues and future trends, is clearly demonstrated in her comparative comments, which allows readers to look at different perspectives.

Valbona Zeneli has written numerous research papers in her academic life, and has been a contributor of editorial commentary in the international business and security field. Her work has been published in well-known outlets such as The Diplomat, The Globalist, The National Interest, Atlantic Community, The Japan Times, SriLanka Guardian, Affari Internazionali among others.

Dr. Zeneli’s focus on economics, governance, and the interlocking aspects of world trade matter in these turbulent times.  Her ability to capture current events and connect them to the foundation and requirements of governing and responsible decision making is truly special.  This is where her skill shine best. Her ability to make sense of what makes societies successful, or causes them to fail, is both subtle and effective. By examining her thinking and it’s development over time,  we are treated to key insights into the ongoing rapidity of   change and the consequences of bad decision making. There articles provide us with key lessons.

She is a strong supporter of European integration of the Western Balkans, and a believer oin open trade and strong transatlantic bonds. A  Europeanist and internationalist at heart, these feeling are evident throughout her writings.

Of equal  importance is the fact that the articles presented here illuminate the mistakes to be avoided in a period of our history where decisions made with  rapid reaction but often based on  poor and even deceptive information  are becoming the norm. Zeneli argues with a constant  key take-away in mind. We live in a globalized world and we are highlyinterconnected.. Policy decisions are seldom exclusively national but have regional and global repercussions.  Zeneli’s collection is a reminder of the butterfly effect where seemingly local actions can lead to major shifts even far away. Events such as poor governance, corruption,

migration, and the like in the Balkans can have a far reaching impact in Europe and beyond.  Trade policies need to be separated from emotions with a heightened sense of clinical rigor and honesty and honor. Already today, but even more in the future, will these concerns be the bane of society. They therefore require our concentrated  attention.

Dr. Zeneli’s articles are  accompanied by  a cartoon. With the artistic support of her eleven-year old son this book offers drawings reflecting both simplicity and understanding of  her commentaries, appealing to the reader with words and sights, and and adding the dimension  of humor to complicated security issues.

Valbona Zeneli’s articles capture what are still current events but she tells a story that will endure. I therefore encourage you to go to your nearest book store and buy this book. It is worth your effort to do so, since a systematic reading of the material presented, your reflection of the ongoing implications and your review of the cartoons, will likely make you the smartest person in the room when it comes to discussions of security, regionalism and trade. My congratulations go to Dr, Valbona Zeneli for the fine work she has conducted.

Michael R. Czinkota

Georgetown University

Washington D.C., January 2018

Global Medical Tourism

Global Medical Tourism

Michael Czinkota

Nittaya Wongtada

Medical tourism can be traced to 4000 B.C. – when Greek pilgrims would sail abroad to seek the healing power of hot springs and baths. Over the past two decades, the industry encountered dramatic shifts.

Once wealthy patients from emerging economies sought treatments not available in their home countries. Since the new millennium, however, the flow of patients goes in the other direction. Rising health care costs prompt travelers from advanced economies to seek international destinations offering lower-cost or timelier alternatives to domestic care.

For instance, a spinal fusion in the United States costs an average of $110,000 in 2016. The same procedure was $6,150 in Vietnam. Heart bypass surgery, which costs $123,000 in the U.S. in 2016, is $12,100 in Malaysia. For many patients from high-priced countries, the solution is clear – it pays to seek medical care abroad!

The size of such tourism has ballooned since the late 1990s. Its value ranges between US $45.5 billion and $72 billion in 2017, with approximately 14 to 16 million patients seeking medical care beyond their countries’ borders.

Modern medical tourism is a global phenomenon. Traditional models emphasized internationalization as an incremental procedure. But the industry surged after the Asian financial crisis of 1997, which drove hospitals in Malaysia, Singapore, and Thailand to seek patients from abroad. They had already undergone substantial modernization, catering to a domestic middle class that demanded medical services commensurate with their newly acquired wealth. With the economic downturn, however, a shrinking middle class could no longer afford these superior facilities. International clients,  provided a ready solution to an excess supply of private medical facilities..

The success of hospitals in Southeast Asia inspired other countries towards medical tourism. Regional hubs emerged due to advantages of geographical proximity and specialization. Malaysia and Singapore, for instance, received an influx of patients from Indonesia, while many patients in India came from Africa and the Middle East. Brazil, Costa Rica, and Mexico all benefitted from their proximity to the United States.

A clear pattern has emerged in the lifecycle of medical industries. First, countries in the developing world begin to offer services similar to those found in advanced economies. As new segments of international healthcare populations emerge, just like sun flowers, new medical tourism destinations grow towards the new opportunity. Close proximity to wealthy consumers constitute a competitive edge. To retain their market share, leading destinations formulate new strategies and options.

In order to survive growing competition, hospitals in emerging nations tend to implement two strategies. Since technologies stem from post-industrialized countries, most can only imitate. Their novelty comes from specialization in specific medical procedures. Doing few tasks very often improves capability, capacity, and efficiency, and thus improves reputational success.

However, this tactic may be ineffective as other hospitals develop similar capabilities. Consumer preferences will hinge on how closely services comply with their own cultural preferences and norms. Hospitals attract patients based on familiarity with local approaches and usages. Such an approach gives room for the increasingly recognized component of holistic healing.

It is important to understand how the lifecycle of hospitals continues to evolve. Different stakeholders – from governments to accreditation services to healthcare providers to patients themselves – will be affected by the expansion of the industry. For example, to date, there is still much unfounded reluctance to accept health care services offered by international sources. Once the industry manages to break out of restrictive domestic silos, a fundamental reconfiguration of service and cost will be the consequence. Let’s look forward to that!

Nittaya Wongtada is a Professor at the NIDA Business School of the National Institute of Development Administration, in Bangkok, Thailand.

 

Michael Czinkota teaches international business and trade at Georgetown University’s McDonough School of Business and the University of Kent. His key book (with Ilkka Ronkainen) is “International Marketing” (10th ed., CENGAGE).

 

This comment is based on the article “Transformation in the Global Medical Tourism Industry”, Transylvania Review, Vol. 25, 2017.

Today’s Spring Break

Today’s Spring Break

This spring, I wanted Michael Czinkota’s students to remember their “Marketing Across Borders” class while they traveled to azure beaches and Caribbean getaways. They were to connect their break experiences to some of the themes we have explored in class. Their responses offered an interesting – and illuminating – glimpse into how international marketing shapes the decisions of young travelers.

As digital natives, most of my students performed the research and planning for their trips online. Whether scoring cheaper flights or finding top restaurants, these young travelers turned to social media platforms and travel websites like AirBnb and TripAdvisor, to find affordable, and often all-inclusive, deals for hotels and flights. Students noted the power of word of mouth, which they far preferred over mass-market pamphlets, in guiding travel decisions. Much trust was placed in the reviews of peer travelers.

Much international travel was to Mexico, the Dominican Republic, and Germany.

But even when my students ventured outside their comfort zones, they still encountered elements of the familiar. They noted the prevalence of Japanese manufactured cars, such as Toyota, in countries like Mexico and Jamaica. For food, they found a preponderance of American brands – like McDonalds and Starbucks – that were almost identical to those in Cincinnati, Ohio.

A student, involved in a social justice immersion trip to Jamaica, found international marketing to be an important tool in business development. She found billboards with emotional global brand messages: “Kakoo loves Pepsi!”; “Jamaica, land we love; Honda, car we love.” Many messages were targeted toward tourists and rendered in English rather than local languages.

In terms of favorite topics, many of my students’ broached food. There was a fascination with the globalization of food products. Students were delighted to taste the delicious meals of the world. “Food trends from around the world had penetrated the Costa Rican market: Breakfast places were serving cold brewed ice coffee, kombucha, acai bowls, avocado toast, and homemade vegan bread. Australians own the best taco joint in Tamarindo. A woman from Minnesota was the chef at a local breakfast café. Markets served poke bowls (sushi bowls from Hawaii), arepas (shredded beef sandwiches from Venezuela), and traditional French pastries.”

Students saw a choice of goods that were produced in the U.S. but tasted differently abroad. In the Dominican Republic, there were different taste versions of Coca Cola. Snacks of choice, such as Doritos, were sold at two different prices depending on whether they were sold in American or Mexican packaging. In Puerto Vallarta, Mexico, the point of sale changed in supermarkets. Oreos were sold alongside American cereals rather than in the cookie section!

All these observations contribute to a wider understanding of international marketing forces that shape tourism for young travelers today. Travel can be good – it gives more perspective, more context and more variety. Surely, there will be more alternatives and new experiences, which make life more meaningful, spicy and more interesting.

Michael Czinkota teaches international business and trade at Georgetown University’s McDonough School of Business and the University of Kent. His key book (with Ilkka Ronkainen) is “International Marketing” (10th ed., CENGAGE).

Georgetown University students, Dina El-Saharty and Lisa Burgoa, contributed to this report.

An Example of Midterm: The Tomato: Vegetable or Fruit?

Today, we had a midterm in the “Marketing Across Borders” course in the McDonough School of Business at Georgetown University. Students were asked to elaborate on the trade consequences of a Supreme Court Decision “Nix vs. Hedden” 1893. Our working title is “The Tomato: Vegetable or Fruit?”.

Here is my summary of the case, please feel free to comment or send us your analysis of this case and I will respond to you. Enjoy!

The Tomato: Vegetable or Fruit?

In 1893, the U.S. Supreme Court grappled with an international legal question that continues to confound to this day — does a tomato qualify as a vegetable or a fruit?

Though many associate the tomato with the stews, salads, and sandwiches that are typically the domain of vegetables, any botanist will tell you that the plant meets the scientific definition of a fruit: a seed-bearing structure that  develops from the ovary of a flowering plant.

But in the U.S. Supreme Court case Nix vs. Hedden, the judges unanimously arrived at a different definition. They ruled that imported tomatoes should be taxed as vegetables, which had a 10 percent tariff when they arrived on American shores, rather than as fruit, which carried no tariff.

Though the court acknowledged that a tomato is technically a fruit, it went on to write that according to the “common” definition most people use, tomatoes fall under the same category as other vegetables such as lettuce, cabbage, and carrots. In other words, a tomato counts as a vegetable because most people thought it was.

A more recent example of changing definitions in trade policy arose during a trade war between Vietnam and the United States that started in 2001. When cheap imports of Vietnamese catfish threatened to put U.S. producers, who had higher costs, out of business, American lobbyists and lawmakers scrambled to find a way to bar Vietnamese producers from the market.

The coalition persuaded Congress that the word “catfish” only applied to U.S. varieties, not Vietnamese imports, even though there was no biological difference between the fish. Thus, when Congress normalized trade relations with Vietnam, its definition of “catfish” excluded basa or tra, the names applied to Vietnamese catfish.

Even today, the questions explored by the Nix v. Hedden case continue to have implications. What does this Supreme Court case – along with the example of the Vietnamese catfish – tell us about trade policy? Who ultimately defines a product, and how could altering definitions affect trade policy? Do tariffs still play a role in modern-day international trade, and can marketers make a difference?

Please analyze this case.

Michael Czinkota teaches international business and trade at Georgetown University’s McDonough School of Business and the University of Kent. His key book (with Ilkka Ronkainen) is “International Marketing” (10th ed., CENGAGE).