By Melanie Evans 

ProMedica, a nonprofit operating more than a dozen hospitals across Rust Belt communities in Ohio and Michigan, is looking to a new market to bolster its anemic growth: China.

Executives and staff from the Toledo-based nonprofit have been touring hospitals in Shanghai, Shenzhen and Chengdu, exploring possible deals in the world's second-largest economy that they hope will help offset weak revenue growth at home.

"We have to look outside our traditional world if we're going to survive, " said Randy Oostra, president and chief executive of the hospital group. "The economic model is tough" in ProMedica's domestic markets, where populations are stagnant or declining and where cost pressures and competition are shifting medical care outside of hospitals, he said.

The hospital industry has been slower to globalize than many other U.S. sectors, daunted by the investment required and content with what was for many years a robust domestic market. Some prestigious U.S. medical centers and HCA Healthcare Corp. entered overseas markets years ago, but most American hospital systems have stayed home.

Now, more are seeking cross-border deals for the first time, while others are expanding their overseas reach. Deals range from consulting and management contracts to acquisitions. Markets attracting U.S. interest are diverse: from posh London neighborhoods to booming Chinese cities and other investments scattered across Europe and Latin America.

The push is an effort to diversify revenue as pressure intensifies from U.S. consumers and policy makers to cut medical spending, some executives said. Others said new markets abroad offer more attractive margins or more favorable payment models. A more global reach can also help in the development of ties with international researchers, a potential benefit to U.S. academic medical centers, officials said.

Boston-based Steward Health Care System reached a deal in February to run Malta's two public hospitals and open a third. UPMC, which is affiliated with the University of Pittsburgh, has long provided consulting and management services in several countries and is now looking to buy hospitals, cancer centers and primary-care networks in Italy, Ireland, Kazakhstan and China, a company executive said. Other U.S. hospital corporations have struck deals in the U.K., Colombia and France in recent years.

The efforts have gained momentum with a health-care overhaul in China, where rising rates of chronic disease and an aging population have increased health spending. China in recent years has said it would allow foreign ownership of some hospitals as part of the overhaul.

"The sheer demand is just massive" in China, attracting investment from insurance companies, entrepreneurs and public and private infrastructure developers, said Axel Baur, a senior partner for McKinsey & Co. who is based in Hong Kong. Developers in China are looking to U.S. hospitals for brand recognition and expertise training staff and setting medical protocols, Dr. Baur said.

Boston-based Brigham Health and Massachusetts General Hospital are helping Chinese partners open new hospitals, while Ohio's Cleveland Clinic disclosed to investors last year that it would consult for a Chinese developer. "The project is in the very early stages," said Cleveland Clinic spokeswoman Angela Kiska.

Dealogic data show overseas acquisitions by U.S. hospital and health-service corporations are on the rise, though the numbers remain small compared with the consumer-product, technology and pharmaceutical sectors.

There are potential pitfalls to that expansion. U.S. hospitals risk their brands' reputations by lending their names to facilities they don't own or manage. And acquiring a hospital in a foreign country leaves buyers vulnerable to changes in local markets or regulations.

Such deals typically don't generate significant revenue, said Lisa Goldstein, an analyst with Moody's Investors Service. But private-pay hospitals abroad could be more profitable with more scheduled and elective procedures than typical U.S. hospitals, she said. Hospitals overseas could also see fewer uninsured patients in countries with national health systems.

ProMedica took a number of steps at home to try to boost growth, including acquiring a dental health-insurance plan and opening free-standing urgent-care centers. But with operations in shrinking markets, ProMedica must also look elsewhere for new business, said Mr. Oostra, the system's CEO.

ProMedica is considering a dozen deals in China, where some fast-growing cities are home to more people than ProMedica's home state of Ohio, Mr. Oostra said. ProMedica would potentially run hospitals or provide consulting services to developers of hospitals, outpatient care and community health initiatives, he said.

ProMedica staff have made seven trips to China since December 2015. Mr. Oostra has traveled there twice and plans to return this year. Between visits, he uses the Chinese messaging app WeChat to keep in touch with potential partners.

Brigham Health, a subsidiary of Boston-based Partners HealthCare, is under contract to help Evergrande Health Industry Group Ltd., based in Guangzhou, design new hospitals. The first, which opened in recent weeks, is a cancer hospital on China's tropical island province of Hainan, near Vietnam.

The hospital is expected to draw patients from around the region, said Mark Davis, executive director of strategic initiatives and business development for Brigham Health. An Evergrande spokeswoman called the hospital "a good start" to the partnership. Partners HealthCare's Massachusetts General Hospital also holds a consulting contract with another developer that opened a Chinese hospital in October.

In the U.K., Cleveland Clinic is leasing a six-story building in central London, which it is renovating into a 200-bed hospital expected to open in 2020. The private-pay hospital, near Buckingham Palace, won't be part of Britain's taxpayer-funded National Health Service.

UPMC has for years held management and consulting contracts in more than a dozen countries. The nonprofit is now attempting to acquire hospitals and clinics overseas, beginning in Italy and Ireland, said Chuck Bogosta, president of UPMC International. In September, UPMC acquired a 50% stake in a private hospital in Rome.

Ownership will give UPMC more control as it tries to build its international brand, recruit global talent and diversify its revenue, Mr. Bogosta said. Managing and consulting is "not as sustainable as ownership," he said.

(END) Dow Jones Newswires

April 22, 2018 07:14 ET (11:14 GMT)