The University of Memphis this week began forging another tie with China, hosting a delegation of 19 health care officials from as many far-flung regions of the world’s most populous nation. They are spending three weeks in West Tennessee learning about American health care, particularly in rural areas.

The visitors are part of a group of 50 from China who are in clusters across the state, seeking strategies to improve rural medicine. After 15 years of TennCare, which has fueled a dearth of doctors in rural parts of the state, Tennessee officials also hope to learn.

“Tennessee is grappling with these issues just as China is grappling with them,” said Shirley Raines, president of the U of M. “We’re not the source of all expertise. We can learn from each other.”

Foundation to build on

The visit stems from a trade mission trip to China last October led by Tennessee Gov. Phil Bredesen. Some economic development projects may emerge from that over time, but the health care initiative is the first to grow legs.

Other groups will visit Vanderbilt University and East Tennessee State University – where the emphasis is on rural primary care – with the goal of reconvening in Nashville at the end of the month for a plenary session.

Memphis enjoys a long history with China; after the 1972 visit by President Richard Nixon to the Communist state, Memphis was the second city after San Francisco to send a group of goodwill ambassadors.

The current visit builds on an initiative begun in 2005 when John Pepin invited MBA students from China to spend six months in Memphis to learn American business philosophy. Pepin, the recently retired dean of the Fogelman College of Business and Economics at the U of M, worked with health care economist Cyril Chang on the project. Chang is director of the Methodist Le Bonheur Center for Health Care Economics at Fogelman.

Chinese professionals are endlessly fascinated, Pepin said, at how American culture functions.

The executive MBA program with China continues, and today Provost Ralph Faudree is working to extend that in both directions, for Chinese undergrads and doctoral candidates.

But it’s the pressure of health care that creates the current urgency.

“We have plenty of cultural differences, but it’s the things we have in common that make this important,” said Matt Kisber, comissioner of the Tennessee Department of Economic and Community Development. “For trade relationships to be successful and sustainable, it must be mutually beneficial.”

Common challenges

Both Tennessee and China face the challenge of providing quality health care in rural areas, Kisber said. The great part of that challenge comes from a common problem: health care can be expensive and rural areas sometimes lack the economic critical mass to support providers.

Chinese officials can learn from Tennessee health care entrepreneurialism, Kisber said.

“Tennessee has some of the best medical schools in the country, and the state’s core competency is in health care management,” he said. “We have thousands of companies who have developed new and creative ways of managing resources.”

Chinese officials have been particularly impressed, Kisber said, with Memphis-based West Cancer Clinic.

After the Sept. 11 terrorist tragedy made it more difficult for foreigners to visit the United States for advanced medical treatment, West’s CEO Steve Coplon chose to take American medicine overseas. West opened its first overseas clinic in Singapore, where patients are evaluated and given the same medical protocol they’d receive in Memphis. West has now opened a clinic in Shanghai and plans another in Manila, Philippines.

Kisber said Americans also can learn from the Asian approach to health.

“In China the treatment of physical ailments has been studied for thousands of years,” he said. “Both sides want to share best practices.”

Forging trust

The initial visit this month is short on specifics, which sometimes can be the case in grand, international connections. The primary goal right now, Chang said, is to forge relationships and trust, and trade goals and ideas.

Chang, a native of Taichung, Taiwan, has been instrumental in the initiative, from extending the MBA program to serving as a liaison with the current visitors.

“Cyril has been absolutely essential,” Raines said. “He’s Chinese; he understands the culture and much of the dialect. When it comes to health care, Cyril has a worldwide reputation.”

Perhaps the greatest lesson the Chinese can learn from Tennessee is what to avoid, said Gary Shorb, CEO of Methodist Le Bonheur Healthcare.

The lesson of TennCare, Shorb said, is in how financial incentives can support better services.

Tennessee, he said, is a profound lesson in what to avoid. Since TennCare was implemented, rural regions of the state have been drained of primary-care doctors, driven to urban areas in search of private-pay patients.

Doctors, Shorb said, are like everyone else; they have to support their employees and provide for their families.

“What we’ve learned is the importance of primary care and access to primary-care physicians and nurse practitioners, or some kind of front-line provider,” he said. “Because we haven’t done that in Tennessee, our emergency departments are being used for all kinds of inappropriate care.”