Market saturation and margin contractions in the U.S. have left many major health systems crowding limited real estate. In western Pennsylvania for example, UPMC commands more than 45% of the local medical-surgical market, limiting options for volume-driven expansion. Now, UPMC has established operations in Italy, Ireland and Croatia. Rising international demand for specialized advanced care options, the ability to leverage virtual care, and the desire to foster research partnerships and build reputation outside the U.S. are further pushing U.S. healthcare providers to stretch their strategic maps well beyond American borders.
Regions such as Dubai (United Arab Emirates) and Hainan (China) create fertile expansion opportunities. Intent on keeping local healthcare spending within their borders and attracting regional patients, these governments are pouring resources into developing medical tourism hubs. U.S. giants like Mayo Clinic are capitalizing on this trend, forging alliances with flagships like American Hospital Dubai. A partial list of others operating outside the U.S. includes UCLA, UCSF, Houston Methodist, Mass General Brigham, Johns Hopkins, and Cleveland Clinic.
These moves have shifted the paradigm: instead of traveling halfway around the world for Mayo-level care, patients can access this in their own region. This forces U.S. providers to reimagine how dollars—or rather, dirhams and yuan—change hands and places new demands on payment and revenue cycle partners
As U.S. hospital groups enter markets from Dubai to Bogotá, they now need to wrestle with cross-border, multi-currency receivables that must clear quickly, comply locally, and protect PHI.
The emergence of global healthcare payments has contributed to the success of companies like Flywire, which processed $8.4 billion in payments across more than 240 countries during Q1 2025. Healthcare is one of its fastest-growing verticals, illustrating the value of platforms that move money quickly and deftly manage foreign exchange, fraud prevention, and local regulatory environments.
Adyen, the Dutch acquirer and processor, is another payment company that is well-positioned to serve the needs of U.S. healthcare providers operating new global outposts. Known for its scalable, integrated payments platform, Adyen operates directly in more than 50 markets with support for over 250 payment methods and currencies. Its unified commerce infrastructure is perfectly suited for U.S. health systems with cross-border ambitions, seamlessly accommodating in-person, digital, and recurring payment scenarios. Adyen’s expertise with compliance, fraud detection, and local-market adaptation can support U.S. hospitals as they export both their care models and operational complexities.
As U.S. healthcare providers stitch together delivery networks that run from Pennsylvania to Palermo and Abu Dhabi, their revenue cycle partners see increased TAM, but also the need to rewire their operating models.
The move into international markets is about more than exporting clinical expertise. U.S. hospitals are setting up branded facilities, partnering with local providers, and entering joint ventures to deliver U.S.–grade medicine for affluent patients in those local markets. Every new clinic, specialty hospital, or telemedicine platform abroad requires robust revenue cycle workflows, adapted to the realities of each market. For RCM vendors, this represents a significant opportunity to offer value—streamlining patient intake, billing, insurance processing, and regulatory reporting in entirely new ways.
For example, migrating DRG and CPT logic into markets that bill under ICD-10 regional variants or bundled tariffs requires dual code sets and AI models trained on multinational claims. R1’s cloud platform already ingests data from more than 500 million annual patient encounters across the U.S., India, and the Philippines—an analytics depth that can be repurposed to tune country-specific edits. An RCM vendor’s ability to ensure data integrity, compliance, and reliable collections will be pivotal for U.S. providers’ success overseas.
In a world where every new affiliate clinic or virtual visit layer adds another knot to the financial web, having nimble, global payment platforms and revenue cycle services partners may prove to be just what the doctor ordered for U.S. hospitals and health systems..