Monday, June 16, 2008

Health Care and Travel

Medical tourism is becoming a big business. According to the Health Matters Blog on the Wall Street Journal online, in the last few years, the idea of traveling to a foreign country for non-urgent health care at a fraction of the U.S. cost has been gaining popularity among a small slice of the population. 

Faced with sticker shock for domestic care, some Americans do their research and jet off to Mexico for dental work or Singapore for surgery. Many times, it’s for elective procedures that aren’t covered by insurance, such as infertility treatments or cosmetic surgery. Statistics are scant, but interest in medical tourism appears to be growing as more Americans lose their health coverage or struggle to pay their out of pocket costs, and as companies sprout up to match U.S. patients with potential hospitals, doctors or dentists in other nations.

Many employers are now considering this option for their workers. Of course, medical tourism isn’t for everybody, and the sheer complexity involved in making it work leaves many employers cold. The Health Matters Blog also reported that employers desperate to stanch their rapidly rising health insurance costs are taking a closer look at adding a dash of medical tourism to their health-care benefits. 

The National Business Group on Health, a coalition of 300 large employers, released an issue brief this week to help employers do their due diligence and guide them through a maze of legal, financial and medical considerations. To be sure, none of the 35 NBGH employers surveyed in February currently offers a medical tourism benefit, and 57% said they had no intention of evaluating it. But nearly a third of this small sample — 31% — said they were in the process of analyzing the option.

The Blog's author reports that the NBGH encourages employers to examine what kind of legal recourse a patient would have if she suffers malpractice abroad and how to ensure U.S.-mandated patient privacy is maintained. The group also advises validating foreign hospital accreditation with the Joint Commission International and the International Organization for Standardization, as well as pursuing case management and cross-cultural services with experienced medical travel operators. 

Among the basic questions to consider, according to the NBGH: Is the patient able to make the trip without disability? Are there typically minimal post-operative complications? Will the procedure require significant follow-up care? What happens if treatment fails — can the patient receive domestic follow-up care that’s covered by insurance or will he have to return to the foreign destination? These questions and more are worthy of consideration to weigh the costs and risks associated with medical tourism.

It’s no surprise that offshoring for certain surgeries would be financially attractive to employers, despite the rising cost of covering air travel for the patient and, often, a companion as reported in the WSJ Health Matters article. A spinal fusion performed in the U.S. averages $62,000 compared with $7,000 in Thailand and $5,500 in India, according to the issue brief. A knee replacement that goes for $40,000 domestically can be had for $13,000 in Singapore. 

 Heart surgeries represent among the biggest potential savings, but also the biggest risks considering the grueling nature of long-distance international travel for an ailing patient. On costs alone, the case is persuasive: a heart bypass operation totals just $11,000 in Thailand, $18,500 in Singapore and $25,740 in England vs. a tab of $130,000 in the U.S. But these figures may assume best-case scenarios, where everything goes as planned and no costly follow-up care is needed. And it’s hard to believe many patients would sign up for major surgeries that happen so far away from the comforts of home and family.

Another question arises as posed by the Health Matters Blog: given how widely the quality of care varies in this country, shouldn’t more employers explore the possibility of sending U.S. patients to more distant U.S. doctors and hospitals renowned for their successful outcomes in particular specialties? Many large employers have programs like this that help patients find the best care for transplants and, increasingly, cardiac problems at what are called Centers of Excellence, regional hubs that have the best outcomes and often do the largest volume of certain procedures. 

Employers or insurers typically cover the travel and accommodation costs. But these benefits are much harder to find among smaller employers. The market for worldwide medical tourism was $60 billion in 2006, and it’s projected to rise to $100 billion by 2012, according to figures cited in the NBGH survey.

According to, there are a range of possible models for how to go about seeking affordable and high quality health care abroad. Many providers, in Thailand, India, Costa Rica, Singapore, South Africa, Malaysia, and elsewhere, provide direct links to their services via the Internet. Many will help facilitate your travel and accommodation logistics, alongside arranging medical services. 

Take note of the different kinds of providers that are out there --- ranging from major hospitals to smaller clinics and private practices --- as you decide what is the best fit for your medical needs. An alternative to working directly with a provider is to consider going through a company that operate as a full-service broker or concierge service. These companies typically arrange the full spectrum of a medical trip abroad, connecting you to health providers, making logistical arrangements for your medical care and travel, and often providing a single, lump-sum total for the entire package. 

Such brokers, whether based in the U.S. or Europe, or in another country or region, often have established working relationships with a set number of providers covering a range of medical procedures. Early on it is important to consider both the potential advantages (convenience, expertise) and disadvantages (limited choice, possible brokerage fees) of working with a broker as you decide what course of action to take in satisfying your health care needs.

As medical tourism continues to grow in popularity, the costs associated with it will also continue to grow, but not as rapidly as existing health care expenses in the United States. The risks associated with receiving health care outside of the U.S. are greater, but not exponentially greater than similar risks in domestic medical clinics, hospitals and other health care service locations. 

Thousands of patients die every year of staff infections and other complications in American medical facilities as a result of negligence or other issues related to mistakes made by health care professionals. The risk associated with having medical procedures done by highly qualified health care providers anywhere is significantly better when the facility is managed by accredited medical professionals. Medical tourism may or may not be for you. Make sure you do your homework well before embarking on this type of adventure just to save a few thousand dollars. The long term results may be just the ticket.

Until next time. 

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