Medical tourism: a role in disease management?

Medical tourism occurs when patients travel to other countries for medical or dental care. I have heard about medical tourism for years but never gave it much thought, believing that most medical tourism was related to cosmetic surgery. After some browsing on the Internet, I found a highly sophisticated, developing market for a broad range of medical tourism, and I am intrigued about its role in the future of American insurers. Countries that are active in medical tourism include India, Thailand, Belgium, Brazil, Costa Rica, Malaysia, Mexico, and Poland. (1) Many websites describe in detail the procedures available in India and Thailand, and their cost.

From a U.S. perspective, the obvious driving force behind medical tourism is cost (for some other countries, the issue might be cost or waiting time to obtain services). A website from Wockhardt Hospital in India describes cost differences for several procedures it offers. (2) For example, at Wockhardt Hospital, open heart surgery for coronary artery bypass grafting costs $7,500, versus $100,000 in the United States. Knee-replacement surgery costs $6,300 at Wockhardt Hospital, versus $48,000 in the United States. Even after travel and accommodations are added, the cost differences can be staggering. A broad range of operations (e.g., cardiac, dental, eye care, orthopedics, and neurosurgery) as well as diagnostic procedures are available.

The initial reaction of most people who are unfamiliar with medical tourism is to question the quality of the care. Interestingly, many of these foreign hospitals have U.S.-trained and American board-certified physicians. Some hospitals tout Joint Commission International (the international unit of the Joint Commission on Accreditation of Healthcare Organizations) accreditation. Many of the hospitals were specifically built to serve foreign tourists. Based on photographs of some of the facilities, they look as nice as my local county hospital, and in fact, many look like high-class hotels. At least two of the health systems I saw on the Internet had relationships with Harvard Medical (Boston) and John Hopkins (Baltimore). With careful research, one might find facilities and physicians with comparable training to physicians performing surgery in U.S. hospitals. It is also possible that service levels are higher, given the lower labor costs.

Medical care in a foreign country is not without concerns. Recovery in a foreign country from major surgery may be stressful, and arrangements must be clear regarding the handling of complications. Most people also worry about making health care decisions based on price (even though we do this in this nation all the time), and fear-mongering by health professionals who are worried about competition can be expected. Patients must also be aware that other countries might have different malpractice laws, and reasonable precautions for personal safety when traveling should be understood. However, an entire medical travel industry facilitates patients' needs in these areas.

My link to this topic and disease management is obvious. Although uninsured patients and self-insured employers have opted for medical tourism, it could easily become mainstream as U.S. corporations face rising health care costs. Princeton University Economist Uwe Reinhardt, PhD, said, "This (medical tourism) has the potential of doing to the U.S. health care system what the Japanese auto industry did to American carmakers." (3) Progressive insurers might be willing to negotiate medical tourism with patients and qualified foreign hospitals as a method to contain costs while continuing to provide an acceptable quality of care. Disease management programs could have a role in facilitating medical tourism for willing patients, and medical tourism could be a viable option for insurers who adequately screen potential patients. It may save money and improve satisfaction for some.

REFERENCES

(1.) Herrick D: Medical tourism prompts price discussions. The Heartland Institute (www.heartland.org/article.cfm?artid=19748), 2006.

(2.) Wockhardt Hospitals. (www.wockhardthospitals.net), 2006.

(3.) Kher U: Outsourcing your heart. Time (www.time.com/time/ magazine/article/0,9171,1196429,00.html), May 21, 2006.

Chris M. Kozma, PhD

Senior Research Director

Strategic Outcomes Services, Inc.

Research Triangle Park, North Carolina