Medical Tourism

The reasons the costs are so much less at overseas hospitals, as compared with U.S. costs, are many:

• Lower wages for providers;
• Less expensive medical devices and pharmaceutical products;
• Less involvement by third-party payors; and
• Lower malpractice premiums.⁴

For example, the annual liability insurance premium for a surgeon in India is $4,000; the average cost of a New York City surgeon’s liability insurance premium is $100,000.⁵

Brazil, Costa Rica, and Mexico are attractive destinations for cosmetic and dental surgeries; Singapore, Malaysia, Thailand, and India have emerged as hubs for cardiac and orthopedic surgeries (Table 1, above).⁶

The growth in medical tourism led the Joint Commission in 1999 to launch Joint Commission International (JCI), which ensures that offshore hospitals provide the highest-quality care to international patients (see “Ultra-Affordable Prices and No Decline in Quality of Care,” p. 28). JCI has accredited 120 overseas hospitals that meet these standards.

“Overseas hospitals are always keen in partnering with U.S. hospitals,” Dr. Li says. Collaborations, such as Johns Hopkins International Medical Center’s partnership with International Medical Clinic Singapore, and Partners Harvard Medical International’s affiliation with Wockhardt Hospitals in Mumbai, India, have helped facilitate the accreditation process and alleviate U.S. patient concerns.

Overseas hospitals not only offer greatly discounted rates than insurer-negotiated U.S. prices, but many of the international hospitals also report quality scores equal to or better than the average U.S. hospital’s.⁷

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Before You Book a Trip …

How do patients find overseas facilities? It’s as easy as a click of the mouse.

“Our survey shows 75 percent of patients located offshore hospitals through the Internet,” says Renee-Marie Stephano, president of the Medical Tourism Association, a nonprofit group based in West Palm Beach, Fla., that was established in 2007 to promote education, transparency, and communication in the medical tourism community. Patients use overseas hospital websites, international medical coordinators, and medical tourism companies, such as PlanetHospital.com and MedRetreat.com, to find facilities and providers, and to coordinate medical travel.

“Medical tourism is currently unregulated,” Stephano says. “One of our goals is to certify medical tourism facilitators to create the best standard of practice.”

In 2007, the American Medical Association (AMA) published medical tourism guidelines to help healthcare entities engaged in overseas medical care.⁸ (Download a PDF of the guidelines at www.ama-assn.org/ama1/pub/upload/mm/31/medicaltourism.pdf.) The AMA suggests that:

• Medical care outside the U.S. should be voluntary, and patients should be informed of their legal rights and recourses before agreeing to travel outside the U.S.;
• Before traveling, local follow-up care should be arranged to ensure continuity of care;
• Patients should have access to physician licensing, facility accreditation, and outcomes data for both;
• Medical record transfers should follow HIPAA guidelines; and
• Patients should be informed of the potential risks of combining surgical procedures with long flights and vacation activities.

Patient Concerns

Hospitalists are highly focused on a patient’s quality of care; the same can be said of some overseas hospitals that attract large numbers of medical tourists. “I think the service and quality of care provided at our hospital compares favorably with the very best American hospitals,” says Kenneth Mays, senior director of hospital marketing and business development at Bumrungrad Hospital in Bangkok.

That might be so, but the growth of medical tourism also raises concerns stateside. With sleek websites making it easy for U.S. patients to schedule procedure vacations from their kitchen tables, many U.S. physician and watchdog groups worry about patient safety, privacy, liability, and continuity of care. Although most international hospitals and physicians provide outcomes data, rarely do the benchmarks compare directly with U.S. hospital quality and safety data.