Medical Tourism

“Quality comparisons are difficult, even within U.S. hospitals, as hospitals use different methodologies to collect data,” says Stephano. “Patients have to rely on JCI accreditation, surgeon experience, volume, and outcomes to decide.”

Recent studies echo the Medical Tourism Association’s claim: Increased cardiac surgery volume at Apollo Hospitals—an 8,500-bed healthcare system with 50 locations throughout India—and Narayana Hospital in Bommasandra, India, has lowered costs, with similar, or even lower, mortality rates compared with the average U.S. hospital.^7,9 Other challenges like getting medical records exist even within U.S. hospitals, so emerging platforms like Google Health and Microsoft Vault, where medical records can be uploaded at the touch of a button, “will benefit patients and providers,” Dr. Li says.

The Medical Tourism Association envisions U.S.-based physicians offering follow-up care to medical tourism patients. “Currently, we encourage patients to follow up with their primary-care physician,” Stephano says.

Dr. Li says malpractice is always a concern when traveling overseas; however, he also notes the legal system in the U.S. is strong enough “to handle any medical malpractice.” That said, a patient who experiences a poor medical outcome as the result of overseas treatment might seek legal remedies, but the reality is that malpractice laws are either nonexistent or not well implemented in some destination countries. That makes malpractice claims on overseas procedures a dicey proposition.

“Patients receiving overseas treatment need to realize that they are agreeing to the jurisdiction of the destination country,” Stephano says. Other risks associated with extended travel include exposure to regional infectious diseases and poor infrastructure in the destination country, which could undermine the benefits of medical travel.

Cost-saving benefits have led some U.S. insurance companies to begin integrating overseas medical coverage. For example, Blue Cross Blue Shield of South Carolina offers incentives for patients willing to obtain medical care overseas at JCI-approved hospitals. BCBS then waives deductibles and copays, and several other insurers have launched similar pilot programs.¹⁰ “We will see more of these changes,” Stephano says, “to cut costs and remain competitive.”

Immediate Impact

In 2008, U.S. healthcare spending was $2.3 trillion.¹¹ A 2005 Institute of Medicine report suggests that 30% to 40% of current U.S. healthcare expenditure is wasted.12 U.S. lawmakers, employers, hospitals, and consumers are scrambling to find ways to reduce healthcare costs and improve efficiency. Medical tourism seems to benefit a select few Americans, only lowering U.S. healthcare spending by 1% to 2%.¹²

Medical tourism revenue generated in destination countries currently is limited to the private sector, but that might change soon. Government funding for healthcare initiatives in such countries as India, Brazil, and Thailand is declining. Some entrepreneurial physicians and hospitals are looking to medical tourism to fill the funding gap.

Medical tourism likely will continue to grow; so too will the legal, quality, and insurance protections for patients. Efficient resource utilization might help reduce U.S. healthcare costs, and improved distribution of destination-country resources might help improve infrastructure and access to better healthcare for their own citizens.

With their leadership skills and expertise, hospitalists can play a major role in reducing healthcare costs.

However, what actual reforms healthcare legislation brings to medical tourism remain to be seen. TH

Dr. Thakkar is a hospitalist and assistant professor in the division of hospital medicine at Johns Hopkins University School of Medicine in Baltimore.

References

1. Medical tourism: Consumers in search of value. Deloitte Consulting LLP website. Available at: www.deloitte.com/dtt/cda/doc/content/us%5Fchs%5FMedicalTourismStudy(1).pdf. Accessed Sept. 13, 2010.
2. Pafford B. The third wave—medical tourism in the 21st century. South Med J. 2009;102(8):810-813.
3. Kher U. Outsourcing your heart. Available at: http://proquest.umi.com/pqdweb?did=1041533291&Fmt=7&clientId=5241&RQT=309&VName=PQD. Accessed Sept. 13, 2010.
4. Forgione DA, Smith PC. Medical tourism and its impact on the US health care system. J Health Care Finance. 2007;34(1):27-35.
5. Lancaster J. Surgeries, side trips for “medical tourists.” The Washington Post website. Available at: www.washingtonpost.com/wp-dyn/articles/A497432004Oct20.html. Accessed Sept. 13, 2010.
6. Horowitz MD, Rosensweig JA, Jones CA. Medical tourism: Globaliz-ation of the healthcare marketplace. MedGenMed. 2007;9(4):33.
7. Milstein A, Smith M. Will the surgical world become flat? Health Aff (Millwood). 2007;26(1):137-141.
8. New AMA guidelines on medical tourism. AMA website. Available at: www.ama-assn.org/ama1/pub/upload/mm/31/medicaltourism.pdf. Accessed March 26, 2010.
9. Anand G. The Henry Ford of heart surgery. Wall Street Journal website. Available at: online.wsj.com/article/SB12587589288795811.html.
10. Einhorn B. Outsourcing the patients. Business Week website. Available at: www.businessweek.com/magazine/content/08_12/b40760367 77780.htm. Accessed Sept. 13, 2010.
11. . Hartman M, Martin A, Nuccio O, Catlin A, et al. Health spending growth at a historic low in 2008. Health Aff (Millwood). 2010;29(1): 147-155.
12. Milstein A, Smith M. America’s new refugees—seeking affordable surgery offshore. N Engl J Med. 2006;355(16):1637-1640.