Crossing the Border: How Far Will You Go with Medical Tourism?

There are not many word combinations more awkward than "medical tourism." But, that's not preventing a whole industry from springing up around the more-and-more common notion that you just might jet off to Bangkok or Buenos Aires for your next knee replacement, face lift or even heart surgery--along with a cozy recovery pool-side and a few days at the spa, of course.

There's lots of talk about medical tourism making a major breakthrough in '09. The stars are aligning not just because the economy is demanding cost-cutting measures that may have seemed extreme before, but because the globalization of health care is making huge strides in terms of quality and accessibility. Over 50 countries are trying to attract patients from the US with JCI-accredited facilities and US-trained doctors and some with outcomes data that would make some of our best hospitals blush. The result: 1.5 million Americans traveled outside the country for health care in 2008, saving 50-80% on the cost of services here. McKinsey expects the number of "medical tourists" to increase 20% annually.

Once just for uninsured or under-insured, medical tourism is now being targeted for the group health insurance market. The reasons for this are pretty obvious--employers represent a huge potential market. And, why market individual-by-individual when one contract can get you thousands of potential patients at once? Several major insurance carriers are writing this into their plans and large employers should not be surprised to see this in renewals this year.

Whether you think this trend is delightful or disturbing, watching this pan out in the group market will be fascinating. We struggle to get employees and their families to do simple things like go to the doctor once a year, get the necessary cancer screenings and actually take their prescription drugs as directed. Even though we have spent years attempting to make employees great "consumers" of health care, most people are overwhelmed and feel unequipped to make important health care decisions--especially when a disease or accident strikes.

How will they react to the option of going to Costa Rica instead of the local hospital for that hip replacement? How will they be able to evaluate the risk and reward? Sure, the employer may save tens of thousands of dollars and be able to pass that along to the employee in terms of a waived deductible (with a family trip to boot!), but how do you help that individual get comfortable with the process? And, how do you serve this up as a real option when there's such big money at stake? (And, those questions just touch the surface of the compliance/liability issues.)

While these are messy messy questions, in the best scenario, medical tourism could actually help push the envelope on consumerism in health care. Clearly, all those millions of people traveling abroad for surgery are already savvy consumers--price shopping, comparing their options, picking facilities and tallying up the costs of the medical procedures and the whole trip (one would argue, you're always a better consumer when it is your own money you're spending, as is the case with uninsured individuals). Subjecting US hospitals to a transparent and open comparison with their foreign counterparts on outcomes data could shed a whole new light on the quality of care we receive here. A surge in Americans traveling outside the US for cutting-edge procedures that the FDA is slow to approve may help adoption of new technology, like stem cell treatments. Getting away from the notion that the best care is always in your backyard may help employees be more receptive to turning to data (not word of mouth) when they pick their next doctor.

But, I'm afraid that is an overly optimistic view. At least in the short term, the option to go abroad is going to add to the overall confusion about how, where and when to get the best care. (This may be less so for companies who have a global workforce already or whose employees travel abroad regularly for work and for fun. But, imagine explaining to an employee who has never left the country that you'd like them to consider going to Bangkok for their next major surgery!) But, with a thoughtful approach, the employers and insurers and facilitators forging through this new frontier may come out winners--if they can keep their costs down while keeping employees happy (and healthy!). Couldn't hurt if they throw in a few more days at the spa, too.

Thanks to Robert Repke at Global Medical Conexions for lots of background material. His presentation in San Francisco sparked this post.

Editor's Note - Jennifer Benz is founder and chief strategist at Benz Communications, a boutique consulting firm that focuses on employee benefits communication. She helps companies large and small connect with their people so that those people (and their families!) understand all the confusing but oh-so-important benefits programs that are out there. She's located in San Francisco, but her team and clients are all over the place.

Comments

[William Taylor]

Thanks for this great post. This is an interesting development, and one that could save self-insured companies (or individuals) quite a bit of money. As mentioned, the challenge will be convincing employee's to agree to medical procedures outside of their home country. Also, if the company one works for proposes this as a solution, and the employee accepts, it will undoubtedly create additional liability for the company. I love this idea though, and think it will force U.S. hospitals and doctors to re-evaluate their pricing models. Let's hope so!

[Margaret O'Hanlon]

The corporate early adapters for medical tourism will have a lot to teach us. The cost savings will be apparent to employees, but it's likely that they will be pretty skeptical about quality of care. Maybe this will spur an improvement in communications about these measures, with the patient getting greater insight into cost/benefit, too. That would be really interesting.

[Jennifer Benz]

Hi William and Margaret,

Thanks for the comments!

As you both note, there will definitely be a lot of tension as this unfolds--but many opportunities and lots to learn along the way!

[Robbie]

More and more employers are investigating Medical Tourism as a way to shave significant money off their expenses for health benefits, but we're increasingly asked about quality of care...The main thing an employer/benefits manager MUST do is careful research on companies that provide them with facilitation services. A reputable facilitator, like http://www.worldmedassist.com will vett the doctors and hospitals allowed into their network with extreme care, looking for those with US-like accreditation, board-certified doctors, state-of-the-art facilities, intense focus on patient care and satisfaction levels...and so forth. Visit WorldMed Assist to learn more about this: http://www.worldmedassist.com/employers/medical-tourism-for-employers.htm The potential to expand employee options while employers save money doesn't come along very often during a downturn like this.