Considering Medical Tourism

Editor’s Note: As always, members have personal freedom and responsibility to make their own health care decisions. Samaritan staff are not health care consultants and do not give advice about health care providers.

According to the National Center For Policy Analysis, more than half a million Americans are traveling out of the country for health care each year. That figure is a conservative estimate because medical tourism is a new area of study in which reliable data are difficult to come by, but basically it’s growing so fast that the statisticians can’t keep up with it. It is known that in 2006 more than 1 million patients crossed international borders for treatment and spent $60 billion in the process.

Some of the most often cited factors driving the growth include the following:

• High cost of American health care, mostly due to government regulation
• Annual cost increases three times the rate of inflation
• Long wait times for treatment
• Ease and affordability of modern travel, especially airfare
• Improvements in technology and standards of care in many countries, even the “third world”
• Widespread Internet access to information that allows patients to know more than ever before

How does it work?
The process of arranging medical tourism is also somewhat difficult to pin down because the industry is developing so rapidly. Typically, a patient seeking treatment contacts some sort of medical tourism provider, often for a second opinion because of frustration with treatments and prices being offered. Most of these intermediaries primarily use the Internet to attract patients, and they are somewhat like specialized travel agents.

The medical tourism provider usually requires the patient to submit a medical report that can be reviewed by doctors or consultants who then advise on the medical treatment options. If the parties are in agreement that medical tourism is a good fit, then cost, choice of destination and hospital, duration of stay, and other issues are discussed.

The savings can be significant and easily make up for travel costs, especially on major procedures. Sometimes patients manage to do a little sightseeing on their trip and still save money, and it’s easy to see how, with heart surgeries for example. Hospitals in India charge $4000 for cardiac surgeries, as compared to $30,000 in the U.S. All kinds of cardiac surgery; kidney and liver transplants; arthroscopic surgeries; knee and hip replacements; and ear, nose, and throat surgeries are some of the more common procedures done. Even more minor things like dental work and cosmetic surgeries are drawing large numbers of medical tourists. One headline recently blared, “Man saves $15,000 by going overseas for dental treatment.”

Growing credibility
Although medical tourism is often reported in the media as only a way for uninsured or self-employed people to get discount (and by implication second-rate) health care, this perception is beginning to change. Some developments have helped medical tourism gain credibility. First, some foreign hospitals have doctors with training in the U.S., many with degrees from prestigious American medical schools. Some foreign hospitals are owned, managed, or affiliated with American universities or health care systems. In many cases medical tourism amounts to going to the branch office of a hospital system in the states.

Talks between General Motors and medical providers in Thailand recently caused quite a stir, and even large insurers such as BlueCross BlueShield have begun negotiating plans with medical tourism providers. Many health care systems in California are developing relationships with providers in Mexico.

Accreditation is increasing as well, with some foreign hospitals seeking accreditation from the same organizations as the American hospitals or raising their own standards with similar accrediting bodies in their respective countries.
The trend seems to be that medical tourism is gaining more and more credibility. Some health care policy analysts believe it is the next major trend in health care.

Caveats
In addition to concerns about the quality of care with medical tourism, there are also ethical problems to be on guard against. The media has recently reported on medical tourism patients being duped into paying for bogus stem cell treatments. In some cases these patients don’t realize the treatments are useless and in other cases they ignore the evidence because they have a desperate condition and are willing to try anything. Leading experts on stem cells issued a statement calling these treatments “snake oil.”

Even worse, almost all of these dubious treatments use embryonic stem cells and destroy human life. Very little mention of this clearly abhorrent practice is made in media reports. The well-established fact that perfectly acceptable adult stem cell therapies hold more promise also seems to get left out (see www.stemcellresearch.org/facts/treatments.htm). Christians should be careful not to support institutions that promote and profit from embryonic stem cell therapies.

Another area of ethical concern is organ transplant. China has drawn most of the criticism in this area because there are reports—even from U.S. congressmen and doctors—that executed prisoners’ organs are harvested and sold on a black market. Thailand is another area of concern. In addition to being well known for “sexual tourism” that exploits women and children, some parts of Thailand also cater to those seeking sex-change operations.

Critics vs. customers
Naturally there will always be skeptics who say medical tourism isn’t trustworthy, but those half-a-million Americans a year beg to differ. The most significant factor in maintaining quality and integrity comes from informed consumers and free market incentives to improve. The free flow of information on the Internet gives individuals unprecedented access to knowledge, the most powerful tool in shaping policy and the market.

Patients can learn more than ever about treatment options, health care providers, emerging technologies, side effects, recovery times, and every imaginable aspect of a health care need. More than anything else, consumer demand drives health care innovations.

What really makes American health care so expensive?
Health care expert and National Center for Policy Analysis president John Goodman believes it is important to point out that heavy regulation in the U.S. is what is making the global competition possible.
Goodman says, “Foreign hospitals are posing a challenge to domestic hospitals similar to the challenge Japanese auto makers posed for Detroit. There is nothing being done in Mexico, Thailand or India that can’t be done just as inexpensively in this country. But to do so, U.S. hospitals need to be freed from unwise public policy constraints.”
“Prices for treatment are lower in foreign hospitals for a number of reasons. Labor costs are lower, third parties (insurance and government) are less involved or not at all involved, package pricing with price transparency is normal, there are fewer regulations limiting collaborative arrangements between health care facilities and physicians, and malpractice litigation costs are lower.”

What about medical tourism within the U.S.?
Medical tourism within the US is more rare than going abroad, but theoretically it should work and could catch on. The same basic principles apply. Travel costs are a small percentage of total costs. Different providers might have different strengths in treatment or lower costs that could be taken advantage of by traveling. One might think that in America even health care providers would recognize that some competition would be healthy. Alas, the situation in the U.S. is incredibly complex. Again, the biggest problem is government regulation that distorts pricing. It’s very difficult to figure out actual costs, let alone compare them but in some cases it can be done.
The Wall Street Journal recently reported on a company in the U.S. that specializes in helping self-insuring employers find better deals on major surgeries for their employees. Employers save thousands on major surgeries by flying the employees to Texas. Similar stories are popping up in other publications. Unfortunately, this company is essentially a specialized insurance plan that can be included in the employers’ self-insurance policies, and it doesn’t work with individuals.
This state of affairs should not discourage individuals from considering medical tourism within the U.S. though. Asking for a second opinion is always a wise course of action and may lead to all kinds of possibilities. The legwork of finding out prices and comparing them will have to be done by an individual. What could be more American than negotiating for the best deal and stretching a dollar?

Is medical tourism for you?
To begin exploring medical tourism, the place to start is online. Just search for “medical tourism” and surf away. Large medical tourism providers tend to come to the top of the searches, and there are also some sites and consumer newsletters that are more oriented towards informing patients of various options. Be aware that they all have sponsors and advertisers.

Some of these medical tourism outlets have contacted Samaritan Ministries to recruit its members, but rather than Samaritan Ministries promoting any particular provider, it’s best for members to explore the options that are suitable to their individual needs. Samaritan would love to hear success stories that would help other members and glorify God, and possibly publish them in the newsletter or on the website.

One example is Bob Svletlik’s story about hip surgery in India. He was unsatisfied with treatments offered at first, and actually found what they considered to be better treatment overseas.

As medical tourism continues to grow, more and more members are discovering it can lead to quality health care and be good stewardship of their resources. In some cases, members really can save money and see the world.