Medical Tourism: The American Invasion

Americans have always traveled abroad for business and pleasure, seeking out exotic locales that offer excitement or financial opportunities that are not available back home. Now, we can add something else to the list of things Americans go abroad in search of: top-notch medical care. In recent years, the number of so-called “medical tourists” traveling overseas in order to seek medical care has steadily increased. Forced by skyrocketing US medical costs to turn to foreign hospitals and physicians, many Americans are booking trips to distant lands, attracted by the prospect of affordable operations and treatment ranging from cosmetic surgery to orthopedic procedures.

In 2006, an estimated 150,000 American patients traveled to countries like Costa Rica, Malaysia, and Argentina—with Thailand and India being the most popular destinations—in search of affordable medical care. That number is expected to increase as care here in America becomes more expensive and more people become aware of cheaper and comparable overseas alternatives. According to David Hancock, author of The Complete Medical Tourist, “Americans are expected to help turn global medical tourism into a $40 billion-a-year industry by 2010.”

Richard Wade, vice president of strategic communications for the American Hospital Association (AHA), says that Americans’ perceptions of who engages in medical tourism have changed over the years. In the past, the view was that Americans didn’t need to do such things, that the only medical tourists were the foreign patients who came to the US to receive treatment at our world-renowned hospitals. “They often looked like real medical tourists who’d come to New York, Baltimore, or Boston, have the care they needed done, and then go sightseeing or shopping,” Wade says.

The Good, the Bad, the Worst

Some foreign hospitals have begun to implement some of the latest healthcare information technology and recruit highly talented physicians (many of whom trained in the US), moves that have improved the level of care delivered at these institutions and raised the profile of medical tourism. Although these changes have made some foreign hospitals comparable to many US-based ones, it is still important for patients who are contemplating traveling overseas to seek medical care to thoroughly evaluate all benefits and potential risks.

For many patients, the most attractive aspect of medical tourism is the extremely low cost of care offered overseas—a 20—80% difference compared to the cost of many US procedures. This is a big deal, especially for the estimated 46 million Americans without health insurance who are unable to afford quality care. Imagine for example that you don’t have health insurance and you need a hip replacement, which costs approximately $40,000 in the US, but only $5,800 in India— would you choose to go abroad in order to save tens of thousands of dollars? Patients who have answered “yes” to that question and traveled abroad for a medical procedure have often reported receiving excellent care from qualified physicians and found better nurse-to-patient ratios and physician-to-patient ratios in many foreign hospitals that cater to medical tourists.

Access to and availability of care are also factors driving this phenomenon. Medical procedures and treatments that have not obtained FDA (Food and Drug Administration) approval are often available elsewhere. Given these benefits, are patients still putting themselves at risk when they seek treatment outside the US? MDNG editorial board member Jonathan Bertman, MD, says “I tell my patients that it’s risky,” when they ask about overseas healthcare. “It’s not like they’re risking losing a little bit of money—they’re risking their life. The question is, how important is it to them?”

In response to patient demand and in order to protect the safety of American medical tourists, several US medical institutions— including Johns Hopkins, The Mayo Clinic, and The Cleveland Clinic—have established affiliations with overseas hospitals. Many American healthcare professionals are also traveling abroad to study with local hospitals and universities and also to train local physicians, further improving the level of care they provide. The Joint Commission International (JCI), a non-profit organization whose focus is to “continuously improve the safety and quality of care in the international community,” has accredited an estimated 120 foreign institutions that have met JCI healthcare standards. If standards of care continue to improve in foreign hospitals and clinics, some aspects of healthcare in the US “could soon follow the flight of manufacturing, services, and software development to the developing world where a lower cost of living translates to cheaper treatment,” said Ruben Toral, marketing director of the Bumrungrad Hospital, based in Bangkok, Thailand.

Still, it remains important for patients to adopt the mindset of “buyer beware” when considering the risks associated with traveling abroad to receive medical care. One concern Bertman mentions is the lack of oversight. “The biggest thing is that overseas care is not regulated the way it is here. You just don’t know what you’re getting into.” There is also the lack of malpractice insurance, which means if complications occur, a patient’s legal recourse could be limited. Other important considerations patients should keep in mind include complications that could arise from traveling so soon after undergoing a procedure, language barriers, and difficulty obtaining follow-up care.

Secret Agent Man

The Internet has greatly facilitated the rise in medical tourism by making it easy for patients to find information on physicians, medical institutions, and medical travel agencies. A quick Google search on “medical tourism” returns thousands of links to information on the topic, including links to medical travel agencies. Their role is to act as the middlemen between the patients and hospitals by booking airline tickets, scheduling surgeries, reserving hotel rooms, etc. Many agencies will also send employees overseas to evaluate the medical facilities and meet administrative staff and medical staff. Agency employees often act as guides and take prospective patients step-by-step through the entire process.

Rajesh Rao, CEO of NC-based IndUSHealth, Inc., told OncNG, “The big value we have is basically being able to help guide someone through the whole journey and process and find a way to ensure their experience is far beyond what they expected.” He said IndUSHealth and other agencies are “tapping a market of individual consumers who are seeking excellent healthcare options elsewhere in order to afford being able to receive good care when they need it.” However, healthcare professionals must also familiarize themselves with these agencies, which may be involved solely for monetary gain, which could put patients in harmful situations. IndUSHealth has been in business since 2005 and focuses on sending its clientele only to India. According to Rao, “the hospitals there provide the best combination of quality and cost” because of what’s known as the “Indian Advantage.”

MedRetreat, an Illinois-based medical travel agency, spent its first year and a half on due diligence. Patrick Maresk, Program Director of MedRetreat, said that meeting the staff of the overseas hospitals allowed the company to “establish the program and explain what the model of the American medical tourist is, so the hospitals could best cater to their needs, which are much different from the local people.” Maresk also explained that cosmetic surgery, orthopedics, and gynecology are the three most popular medical reasons MedRetreat clients go overseas. In fact, the company is anticipating that by the end of 2007, it will send more than 300 patients abroad to affiliated hospitals in Brazil, Thailand, and Turkey for procedures.

For now, medical tourism is consumer-driven, but companies like IndUSHealth and MedRetreat have begun investigating the possibility of providing businesses the opportunity to receive lower insurance premiums if employees go abroad for healthcare.

Change is Good

Although the US still offers the best healthcare, rising costs have pushed many Americans to search elsewhere for treatment. Dr. Bertman says, “The fact that medical tourism exists and there’s a demand for it, is a reflection on problems within our own healthcare system.” Alain Enthoven, senior fellow at the Center for Health Policy in Stanford, CA, echoed this view. “Global healthcare is coming and American healthcare, which is pricing itself out of reach, needs to know there are alternatives,” in order to improve.

To remain competitive, US hospitals will need to figure out a way to make quality patient care available at affordable costs. Bertman says this can be a good thing. “I think competition can lower prices, which is what we want.”

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