Over the past two years, with ballooning national deficits and high unemployment rates, looking for growth in any industry has become something far easier said than done. Not so for the medical tourism industry, however, which is showing robust growth. In 2007, 750,000 Americans traveled abroad to receive medical care. By 2012, that figure is expected to more than double, to 1.6 million.
The term “medical tourism” was contrived by travel agencies to describe the act of traveling to receive medical attention. The inherent frivolity that accompanies the term “tourism” was seized upon by some healthcare providers and media outlets to belittle the practice. According to Vivian Cho, Chief Development officer of the Medical Tourism Association (MTA), efforts to rebrand the industry seemed futile. Receiving medical care and traveling were two priorities that were perceived as distant and incongruous. However, MTA embraced the term and was able to counter the pejorative use of it by taking advantage of the sometimes contradictory desires both to save money and to see new places.
Although outbound medical tourism (U.S. patients traveling to other countries for medical care) is nascent, the practice itself is anything but. Asklepios, the Greek god of healing, was said to dwell in the Saronic Gulf and Greeks travelled from all over the Mediterranean to seek medical attention. Much later, spa towns in England for the treatment of a variety of ailments and sanitariums in Arizona for the treatment of tuberculosis could be considered early forms of the practice. History shows that people will always be willing to travel in order to relieve pain, save money and expand their levels of comfort. It should be no surprise then that this industry is poised to capitalize on our contemporary situation by simply providing a service that has been sought throughout antiquity.
For most Americans, however, the notion of going abroad for medical care was virtually unheard until recently. After all, why go somewhere else when the world’s best medical care can be had at home? It is a notion that has been underpinned by America’s standing as a leading world power, its own vanity and a strong core of truth. But it has also been supported by a concern that elsewhere, medical care is simply not up to U.S. standards.
But as foreign countries improve facilities and U.S.-trained physicians come back home to practice, that concern is rapidly diminishing. For example, the Joint Commission International (JCI) is the international division of Joint Commission Resources, a non-profit organization that provides services to hospitals, ambulatory facilities and laboratories looking to improve patient care and gain accreditation from the body. According to a survey produced by Deloitte’s Center for Health Solutions, JCI had over 220 approved medical sites outside of the U.S. in 2008 and the number is growing.
Likewise, the United States has long been a primary destination for foreign doctors looking to get trained. But as many of those same doctors then go home to practice, they bring U.S. standards of care with them. Over time, this has created an unusual pairing of skilled medical professionals and accredited healthcare facilities, but in countries with economies that charge a fraction of the price for medical care than what is charged in America.
When these factors are taken into consideration, combined with Americans’ newfound sense of frugality, an increase in medical tourism seems almost inevitable.
Deloitte’s report states that medical tourism had reduced growth in 2008-2009 (growth is the operative word here) due to the recession but it is on track to resume rapid growth in 2010. As the recession forced many Americans to become much more savvy consumers, it also set the groundwork for expanding the medical tourism industry.
In the past, medical tourism tended to conjure images of adventurous individuals traveling to foreign countries to undergo fairly safe procedures such as dental cosmetics. Less fashionably, it suggested individuals who would leave the country for operations that were either illegal at home or were culturally taboo, such as sex change operations.
Such notions have shifted entirely, however, as the most popular procedures to have done abroad are now fairly mundane (Figure 1). They are also largely elective, mainly because leaving the country usually is not an option for addressing urgent, serious medical problems.
Industry-watchers note that outbound medical tourism is bound to have serious impacts on the status quo of stateside healthcare. Going even further, critics of medical tourism liken it to outsourcing of medical care, especially as Asia becomes an increasingly popular medical tourism destination.
According to Deloitte’s Update to their Survey, Medical Tourism Updates and Implications the effect that healthcare reform will have on medical tourism is opaque. In the short term, there will undoubtedly be some snags with the implementation of the new rules and guidelines and this will most likely contribute to the industries growth. However, it will be sometime before anyone will be able to quantify the implications that the recently passed legislation will have. With many of the provisions in the healthcare bill not being enacted until 2016, this gives medical tourism an opportunity to grow even further. “I actually view healthcare reform as accelerating medical tourism,” said Paul H. Keckley Ph.D., Executive Director, Deloitte Center for Health Solutions.
Employers as well as their employees are under financial pressure and the same reason that makes medical tourism an attractive option to the individual make it equally attractive to the organization. In January of 2008, supermarket chain Hannaford Bros. introduced a program to employees where they would pay travel expenses as well as medical bills for employees that were willing to travel to Singapore for hip and knee replacements. The program was met with a tepid response. Some in the industry contend that the Hannaford Bros. plan could have been used simply as a bargaining to chip to jockey lower costs from its healthcare supplier.
In 2007, two Bills were introduced to Congress pertaining to medical tourism. In West Virginia, HB 2841 was aimed at authorizing incentives for employees who would elect to have medical care in foreign healthcare facilities with JCI accreditation. The Bill died in committee. A similar Bill introduced in Colorado sought to provide incentives for state employees, covered under the state group medical plan to obtain medical care died in committee. As healthcare costs rise, and revenues and salaries remain stagnant, medical tourism will linger on the minds of policymakers and regulators.
Regardless of the support it gets from legislators and employers, as medical tourism becomes a more common practice, some travelers will find that the problems that arise when they travel for leisure are exacerbated when traveling to receive medical care.
Medical malpractice suits are ammunition for thorny litigation in the U.S. legal system, which despite what its critics say offers a fairly clear and delineated legal process when compared to other countries. Some countries that are attractive medical tourism destinations may have starkly different legal systems than Americans are used to and representation by a foreign lawyer may be expensive and ineffective. When malpractice occurs abroad, a medical tourist can be left with few options. Patients may not have sufficient coverage under their own personal insurance to remedy the error when they return home. Hospitals and doctors that the patient could be suing may not have adequate coverage to repay the patient should they win in court.
Other issues demand attention, also. In Asia especially, there are infectious disease-related risks that accompany any traveler to the region but are intensified after a surgery. If an individual is not planning a brief stay after release from the hospital a long flight home may also pose a risk to a comprehensive and healthy recovery. In some countries there are ethical issues that arise as well. The illegal purchase of organs and tissue from poverty-stricken members of the local population is prevalent in some countries such as India and China and in areas where medical tourism has worked too well, such as Thailand, local hospitals are becoming saturated with foreign medical tourists, which negatively impacts the ability of doctors and hospitals to treat the nationals that they have a primary obligation to.
Due to medical tourism’s incipient nature in the U.S., coverage has not been widely adopted and hence the procedures that are being performed are paid for out of pocket. With people shifting their coverage into vehicles like HSAs, medical tourism becomes even a more attractive option. There are substantial savings to be had.
As with many global trends, initially companies and individuals are hesitant to get on board. And in this time of economic uncertainty, apprehensiveness and cautious investing are prudent practices. It is difficult however to argue with growth and logic. The fact remains that medical tourism is growing at a very strong and tenable rate and as changes to our own healthcare system are put into place, the option for receiving care abroad will appear more and more attractive to individuals. The question remains, when will the option to capitalize on the situation become attractive healthcare providers.