Medical Tourism Has Appeal, but Requires Homework

I magine this scenario: An employee schedules a meeting with you because she needs immediate spinal surgery and can’t cover the out-of-pocket costs. She informs you that she is thinking about taking a trip overseas and having the procedure done by an accredited hospital and physician in India. She wants to know if the company will cover any of the costs.

If it hasn’t happened already, it’s only a matter of time before someone in your organization asks you about the company’s policy on medical tourism.

Employees covered under high-deductible plans or those with no insurance at all can save a great deal of money by seeking medical care abroad. According to the Medical Tourism Association, most procedures abroad cost half of what they would in the United States.

The cost of a heart bypass in Thailand costs $11,000, compared with up to $130,000 in the United States. Spinal fusion in India costs $5,500, compared with $60,000 stateside. A knee replacement in Singapore is about $17,800, or around half the U.S. price.

In 2005, an estimated 500,000 Americans went abroad for health care. In 2006, the medical tourism industry grossed about $60 billion worldwide. McKinsey & Co. estimates that this total will rise to $100 billion by 2012.

Insurers and employers have slowly begun to accept the international practice of medicine by forming medical tourism subsidiaries and considering policies to cover workers who travel to a foreign country for treatment. For example, insurance companies are beginning to form subsidiary companies that provide international coverage and manage travel arrangements for beneficiaries seeking care abroad.

These developments have raised concerns among HR directors and benefit managers. Their questions include issues of proper credentialing, comparative provider training and access to quality post-operative care. They want to know how the quality of care is measured. How are physicians credentialed? How are provider hospitals regulated? What happens in a post-operative emergency? What is the employer’s liability if something goes wrong?

The global economy is allowing for some answers to these concerns. Foreign health care providers often have physicians with international credentials, and many were in fact trained in the United States. More than 120 hospitals abroad are accredited by the Joint Commission International, which accredits American hospitals participating in Medicare; another 20 are accredited through the International Standards Organization. Other countries have begun creating independent accrediting rules and regulations.

The U.S. health care consumer today also has different perceptions regarding “cheap” health care abroad. The informed consumer now realizes that 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 in health care delivery, or are not involved at all. There is less regulation and malpractice litigation costs are significantly lower.

Because there are solid market justifications for the significant price difference in health care services overseas, some fail to assess the impact that the lack of regulatory oversight may have on provider services. Employers and employees need to be aware of the level of regulation and conduct additional research in any country they may be considering as a treatment location.

When it comes to post-operative care, which is another area of concern, telemedicine is providing answers. Because potential medical tourists must first be evaluated remotely, most medical intermediaries for patients use electronic medical records to store and access patient files. Patients can then discuss the procedures with potential physicians via conference call.

Patient electronic medical records can be transferred back and forth, managing the continuum of care from pre-operative assessment to post-operative care. Such modes of communication enhance the continuity of patient care and can eliminate concerns about a patient’s recovery at home from an overseas procedure. In the United States, by contrast, only about one out of four U.S. hospitals store medical records electronically.

So how would you advise the employee described at the beginning of this article? The facility abroad is highly accredited. The physician is U.S. trained. Staffing levels are greater. Her records can be transferred digitally for post-operative care. And the employee’s costs will be reduced significantly.

With globalization quickly moving into health care services, employers providing health care benefits must begin to reassess their approach to this new treatment option. Employees know about medical tourism—they’ve seen it on the news, or perhaps they’ll even read about it in one of this summer’s beach books, Robin Cook’s Foreign Body (where a New Delhi hip replacement doesn’t turn out that well).

And although only 11 percent of organizations offer medical tourism as an option for covered medical care now, more will likely join the trend. It appears to be a viable, safe option—under the proper circumstances. Your organization should be in a position to tell employees why you do—or don’t—want to make it an option for them.