Violence Overseas Keeps Some Medical Tourists at Home

By Staff Report

Jan. 13, 2009

Terrorists attacks in India. Hamas rockets in Israel. Kidnappings in Mexico.

Not the kinds of headlines that help sell risk-averse employers on the idea of sending employees abroad for medical care. The threat of violence is one reason few employers have signed up with companies that offer low-cost medical care at foreign hospitals and even fewer are sending employees overseas, medical tourism operators say.

Despite cost savings in elective surgeries such as hip replacements, employers remain concerned about liabilities—medical and otherwise—related to receiving health care overseas.

One medical tourism company, Calabasas, California-based Planet Hospital, has signed up five employers. But after the November terrorist attacks in Mumbai, Planet Hospital’s employer clients said they wanted to cross India off their list.

What started out as interest in medical tourism has yet to translate into sending employees abroad.

“They sign up but they don’t execute,” said Planet Hospital founder Rudy Rupak. “The employer says, ‘We’re not going to do this until we’re absolutely protected against malpractice.’ But you’re not going to get absolute protection even in America. If a person wants to sue, they’re going to sue.”

The company has for months been working on providing liability insurance to employers against being sued by employees who experience medical complications. Rupak said Los Angeles-based clothing retailer American Apparel recently signed up for the service. But the company is restricting its options to Mexico, despite a recent string of high-profile kidnappings in the country.

Employers, though, are often more concerned than employees about safety risks, said Tom Keesling, president of Indus Health, a Raleigh, North Carolina-based medical tourism company focused on India.

“While we might say an employer may be hesitant because of worldwide unrest, we know that when employees are asked to assess that risk themselves we know they want to go,” Keesling said.

That’s because often the incentive for individuals is cost. In the U.S., a hip-replacement surgery can cost $30,000 to $40,000 for uninsured patients, according to BlueCross BlueShield of North Carolina, compared with about $9,000 in India and $12,000 in Singapore.

But unless employees are uninsured or underinsured—that is, they have high out-of-pocket costs associated with surgeries—there is no financial incentive steering them overseas for care.

In 2007, some 750,000 Americans traveled abroad for care, according to estimates by the Deloitte Center for Health Solutions, which is part of the Deloitte audit and advisory firm. Most were uninsured or underinsured individuals. A few were employees whose firms gave them an incentive to go.

Keesling said he has one corporate customer that has sent 15 employees overseas for care. The client did not want to be named because of a backlash that occurred against Blue Ridge Paper, a North Carolina company whose efforts to send an employee abroad for care created a public uproar.

Still, Keesling said that during the terrorist attacks in Mumbai in November, he had four clients in India. While everyone else worried, the patients, who were far away at a hospital in Bangalore, were not, Keesling said.

He said subsequent trips to India were not canceled.

“Patients knew about what was going on in India, but there wasn’t enough concern to cancel flights,” Keesling said. “Nobody canceled.”

Russell Bigler, CEO of the Self Insured Schools of California, which manages benefits for public school districts in Central California’s Kern County, said he had considered medical tourism but decided against it.

Though he had been in Thailand this fall when the airport was shut down by anti-government protesters, his decision had nothing to do with global instability. Benefit design is why his 250,000 members do not have the option to go overseas. Teachers and other beneficiaries of the heath plan do not have the high out-of-pocket costs that would make surgery outside the U.S. worthwhile.

“The deductibles, the co-insurance [are] not big enough to warrant something like that,” he said. “It’s for a company that’s self-insured that has $5,000 deductibles.”

—Jeremy Smerd

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