Consumers increasingly are trying alternatives to their local hospitals and doctors, from going abroad for less-costly surgery to seeking quick, basic care at new clinics in drugstores and discounters, experts say.
The number of people heading abroad for “medical tourism” could jump tenfold in the next decade, to nearly 16 million Americans a year seeking cheaper knee and hip replacements, nose jobs, prostate and shoulder surgery, and even heart bypasses, according to a forecast by health care consultants at the Deloitte Center for Health Solutions.
Meanwhile, the number of retail clinics operating in pharmacies, big-box and discount stores and supermarkets has jumped from about 200 in 2006 to nearly 1,000 last month, according to a second report from the Deloitte center.
While growth is slowing and some early players funded by venture capitalists have folded or been bought out, major retailers such as Wal-Mart Stores Inc., CVS Caremark Corp. and Walgreen Co. have announced plans to open hundreds more clinics in their stores in the next few years.
The two reports show potential big savings for U.S. consumers – and probably their health insurers – would come at the cost of American hospitals and doctors losing billions of dollars a year in revenue.
“Significant numbers of people are willing to vote with their feet to try something different, whether it’s retail clinics or medical tourism,” said Paul Keckley, the center’s executive director. “U.S. providers are having to pay attention.”
He cites patient dissatisfaction with high costs, long waits in the doctor’s office or to get a procedure, and reports about errors and quality problems in U.S. health facilities as fueling both trends.
Surgery in some of the countries that have become hubs for medical tourism, from Thailand and Singapore to Mexico and Brazil, can cost less than half the U.S. price, even when including outlays for airfare, hotel and meals abroad. In a few cases, procedures overseas can cost one-tenth as much, Keckley said.
Many of these countries actively market their programs in wealthier nations and have new, 21st-century hospitals. Most of their physicians are trained in the United States and know all the latest techniques, according to Keckley and Michael Taylor, a global health consultant at Towers Perrin.
But in the event of botched surgery or complications later, who takes care of the patient?
“That’s one of the two big question marks about this, and the other is liability,” said Keckley.
When patients work with specialized brokers who arrange the surgery, travel and hotel, contracts sometimes provide for a doctor or hospital back home to handle follow-up care and spell out who is liable if a lawsuit follows, he said, but that’s inconsistent.
“In many ways, it’s still the Wild West,” Keckley said.
About 750,000 Americans headed abroad for major health care last year and an estimated 1.5 million will do so this year, according to the report.
“I think that’s very optimistic,” said Towers Perrin’s Taylor, who says host countries probably are inflating their reported numbers of American patients.
At least one Blue Cross/Blue Shield plan is encouraging medical tourism and U.S. hospitals are reacting to the trend. According to Taylor, some teaching hospitals in the Midwest have been trying to match costs for foreign surgery to retain patients.
Taylor and Keckley note that some of the country’s most renowned teaching hospitals – Johns Hopkins, Cleveland Clinic, Harvard, Duke and others – have started partnerships where they do the pre- and after-care at their facilities, either for consulting and other fees or in exchange for part ownership of the foreign hospital.
Big-name partnerships also can be crucial in the retail clinic business, which is barely a decade old. Some small, independent groups such as SmartCare Health Clinics have shut down, but retail giant Wal-Mart recently signed deals with RediClinic and various hospital systems to open co-branded clinics, with 400 planned by 2010, according to Deloitte.
In the past two years, CVS Caremark and Walgreen each bought retail clinic operators and are expanding, with CVS Caremark planning 2,500 clinics eventually.
Such clinics are staffed by nurse practitioners or physician assistants, who can handle minor injuries, ear and throat infections and other problems far faster than most doctors or emergency rooms. Appointments aren’t necessary, wait times are usually 15 minutes, visits often are twice as long as in a doctor’s office, most services cost $50 to $75, and they accept insurance