Over the next 10 years, expect to see a 25-percent annual increase in medical tourism spending as more patients — sometimes with support from their employers — travel hundreds or even thousands of miles to get better and cheaper care.
About 14 million people each year travel abroad in search of more affordable medical care and spend about $45.5 billion for it, according to a recent report by Visa and Oxford Economics that analyzed billions of the credit card company’s transactions by spending category. They calculated that the market will grow by 25 percent annually to reach to some $3 trillion by 2025, and estimate 3 percent to 4 percent of the world’s population will become medical travelers.
The researchers say they believe “medical tourism is primed for accelerated growth as more of . . . older travelers [65 and older] seek new treatments, as well as lower cost or higher-quality care not available in their home country.” By examining cross-border spending for medical services in more than 176 countries, they found that the United States was the single largest hub for medical tourism, with Thailand, Singapore, Germany, Korea and Spain “quickly catching up, increasingly attracting visitors from around the world.”
In some cases, procedures and travel expenses can be under 25 percent of local medical facilities’ costs. Patients also benefit because high-volume locations mean more efficient procedures, more evidence-based approaches, fewer complications, and better overall outcomes, says Ralph Judah, managing director for Monitor Deloitte’s Leader Health Plan Global Markets.
In recent years, dozens of large companies — including GE, Walmart, Lowes, Pepsi and Intel — have explored medical tourism in their self-funded healthcare programs. Expect to see the trend filtering down to other large and even to mid-sized companies, says Jonathan Edelheit, chief executive officer of the Employer Healthcare & Benefits Congress and the Medical Tourism Association, based in West Palm Beach, Fla., and president of the Health Care Reform Center & Policy Institute.
Judah says U.S. employers with self-funded healthcare plans are increasingly connecting with international providers as well as domestic centers of excellence to provide their workers with expert bariatric procedures, orthopedic surgery and cancer treatment, to name a few, in distant locations. He also notes that the national health plans in the United Kingdom and Europe have become “increasingly aggressive” about outsourcing surgical procedures to specialty-focused hospitals in places such as India, Malaysia and Egypt.
While U.S. employees and HR advisors readily see the benefits of having a procedure done at a center of excellence such as the Cleveland Clinic, Sloan Kettering Memorial Hospital, Massachusetts General Hospital and other high-reputation medical centers, the tough part has been to convince them of international medical tourism’s benefits, Judah says.
“There continues to be reticence on the part of the U.S. workforce based on nothing in particular,” he says. “There’s a great deal of . . . irrational fear, and [people in] the benefits department in particular are very leery of putting [the medical-tourism] proposition to their [employees.] The last thing that a benefits department [wants] is for somebody who they sent to Panama to come back with two left legs, and that irrationality spreads into the HR community, to some degree.”
The best medical-tourism programs share several features, says Harvard Law Professor I. Glenn Cohen, such as compliance with U.S. laws, adequate medical malpractice insurance coverage, arbitration agreements, accreditation from healthcare quality review organizations such as Joint Commission International, and dedicated lines of communication between physicians in the home and destination areas.
It’s also important, Cohen says, for finding a good cultural and legal/ethical “fit” when matching some people — women or gay patients, for example — to an international or even a domestic religious-based hospital or clinic that supports their reproductive or civil rights.
There’s also some self-selection of patients going on, depending on the country or culture they’re going to for their procedures, says Edelheit. Puerto Rico, for example, appeals to U.S. residents because they don’t need a passport, the medical facilities are automatically subject to the same legal liability system, and both English and Spanish-speaking patients will feel comfortable — plus, you could save about 60 percent to 70 percent on costs.
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Transparency is another critical feature, says Aamir Rehman, M.D., partner and senior clinical and total health management strategy consultant in Mercer’s Chicago office. He says companies should look for transparency about the quality of care, what is covered for the price, and whether the destination provider has a reputation for performing the appropriate procedures for patients.
Companies should also analyze their own anonymized healthcare data to track the quality and cost of healthcare providers, Rehman says.
While it’s still a challenge to educate patients about medical tourism’s overall benefits, Edelheit says, a bigger problem is connecting the foreign hospital or clinic to domestic medical-information systems for transferring medical records and reporting back on results and prognoses.
Creating those connections is “in its infancy stage,” he says, adding that it could take one to two years to develop the technology interface to make the sharing of medical information more efficient.
The Affordable Care Act has contributed to the increasing popularity of medical tourism and centers of excellence because insurers developed “skinny networks” to keep costs down, Judah says. These programs limit the number of options to best-priced in-network providers and so when people want to go outside the network, there’s an added incentive to seek affordable medical services. Advisory services, online resources, and some insurance companies are making cost and outcomes more transparent.
“Even if it’s normal coverage,” says Judah, “it is increasingly coming out of your own pocket, so with the combination of co-pays and deductibles, the out-of-pocket proportion of total health costs has risen up into the 20-percent range. There is a lot of comparison-shopping going on.”