Medical Tourism is defined as people crossing international borders for the purpose of receiving medical care. Traditionally people have moved to markets with greater expertise than available in their domestic markets, others by a desire to pay a lower price for care. Most sources reference prices in US dollars and site our country as having the highest relative prices. CDC.gov estimates that 750,000 Americans traveled abroad for healthcare in 2015, presumably most were motivated by lower prices.
At times medical travel is fueled by a desire for privacy or for services that are not legal/available in their home location.
One example was a recent NPR radio podcast that highlighted the complexities of babies caught in the Nepal earthquake whose father was a gay Israeli citizen (only heterosexual married couples may pursue surrogacy in Israel) and biologic mother was a contracted egg donor from Ukraine. The medical procedure took place in India with a local surrogate, but the birth had to had to take place in neighboring Nepal for legal reasons.
The types of procedures that patients traveled for, whether inbound or outbound, in order of demand were: cosmetic, dental, cardiovascular, orthopedic, oncologic, reproductive, bariatric and second opinions.
Follow up care and complication risks surfaced as hot button issues. I have certainly seen issues with patients returning from procedures done outside the country. They can present through the emergency room with no real chance of retrieving records which might help sort out the medical details of their procedures. Other times, we have made use of Google Translate to decipher the documents they have carried back home – (while helpful it does not seem to capture the nuances of medical terminology.) In those instances when a physician can be reached, communication can be still be challenging when accounting for language differences. Traveling in close time frames with general anesthetics and having limited mobility may also increase the risk of DVT.
Patients Without Borders estimates that 12 million cross-border visits will take place in 2016 with an average of $3,800 – 6,000 USD spent on fees per visit. That puts the size of the market between $45.5 – 72 billion, with approximately $1.4 billion coming into the United States. Pinning down exact numbers on inbound medical tourism can be a bit challenging, but a 2015 article for Trends in U.S. Health Travel Services for the USIT estimates that 0.5% of foreign individuals entering this country list health care as a reason for their travel. The origin of inbound medical tourists breakdown: from the Caribbean (44%), Europe (24%), Central America (10%), Middle East (8%).
A current article highlights an interesting venture of a Chinese Company, Miracle Enterprise, that converted a former shoe mill in Auburn, Maine to a 200 bed recovery facility that can care for 5,000 patients per year. Central Maine Medical Center provides the actual medical services. They would have a real insight into the translation needs and cultural issues such as culinary offerings for patients traveling in from China.
Medical Tourism offers the CAPITALISTIC opportunity for patients and providers to work together to set the Actual Value of services. It is an old fashioned model for the delivery of healthcare — an individual takes responsibility for their own health, chooses the doctor that best suits their needs and together they agree on the price of care. We physicians in this country have long had this relationship interrupted by insurance companies and government agencies acting as intermediaries. Physicians have restrictions imposed on how we can practice –for example no labor organizing and Stark regulations limiting vertical integration. Medical tourism allows an ‘Elective way out’ of the current rut of practice regulation.
Another example of capitalistic virtue, the Maine project mentioned above created 80 jobs and could serve as an EB-5 Regional Center, potentially attracting further foreign investment. (EB-5 is a federal program started in 1990 that ‘fast tracks’ the immigration process to a Green Card for investors who invest a threshold of $500 k in a designated project that creates at least 10 jobs.)
Challenges to surmount include: language / translation barriers, complete screening of medical records prior to committing to travel, immigration regulation, hospitality co-ordination – possibly for an entire family, managing complications and integrating follow up.
The United States is recognized as having State of the Art medical technology & training. Our facilities and providers maintain stringent certification. Our country provides a reliably clean and safe environment. We have an excellent opportunity to establish the United States as an emerging power in Medical Tourism worldwide.