Medical Tourism: Background information when reading Internal Medicine

Medical Tourism

This article relates to Internal Medicine

Internal Medicine is but one view of the U.S. medical system. According to The Commonwealth Fund, a private foundation looking to foster a better health care system in the USA, the U.S. ranked last in a survey of healthcare in 11 developed nations - behind Canada, ranked at #10, and way behind Germany & Netherlands in a tie at #5, with Switzerland at #2, and the United Kingdom topping the list. The U.S. ranks last in large part due to its lack of universal health coverage which leads to many having limited access and inadequate coverage due to cost. But access is not the only issue - when efficiency is measured, poor performance is noted on many fronts (such as administrative costs and avoidable emergency room use).

One result of the trouble with healthcare in the United States has been a rise in medical tourism, which the Centers for Disease Control and Prevention (CDC) defines as "traveling to another country for medical care." While the CDC has identified issues with medical tourism, such as needles being reused and possible poor quality of medicine in some countries, it estimates that 750,000 residents travel abroad each year for care. One reason is lower costs. The Medical Tourism Association (MTA), a non-profit association for medical tourism and the international patient industry, estimates a 90% cost saving. MTA also says that patients travel "because of the high quality of healthcare, affordability, access of care or better availability."

In September 2013, Joy Guion, one particular medical tourism patient, was profiled by ABC News in a story that saw her fly from North Carolina to Costa Rica for extensive weight loss surgery to bring her down from the 283 pounds she carried on her 5-foot-9 frame. She made this choice because her employer, HSM, an auto parts and furniture manufacturer, told her she could either co-pay for the surgery or go abroad and have it done for free. The $30,000 it would have cost Guion in North Carolina dramatically dropped to $17,386 in Costa Rica, and was covered 100% by HSM. The company says that it saves money by presenting such an option. Guion's treatment came not only with a stay in a pristine hospital, but recuperation back at her resort hotel with daily visits from a nurse and physical therapist until she was ready to fly back home.

According to the CDC's Yellow Book for travelers, Thailand, Malaysia, Cuba, Argentina, Singapore and India rank among the most common destinations for procedures that range from dentistry to cosmetic surgery to orthopedic surgery, and even cardiac surgery. A 2007 article in Kiplinger pegs the most likely medical tourists as those who either don't have health insurance or have health insurance with high deductibles, because they have to pay out of pocket, no matter where they go for a procedure.

In August 2013, The New York Times featured a story about 67-year-old Michael Shopenn's desperate quest for an artificial hip due to severe arthritis. Belgium was his destination for that hip, and St. Rembart's, the hospital at which Shopenn had his surgery, paid $4,000 for his implant, compared to the $8,000 that American hospitals typically paid for the same model. Shopenn had the surgery on a Tuesday, and was transferred to St. Rembart's rehabilitation unit the following Friday. Twelve days later, he paid the hospital's price for hip replacements for foreign patients ($13,660). A Belgium patient would have paid considerably less as their health care system pays 80% of each treatment (except for people on low incomes who are covered at 100%). Six weeks later, an orthopedist in Seattle removed his stitches, took a postoperative X-ray, and told him that no further visits were necessary. The procedure had been done correctly. Despite the spartan surroundings at St. Rembart's, Shepenn found an efficient system. The Belgian government sets prices for procedures and limits profits, and hospitals receive a fixed daily rate and surgeon fee that are negotiated every year between the state and national medical groups.

Because of Belgium, Shopenn, didn't have to pay the $65,000 that a stateside hospital estimated, not including the surgeon's fee. Patients Beyond Borders, a worldwide source of information about medical tourism, states that the market for it is growing, with the world population "aging and becoming more affluent at rates that surpass the availability of quality healthcare resources." And Belgium is not the only country offering such savings. In Costa Rica, for example, you can save an average of 45-65% of the cost of treatment compared to U.S. prices; in Thailand 50-75% and in Mexico 40-65%. Statistics like these, and stories like Joy Giuon's and Michael Shopenn's pose significant questions about what the United States needs to do to try to improve medical care, particularly the financial cost of remaining healthy. In the meantime we can expect increasing numbers to go overseas to get what they can't get easily here.

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This "beyond the book article" relates to Internal Medicine. It originally ran in October 2014 and has been updated for the October 2015 paperback edition. Go to magazine.