Medical Tourism First-class travel and care

Transcription

1 Medical Tourism First-class travel and care HR WHITE PAPER With the high costs of health care in the United States, a rather innovative practice has been occurring over the last number of years called medical tourism. This refers to the exodus of patients to foreign cities or countries to receive medical care (usually non-emergency) at a much reduced cost. One individual told his story of traveling to Bangkok, Thailand, for a colonoscopy. His story is a bit unusual. At age 49, he was an assistant vice president of health care services for a major health insurance company. He had good health care benefits, but wanted to put his money where his mouth was and check it out personally. The colonoscopy tab was $640 quite a bargain by U.S. standards. Another gentleman, 45, a retired chiropractor without health insurance and not yet eligible for Medicare, was in a car accident which left him with a herniated disk in his neck that needed surgery. He did his homework and made the trek to Bangkok, where a U.S.-trained surgeon repaired the injured disk for less than $10,000. In addition, he enjoyed the facilities with bellhops, fountains, and restaurants all resembling a grand hotel more than a clinic. Perhaps more Americans will join these two individuals in their voyage overseas or over state lines in search of affordable health care. Medical tourism may be more attractive when the trip includes a vacation. Popularity Although the concept of medical tourism has been around for a number of years, it began to take off as health care costs continued to escalate in the United States. The internet has often been cited as the means for disseminating the concept to many people. The idea of traveling to a foreign country to receive medical care for a fraction (often up to 90 percent less) of the cost it would be in the U.S. can be a little intimidating to most people. However, with the latest twist a vacation thrown into the deal it may deserve a second look. Not only is it being touted as a great deal financially, it is now being paired with an inexpensive (or possibly free) vacation to a foreign country with a companion or family member. The biggest factor is cost. According to some sources, the cost of a heart bypass operation in the U.S. would be approximately $144,000. Although estimates vary, this same procedure in Thailand may be $26,000; and in India, $10,000. (2009 values)

2 Page 2 The waiting time for many procedures is relatively short or non-existent. This is very appealing to many patients who have busy lifestyles and must plan on very short notice for their upcoming treatment. Many Canadians take advantage of this option since the waiting time in their country can be up to a year for some elective surgeries. Likewise, many Great Britain patients often can t wait for treatment by the National Health Service. Upfront cost estimates from the various hospitals and physicians are usually available. This allows patients to make educated decisions on whether it would be especially advantageous for them in each particular case. Patient Care Personal care has been shown to be another benefit offered by participating healthcare facilities. The ratio of patients to doctors can be extremely low compared to that ratio in the U.S. Many patients have compared it to being at a spa or resort with the individualized and pampered care they received. The facilities are typically state of the art. Although this is not the usual picture that comes to mind when thinking of foreign medical facilities, it has been shown that they are often equal to or superior to those available in the U.S. These countries realize the importance of staying ahead of the curve in offering excellent service and facilities to medical tourists. It is growing to be an extremely important business in many of these countries. They often have the very rich and the very poor in close proximity, but cater to medical tourists who have the resources. Since the U.S. population has become more diverse, more individuals living in America may prefer to go home to their countries of origin to receive treatment. Many individuals may hesitate to undergo treatment in a location where family is not nearby. These individuals, however, may have family members in distant locations, removing such an issue. Dubai is one of the newer locations that is projected to be one of the most popular locations in the next few years. Locations While many students from foreign countries have come to the U.S. to obtain their education, the tables have begun to turn. These students have recently found that practicing medicine in their home country is an appealing option, and they have returned to their homeland. Because of this, many of the countries that participate in medical tourism offer U.S. board-certified providers. Some of the most common countries offering medical tourism include Thailand, India, Mexico, Singapore, Turkey, Ireland, Costa Rica, South Africa, South Korea, Taiwan, Philippines, and Malaysia. Dubai is one of the newer locations that is projected to be one of the most popular medical locations in the next few years. It is already known as a luxury vacation spot, and the Dubai Healthcare City was completed in 2011, making it the world s largest healthcare development. It will be the largest international medical center between Europe and Southeast Asia, and incorporates a division of the prestigious Harvard Medical School. Bangkok Phuket Hospital is quickly becoming a favorite place to go for sex-change operations.

3 Page 3 Other countries starting to get into this marketplace include Israel, Jordan, United Arab Emirates, Colombia, and New Zealand. Procedures Cosmetic surgery is a mainstay of medical tourism. Although this type of surgery has been traditionally elective since it is not covered by insurance, other types of surgery also fall into the elective category. Heart bypass, hip or knee replacement, hysterectomy, spinal fusion, and dental surgery can all be common elective surgeries. Weight-loss surgery, such as bariatric or lap band, is projected to become very popular in the near future due to the American obesity epidemic. Many times, these are excluded from coverage under insurance plans, and consumers are looking to other countries where the cost is much lower. Drawbacks Of course, with all good things there usually are not-so-good things to consider. One of the main concerns is the quality of care that consumers will receive. That is why it is vital that anyone considering medical tourism as an option should do their homework in advance. Research should be conducted as to the background and credentials for both the hospitals and the providers chosen. In some situations, there may be cultural or linguistic barriers to overcome. In some cultures, medical professionals are not accustomed to being questioned regarding their decisions and actions. Many Americans may not hesitate to question such authority, however. People traveling in a foreign land may not have built up immunity to local infectious diseases, which, of course, can cause complications. Traveling long distances can also add stress to an individual s already compromised health. There is always an element of risk in any surgical situation. Complications for these procedures do occur. There is always an element of risk in any surgical situation. Complications for these procedures do occur. In the U.S., the patient has legal recourse for malpractice suits. However, there is very little, if any, recourse in a foreign country. It is this lack of internal legal regulation or malpractice laws that helps enable the costs to be so low in these countries making it a doubleedged sword. If complications should occur while in a foreign country, the costs associated with evacuation to the U.S. can often negate any savings that were anticipated. The patient may find that U.S. physicians are hesitant to try to correct or fix whatever may have been initially done in another country. Even though most U.S. hospitals are not reacting to this latest craze, the American Society of Plastic Surgeons has issued warnings to consumers to be aware of the consequences of traveling out of the country for medical services. They have even created a video depicting a medical tourist that had complications overseas. They may have a vested interest in keeping the business local, but they may also have a point. One of the main concerns they stress is that sunbathing, sightseeing, and traveling after cosmetic surgery should be avoided or at least postponed. Such activities could lead to complications when a patient tries to turn a medical situation into a

4 Page 4 vacation. Pulmonary embolisms, blood clots, and infections are some of the complications they warn about. They urge patients to take the procedure seriously. AMA Guidelines The American Medical Association (AMA) acknowledged the impact of medical tourism on the health care industry by issuing guidelines in June The AMA advocates that employers, insurance companies, and other entities that facilitate or incentivize medical care outside the U.S. adhere to the following principles 1 : (a) Medical care outside of the U.S. must be voluntary. The American Medical Association (AMA) has acknowledged the impact of medical tourism on the health care industry by issuing guidelines. (b) Financial incentives to travel outside the U.S. for medical care should not inappropriately limit the diagnostic and therapeutic alternatives that are offered to patients, or restrict treatment or referral options. (c) Patients should only be referred for medical care to institutions that have been accredited by recognized international accrediting bodies (e.g., the Joint Commission International or the International Society for Quality in Health Care). 1 American Medical Association, copyright 2008 (d) Prior to travel, local follow-up care should be coordinated, and financing should be arranged to ensure continuity of care when patients return from medical care outside the U.S. (e) Coverage for travel outside the U.S. for medical care must include the costs of necessary follow-up care upon return to the U.S. (f) Patients should be informed of their rights and legal recourse prior to agreeing to travel outside the U.S. for medical care. (g) Access to physician licensing and outcome data, as well as facility accreditation and outcomes data, should be arranged for patients seeking medical care outside the U.S. (h) The transfer of patient medical records to and from facilities outside the U.S. should be consistent with Health Insurance Portability and Accountability Act (HIPAA) guidelines. (i) Patients choosing to travel outside the U.S. for medical care should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities. The AMA is also in the process of developing model legislation for state lawmakers to use to govern medical tourism in the future.

5 Page 5 Companies doing it Because some companies are pioneers in offering medical tourism programs to their employees, you may want to consider the following from a corporate perspective. News sources reported that: Blue Shield of California and Health Net both encouraged their employees to travel to Mexico for various procedures. United Group Programs, a third-party administrator (TPA), promoted Thailand and India as countries of choice. Hannaford Brothers Company, a supermarket chain in Maine, used Aetna Insurance to promote Singapore for its employees. Its package included paying airfare and lodging for the patient and one accompanying person. Lowe s partnered with the Cleveland Clinic to allow employees who are willing to travel to take advantage of the clinic as a cardiac center of excellence. Many times, a company will promote medical tourism by offering an incentive to its employees. Typically, these would be cash incentives such as waiving the deductible, copayment, or coinsurance to the employee; covering travel costs for the patient and family members; or offering a percentage of the savings to the employee. It can still be a win-win proposition for both parties. International partnerships It may be surprising to discover just how many U.S. hospitals and clinics have already partnered with a facility in another country for the future. Here are a few of the more well-known U.S. facilities and the countries they are reportedly associated with: Weill Cornell Medical College Doha, Qatar University of Pittsburgh Medical Center Doha, Qatar Duke Medicine, North Carolina Singapore Johns Hopkins Medicine, Baltimore Singapore Columbia University Medical Center, New York St. Luke s Medical Center, Philippines Medical Tourism Firms The task of doing in-depth research on all the intricacies involved in medical tourism can seem overwhelming to the average consumer. That is why businesses have sprung up to assist consumers in this task. They consider themselves to be a type of health travel agency. Some of the specialty companies include: World Med Assist MediTravels Med Retreat Planet Hospital Companion Global Healthcare Healthbase

6 Medical Tourism Corporation Bridgehealth Medical Page 6 Many of these companies will perform the entire planning process for the consumer. Many of these companies will perform the entire planning process for the consumer. They will assign a U.S. contact person to you. They will do all the research for your type of procedure and determine the best location or provider for you. If you choose, they will also arrange your air travel and transportation, hospital/hotel stay (usually luxury accommodations), all as a package deal. They definitely found their niche since most consumers would be more than willing to have a professional in the travel industry do it for them. The good news is that even with these services and all accommodations for the patient and usually a companion, the cost is still only a fraction of the original cost in the U.S. Domestic Medical Tourism Medical tourism is not limited to travel to foreign countries for treatment. Domestic medical tourism has seen growth lately, as patients have had reservations about long-distance travel and related treatment. Again, cost savings is at the core of the reasons for such innovation. The U.S. has many centers of excellence that can provide not only lower-cost options, but also quality care. Employers may also have less hesitation to put an employee on a plane for two hours as opposed to 18 hours. Some domestic healthcare providers will offer an up-front price to cover all costs of care, so health plans can budget for such events. This may be attractive to self-funded plans, in particular. Employers can work directly with such facilities, often paying a flat rate for certain procedures. Studies A study by the International Foundation for Employee Benefit Plans (IFEBP), Health Care Benefits: Eligibility, Coverage and Exclusions, found that 11 percent of surveyed companies covered medical tourism. Four hundred U.S. corporate benefits managers, professional service providers, public employers, and multiemployer plans participated in the study. The Deloitte Center for Health Solutions conducted a study entitled Medical Tourism: Update and Implications in 2009 which indicated that medical tourism did not grow as much as expected in recent years. Reasons may include the economic downturn, which left many individuals without health care coverage, and health care reform, which forced many plan sponsors to step back from innovative concepts like medical tourism to see how the new law would impact their decisions. The health care reform law did not stop the increase in health care costs, which may help drive stakeholders to embrace the concept of medical tourism domestic and foreign.

7 Page 7 Conclusion Perhaps U.S. employers will be able to limit benefits at home and bring costs down if international coverage becomes the norm. Perhaps the Baby Boomers who are not yet eligible for Medicare will be able to more effectively manage unexpected surgical costs via medical tourism. The containment of health care costs both for employers and for individuals with inadequate insurance or without company-provided insurance is at the forefront of everyone s minds. No one knows if medical tourism is just a phase or whether it will continue to grow in popularity. It is here today? Is it here to stay? How will it evolve? About J. J. Keller & Associates, Inc. J. J. Keller & Associates, Inc., was established in 1953 and has become the nation s leader in risk and regulatory management solutions. The company employs over 1,100 associates and serves over 350,000 customers including more than 90 percent of the Fortune 500. J. J. Keller s diverse product line includes publications, training programs, computer software, consulting, online services, and outsourced services. For additional information about the human resources product line, visit the J. J. Keller website at Laws, regulations, and best practices change. The observations and comments drawn today may not apply to laws, regulations, or best practices as they may be in the future. J. J. Keller & Associates, Inc., cannot and does not assume responsibility for omissions, errors, or ambiguity contained in this response. Individuals needing legal or other professional advice should seek the assistance of a licensed professional in that field.