"...an increasing number of patients headed for...operations climb out of the car at the airport, rather than at the hospital"

Medical Tourism Takes Off, But Not Without Debate
By LISA A HIGGINS
Published: April 2007
Managed Care Magazine

This article fits into the puzzle by analyzing the perks of medical tourism from a completely different angle: the US health care market. By tapping into the forces in the US that drive medical tourism in the first place, this article highlights underlying problems in this country, and also shows that medical tourism may not be as popular as the media thinks it is.

The major points in this article were:

• The only company in the US to have tried medical tourism as an option for its employees is located in North Carolina, but the company rescinded the offer after a labor union was against the idea
• Medical tourism may really take off in the US if HMOs implement a cash reward for going abroad: they may choose to split the difference between cost in the US and cost overseas with a patient who will travel; this scenario is ideal for patients with high deductibles.
• Many more companies may join the medical tourism trend only if they see that there are no huge consequences that have yet to manifest; the second wave may actually never happen, many experts caution
• Seeking medical care abroad has traditionally been the chosen path of the uninsured seeking necessary and expensive care
• Care abroad may actually be better than care in the US: facilities in India rival the Mayo Clinic in outcomes, they offer higher staff to patient ratio, etc
• A large benefit that the US may derive is in the form of competition: perhaps US institutions will offer better procedures to keep patients here
• The long-term consequences of medical tourism that have yet to be explored involved post-op complications and malpractice litigation abroad

This was a very dense and informative article, but the point that I thought was most relevant was about the effect of competition in the US. If American facilities try and improve high-end surgeries to keep patients in the US, the focus is going in the wrong direction! People that are uninsured go abroad the most: focusing on improving the health care system so that they are not driven abroad is the primary concern here; by improving high-end surgeries that are very lucrative but only cater to a few, the US system is still only tapping the market of people who are able to pay. They are not the primary audience when trying to alter the system today: we care about the uninsured, the neglected, and those who cannot pay.

I'm also questioning the logic of sending patients with high deductibles abroad. Patients that have higher deductibles also tend to be patients with chronic illnesses and pre-existing conditions. These are some of the most vulnerable patients, and sending them abroad is tricky because they are already in bad medical states. Also, dealing with issues of complications brings me to the next important point in this article: procedures in countries like India and Thailand are substantially cheaper because there is no environment of litigation in these countries, and there is no malpractice system in place.

If American patients with chronic illness or expensive and life threatening conditions receive care abroad, what happens when they return home and have complications? This emergency care will be paid for either out of pocket (which is so expensive that going abroad in the first place to save money gets canceled out) or through the government, which increases overall costs to the entire system that sending patients abroad is once again, negated.

This article, interestingly enough, does not address the issue of elective surgeries abroad. Many patients go abroad for routine dental care, cosmetic care, abortions, etc. While this is not a new trend, it is an important trend: wouldn't the patients with these non-emergency needs who are willing to go abroad already have more disposable income for health care? They aren't part of the US-health-care-system-in-trouble analysis that is the biggest controversy surrounding medical tourism in the first place. This article, then, is the perfect complement to "The Private Health Sector in India" because we are once again faced with sugar-coating the larger problems by pursuing medical tourism.