Medical Tourism, separating facts from fiction
by Michael Halasy Practicing Emergency Medicine PA, Health Policy Analyst, and Health Services Researcher
Medical Tourism, separating facts from fiction
One of the greatest myths that I hear on a somewhat regular basis, centers around the belief that the US must have one of the greatest health systems in the world, because everyone comes here for their care. Well, let’s examine that shall we?
As with many things, reality is a little different from the mythology.
According to the Deloitte Center for Health Solutions and Health-tourism.com, there will be roughly 561,000 inbound medical tourists to the United States by 2017….Conversely, 750,000 Americans traveled to foreign countries in 2007, and this grew to between 1.1 and 1.3 million outbound tourists in 2008. Spending on healthcare in foreign countries was estimated to be 20 billion dollars in 2008.
Estimates for growth demonstrate a consistent 35% growth in outbound medical tourism annually. Projections indicate that roughly 1.6-2.5 million Americans will travel abroad in 2012, and spending could reach 100 billion dollars. That’s right, 100 billion US dollars being spent in foreign countries for healthcare such as elective surgeries, complicated dental surgery, plastic surgery, and even coronary bypass surgery.
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Where are they going?
According to survey results:
Thailand, with one hospital in Bangkok taking care of 64,000 US patients in 2006.
Singapore
Latin America
Mexico
Malaysia
India
Of these, India has the greatest potential for growth.
A legitimate question revolves around what reasons these patients are traveling for. Predictably, a lack of health insurance had a high correlation with travel for services. Surprisingly though, only 9% of patients who were surveyed listed price as the primary factor in their decision.
An entire industry is springing up to support this, and companies are now offering packages, and entering into arrangements with foreign hospitals.
What may or may not come as a surprise to many, is that, as the Deloitte report lists, there are many American Health Insurance companies that are entering into pilot studies sending American patients to foreign hospitals for treatment.
Some examples include:
Anthem BC/BS in Wisconsin (700 group members initially, being sent to India for treatment)
United Group in Florida (Promoting tourism to India and Thailand to 200,000 members)
BC/BS of South Carolina (Promoting tourism to Thailand)
So while there are foreign citizens who come to the US for treatment every year, it pales in comparison to the number of American citizens traveling elsewhere.
(Rdan here…One of the throw away lines about the where US Healthcare stood in the scheme of things is that Canadians come over the boarder for treatment, which is characterized as a comment on the Canadian healthcare system. No numbers are ever provided even when requested…maybe it is more complex than many are willing to deal with)
Gee, why didn’t I think of this? If outsourcing jobs is profitable in electronics and telemarketing, think how much more profitable it could be in medical services where labor costs are particularly high. Mexico sounds like a great place to get your chin lifted in that context. NancyO
My experience with medical tourism: We’ve been going to northern Thailand for the winter for several years so it was natural to go there and have my hernia operation done. I have insurance but would have to go to California, wait for weeks or months for an operation, and pay a $3,000 deductible. The day after we got to Thailand we walked over to the hospital and went in to make an appointment for the initial consultation, which I assumed would take 2-3 days. An hour and a half later I walked out having had that consultation and exam, seen the doctor who would do my surgery, talked to him as long as I wanted to ask anything I needed, made an appointment for the surgery 5 days later (it could have been done in 3 days but there was a holiday I thought we’d want to see beforehand). I also had the cost: $1500.
I went in the morning of the surgery, everything went very smoothly, saw a cardiologist and had a general medical exam to make sure there were no issues with having surgery, and filled out patient history forms etc. with six (!) nurses in my private room (private room: $40/night). There was a bed for my wife to sleep there if she wished, as Thais usually have a family member stay with them at times like that; we figured she’d have trouble sleeping and I’d be fine. The surgery went fine and I spent the night in as much comfort as one can after surgery. A nurse came in every hour and a half to take my blood pressure, blood oxygen levels, and just check up on me. I also had a call button, TV, etc. The next day I got breakfast (with fresh squeezed orange juice), the doctor came in and said I could stay another day if I wanted but it was up to me, so I went back to the hotel. They got a cab and helped me in, telling the driver to drive smoothly as I’d just had an operation, and he made sure to not hit even the slightest pothole or bump.
Oh, when the nurse took me to the cashier to pay she asked if I had a discount card, which cost a few dollars but would save 10%. I said no, and thought, damn, wish I’d known about that, but she just said well, you should get one and so I did and they applied the 10% discount, saving me $150.
Recovery also went well, with several appointments to see how I was doing and get stitches out. Never more than a 15 minute wait for the doctor, never the slightest rush to get me out of the office, not even a hint that he needed to do anything except talk to me until I was ready to leave. All that, plus painkillers and antibiotics, was included in the price. I’ve been fine since.
The main point is: even if the price was the same as at home my experience in Thailand was so much better that I would go back for any significant medical procedure — and small ones are so cheap (had 6 moles removed with 3 biopsies the prvious year: $116).
There is one downside, and although it’s rare it could be big. Because Thailand, and many other cheaper countries, tend to have institutional corruption (due largely to the lack of a tax base which in turn is due to richer people not wanting to tax themselves and they’ve got the power) it can be difficult to sucessfully sue for malpractice. This is, as I said, a rare problem — they’re generally very good, and because your dollar goes far you can go with the best — but it is potentially a big problem in those rare cases.
Thailand is number one on the list? Is that for number of patients served? How to account for that? My first impression is that Thailand is not a place where I would expect to find highly trained and skilled medical staff. pf course it may be the best place to go for men with a male sxclusive dysfunction. Post-op testing could take advantage of that other well known Thai industry.
Thailand has excellent doctors, nurses, and dentists (we’ve gotten a lot of dental work done there too). The universities there train excellent doctors and dentists, but some of the dentists we’ve gone to have trained in the US or Germany as well. A friend of ours had some touchy spinal surgery in Bangkok and had a US-based doctor relative check out his propsective surgeon, who it turns out was the best man in Asia and one of the best in the world for that operation. Another firned had hip replacement surgery in the US, completely paid for by Medicare, but wishes he’d spent the $12,000 to have in done in Thailand.
They certainly do good sex reassignment surgery if you’re lookign for that; in fact I think RAM Hospital in Bangkok has it listed as one of their price examples on their website.
As for the dentists, which I should’ve mentioned in my first comment, they’re terrific, caring, and are the tops at explaining what needs doing, why it needs doing, and what your options are, both cheap and pricey, with the pluses and minuses for each. I’ve had some good dentists in the States and Canada, but not as good as them. The woman fitting our crowns last year was so much a perfectionist that she wasn’t happy even when we were initially happy with how close it was. She wanted it, and got it, perfect. I wish we’d thought about Thailand when we had a lot of dental work done about 12 years ago; for the same price we could’ve had all that dental work done, plus a free 2-3 month trip to Thailand.
Dan, the number of Canadians coming to the U.S. for healthcare is vanishingly small. It’s a myth.
http://www.asymptosis.com/canadians-flooding-over-the-border-for-health-care-not.html
Dan,
I’ll throw in one other aspect of US residents going overseas. They can get medical procedures done overseas that cannot be done here. My brother-in-laws partner went to Vietnam (I think, may have been Thailand)) and got some very experimental gene therapy done on his heart (I’m not a doctor so don’t ask). It was very successful and he’s still alive 5 years or so later. He was given 6 months to live by US doctors who basically proscribed bedrest and painkillers until he was ready for the morgue.
I expect this aspect to become a growing sector due to the long delays in FDA approvals. Something to think about.
Islam will change
One result of overseas medical treatment….http://www.nccid.ca/en/story;story,1660;India-to-look-for-NDM-1-in-New-Delhi-hospitals,-water-supply
Although the media keeps repeating and reporting the Deloitte numbers, those actually involved in the medical travel industry will tell you the Deliotte report and its numbers are vastly overstated and projected. Only a fraction of the US patients projected actually traveled for treatment outside the US. Deloitte actually revised their initial report numbers (lowered the number of projected US outbound patients) and even the revised numbers are probably 10 times more than actual! As for the three US health insurance companies with pilot plans you listed. To my knowledge, not one insured has taken up their offer to travel abroad for treatment and why should they, as they are already covered in their hometown USA hospital and the incentives provided (waive dedutible and coinsurance) are not enough to entice an employee to travel for treatment. Bottom line, US outbound medical tourism is more hype, smoke and mirrors than the actual practicality of travel and savings realized by the majority of US citizens.
As a 9 year visitor and now 1 year resident of Thailand I can attest to the good medical care here. I will say that like most places in the US, some hospitals are better than others. In general, the medicines and doctors total cost is less than my co-pay would be when I had insurance in the states. The courtesy, speed and efficiency puts US health care to shame. I would much rather be here for medical procedures than the US. There has been a rise in medical costs here and some controversy over the tourist health care industry in the last couple of years. My greatest concern here is a medical procedure (ie. cancer, heart disease) that will cost a lot as I only have Medicare and a supplemental from my work retirement that if they find out I am here full time will cancel in less than a heartbeat. That means that I have no insurance as Medicare will not cover out of the US. Of course when the repungents finish there won’t be any Medicare anyway.
Yes, Deloitte did revise their numbers. I used the revised projections. Originally, they had estimated in 2008 that 6 million Americans would travel overseas in 2010. They revised this in 2009 as MORE data became available. The problem is, that data on this market is somewhat “soft”, and we can only rely on projectional estimates. I don’t think it’s hype, smoke, or mirrors, but one legitimate question that we don’t have the answer to, is HOW many are traveling for WHAT type of care. Many of these travelers may be traveling for dental care to Mexico, etc. That is a legitimate question, especially as the data lacks fine granularity. Bottom line is, even if their numbers are off, by let’s say 25%, that would still mean 1.2 million Americans traveling elsewhere, compared to only close to 500,000 inbound patients. No matter how you slice this….MORE Americans are going elsewhere, than foreigners are coming here. BTW, CNN did a story on a guy who owned his own business and traveled to India for Coronary Bypass surgery. Sanjay Gupta was quite surprised at how well the surgery went, and how good the care was there. I think he used the term “exceptional”, IIRC. This is anecdotal of course, and only represents one patient, but the fact is that it happens.
Nancy:
You can got to Mexico for tooth implants now and at a far lower costs then in the US
Medical tourism is potential industry for my developing countries like Costa Rica, India, Thailand and Mexico. It is estimated that in the next few years millions of Americans will leave the US spending billions of dollars to travel to international destinations for high quality of healthcare.
Neelam,
Medical Tourism Expert
http://www.globalbenefitoptions.com
IMTJ released an article with information pertaining to the fact that the GCC is witnessing a rapid population growth rate combined with an ageing population and an acute shortage of qualified medical staff and bed capacity. A report from consultancy McKinsey, published last summer, estimates that over the next 20 years treatment demand in the region will rise by 240 per cent. The medical establishments in the Gulf are not equipped to handle these numbers, and therefore there will still be a great need for Gulf nationals to go abroad.
Hubert
I think its time that the United States should do something about their overwhelming medicare rates. Not only individuals are traveling offshore to undergo medical procedure but even large-scale companies are now thinking of outsourcing their employers to foreign healthcare sectors.
Mika Williams
Plastic Surgey in Mexico