Going offshore: The pros and cons of medical tourism

The patient needed a knee replacement but he was told he’d have to wait two months to get on the surgery schedule. He was also worried about the cost of the surgery and the post-op rehabilitation.

At the suggestion of a neighbor, he decided to have the surgery done overseas instead. Not only could he have the procedure done sooner, but it came to a fraction of the cost of a total knee replacement in the U.S.

Unfortunately, a couple of weeks after returning home, the knee became painful and swollen – and when he contacted the U.S. orthopedic surgeon with whom he’d initially consulted, he was told he’d have to call the operating surgeon overseas instead.

This actual case, which appears in the latest edition of the Agency for Healthcare Research and Quality’s online morbidity and mortality rounds, highlights some of the challenges that have been surfacing amid the growth of medical tourism, aka offshore care. Namely, how do you address continuity of care and ensure patients don’t fall through the cracks before or after receiving care overseas?

At one time, medical tourists tended to be people who went to another country for relatively minor cosmetic procedures. But it’s now becoming a more mainstream trend, with patients going overseas for procedures such as joint replacements, weight-loss surgery, dental procedures and infertility treatment, explains Dr. Mary H. McGrath, who provided the commentary analyzing the AHRQ case. She writes:

A consequence of escalating health care costs in the United States, the global market for long-distance medical services is expanding. Several operational models are already in place. There is the outsourcing of hospital services such as transcription, insurance processing, and information technology to other countries with lower labor costs. Certain medical jobs are also moving offshore as low-wage foreign providers offer deep discounts on services like the real-time reading of radiographs. Offshore surgery is seen as an opportunity for low- and middle-income Americans to have surgery for 20-25% of the cost in the United States, often with surgeons who are U.S.-trained, may be U.S. board-certified, and who may be working in hospitals that are JCI (Joint Commission International) accredited.

There’s even a nonprofit Medical Tourism Association, among whose goals are to raise awareness of the health care services available in other countries and to help give unbiased information to consumers, employers and health plans.

For people who have large deductibles or who are uninsured, going overseas for surgery can result in major savings. For instance, hospitals in India charge around $12,000 for a knee replacement that costs $30,000 in the U.S., according to this report put together by the National Center for Policy Analysis. The same study estimates the global tourism industry grossed $60 billion in 2006, an amount that could grow to $100 billion by 2012.

Solid numbers are hard to come by, but it appears that about half a million Americans traveled to another country for medical care in 2009. Presumably some of these patients were from Minnesota, and it’s entirely possible the local market will see some patients opting for offshore surgery in the not-too-distant future.

Minnesota medical providers are already starting to think about how they’ll handle this. Next month the Minnesota Hospital Association is hosting a Web conference to help hospitals, whether they’re a community hospital or a large teaching facility, develop a medical tourism strategy. The ethical considerations of medical tourism, especially for physicians who might have to care for a patient after complications arise from an offshore surgery, were also a hot topic for discussion recently among the members of Rice Memorial Hospital’s ethics committee.

The report by the National Center for Policy Analsysis concludes that U.S. policymakers would do well to allow American health care consumers to take advantage of the opportunities offered by global competion in medical care. From the report:

The first step is for state and federal policymakers to understand that global competition in health care will benefit American consumers by reducing costs and improving quality through competition. Just as global competition improved the quality of automobiles, it will also improve the quality of medical care. Local politicians and community activists often fight to protect community hospitals from closure in the belief that communities cannot do without them. However, lawmakers must take advantage of cost-saving techniques in health care.

But excuse me for being somewhat skeptical that offshore surgery is going to be one of the answers to what ails American health care.

McGrath notes, “The type of procedures appropriate for medical travel (non-urgent, short-duration, costly, suitable for healthier patients capable of air travel) account for less than 2% of U.S. spending on health care. Moreover, from an operational standpoint, implementation of organized overseas programs will skim off from a U.S. hospital the most lucrative interventions with the best results, a practice unlikely to improve its bottom line.”

The issue raised by the AHRQ case study – continuity of care when complications ensue from an overseas surgery – is one of the key concerns from a medical perspective. There’s also the question of who’s responsible for followup care and ensuring that the patient’s physician at home is in the communication loop. From McGrath’s commentary:

The most pressing task for the American medical community is the education of patients who choose to travel abroad for medical care. Patients need to be informed that complications occur in a predictable number of interventions under any circumstances, that devices and treatments available outside the United States may not be subject to rigorous scrutiny, and, most importantly, that a surgical procedure is not an isolated event.

In other words, buyer beware.

It’s hard to say whether medical tourism will catch on to any great degree. I suspect many people simply won’t want to deal with the logistics of medical tourism, even though there’s a growing industry of medical travel facilitators who can help with booking flights, hotel stays and so on. Being a medical tourist also requires a level of consumer research, savvy and communication that not everyone is willing or able to muster.

Admittedly, the lower cost of overseas surgery is a significant lure. But should this be important enough to overlook all the other considerations? In the final analysis, medical tourism is a tradeoff and it’s too soon to know whether it’s really going to be worth it.

Photo: Taj Mahal, Agra, India.

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