Growing Reasons to Consider Medical Tourism

Medical tourism, largely grounded last year by the sharp economic downturn, is expected to make a comeback as people begin to feel more positive about their finances. Medical costs in many nations continue to be far below those in the United States. Other factors that may help spur the comeback include improving medical facilities overseas, stronger accreditation programs, more consumer support services, and maturing relationships between leading U.S. medical schools and foreign partners. 

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To date, medical tourism has clearly not been a market for seniors, says Paul H. Keckley, executive director of the Deloitte Center for Health Solutions, a unit of the consulting firm that closely follows medical tourism trends. "It's really been a young market," with most customers getting things like dental work, cosmetic surgery, and other one-time elective procedures, he says. "It hasn't really been a senior market."

 But as baby boomers reach retirement age, there is every reason to expect that they will be seeking more cosmetic touch-ups, along with joint replacements and critical cardiac procedures. The United States is aging less rapidly than other industrial countries, and overseas medical facilities have long been gearing up to serve more international patients. Keckley sees a process evolving in which insurance companies will step forward to support medical tourism, particularly if major employers endorse the concept in their benefits packages. He sees large multinational companies as likely trendsetters because they have long been dealing with medical care decisions on a global basis. 

"Medical tourism has reached a tipping point," says Rudy Rupak, founder of PlanetHospital, a Southern California company that specializes in medical tourism and has developed its own network of recommended physicians and hospitals. "Patients are no longer concerned about going anymore. Now, it's simply a matter of choice." 

The typical trip is five to six days, Keckley says, and the medical procedure is either done on an out-patient basis or with a day or two of hospital time. Then there are a few days to recuperate with some light tourist activities before returning home. Rupak and other experts note that the biggest beneficiaries of the tourism element of medical tourism are not the patients but their spouses or other traveling companions. "A lot of the data says that for these minor procedures, people do treat it as a small vacation," Keckley says. 

Overseas medical care is still largely uncovered by insurance and tends to be heavily concentrated on cosmetic surgery and dental care. Medicare does not generally cover medical services outside the United States, a spokesman says. However, several health insurers are using pilot programs to see how they can lower their medical costs. Should some form of national health insurance come to pass, Rupak says, he would expect insurance companies to consider greater acceptance of overseas medical procedures as a way to control expenses. Even without national reforms, the need to control healthcare costs will support greater use of cheaper international care. "What will drive this trend is the price differential [of U.S. and foreign care] for the people who can afford it," says Keckley. 

In a major 2008 study, Deloitte identified 10 regional hubs for medical tourism around the world. Estimated costs in these areas ranged from 20 to 50 percent of those in the United States for comparable procedures, Deloitte found. Keckley says those ratios still hold. 

In an update of that study released late last year, Deloitte concluded that the recession had caused the number of people traveling outside the United States for medical care to drop from 750,000 in 2007 to 540,000 in 2008, before rebounding to 648,000 last year. The strengthening economy, Deloitte forecast, will support 35 percent annual growth rates, which would mean an estimated 878,000 medical tourists from the United States this year, nearly 1.3 million in 2011, and more than 1.6 million in 2012. Still, these forecasts are sharply lower than Deloitte's bullish forecast in the earlier report. Then, it had predicted 100 percent growth rates and 6 million Americans traveling outside the United States for medical care in 2010. Research from McKinsey & Co. places the numbers at roughly an eighth of Deloitte's estimates, but Keckley says the big difference is that Deloitte includes out-patient procedures in its figures and McKinsey does not. 

The 10 most popular destinations for medical tourism are Mexico, Costa Rica, Thailand, India, Turkey, Ireland, South Korea, Singapore, Taiwan, and Germany, according to Mondial USA, a large travel insurer. The top noncosmetic procedures, it says, are heart bypass, heart valve replacement, hip replacement, knee replacement, hysterectomy and other gynecological procedures, spine fusion, gastric bypass, and major dental procedures. PlanetHospital says its popular destinations also include Belgium, El Salvador, and Panama. Among noncosmetic procedures, nearly a quarter of PlanetHospital's clients receive some type of weight-loss procedure, and 15 percent seek fertility treatments, the company says. 

Finding the best hospital and physicians outside of the United States can be challenging, but it's getting easier as the industry matures. PlanetHospital has built its own network, Rupak says, and visits each hospital and physician before including them in its network. "We visit the hospital in the daytime, to make sure the nurses speak English and to do things like check out the food," he says. "But we also visit the hospital at night because that's when a patient is most vulnerable." Many leading medical schools are building international healthcare networks and can provide solid referrals. 

Accreditation bodies have been expanding their reviews of foreign hospitals to include more facilities and to provide accreditation of specific procedures and disciplines. The Joint Commission International is the major U.S.-based provider of foreign hospital certifications. It has a list of more than 200 certified facilities in more than 30 countries on its website. A smaller list of 42 recommended international healthcare providers has been drawn up by Patients Beyond Borders, a leading provider of guidebooks about medical tourism.

The JCI recently announced a new Clinical Care Program Certification for 15 categories: 

1. Heart failure

2. Acute myocardial infarction

3. Primary stroke

4. Diabetes mellitus (type 1) and/or diabetes mellitus (type 2)

5. Chronic kidney disease (stages 1 to 4)

6. End-stage renal disease

7. Palliative care (all types)

8. Traumatic brain injury

9. HIV/AIDS management

10. Cancer (all types)

11. Pain management

12. Asthma

13. Joint replacement (all types)

14. Transplantation (all types)

15. Chronic obstructive pulmonary disease 

The American Medical Association does not take a position on medical tourism, a spokeswoman says. But in 2008, it issued nine guidelines for people seeking medical care outside the United States. While these recommendations do not carry any legal authority, they should be on your personal checklist: 

• Medical care outside the United States should be voluntary.

• Financial incentives to go outside the United States for care should not inappropriately limit diagnostic and therapeutic alternatives or restrict treatment or referral options.

• Financial incentives should be used only for care at institutions accredited by recognized international accrediting bodies.

• Local follow-up care should be coordinated and financing arranged to ensure continuity of care.

• Coverage for travel outside the United States for care must include the costs of follow-up care upon return.

• Patients should be informed of rights and legal recourse before traveling outside the United States for care.

• Patients should have access to physician licensing and outcomes data, as well as facility accreditation and outcomes data.

• Transfer of patient medical records should be consistent with HIPAA guidelines.

• Patients should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities. 

While consumers should work with their primary doctors in the United States to reach solid medical tourism decisions, that often doesn't happen. American doctors may be skeptical of the quality of overseas care or simply may not like the idea of losing business. Rupak says that many of his customers have decided not to involve their physicians and have already decided on a course of action when they come to his firm. Still, working with your physician is the best way to begin this process, especially if you will need to coordinate future medical care after a healthcare procedure abroad.

Corrected on 02/25/10: An earlier version of this article misstated the name of Patients Beyond Borders, a provider of guidebooks about medical tourism.