It was only a matter of time before globalization hit the health care economy.  The fact that it is sooo much cheaper to send Mr. Jones from Boston to Bangkok for a double knee replacement (together with Mrs. Jones, with a week on the beach thrown in for good measure) than to provide his care locally is a testament to the craziness of the system we love to hate.  (Economists can prognosticate more intelligently than I can on the question of how long we can save money by sourcing goods and services abroad, but I don't think this will last forever.)

Until we have a true global economy (i.e., with equivalent standards of living, prices and wages throughout a unified economy) there will be interest in the savings available by going to South Asia for major surgery.

And there should be.

There are undeniable savings available, and there are reasonable quality standards in place (Joint Commission international accreditation, for example).  Many physicians practicing in centers catering to medical tourists trained in the U.S. and Western Europe.  There is a growing number of middlemen identifying the best health care providers abroad and facilitating communication among U.S. patients, their local physicians, and the overseas providers (as well as facilitating transportation, etc.).  These middlemen are well-positioned to filter out additional providers as well.

Will there be horror stories related to overseas health care?  Sure, just as there are horror stories related to health care right here at home.  Any sentinel event should be subject to scrutiny wherever it occurs.

Given the overwhelming financial responsibilities of industrial employers to their retirees, the growth of self-insurance and the rate of medical inflation in the U.S., among ther factors, medical tourism is here to stay and will be on the rise. 

The questions sketched out by Dale will have to be answered on the fly, as more and more individuals are exposed to the medical tourism experience for medically necessary as well as for elective procedures.

-- David Harlow

    HealthBlawg

I will be attending the conference at the Venetian in a few days.  I was wondering if Mr. Van DenMark could comment on the size of the current market in the USA and any good faith estimates of what it might be in say 2012?  In addition what resources are there to identify other markets out there such as the Canadian, English, Carribean, Latin Americans,etc.

Thanks to the two individuals who posted the last two comments.

 As we saw at the conference, and will undoubtedly discover at the conference in December, there is significant interest in the US market.  Foreign providers looking to US for patients have traditionally relied on the self-pay market.  Now, however, US insurers and employers are looking at medical tourism as an option to lower costs.  In this regard, the southern California cross-border plans may serve as a model.

Another factor to consider when evaluating the industry is the development of medical tourism "destinations" for US consumers.  Not many providers (beyond providers of cosmetic procedures) have actively marketed themselves to the US consumer.  This is beginning to change.  (Also - look forward providers trying to open facilities closer to the US market.)

US entrepreneurs and private equity are also investigating ways to participate in the medical tourism industry.  Right now, with the industry still developing, there is a tremendous amount of experimentation with business models and approaches to industry participation.  As with most things, following the money would be an effective way to follow how the market develops.

 Of course, a key to the development of the industry will be the ability of foreign providers to convince US consumers that the quality is there.  JCI accreditation is one factor, but other factors exist as well, including local accreditation and certification and the existence of centers of excellence.

Thanks for this excellent analysis of the situation. You have very precisely listed all the external factors that are hampering medical tourism today. Yet from a systemic point of view there are a few facts that could further your analysis:

The need of a end to end follow up system: I assume that people aiming at medical tourism are low cost seekers, but conversly there are not short life seekers! The main problem with medical tourism is people are opting for a quick patch without carefully estimating there post surgery needs. Only mentionning a knee cap surgery is enough to weigh in post surgery practices. What is needed is a good follow up service throughout the medical procedure, namely before and after the surgery so that there is a common basis between surgeons and doctors from both side of the Pacific or the Atlantic (depending of the location you will finally choose).

Tele consultation: people need to get some hints about such surgeon or that hospital. Many people are just wandering through websites with no real insight about where there are heading to. Being at Bumrungrad in Thailand (I worked as an investment banker in Southeast Asia a while ago), I finally came to the point where I think that Asian Hospital are better than European Hospitals (I am French indeed). All in all there should be some iniatives stemming from these low costs hospitals to forge a real tie with their prospective clients and I assume that tele consultation is a good way to do it. Patronizing also (a fellow medical tourist advising you...)

Cheaper. This is the word for medical tourism. People goes overseas for cheaper treatments. I have a question: how the hack do other countries to handle such lower prices for complicate treatments? I'll try the answer myself: less greed.

__

color brochure printing and business cards printing

Thanks for the nice post.Incase if you are interested on my site on Health Tourism and blog on Health Tourism please visit www.besthealthtourism.com

It has been a year since I posted my initial entry here, and there have been a number of comments and questions posted since then.  Accordingly, I thought I would take a moment to update the six items I originally posted:

1. Quality: Quality standards, and the communication of those standards, continues to be an issue for overseas providers and medical tourism facilitators.  However, organizations, such as the Medical Tourism Association, are beginning to explore ways to provide standardized information on quality.  As more third-party payers begin to develop products, they are developing their own methodologies to determine the quality of overseas providers as well.

2. Employer Participation: It is happening - and sometimes because of interest expressed by employees.

3. Third-Party Payer Participation: This is happening as well.  Payers are coming up with a variety of plan designs, and are assessing issues arising under state insurance regulations and ERISA, depending on the product under development.

4. Liability and Malpractice: Employers and payers are understanding better the liability issues associated with bad outcomes and are taking steps to minimize risk.  Although, because this is a relatively new industry, and there is no case-law, things can change.  Consumers also have the option to obtain some travel insurance protection against bad outcomes through medical travel insurance products that are being offered or are under development.

5. Government Reaction: Medical tourism seems to be under the radar in this election cycle.

6. US Healthcare Providers: US providers are very active in the international market - and many are trying to attract medical tourists to their US facilities. There are many reasons US providers look abroad, and not many have embraced medical tourism.

My friend recently went to the Philippines to receive Hip Replacement Surgery. Medical tourism really does seem to be low cost and affordable. Maybe I'll go abroad soon.

Hundreds and thousands of Americans are voting with their feet every year for medical tourism. That is how this trend has become an industry!

Thanks, again to everyone who has taken the time to post a comment on this blog.  The recent turn in the world economy has disrupted the growth and development of many businesses and industries.  The same is true of the medical tourism industry.  Nonetheless, the industry continues to mature, with the ongoing work to develop risk mitigation products and uniform accreditation and measurement standards.

Of the six factors I originally identified, all remain crucial touchstones for the development of the industry.  We have seen development on many fronts - particularly in the areas of third-party payor involvement and employer involvement.

As always, we welcome your thoughts!

I doubt it will develop there at all as they are the most expensive regarding surgery

Thanks for sharing such a fine piece of advice. Its really great to read and as well as very helpful to get to know such a great thing, thanks a lot for posting this.

In ideal the best practice and also normal human rights are to choose medical professionals and facilities all over the world. And for now a lot of people take a risk to make a surgery or get medical treatment abroad without any insurance is not an easy decision to make=,but "6 million Americans will travel abroad for medical tourism in 2010" anyway.This is already international business industry.

The Turkish Ministry of Health owns and operates approximately 55% of Turkey's more than 1200 hospitals, whilst the rest are owned by universities, private companies and foreign entities. Many hospitals have local and international accreditation including the JCI (Joint Commissions International), the JACHO (Joint Commission on Accreditation of Healthcare Organizations), ISO (International Organization for Standardization) and affiliations with Western medical groups and facilities.

Buildings are not very cheap and not everyone is able to buy it. However, personal loans was invented to support people in such cases.