Medical Tourism

David Dupray, a 60-year-old uninsured coffee shop owner from Bar Harbor, Maine, had been having left leg pain on ambulation for four years. His cardiologist recommended stent placement for left iliac artery stenosis. The estimated bill: approximately $35,000.

Unable to afford the procedure, Dupray began searching the Web for affordable medical care overseas. His physician suggested Thailand. Within days, Dupray had an appointment with a cardiologist halfway around the world—at Bumrungrad Hospital in Bangkok, Thailand. Dupray spent two days in the hotel-like hospital, had three stents placed in his leg arteries, and completed a cardiac stress test. The total bill: $18,000.

“I will never go to a hospital in the U.S.,” says Dupray, who represents a growing number of Americans searching for affordable healthcare in the global marketplace.

With rising U.S. healthcare costs and millions of Americans uninsured or underinsured, more American patients are seeking affordable, high-quality medical care abroad—known as “medical tourism.” In 2007, an estimated 750,000 Americans traveled abroad for medical care; the number is expected to increase to 6 million by the end of this year.1 On the flip side, only a little more than 400,000 nonresidents visited the U.S. in 2008 for the latest medical care.1 Globally, the medical tourism industry is estimated to grow into a $21 billion-a-year industry by 2012, with much of the growth expected from Western patients traveling overseas for affordable care.2

“As hospitalists, we have been seeing increasing numbers of patients going overseas for urgent and elective procedures, as it is a general perception the medical treatment overseas is less expensive,” says Joseph Ming Wah Li, MD, SFHM, director of hospital medicine at Beth Israel Deaconess Medical Center in Boston and SHM president-elect.

Physicians in U.S. hospitals encounter potential medical tourists all the time. Some are uninsured or underinsured. Some have insurance carriers that limit or exclude coverage for certain procedures and treatments. Even those with insurance sometimes struggle to pay deductibles, copays, and their costs after insurance has paid its part. Others are uncomfortable with the language barriers and cultural differences of U.S. hospitals and physicians.

Medical tourism also lures patients who are citizens of countries (e.g. Canada, the United Kingdom) that offer universal healthcare, Dr. Li says.3 For example, more expatriates from India and Malaysia are traveling to their native countries for medical care, as they receive affordable and quicker medical care while visiting family.

Hospitalists routinely care for patients requiring essential cardiac or orthopedic surgeries—conditions that are common in the medical tourism trade. With medical tourism growing in scope and popularity, it is essential that hospitalists are prepared to discuss with their patients the pros and cons of traveling for medical care. Hospitalists should be able to:

  • Identify patients who might benefit from medical tourism;
  • Know where and how to look for an accredited overseas facility; and
  • Explain to patients the potential travel risks and complications, including insurance coverage and legal restrictions in destination countries.

A basic understanding of the industry and the issues can help guide your patients through medical decisions and help you care for those who have returned from a medical trip.

Table 1. Average medical costs for select surgeries in the U.S. versus overseas hospitals*

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Medical tourism offers a wide range of medical services performed in hospitals on nearly every continent, with a wide range of costs for certain procedures (Table 1, p. 26). Most surgeries cost 50% to 90% less than the average cost of the same surgery at a U.S. hospital. Many in the medical tourism industry say these types of savings have brought once-unaffordable surgery within the reach of most Americans, regardless of insurance status. For example, cardiac bypass surgery on average costs $144,000 in the U.S.; it costs about $8,500 in India.

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