Revisiting ‘Medical Tourism’

by JHI Staff on May 12, 2014

It was nice to see The Economist weigh in with a brief examination of the “medical tourism” market that echoes themes I’ve emphasized before, even going back to one of my very first posts. I’ve long argued that there isn’t a lot of substance to the much-hyped notion that millions of patients would seriously consider traveling overseas for relatively routine and sometimes expensive medical procedures to save money while enjoying an exotic vacation, and the article backs me up on this.

The article points out that, for starters, the data thrown around by medical-tourism boosters has been muddled:

In 2008 Deloitte predicted an “explosive” boom in medical tourism, saying that the number of Americans going abroad for health care would grow more than tenfold by 2012. It did not happen. Poor data were part of the problem: whereas Deloitte counted 750,000 American medical tourists in 2007, McKinsey, another consultancy, found at most 10,000 a year later.

I would add another observation related to the problems with data in this field. To the limited extent that there are patients who get routine procedures far from their native countries, many are ex-pats who are living in or close to the country where they’re being treated, not people who have traveled far specifically for care. In other words, there isn’t a useful definition of what a “medical tourist” is. That fact alone ought to cast doubt on claims about the size of the industry, including those made by hospitals advertising themselves as centers of medical tourism.

I don’t mean to deny that the industry exists. It’s true that significant disparities exist from country to country in the costs of some treatments, and there really are opportunities for some patients to travel to get good care at lower cost.

But this observation needs to be heavily qualified. First, globe-hopping for medical treatment is likely to make the patient’s experience more challenging. Patients undergoing treatments—especially the more costly, extensive ones that someone might travel for—are vulnerable to pain, discomfort, depression, loneliness and anxiety both before and after the procedure. Certainly attentive, empathetic, highly trained hospital staff can help patients cope, and we work hard here at Johns Hopkins Medicine to do that for our international patients.

But patients also appreciate the presence of family and friends, and a chance to be back in their homes as soon as possible. As the Economist article notes about medical tourism:

Patient interest also turned out to be lower than predicted. Though some patients in the rich world seek out deals, most receive adequate health care at a manageable price and would prefer to stay at home. Potential savings are often insufficient to trump concerns about quality and the lack of recourse if something goes wrong. In 2008 Hannaford, an American supermarket chain, offered to pay the full cost of hip and knee replacements for its employees, including travel and patients’ usual share—provided they would go to Singapore. None took up the offer.

The article also points out that 98 percent of medical costs go to treatments that don’t readily lend themselves to the delays and stresses of travel. And it adds that even with the sort of short, relatively hassle-free travel faced by European patients who want to get medical care in another European country, cross-border health care accounts for only 1 percent of public health care spending.

The other qualification I would make is that even in those cases where medical tourism might make sense today, there will be fewer of those cases moving forward. Medical tourism is a transitional market—it’s a short-term response to the large changes roiling health care industries around the world. Right now we’re at a stage where patients in the United States and some other highly industrialized countries face much higher prices for some treatments than patients in other countries, even though the quality of treatment isn’t always that much better here.

But because of the Affordable Care Act (ACA) and other efforts to reform health care in the United States, costs here may well come more into line with the rest of the world, and quality and outcomes are likely to improve. In addition, the ACA should ensure that fewer Americans find themselves with insurance gaps that necessitate large out-of-pocket costs for treatments.

Those sorts of improvements, and not medical tourism, are the longer-term, more steady-state solution to the cross-border inequities in availability, quality and cost of medical care. That’s one of the reasons the world has seen the rise of the new global collaborative health care industry that we at Johns Hopkins Medicine International are proud to be a part of. Global health care leaders are working to identify ways to more evenly distribute top-notch health care resources and facilities to all populations. Everyone with a role in health care—from investors to academic medical centers to governments to NGOs—also has a collaborative role to play in this new field.

There may always be certain complex, highly advanced procedures that patients will have to travel for. But as global collaborative health care efforts progress, we should see fewer of those—just as in the United States, we’ve seen once-daunting procedures such as common forms of cardiac surgery migrate from top medical centers to community hospitals.

An extensive medical procedure won’t ever be much fun. But it can be less of a burden when it takes place close to home. I hope more of us in health care can work together to make that happen for patients around the world.

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villa la estancia cabo all Inclusive August 20, 2014 at 6:02 am

Pretty! This was a really wonderful article. Thank you
for supplying this information.

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Susan@ Global Medical Tourism August 14, 2014 at 6:30 am

With medical tourism still in its early stages, gaining reliable data is challenging. Medical travel continues to enjoy active growth as a rising number of Americans prove willing to cross international borders to obtain healthcare in response to the shift toward quality and increased consumer education. Culture-based fears about safety and quality are beginning to fade.

ACA does not cover many of the medical travel industry’s in most popular procedures, one good example is in vitro fertilization. Thus, it should be no surprise that U.S. consumers are willing to travel abroad to receive such healthcare services. Number of other companies have recently issued similar domestic medical travel opportunity thus the widespread acknowledgement of domestic medical travel will give more employers better value at lower cost. It may take a couple of shifting years to really take hold, but domestic and international medical travel opens up an alluring mix of high quality and affordable cost.

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Mark McCracken May 13, 2014 at 10:12 pm

Thank you for highlighting the Economist's article. I couldn't agree more with the conclusions and I'm glad that the longer term, more steady state solutions are winning out over medical tourism, as they should.

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