Patients travel from around the United States and the world to see Richard Guyer, MD, an orthopedic spine surgeon at the Texas Back Institute in Plano, TX, because he is a recognized, widely published expert in disc-replacement surgery.<\/p>\n
But when Guyer, 66, recently needed surgery himself\u2014a complex procedure to remove a benign tumor\u2014he flew to Florida. Good care was available in his own hospital, but he chose a surgery center where surgeons perform the procedure, on average, 50 times a week, using advanced techniques.<\/p>\n
Guyer\u2019s experience\u2014both as sought-after surgeon and as traveling patient\u2014is becoming more common. Proximity no longer determines health care. A growing number of Americans are willing to travel to other states or overseas as part of a trend called \u201cmedical tourism.\u201d<\/p>\n
Medical tourists travel to save money, to get cutting-edge or high quality care or for procedures not available locally.<\/strong><\/p><\/blockquote>\n
Medical tourists leave home to access the best available care or to save money or, in some cases, both. Patients Beyond Borders, an information service for consumers, estimates that 1.7 million Americans will go overseas for elective medical care in 2017. The global medical tourism market is estimated to be $45 to $72 billion annually, with approximately 14 million patients crossing borders worldwide, including those who travel to the United States for medical care.<\/p>\n
Data on domestic medical tourism\u2014traveling within the United States to another state for health services\u2014is scarce and largely anecdotal. But, noting a growing willingness to travel for care, physicians and medical centers are adjusting their practices to attract patients, particularly for out-of-pocket elective procedures.<\/p>\n
What Sends Patients Packing<\/strong><\/p>\n
Within the United States, medical travel typically takes patients to centers of excellence for highly complex procedures, such as the Cleveland Clinic for heart surgery, or to research hospitals offering the latest and best care, such as Memorial Sloan Kettering Cancer Center.<\/p>\n
Older Americans are driving the trend. Josef Woodman, CEO of Patients Beyond Borders, estimates that about 85 percent of overseas medical travelers fall within the ages of 45 to 65\u2014too young to qualify for Medicare but at an age more likely to develop complex medical conditions.<\/p>\n
Other drivers include the relatively inexpensive cost of travel and wide disparities in care and treatment pricing at home and abroad. Also, the Internet makes it easier for patients to research options and for providers at different locations to share medical records.<\/p>\n
Gaps in health care insurance are also a factor, especially as a growing number of patients rely on health plans with high deductibles.<\/p>\n
\u201cAs health plans continue to become more expensive and less cost-efficient for the patient, the \u2018underinsured\u2019 patient can often realize cost savings on more expensive surgeries over and above their plan reimbursement,\u201d Woodman wrote in an email interview.<\/p>\n
A 2012 study by Woodman, published in AARP International\u2019s Journal, identifies three categories of medical tourists:<\/p>\n
\n
- Value patients, usually those 50 and older, who are uninsured or underinsured or who seek procedures that insurance doesn\u2019t cover<\/li>\n
- Access patients, who live in areas where available health care lacks quality or where specific procedures may not be available<\/li>\n
- Quality patients, who are willing to travel for exceptional specialty care, including cutting-edge surgeries or new therapies<\/li>\n<\/ul>\n
Bill Ruth falls into the quality category. When the 64-year-old retired teacher and coach learned that he needed heart surgery, he called on a few physician friends for advice. They steered Ruth to the Cleveland Clinic or Baylor University Medical Center in Dallas, even though Ruth lives in Estes Park, CO. After researching his options and interviewing physicians, Ruth chose Baylor. He traveled to Dallas, where the procedure was successfully performed. Within a few days, Ruth was up and walking five miles at a time. And within a few weeks, he went to the high school in Pennsylvania, where he once taught, for his induction into the school\u2019s athlete hall of fame.<\/p>\n
Ruth\u2019s insurance plan, through the teachers\u2019 union, covered all of his medical costs; he picked up the cost of travel for himself and for his wife.<\/p>\n
As a triathlete who organizes health and fitness programs in his community, Ruth said he would never consider just going to the nearest provider without doing his research.<\/p>\n
Treatment abroad can be 20 to 80 percent less expensive, depending on the country and the procedure, and including the cost of travel.<\/strong><\/p><\/blockquote>\n
\u201cYou want the best care possible,\u201d he said. \u201cWhy shouldn\u2019t people travel to get the best medical care?<\/p>\n
\u201cSome people put more research into buying a car (than medical care). But when you really care about your health and your activity level, you do what it takes to find the best care.\u201d<\/p>\n
Typically, for necessary procedures like Ruth\u2019s, insurance will cover the treatment at most US locations, although often at out-of-network rates. (Be sure to confirm coverage with the insurance provider before any procedure.) Patients almost always pay the cost of travel.<\/p>\n
But in some cases, medical travel is paid for by an employer. Home-improvement retailer Lowe\u2019s sends employees in need of complex, non-emergency heart surgery to the Cleveland Clinic. Lowe\u2019s, which self-insures its employees, struck deals for bundled prices with the Cleveland Clinic, allowing Lowe\u2019s to save money even after paying all medical and travel costs. By going to a center of excellence for heart surgery, patients enjoy better outcomes and fewer readmissions, which in turn helps employees return to work healthier.<\/p>\n
Lowe\u2019s typically picks up the cost of the trip for a caregiver too and sometimes pays the deductible as an added incentive. (Employees who don\u2019t wish to travel may choose a local provider and receive normal coverage.) Other large, self-funding companies, including Walmart, Boeing and PepsiCo, have similar approaches.<\/p>\n
Heading Overseas<\/strong><\/p>\n
Patients are traveling to Thailand for plastic surgery, Germany for cancer treatments, Costa Rica and Mexico for dental care, Turkey for eye specialists, Israel for fertility treatments, Poland for dental implants, the United Arab Emirates for bariatric surgery, to list a few.<\/p>\n
About 70 percent of Americans who go overseas for medical care do so for elective treatments that insurance typically doesn\u2019t cover, such as dental work, cosmetic surgery, bariatrics or fertility treatments, Woodman said.<\/p>\n
Opting for treatment abroad can be 20 to 80 percent less expensive, depending on the country and the procedure, even after the cost of travel. What\u2019s problematic, however, is judging quality of care.
\nLeigh Turner, PhD, associate professor at the Center for Bioethics, University of Minnesota, cautions that much of the information available online is created by providers, who have a financial stake in painting a positive picture.<\/p>\nWhen you travel for care, coordinating long-term follow-up and managing postsurgical complications can be problematic.<\/strong><\/p><\/blockquote>\n
\u201cIt\u2019s not so easy to spot the bad actors,\u201d Turner said. Overseas providers are \u201cbusinesses that are trying to attract patients, and they are quite savvy in painting a positive picture. While the Internet gives patients more access to information, it\u2019s also creating more misinformation.\u201d<\/p>\n
It\u2019s extremely important for medical tourists to do their homework. Patients must have a good understanding of the desired procedure and make careful assessments of the quality of the provider. Patients Beyond Borders advises contacting physicians in advance for references and to check accreditations.<\/p>\n
\u201cIf the doctor is evasive, hurried, or frequently interrupted, or if you cannot understand his or her language, then either dig deeper or move on,\u201d Woodman writes in his book, Patients Beyond Borders: Everybody\u2019s Guide to Getting Affordable, World-Class Healthcare<\/em> (2015).<\/p>\n
Medical-tourism concierge services can help you locate clinics and arrange travel, but they are not regulated and do not provide medical advice. Some may steer patients toward clinics that pay commissions. You should get recommendations from former customers, ask how the agency is compensated and use a US-based agency if possible.<\/p>\n
Those who use overseas hospitals have little recourse in the event of poor outcomes. Regulation and oversight can vary widely, although that may be changing. The Joint Commission International (an independent, not-for-profit accrediting organization for US hospitals and medical providers) now accredits more than 400 hospitals worldwide<\/a>, giving patients some reassurance as to quality.<\/p>\n
Costs of Medical Tourism<\/strong><\/p>\n
Medical travel remains an option largely for those who can afford it. With very few exceptions, you must cover your own travel costs, as well as those of any accompanying caregiver.<\/p>\n
Medicare patients may seek care at any US provider that accepts their plan, but aside from a very few rare circumstances, Medicare doesn\u2019t pay for overseas procedures or travel costs, foreign or domestic. (Some Medicare Advantage plans might cover the cost of the trip for those who must go to a distant US facility for transplant surgery.)<\/p>\n
Patients must also consider nondollar costs. There will be additional time spent traveling to the location and recovering there. You may need to avoid air travel, especially very long flights, for a period of time after surgery. When you are overseas, language and cultural differences can create additional stress. \u201cReceiving care at a facility where you do not speak the language fluently might increase the chance that misunderstandings will arise about your care,\u201d warns the Centers for Disease Control and Prevention\u2019s website.<\/p>\n
Some overseas hospitals offer hotels or resorts where patients may stay for recovery and post-op care before returning home. However, coordinating long-term follow-up and managing postsurgical complications can be problematic. Studies suggest that when patients are admitted for complications at a different hospital than where the original surgery took place, mortality rates are higher.
\nGuyer, the Texas surgeon, sees that as a key difference between domestic medical travel and overseas travel.<\/p>\n\u201cIf a patient comes here from Montana for surgery and later has problems, they can send pictures, we can consult over the phone, and they can fly back if need be,\u201d he said. \u201cIf somebody goes abroad for surgery and then has a problem, we don\u2019t like to take care of it here, because we weren\u2019t there for the surgery.\u201d<\/p>\n
Effects of Medical Travel<\/strong><\/p>\n
Many hope that the trend toward medical tourism could drive improvements in quality and help keep costs down in the United States.<\/p>\n
\u201cTheoretically, it makes sense\u2014as you expand patients\u2019 options, there\u2019s increased competition in terms of quality and price,\u201d said Steve Wojcik, vice president of public policy for the National Business Group on Health. \u201cThat benefits everybody.\u201d<\/p>\n
When employers like Lowe\u2019s send patients to the Cleveland Clinic, for example, that takes patients away from local providers.<\/p>\n
\u201cIn those cases, a local provider might approach a big employer and say, \u2018We know you\u2019re sending people out of town; here\u2019s our data, and here\u2019s what we can offer you,\u2019\u201d Wojcik said.<\/p>\n
But while increased competition should reduce prices and improve quality in theory, price transparency in the United States is still spotty, especially for nonelective procedures, and price disparity is wide. A 2013 Journal of the American Medical Association study of domestic providers found a wide range in pricing for hip replacement surgery: as low as $11,000 or as high as $125,000. Also, when researchers posed as patients prepared to pay cash, more than half of the hospitals queried would not provide prices upon request.<\/p>\n
Some US medical centers offer a concierge service to assist with trip arrangements.<\/strong><\/p><\/blockquote>\n
\u201cThere\u2019s no correlation between cost and quality,\u201d said Jesse Gomez, executive vice president of sales and marketing for BridgeHealth, a Denver health consulting firm that negotiates bundled rates for self-insured employers for procedures at centers of excellence. \u201cBut fortunately for consumers, objective provider data is becoming increasingly more accessible.\u201d<\/p>\n
Gomez notes that patients can now find average prices for common procedures<\/a> from the Health Care Cost Institute by way of its consumer website and hospital quality ratings<\/a> by way of websites like www.carechex.com.<\/p>\n
But some foreign providers make it even easier. Bumrungrad International Hospital in Bangkok, a top destination for global medical tourism, publishes costs online for some 30 procedures and offers package pricing in many specialty areas.<\/p>\n
\u201cWe can only hope for this kind of transparency to visit us sooner than later here in the US,\u201d said Woodman of Patients Beyond Borders.<\/p>\n
The desire to attract patients is clearly changing the way some medical providers do business. The Cleveland Clinic\u2019s website offers extensive information for foreign and domestic travelers, plus a concierge service to assist with trip arrangements. Other centers of excellence that attract domestic medical travelers are improving the ways they integrate post-treatment and follow-up care with local providers.<\/p>\n
Some of those providers are becoming more transparent and consumer-friendly on pricing, especially those that cater to cash patients. For example, Guyer\u2019s clinic negotiated with the Texas Health Center for Diagnostics & Surgery to offer a package price, which allows out-of-pocket patients to pay up front and avoid unexpected charges.<\/p>\n
The option of medical tourism is also encouraging people to become more educated and more proactive in their own medical care.<\/p>\n
\u201cThe patients who travel to see me have done their homework,\u201d Guyer said. \u201cThey know all about the procedure and they know what questions to ask.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
Patients travel from around the United States and the world to see Richard Guyer, MD, an orthopedic spine surgeon at the Texas Back Institute in Plano, TX, because he is a recognized, widely published expert in disc-replacement surgery. But when…<\/span><\/p>\n