Pro athletes aresome of the most famous medical tourists in theworld. 

Denver Broncos quarterback Peyton Manning traveled to Europe forsurgery on his neck so he could resume his pro football career.Kobe Bryant and Alex Rodriguez have traveled to Germany to getmedical procedures for various joints. And what serious sports fanisn't relieved when they hear a favorite player will travel toBirmingham, Ala., so renowned sports doctor James Andrews canoperate and return them to glory? 

But medical tourism isn't just for the rich, famous and oftensacked. 

Hundreds of thousands of Americans travel for health care everyyear. And now that the Patient Protection and Affordable Care Actis here to stay, leaders in the medical tourism industry expectmore Americans to seek health care elsewhere. 

Brokers and agents looking to navigate the stormy waters of apost-PPACA world should learn about medical tourism and be preparedto discuss it with clients or potential clients. As health reformbecomes reality, employers will be looking for ways to reducecosts, expand options and improve quality—and medical tourism canaddress all three. 

“The more employers get squeezed, the more we have to findoptions for them,” says Trish Freeman, owner and agent at TrishFreeman Insurances Services in Gonzalez, La. “For my block ofbusiness, come 2014, what's going to happen? No one knows. What ifeveryone moves to the exchanges? Where does that leave brokers likeme? Possibly without a job. Medical tourism gives you anopportunity to help someone who's struggling to pay bills and maybe at the end of their rope, and you can say, 'Here, I have anotheroption and why don't you consider this?'” 

What is it?

Simply stated, medical tourism is when patients travel to obtainhealth care elsewhere. Destinations can include domestic andinternational medical facilities. Top international destinationsinclude Brazil, Costa Rica, Japan, China, India, Turkey, Israel,Jordan, Germany, Thailand and Mexico. And there are manyothers.

Attitudes about medical tourism have changed over the years,with a 2009 Gallup study showing 29 percent of Americans wouldconsider getting medical care outside the UnitedStates. 

People travel for prescribed, elective and experimental medicalprocedures. Most of the time, medical tourists work withfacilitators who understand where they're traveling, speak Englishand provide concierge services. Some international hospitals evenhave programs catering exclusively to international patients orwork with recovery centers for their foreign patients.

So far, employers with self-funded health  care planslead the way in offering medical tourism as a benefit, mainlybecause these organizations are generally more risk-averse in theirattempts to control costs. But that's not to say fully insuredproviders aren't taking notice. Blue Cross Blue Shield of SouthCarolina launched Companion Global Healthcare in 2007 to reapmedical tourism's advantages. 

“One complaint I hear about brokers selling health plans is thatthere's nothing new ever,” says Robert Repke, CEO of Global Medical Conexions in SanFrancisco. “This is something different.”

Reducing costs

Perhaps the single biggest reason brokers should talk aboutmedical tourism with their clients or potential clients is costreduction. International and domestic medical tourism can saveemployers money—and a lot of it. 

With international medical tourism, employers and patients cansave anywhere from 50 percent to 90 percent, according to someindustry estimates. Why? Medical care is so much cheaperoverseas. 

For starters, the cost of labor is lower in other countries,which contributes to savings on hospital staff and employees aswell as reduces the cost of medical devices. American doctors andhealth care workers are paid much more than their internationalcounterparts. Foreign countries also have less stringentregulations and less litigious societies. In the United States, itcan take 10 years to get a drug through the FDA and litigation isalmost a given.

Because American health care costs so much, employers can oftenpay for the procedure, the travel to the destination and the entirelodging bill in a foreign country and come out ahead.

“The quality is equal to what they would get and in some casesbetter than what their employees would get at their localhospital,” says Jonathan Edelheit, CEO of the MedicalTourism Association. “We have an amazing health care system inthe United States, but we work with the top hospitals in the world.Why not give the option for employees to go to the best place inthe world?”

With domestic medical tourism, employers can take advantage ofhospitals and clinics that specialize in performing a certain typeof procedure or providing a certain type of care. Often referred toas medical centers of excellence, facilities that specialize incertain types of care reduce costs by performing more procedures,investing in their facilities to increase rates of return,attracting top doctors and incurring lower rates of malpractice andre-admission costs. 

“If you do something frequently and you have the best people andyou have the best processes you've gotten the error out of thesystem,” says David Vequist, director of the Center for Medical TourismResearch at the University of the Incarnate Word in SanAntonio. “Re-admissions add quite a bit to the cost of health careoverall.” 

More options

Under the PPACA, employers already have started reducing theirofferings to save money. That means health insurance plans maylimit what they cover or discontinue some coverage altogether.Dental and vision plans—once considered standards—are now beingreduced or even dropped from health care plansaltogether. 

Medical tourism, however, gives brokers a tool to put in frontof employers that want to continue offering robust health plans oreven expand options for their patients. Medical tourism is largelya voluntary benefit, so employers can add them to their benefitspackages and expand health care options with little or no effect onthe bottom line.

“It offers a broker an opportunity to provide a unique serviceto their client,” Repke says. “The way we have it set up, we don'tcharge for a service until a client uses it. A broker could add ournetwork for free and deliver something unique and high quality totheir client without having to change the plan. They could offerjust elective services—things like cosmetic surgeries, weight losssurgeries and dental. You could offer it to families and extendedfamilies, too.” 

Repke adds that medical tourism allows employees access toexperimental procedures that may be unavailable in the UnitedStates. 

Medical tourism also puts the employer and the employee on thesame side when it comes to health care decisions. 

“PPACA will drive up premiums and that will drive theconsumer-directed market, enabling employees to be bigger directorsof what they spend,” says Tom O'Hara, president of Surgical Trip,Rednor, Penn. “People want to go to top-quality places. People wantto have options. Medical tourism is perhaps the best way to givethe quality of health care choices they desire while alleviatingthe cost they're incurring.”

Access to quality

An open question about Obamacare is whether it will improve theoverall quality of American health care. While that will take sometime to figure out, medical tourism already provides employees withaccess to top-quality health care. 

For instance, Lowe's, a national chain of home improvementstores, recently announced a partnership with the Cleveland Clinicto offer heart surgery for employees and their dependents whoparticipate in the company's self-funded medical plan. As part ofthe program, Lowe's covers medical deductibles, coinsuranceamounts, travel and lodging expenses for the patient and acompanion plus concierge service. 

Yes, the arrangement saves Lowe's money. But it also gives theiremployees access to a medical facility that's routinely rated thebest place in the world for heart treatment. 

“In working together with Cleveland Clinic, our employees willbe able to experience the best of the best in health care withlower out-of-pocket expense than having the surgery at anotherfacility,” says Bob Ihrie, Lowe's senior vice president of employeerewards and services in a statement. “We believe that having thecorrect diagnosis, combined with surgery by the undisputed leadersin this field, will produce the highest-quality outcomes for ouremployees.”

In the future, the PPACA could increase the time it takes to geta procedure, making Americans participate in a health care systemthat's more like those found in Europe and Canada. Medical tourismcan step in and reduce potential wait times or give employeesaccess to procedures much more quickly. 

“My suspicion is that as utilization gets to levels elsewhere,then Americans will have to wait weeks and months for certain typesfor procedures,” Vequist says. “If you tell a woman they're goingto have to wait seven-and-a-half weeks to get a scan of a lump inher breast, they may want to go to Mexico or fly to India thatweek.”

Important answers

Brokers should know that several organizations make sure foreignmedical standards meet or exceed U.S. standards. One such body isthe Joint Commission International, which works with medicalfacilities and foreign governments to enact high standards of carearound the world. Currently, the JCI is present in 90countries. 

Also, medical tourism providers also seek out medical facilitiesthat align with American medical facilities through partnerships.For instance, top hospitals like the Memorial Sloan-KetteringCancer Center and Johns Hopkins partner with medical facilitiesacross the globe. 

Reputable medical tourism providers also conduct their ownassessments of foreign medical facilities and build relationshipswith top-performing medical facilities. 

“We've gone around the world and personally visited everyhospital in our network,” Repke says. “We have picked countrieswhere we personally would feel comfortable traveling. We pickcountries that aren't volatile and have a stable economy. We pickhospitals that have strategic liaisons with hospitals in the UnitedStates and they're fully accredited so the way they run theirhospitals is recognized by U.S. standards,” he says.

Third-world countries aren't on the list, nor are places thataren't easy to get to and where English isn't spoken, he says.

“If I send you to Panama, which has a great hospital with aJohns Hopkins affiliation, someone would be there to hold your handall the way through,” Repke says. “We arrange for the individual tohave a phone interview and Skype sessions with the hospital beforemaking a decision. We want to make it comfortable for anyone whouses our service.” 

Creative solution

Many medical tourists have high praise for theirexperiences. 

“Pretty much to a person, people have been ecstatic about theservice and the procedures and the welcoming accommodations they gointo,” O'Hara says. “It's been exceptional.” 

So as health reform continues to affect American health care andthe news about medical tourism gets out, brokers shouldn't beafraid to offer out-of-country solutions to in-countryproblems.

Freeman says she has talked medical tourism with many of herclients. It's not the easiest subject to bring up, but it's adiscussion definitely worth having. 

“People are kind of shocked the first time you mention it,”Freeman says. “The next time they say, 'It's not that bad an idea.'They see people aren't dying, so the more you educate, the morethey get comfortable with the idea. Then they start asking realquestions.” 

Illustration by Gary Sawyer / agoodson.com