Though health insurance has undergone a major operation thanksto the Patient Protection and Affordable Care Act, much about thecountry's health care operation has remained the same. Even beforePPACA, some benefits brokers and agents — in an effort to put morecost-saving choices in front of their clients — began to show themmedical tourism options.

Medical tourism, which refers to a patient that travels out ofstate or abroad for health care or a patient that travels to theUnited States seeking the same, made serious dollars and sense insome cases.

In some countries, it's possible to spend less — sometimes muchless — money paying for travel expenses and proceduresout-of-pocket than paying deductibles and uncovered costs, or foruncovered procedures altogether. Also, patients could travel totake advantage of health care facilities that serve as centers ofexcellence for a certain procedure in hopes of increasing the oddsof a positive outcome.

Others try to obtain treatments or drugs that haven't receivedregulatory approval in the United States. And there are still morereasons to opt for a medical tourism solution, even the verymundane.

“The media loves to talk about the heroic heart transplant inBangalore, but that's the exception,” says Josef Woodman, CEO ofPatients Beyond Borders, an online and print resource for consumerinformation about international medical and health travel based inChapel Hill, North Carolina. “There's a lot of medical tourismthat's fairly unsexy and pedestrian. Fifty percent of medicaltourism is for dental care. And it's mostly short-haul trips fromthe population centers in California, Texas and Arizona. Millionsdon't have dental insurance. It's not a rip-off but it doesn't doany good and for the average single employee or citizen it's notpractical.

“When you get older, you start having trouble with your teeth. Iwas down in Costa Rica and a guy had been quoted $60,000 for newteeth,” he continues. “He got them in San Jose for $17,000. That isreal money being saved. The second biggest reason is cosmeticsurgery, which is not covered. That's 65–85 percent of all travelthat is either for dental or cosmetic. The remainder is forelective surgeries — a patient isn't satisfied with the doctor orthe claims processing, even the conditions. And by the time you addup all the copays, gotchas, ceilings and other costs, it's cheaperto travel for oncology, heart procedures and other procedures.”

But even in a span of health care upheaval, medical tourism haslargely remained stable. While there have been areas of growth — incertain kinds of procedures and international medical capacity, forexample — and increasing acceptance among consumers, industryobservers say that PPACA's impact on medical tourism could mainlylie still in the days to come.

“In a lot of ways, it really hasn't yet and it's not likely tofor a while,” Woodman says. “On the one hand, you've got millionsof new uninsured patients entering the system, and those are folkswho are not likely to be considering medical tourism as an option.On the other hand, you're going to start seeing longer waits forspecialty care just like in Canada and the United Kingdom —especially for invasive procedures. There's a lack of specialistsand there's triage — you can't support the best health care foreveryone.”

A new boost?

But now that the linchpin year of 2014 has almost passed, andmillions of new consumers have entered, or plan to enter, thehealth care marketplace, PPACA may unintentionally give medicaltourism a boost.

“The next shoe to drop will be employers deciding to putemployees on exchanges and thus making them more cost-focused —particularly people on high-deductible plans,” says David Vequist,founder and director of the Center for Medical Tourism Research atthe University of the Incarnate Word in San Antonio, Texas. “Also,the demographics of the people signing up haven't helped reducecosts of health care because it hasn't increased the young andhealthy as expected. And hospitals and physician practices havebeen merging, which leads to greater pricing power and consumerprices. The costs of health care will continue to rise at a greaterrate than expected. Therefore, more self-funded employers willchoose domestic medical tourism benefits plans such as Wal-Mart,Boeing, Pepsi and Lowe's have already done.”

Also, new health care consumers combined with an agingpopulation could make medical tourism a more attractive option ascosts continue to rise.

“Even if more people are insured under the Affordable Care Act,the combination of higher deductibles and increased out-of-pocketcosts through private insurance plans, as well as Congressionalbudget cuts to hospitals and doctors mandated by Obamacare, willpush consumers toward alternative means to stretch their healthcare dollars,” says Renee-Marie Stephano, president of the MedicalTourism Association in Palm Beach Gardens, Florida.

Enter medical tourism, “where cost-saving can be as much as 70percent lower than offered for similar procedures in the UnitedStates,” she continues. “Overseas opportunities will be ofparticular interest to baby boomers, who will be seeking electiveprocedures most associated with aging — orthopedic, ophthalmology,dentistry, cancer and cardiovascular treatments, and comprehensivehealth screenings.”

For those reasons, optimism is running high in the medicaltourism industry in the United States and internationally. TheMedical Tourism Climate Survey, which was compiled and published inApril by the International Medical Travel Journal in the UnitedKingdom, finds that health care professionals from across the globepredict medical tourism growth.

“Medical tourism is an important contributor to the health careeconomy of many countries,” says Keith Pollard, the journal'smanaging editor. “Growth is expected to be biggest in two verydifferent areas — cosmetic surgery, which continues to be a veryactive area, and cancer treatment, with patients seeking treatmentsnot available to them in their own countries.”

Vequist says there could be other reasons to expect growth inmedical tourism.

“It has the potential to be a growth industry — for both inboundand outbound [patients],” Vequist says. “But this just might be aregression to the mean effect — in other words, for outbound,because many more people around the world travel across borders forhealth care, it's likely that the percentage of Americans thatchoose this will rise over time. The inbound effect will be becauseAmerican health care facilities will continue to pursue highermargin medical travel patients as domestic revenues become lessprofitable.”

Woodman adds that international medical facilities continue tomultiply, too, with some of the best medical facilities in theworld showing up in places as far apart as Health City CaymanIslands and Bumrungrad International Hospital in Bangkok, Thailand,thanks to the international accrediting body that monitors healthcare standards and quality.

“You still have the continued growth of internationallyaccredited hospitals,” Woodman says. “[The Joint CommissionInternational] is on a tear. Now there are between 600–700hospitals. That gives patients more choice and comfort. There hasbeen a lot of these JCI hospitals that were not at capacity andwhen they got JCI accreditation, they got international businessbut they also got people in their own country who were gaining inaffluence. These hospitals are quickly filling up, but I haven'tbeen at a JCI hospital that hasn't been at or over capacity intwo-and-a-half-years.”

Climate change

The International Medical Tourism Journal's 2014 Climate Surveytalked to medical professionals from 280 health care facilities andmedical tourism companies around the world. Here are more of thesurvey's findings:

• 48 percent of clinics, hospitals and medical tourism agenciesreported growth in international patient numbers over the last 12months; 30 percent saw no increase and 11 percent experienced adecline.

• 76 percent expect their international patient numbers to growover the next 12 months.

• More than half expect annual growth of more than 10 percent inthe medical tourism market over the next five years.

• Over the next five years, cosmetic surgery is seen as thebiggest growth area for medical travel—cited by 55 percent ofrespondents—with cancer treatment, infertility treatment and dentaltreatment also expected to experience significant growth.

• When asked to name the most popular destinations in terms ofpatient numbers, respondents selected Thailand, India and theUnited States.When asked to name the leading destinations in termsof quality and range of services provided to internationalpatients, the respondents ranked the United States, Thailand andIndia the highest.