From the July 2011 issue of Benefits Selling:

Over the past year there has been a lot of buzz about the term “medical tourism.” With health care costs continually rising, the attractiveness of providing medical care at up to a ninety percent saving is pretty hard to resist.

For those who have been resisting this growing trend, the resistance is usually because they don’t want to be the “trendsetter” in U.S. healthcare. More than a year ago, medical tourism was one of the top projects for all the major U.S. health insurance carriers. They all were moving forward with it, issuing RFPs for companies to propose implementing it for them, and performing site tours of top international hospitals to add to their network.

Then a huge roadblock happened: health care reform. When health care reform came around, all the health insurers in the United States stopped all innovative projects, including medical tourism, and started fighting for survival with the threat of health care reform putting them out of business. Times have changed.

Most insurance companies and employers are finally “comfortable” with health care reform. Comfortable meaning, they understand it, know how it will affect them, and they are in compliance with it. For the first time in more than a year, insurers and employers are going back to the innovation table. They know health care reform isn’t going to reduce health care costs, but actually raise costs and they need to implement programs to reduce costs before they are totally out of control.

Many insurance companies and some of the biggest employers in the United States now are turning to medical tourism as the solution. In the voluntary benefits arena over a year ago two limited medical/mini-medical carriers implement medical tourism, and now another limited medical carrier is about to implement it.

Soon more limited medical carriers will implement medical tourism simply to stay competitive in the marketplace and to offer similar benefits that other carriers offer. Voluntary benefits carriers are also starting to move forward with medical tourism. There are dental insurance carriers moving forward with implementing medical tourism, so that their insured can use their dental benefit overseas.

The annual max of $1,000 to $1,500 per year won’t even cover one dental implant. Add medical tourism and allow the dental patient to travel to Central America or somewhere else in the world, that $1,000 max could be a $10,000 benefit. Once the first dental carrier announces this benefit, which should happen first, the rest of the dental carriers will race to implement this, because if they don’t, they will no longer be competitive in the marketplace.

Other carriers examining medical tourism are critical illness and cancer insurers. If you have a $10,000 cash benefit when someone is diagnosed with cancer or one of the qualifying critical illnesses, then $10,000 won’t go very far in the United States. But take that benefit overseas and it could be worth $100,000. A major market for medical tourism is ethnic employees or patients.

Studies show that many ethnic patients who need a major or minor surgery prefer to travel back to the country they or their family is from and recover around family and comfortable surroundings. There is no cultural or language barrier or perception about the quality of the health care system.

Another large growth area is domestic medical tourism, where Americans travel within the United States for their major surgeries. There are many centers of excellence around the country that have streamlined their process and lowered their costs for orthopedic and heart procedures. Smart employers are learning that they can pay 60 percent of the cost of a knee replacement simply by incentivizing employees to travel to specific hospitals for their knee surgery.

A perfect example of this is the partnership between the Cleveland Clinic and Lowe’s. Lowe’s—a huge U.S. company with some 228,000 employees—recently implemented a domestic medical tourism benefit allowing full-time Lowe’s employees and their covered dependents enrolled in the company’s self-funded medical plan the opportunity to schedule heart procedures at Cleveland Clinic, one of the country’s most renowned hospitals.

Lowe’s approached the Cleveland Clinic as they were developing a benefit that would allow employees to seek out the best medical care in the country. Bob Ihrie, Lowe’s senior vice president of employee rewards and services says of the partnership: “In working together with Cleveland Clinic, our employees will be able to experience the best of the best in health care with lower out-of-pocket expense than having the surgery at another facility.”

The idea is that the patient will be at the best location for heart surgery, which will decrease the likelihood of additional operations or complications so there will be a lower cost in the long run. In today’s economic climate people are smarter shoppers of health care than ever before. They are willing to travel for the best care and are starting to become more consumer driven, comparing quality and pricing.

In the voluntary benefits industry, these employees are paying 100 percent of the cost for their voluntary benefits. They don’t have a huge bank account, and they want their dental plans, critical illness, cancer and long-term care plans to go further than ever before. There are no magic ways to make a set dollar benefit in a policy to go further or last longer, but medical tourism offers that possibility.

2012 will be the biggest year yet for medical tourism as the insurance industry and the voluntary benefits industry adopts it with open arms, by choice or just to remain competitive.

Instant Insights /

Around the world in 80 co-pays: A look at medical tourism

More From HR Executive

Related Stories

Recommended For You