Volunteering overseas gives travel a purpose Although traveling to other countries forspecialized care was not uncommon before the turn of the century,the early 2000s saw a definite boom in the medical tourismindustry.
(Photo: Shutterstock)

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Medical tourism is not a new phenomena—in factit goes back to ancient Greece, where people would flock to templesof gods dedicated to the healing arts. In U.S. history,destinations such as hot springs drew thousands, includingPresident Franklin Roosevelt, who found relief from symptomsassociated with polio.

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But medical tourism in modern times has centered around twoconcepts: expertise and affordability. Some centers of excellence, such as Mayo Clinic orJohns Hopkins, draw patients from across the U.S. and othernations, due to their reputation for quality.

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On the other hand, some countries and hospitals in other nationshave become destination for specific types of care. After aneconomic crisis in the late '70s, Thailand's government invested in medicalcenters that specialized in plastic surgery and sex changeprocedures. The country's decision to focus on a medical need thathad growing demand and few practitioners helped it became one ofthe top destinations for medical tourism. Other countries havefollowed suit by developing centers that specialize in areas suchas orthopedic surgery, dental procedures and gastric surgery.

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Price is also a factor in many destination medical centersaround the world. According to the Medical TourismAssociation, U.S. citizens can save between 50 percent and 80percent on medical procedures done outside the U.S., which has someof the most expensive health care costs in the world. For example,knee replacement may cost $35,000 in the U.S., but could be donefor as little as $6,600 in India.

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On the other hand insurance coverage, type of procedure, risk ofcomplications, language barriers—all are factors that maycomplicate a decision on medical tourism for individual patients.This two-part series will look at the recent history of medicaltourism in its first part, followed by a discussion on how brokersand employers are viewing the concept today.

How the ACA changed the playing field

Although traveling to other countries for specialized care wasnot uncommon before the turn of the century, the early 2000s saw adefinite boom in the medical tourism industry.Many start-up companies began offering patients options in variouscountries for care.

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“In 2006, 2007, there seemed to be a flurry of interest aroundthis topic,” says Leigh Turner, PhD, a professor of Bioethics atthe University of Minnesota. “There was a proliferation ofbusinesses engaged in promoting this model. It was no longer justindividuals making decisions for themselves, there was a wholenetwork of medical tourism companies, which took on the role ofhelping people to get to their destinations.”

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However, at least some of this was driven by the complicated andsome might say dysfunctional health care system in the U.S. At thetime, a significant number of Americans were unable to obtaininsurance coverage due to pre-existing conditions or otherexclusions—which limited their care options in this country. Manypatients were not impoverished, but if they lacked coverage and hadto pay out-of-pocket, the lower-priced options in other countriescould be an attractive alternative.

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With more patients looking at those options, the future ofmedical tourism seemed bright. But the passage of the AffordableCare Act in 2010 resulted in a major re-structuring of theinsurance landscape. Insurers no longer could drop coverage forpatients because of pre-existing conditions. Other exclusions suchas lifetime caps were also ended. As a result, the medical tourismoption still was attractive for some, but not nearly the necessityit might have been for others.

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“In the US, lack of health insurance, or being underinsured, hasbeen a driver of medical tourism,” Turner says. “With passage ofACA, we've seen the number of Americans who travel for caredropping off.” However, he noted, it has been difficult to documentthe changes in demand. “There's not great quantitative data on UScitizens going for medical care in other countries,” Turnernotes.

Is direct contracting the future?

With the shift in demand from U.S. patients after the passage ofthe ACA, some medical tourism companies closed up shop—but the concept has continued toevolve.

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Recently, medical tourism has less focus on overseas facilities,and more on centers of excellence in the U.S., with insurers andemployers seeking partners in the provider community to help themhold down costs.

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According to Renee-Marie Stephano, president of the MedicalTourism Association, her organization started out as a resource forU.S. patients who needed information on medical travel optionsoverseas, but today the association does much of its work withmedical centers in this country.

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“When we started it was really focused on outbound travel fromthe US,” she says. “But through the years we've developed quite amarket for domestic medical travel. It's always based on the valueproposition, but in general it's easier to convince employees totravel to a different state than to a different country [forcare].”

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Stephano points out that a higher volume of procedures leads toboth lower prices and greater expertise, and that's true forproviders no matter where they are. “US hospitals didn't alwaysbelieve they were in the business of medical tourism, although theydid have inbound patients from other countries,” she says. “Today,we're seeing that they feel that they need to proactively buildtheir brand and diversify their income.”

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In part two of this story, we'll look at how employers areworking with providers to bundle care and create direct contractingfor medical services at destination facilities. The evolution ofmedical tourism may be keeping patients closer to home, buttraveling to find the best health care solution is still a conceptthat appeals to many.

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