One-Way Road: The Realities of Medical Tourism

, medical tourism has emerged as a profitable industry only equipped to grow in the coming years.

But how big is it? Varying reports on revenue generated by medical tourism differentiate by 8 or 9 figures. An Allied Market Research report from October 2017 valued the global medical tourism market more than $61 billion in 2016. By their estimate, it should reach $165 billion in the next 5 years.

However the bottom line looks, the CDC believes about a third of it comes from the estimated hundreds of thousands of patients that leave the United States annually seeking treatment in other countries. Most patients pursuing treatment outside of the United States do so in hopes of saving money, though many are looking for shorter waiting lists, or treatments that may not be readily available or approved by the US Food and Drug Administration (FDA).

“Doctors are going to be dealing with patients who are asking questions about going outside the United States for care,” Leigh Turner, PhD, Associate Professor at the Center for Bioethics at the University of Minnesota, told MD Magazine. “They'll want to try and think carefully about how to respond when someone is asking questions about leaving the United States.”

Because insurers generally don’t cover the expenses of cosmetic surgery or dental work — and even patients with applicable insurance may be paying mostly out of pocket — they are among the most common procedures US residents are seeking in other countries.

Elaina George, MD, an ear, nose and throat specialist and author of Big Medicine: The Cost Of Corporate Control And How Doctors And Patients Working Together Can Rebuild A Better System, told MD Magazine that the majority of patients who go abroad for surgery are those with high deductible insurance or no insurance at all. To her, the increase in medical tourism reflects a broken healthcare system in the United States.

“I think it's grown dramatically after the Affordable Care Act passed,” George said. “There's a huge shift of the patient being hooked with paying more out of pocket.”

George noted that one of the main drivers of hiked US surgery prices that often push patients to medical tourism are facility fees — charges that the patient pays on top of the price of surgery to the hospital where their procedure takes place. Most health care facilities in other countries do not charge their patients these fees.

Rushing to the Business

As interest in medical tourism has grown, some insurance companies and US-based medical schools have adapted to the shift. Big-name research institutions, medical centers and universities such as Harvard Medical School, Johns Hopkins School of Medicine, and Duke University have established facilities and systems in Singapore, and the United Arab Emirates, for example.

“It's become a really big business,” George said. “Actually, some insurance companies are starting to cover care overseas because they've also figured out that it's a lot cheaper.”

Nonetheless, Turner believes the estimates of patients seeking care overseas may be inflated. Most patients who do go abroad for medical care rely on private companies or concierge services to connect them with providers. Turner says many companies try to provide this service, but few survive. The high rate of turnover may contribute to the misperceived rate of patients seeking care abroad.

“There are some signs suggesting that some of the larger numbers that get tossed around are probably overblown,” Turner said. “We're not talking about that large of a population that chooses to leave their local communities and go to another country for medical care. I don't think it's as easy to move patients around the world as it is to, say, ship electronics around the world.”

Travelers Beware

Even with concierge companies helping patients identify ideal locations for care, traveling for surgery comes with inherent risks. Every company is different, and some may not track patient outcomes or check for appropriate certifications, such as the Joint Commission International’s accreditation and certification. They may have different requirements for the security of patient data.

Depending on the location of the surgery, there may be risks for complications that differ from what one might experience in the United States. It is well-known that flying can increase the risk of blood clots and pulmonary emboli, but receiving care in other countries may also increase the risk of unique infections. While antibiotic resistance is a risk throughout the world, patients in other countries can get exposed to different resistant strains of bacteria, which may be more difficult to treat.

In some cases, patients are exposed to an infection during surgery, but do not display symptoms until after they’ve returned home. Last year, several patients who traveled to the Dominican Republic for cosmetic surgery were diagnosed with nontuberculosis mycobacterial infections months after returning home. The skin infection causes progressive disfiguration and can require substantial medical or surgical treatment. It has been known as one of the infections commonly associated with traveling abroad for medical care.

The risks may be even greater for patients seeking treatments that aren’t approved in the United States. In 2014, several patients who traveled to Germany for intramuscular live stem cell injections from sheep developed Q fever, a difficult disease to diagnose and treat, which presents flu-like symptoms and can be life-threatening.

One of the most important factors patients must consider is continuity of care. Patients and doctors need to have a plan in place for how to continue recovering from surgery when they return to the United States, and should consider discussing how to handle complications should they arise. The CDC recommends saving package inserts from all drugs obtained overseas, and consulting the CDC Yellowbook — a resource that they update and publish every 2 years with guidelines for avoiding infections when traveling abroad, whether for medical care or any other reason for travel.

Aside from being prepared to guide patients to safe decisions about receiving care in other countries, DGeorge suggests doctors review their own pricing structures to encourage patients to stay in the United States. She runs a cash-based practice, rather than dealing through insurance. She lists her fees as flat-rates online, to avoid any surprises for patients.

“Patients are getting a little bit more consumer savvy because they kind of have to be,” George said. “I think doctors in the United States should get into the cash-based game because there's no reason that a patient needs to go outside of the country. We could capture these patients who are leaving the country and they would stay.”

Turner emphasized that leaving the country for care is unlikely to be a patient’s first choice, and that people with serious health problems would rather be with their families, friends, and community during their care.

But it doesn’t take much to see the reality behind the US medical tourism industry.

“There are an awful lot of Americans who struggle with the cost of medical care,” Turner said.