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Employers, Insurers Consider Overseas Health Care

Kevin Stewart, who received a liver transplant in India, is recuperating in Florida's Big Pine Key.
Greg Allen, NPR
Kevin Stewart, who received a liver transplant in India, is recuperating in Florida's Big Pine Key.
An Arab family waits outside Bumrungrad International Hospital in Bangkok, which attracts patients from across the world, in 2005.
Saeed Khan / AFP/Getty Images
AFP/Getty Images
An Arab family waits outside Bumrungrad International Hospital in Bangkok, which attracts patients from across the world, in 2005.

Maybe you're going to have surgery, a serious but routine procedure like hip replacement, cataract removal, a heart bypass.

Would you prefer to have it done at your local hospital or at one in Singapore, Thailand or Costa Rica? That's a choice Americans are increasingly being asked to make.

"Medical tourism" — traveling overseas for medical care — was first embraced by consumers. But it's now also being looked at by employers and health insurance companies.

The name can be misleading. While there are many people who choose a medical procedure in an exotic locale so they can enjoy the travel experience, medical tourism also includes people like Kevin Stewart. Last year, he learned he had cirrhosis of the liver and that a liver transplant was his only option.

Looking Overseas for Help

Stewart had his own landscape maintenance business in Naples, Fla., but because of high premiums, he had let his health insurance lapse. Fortunately, he had a potential donor — his sister — and he began calling hospitals to see how much a liver transplant might cost.

"It was $30,000 for them to check me out to see how badly I needed a liver. And, if they decided I needed a liver transplant, I should pay them $300,000," he says.

That was more than he could afford.

With his sister's encouragement, Stewart began looking to other countries for medical treatment. He contacted a medical tourism Web site, WorldMed Assist, which researched his situation and came back with two hospitals that could perform the liver transplant — both in India.

Stewart quickly settled on a hospital in New Delhi and a surgeon who, at that time, had already performed 120 similar liver transplants. It was an easy decision, he says, in part because it was really his only option. But others saw it differently.

"Everybody I spoke to thought I was a crazy person. 'Why would you go there ... you're going to get infected, it's a dirty place...' Now I'm certainly happy to spread the word to people that you do have choices. You don't have to lay down and die," he says.

Four months after the transplant, Stewart is doing great — recuperating in the Florida Keys — and looking forward to getting out on his boat for snorkeling and fishing. The total cost of his medical treatment and his travel to India? Less than $90,000 — about one-quarter of what he would have paid in the United States.

'Great Quality, Immediate Service'

It's an extreme example, but by no means unusual. Numbers are hard to come by, but it's estimated that a half-million Americans traveled to a foreign country for medical treatment last year. Many go to clinics just over the Mexican border that specialize in dental implants or lap-band surgery for obesity.

But increasingly large numbers are going farther — to hospitals in Costa Rica, Thailand and India — for hip joint resurfacing, kidney transplants and prostate surgery.

Probably no institution serves more foreign patients than Bumrungrad International Hospital in Bangkok — 450,000 last year alone. Ruben Toral, a medical tourism consultant who works with Bumrungrad and other hospitals throughout Asia, says the appeal is simple: It's about value.

"Great quality, immediate service," he says.

Toral says it's service that "you'd never find in an American hospital or even a European hospital. Price ... is going to be anywhere from one-half to one-eighth the cost of health care in the United States. And access — you can see a doctor when you want to see a doctor. There is no issue of waiting."

Toral and some of the hospitals he represents recently joined with other institutions in the United States and around the world to form a trade group, the Medical Tourism Association.

They are working to bring some order to the rapidly expanding universe of global medical care. One goal is to make medical tourism appealing not just to the uninsured, but also to employers and health insurance carriers.

"If the insurance companies created essentially an international provider network where people could actually choose to go overseas for health care in exchange for lower premiums, lower co-pays, that ... would be a very attractive alternative for corporations who are looking at lowering their health care costs," Toral says.

Interest from Insurance Companies

In fact, many health insurance carriers are looking at medical tourism. A few have already begun to offer it as an option to their members. One of the pioneers is OptiMed Health/United Group Programs, a health insurance carrier that, more than a year ago, began offering medical treatment abroad to its members.

Overseas treatment is offered just as an option, but there are inducements. The company covers all travel and expenses, eliminates the member's deductible and co-pay and now, in some cases, offers to pay the patient $5,000 in cash.

With all that, former OptiMed executive Jonathan Edelheit says medical tourism is still a good deal for insurance companies and employers. "Oh, absolutely," he says. "Because for a heart procedure that might cost $100,000 here in the United States, it might cost $9,000 in Asia."

Edelheit, now president of the Medical Tourism Association, says although several insurance companies have joined his group, most big carriers aren't yet ready to jump into medical tourism. One reason is liability. If there are bad outcomes, Americans who receive medical treatment abroad will find it difficult, if not impossible, to sue for malpractice overseas. Some insurance carriers are leery that might leave them vulnerable to lawsuits.

Another big issue is the quality of care. What assurances are there that a hospital in a foreign country measures up to American standards? Edelheit says his association is working to develop benchmarks that will allow consumers to compare U.S. hospitals with those overseas, measuring things like infection rates, success rates and mortality rates in a hospital.

Edelheit says the benchmarks will allow consumers to know what kind of care they can expect from a foreign hospital.

"They know this hospital has a 3 percent infection rate per thousand people versus this one that has an 8 percent. And obviously, you'd want to go to a hospital that has better care, which means lower infection rates and higher positive outcomes," he says.

Taking on Additional Risk

But as medical tourism grows, Nathan Cortez sees a danger. Cortez, an assistant law professor at Southern Methodist University, is publishing a paper soon on medical tourism. In signing waivers and agreeing to overseas treatment where malpractice lawsuits are impractical, he says, patients should be aware they are assuming additional risk, and he believes they should be compensated for it.

While patients should be free to travel overseas and reap savings if they wish, one consequence may be that people who insist on receiving treatment only in the United States will end up paying more, he says.

"We see this all the time with other industries," Cortez says. "Health care has been notoriously a local industry, and now it's ... succumbing to globalization like other industries have."

Concerns about the outsourcing of American health care jobs have led some unions and employers to oppose medical tourism. But those opponents don't include leading members of the U.S. medical establishment. Both the American Hospital Association and the American Medical Association have looked at medical tourism and, so far at least, they are remaining neutral.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

Greg Allen
As NPR's Miami correspondent, Greg Allen reports on the diverse issues and developments tied to the Southeast. He covers everything from breaking news to economic and political stories to arts and environmental stories. He moved into this role in 2006, after four years as NPR's Midwest correspondent.