Can Medical Tourism Save Us From Obamacare?

Outside of the United States, going to another country for medical care can lead to survival and recovery for patients otherwise facing certain death or long waits for treatment at home. Nigeria has no oncological care to speak of, so cancer-stricken citizens are increasingly going abroad for modern care. Battle-wounded Syrians are getting life-saving surgeries in Turkish hospitals. Canadians come to the U.S. to avoid average wait times of four months for non-emergency procedures.

If the double whammy of Obamacare, which will be fully up and running in 2014, and a rapidly aging population creates pronounced health-care shortages, more and more Americans may soon start looking abroad for fast, affordable, and effective treatments for all sorts of medical problems.

The global health-care industry is booming, which is creating new opportunities for medical travelers to purchase everything from discount dental work to state-of-the-art heart surgery. The international accreditation agency known as Joint Commission International evaluates the quality of hospitals around the world. It has given its stamp of approval to 546 hospitals worldwide and the list is growing faster than ever.

Foreign governments and hospitals are staking big dollars on promotion and infrastructure in an effort to burnish their reputations as medical destinations. That enthusiasm was on display last October at a medical tourism industry conference in Miami, which drew participants from 90 countries. Turkey, which paid close to $100,000 in exchange for prominent branding at the conference, drew 500,000 foreign patients in 2011. Medical tourists brought the country $3.5 billion in revenue in 2011, according to the head of the Turkish Healthcare Travel Council, Emin Çakmak.

Josef Woodman is the founder of Patients Beyond Borders and the author of several guidebooks to the medical tourism industry. He says foreign hospitals face more pressure to keep their costs down than their U.S. counterparts because their patients generally pay their bills out of pocket. And even highly skilled doctors in most countries earn significantly less than in the U.S. In India, heart-valve replacement surgery costs one-tenth of what U.S. hospitals charge. A knee replacement in Thailand runs about one-third of the U.S. price. In South Korea, gastric bypass surgery can be had for half the U.S. price.

The globalization of health care means countries are specializing in certain kinds of care. Turkey excels in pediatric cardiology. Singapore is a destination for oncological care. Chinese heart patients needing top-notch angioplasty go to Japan. Israel and Barbados excel in fertility treatment. Costa Rica and Hungary have become dentistry destinations. Thailand excels in a wide range of specialties thanks in part to its renowned Bumrungrad International Hospital, which serves 400,000 foreign patients a year.

Port Charlotte, Florida-based orthopedist Sam Hess is part of a group that's working to open a full-service hospital on the Caribbean island of St. Maarten. Hess says he's grown tired of the legal and bureaucratic headaches of practicing medicine in the U.S. "I still love what I do, but the issues I have to deal with that have nothing to do with patient care take a lot of wind out of my sails," explains Hess. "We have to assign more and more of our staff to address insurance concerns and approvals. We order tests we don't need to cover ourselves legally."

Hess would also like the freedom to offer treatments that aren't legal yet in the U.S. Medical tourism offers doctors and patients a way around the FDA's often slow-moving approval process. Consider an orthopedic procedure called Birmingham Hip Resurfacing that gives younger patients an alternative to a total hip replacement. It was invented by a British Surgeon in 1991, but the FDA didn't approve the technique until 2006. In the interim, patients flocked to Chennai, India, to be treated by star surgeon Vijay Bose.

Medical travelers don't always make wise choices. Many seek out bogus stem-cell treatments for disorders like autism, multiple sclerosis, Down syndrome, and depression. Researchers anticipate that one day stem cells will be used to treat a broad range of diseases and conditions, but so far they've have been clinically proven effective only for certain blood disorders.

Harvard Law professor I. Glenn Cohen, the author of a new book about the globalization of health care, says the stem-cell industry could be largely self-regulating if patients had access to better information online. The scarcity of reliable performance data is a major problem in the medical tourism industry, according to Harvard Medical School Professor Sharon Kleefield, who is working on developing better methods for gathering information from foreign hospitals. There's no ranking of the best global hospitals by specialty, which Kleefield thinks would go a long way towards convincing skittish U.S. employers and insurance companies to partner with foreign health-care providers.

Most medical tourists traveling out of the U.S. are seeking procedures that traditional health insurance companies don't cover - such as dental work, plastic surgery, and in vitro fertilization (IVF). But that's likely to change as health care becomes scarcer. Obamacare, which will be fully enacted in 2014, increases the demand for health care without doing much to grow the number of doctors, nurses, and hospital beds necessary to meet that demand. The aging of the baby boom generation (those born between 1946 and 1964) is already putting a strain on resources. By 2025, there will be 64 million Americans over the age of 65. That's almost double the number at the start of the century.

Some U.S. patients will follow in the footsteps of the nearly 50,000 Canadians a year who forego their insurance coverage and pay out of pocket for better and immediate treatment abroad. Medical tourism may also flourish within the regulatory confines of Obamacare. Southern Methodist University's Nathan Cortez argues in an soon-to-be published essay that there's nothing in the Affordable Care Act that specifically prohibits insurance companies from encouraging their clients to use foreign providers. It's also possible that insurance plans that utilize medical tourism could be offered on the state-based insurance exchanges, although the U.S. Department of Health and Human Services may choose to interpret the law in ways that makes that difficult.

Whatever the hurdles, the often-impeccable quality and low prices available abroad will lead more patients to travel for treatment in the coming years. "You're going to see huge competitive forces coming to bear on the U.S. health care system," says Josef Woodman of Patients Beyond Borders. "And god knows, we need it."

Video shot, edited, narrated, and written by Jim Epstein.

Approximately 4 minutes.

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