Medical tourism: What questions should health plans and employers be asking?

Until now, medical tourism has mainly been a self-pay phenomenon. But over time the patient base has expanded from the plastic surgery crowd to the uninsured and underinsured. Now health plans and employers have started to ask what role medical tourism can play for them. We’ve been receiving a number of inquiries on the topic at my consulting firm, MedPharma Partners. Soon we’ll be developing a medical tourism white paper. In the meantime, here are some questions health plans and employers should be asking:

  1. Should I include overseas providers in my network at all? If so, which ones?
    • For some payers the time is now. For others waiting to learn from the experience of others will make more sense
    • The providers that are popular with self-pay patients may or may not be the right ones. Proximity, local infrastructure, quality and capacity may be more important considerations for employers and health plans
  2. How should I engage my employees or members? Should I require patients to travel or should I make it optional?
    • The moment health plans and employers start to encourage the use of overseas providers they will be met with suspicion, but there are ways around this. Making overseas care optional will reduce the suspicion but limit the savings
    • It’s important to let prospective traveling patients engage with their peers. That’s one objective of the forums at MedTripInfo
    • It can also make sense to share some of the financial benefits with employees and members or simply to grant them additional vacation time, which they can enjoy overseas
  3. How do I guarantee quality and overcome the challenges of patient safety?
    • You might want to ask this of your local providers, too! But seriously, there are international accreditation bodies like JCI. Also, many overseas hospitals are going over and above those requirements
  4. What about medical malpractice and liability?
    • That’s a tough one to address and we’ll see what evolves. There are promising approaches emerging involving arbitration and insurance for complications
    • This may be a hard argument to make, but patients actually don’t have great recourse in the US when things go wrong. Cases take several years to reach trial and plaintiffs usually lose, unlike in other personal injury cases
  5. How will pre- and post-travel care be coordinated?
    • This issue needs to be addressed differently depending on the procedure and patient population
    • It’s essential to work with your existing provider network rather than handling medical tourism in a vacuum
  6. Should I contract with providers directly or work through an aggregator?
    • It will be difficult to develop and maintain a comprehensive network on your own so working with one of the emerging provider networks is a better idea
  7. What procedures and treatments should be included?
    • This will depend on your patient population but it will generally include orthopedic and cardiac surgery
  8. How much am I likely to save and how can I increase that number?
    • Most of the estimates tossed around, touting “90% savings” and so on are based on a comparison of US charges with the price paid overseas. First of all, only the uninsured get stuck paying charges, plus you’ll need to factor in the costs of travel –maybe also for a companion. I haven’t seen a really good estimate of the true savings potential for an insured population
  9. How will domestic providers react?
    • Depends on how they’re managed, and this is one place where the interests of health plans and employers may diverge. Health plans may want to use the threat of sending patients abroad in order to beat down providers on price. Employers are more interested in maintaining relationships
  10. What is the relationship between medical tourism and consumer directed health plans?
    • In theory patients with consumer directed plans are a great fit for medical tourism. In practice, they may blow through their HSA even at steeply discounted international prices, so it may not make that much of a difference
  11. How well does medical tourism fit with limited benefit/”mini-med” plans?
    • Potentially very well. It offers the opportunity to include a major medical component at an affordable price
    If you’d like to discuss these topics or receive a copy of the white paper when it’s published, send me an email: dwilliams@mppllc.com

    August 9, 2007

8 thoughts on “Medical tourism: What questions should health plans and employers be asking?”

  1. Hi David,

    Congrats on your three years! Thanks for your dedication to informing people and being an advocate. Re-reading your celebratory posts here, I wanted to respond as an advocate as well to a couple points here about Medical Tourism…

    5. How will pre- and post-travel care be coordinated?
    This issue needs to be addressed differently depending on the procedure and patient population
    It’s essential to work with your existing provider network rather than handling medical tourism in a vacuum .

    –> Pre and post care IS essential and wound care in the post op period is grossly neglected when consumers alone think about their budget and overall experience. Unfortunately, providers now looking at sending patients abroad, have not even considered the “consequences” involved if medically appropriate post op care is not provided and professionally coordinated and whose responsibility it is. Is it the hospital? So what if the hospital is “accredited.” How is the patient managed after discharge and while they are still in the “care” of the Health Plan that sent them to the country for treatment. Treatment does NOT stop at the hospital in the unique case of Medical Tourism. The Patient is staying for an extended time to heal, and this post op period is still the responsibility of whomever sent the patient to the country. The ENTIRE patient experience must be considered, not just hospital accreditation.

    Thank you! See you in Vegas for more on this!
    Blessings,
    Christina deMoraes, BA, CMC
    President,
    MedNetBrazil Concierge Services, Inc.

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  4. Although, I agree with your discussion. I still feel that as professionals instead of focusing on the ‘business’ aspect of healthcare, we should direct our efforts in making our clinical skills more sound. Below is a nice website, where you can start.
    Rajesh
    http://www.Rxnotes.net
    1. Central searchable repository of a pharmacists ‘curb-side’ notes.
    2. Transition between hospital and retail settings, your notes can transition with you, not your job!
    3. For access from anywhere, when I do not have direct access to my references/websites.
    4. For the Pharmacist, BY the Pharmacist.

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