Medical Tourism in the Sceptered Isle

A recurring topic at IB over the past couple of years is a phenomenon known as “medical tourism” – basically, patients who seek medical care outside their own country. Medical tourists take advantage of the high-quality care, and the technology for delivering such care, that is increasingly available around the world - including many so-called third world nations – at a fraction of its cost at home. Not a surprise that up to now, medical tourists tend to be wealthier patients and tend to come from wealthier nations.

Some nations – especially Jordan, Bahrain, Qatar – are spending billions to construct first-class medical facilities, and have contracted with high-profile U.S. health care organizations – Harvard and Johns Hopkins Medical schools, for example, and Cleveland Clinic – to help equip and staff the facilities, and ensure the delivery of a “world-class” level of care. Nations such as India, Thailand, South Africa, and others too have built a fair number of truly excellent health care facilities that also cost far less than in the U.S. and perhaps surprisingly, less than in Western Europe as well. And they deliver arguably equivalent care.

Medical tourism among Americans has been steadily growing even though it still represents a tiny fraction of total Ameerican spending on health care.

But now comes news that medical tourism is rapidly growing in the U.K.

This should be a surprise to most Americans. In the first place, most Americans believe care in the U.K. is “free”. No Brit needs to seek care in another country in order to save money. And in the second place, most Americans believe that access to health care, the quality of health care received, and finally the resulting health of the British population are superior to the U.S. And in large part, such superior outcomes are believed to be a natural product of the single-payer U.K. system. Nevertheless, medical tourism is present, and growing rapidly in the U.K. That’s surprising – at least to me it is.

As reported in the London Daily Mail, there seem to be two main reasons. First reason: to escape the waiting list for service. The average waiting time for specialist or hospital care, after one has seen one’s GP, is more than 4 months. In the U.S. we hear a lot of objection that the queues are imaginary. But medical tourists suggest that the queues in the U.K. are not imaginary after all. Second reason – and more recently: to escape superbug infections in NHS hospitals. Both reasons involve, at least as reported in the Daily Mail, the desire to “escape” the NHS.

The head of a British patient advocacy group believes that Medical tourism reflects “shrinking public faith in the Government's handling of the NHS”. The shadow health secretary (the shadow knows) says the growth in medical tourism figures are “a terrible indictment of government policies” that were “undermining the efforts of NHS staff”. In other words, the blame is being aimed directly at the government – not at doctors or hospitals, or other clinical staff for that matter.

And this is a very important distinction. Brits are not afraid of their doctors. But they seem to be losing confidence in their health care system. More people seem to believe their government is mismanaging NHS and this naturally leads to fear of NHS. So the growing phenomenon of medical tourism may well reflect the growing dissatisfaction with government mismanagement of the health care system. Voting with your feet, I guess you could say.

One department of health official stated that “almost half of patients were treated within 18 weeks of seeing a GP.” Almost half, eh? So the median wait is even longer than 18 weeks? The same official added “Most people who had hospital care did not contract infections.” Is it reassuring to be told that "most” people won't be infected by the hospital they are in? Government statements like these make it easy to understand why people are mistrustful.

The incidence of medical tourism in the U.K. is still quite small but I think the important questions are: how soon can the government restore public confidence in their ability to manage NHS? And how exactly will they go about it?

Medical Tourism Interview: An InsureBlog Exclusive

Last month, we mentioned a new resource available to those wishing to travel abroad for medical care. All Medical Tourism's site offers a variety of tools to help one determine availability and cost of various treatments. I was so impressed with the site that I contacted the folks behind AMT for more details.

I soon received a reply from Michael Thomas, the company's Chairman and CEO. We met up by phone last Friday, and here's what I learned:

InsureBlog (IB): What was your motivation to put this together?

Michael Thomas (MT): Back in 2000 or 2001, I received a gift certificate for a full checkup in Atlanta. I was impressed and began to make it an annual occurrence. A few years later, I found myself spending more and more time in Bangkok, and while there, check-up time rolled around. I decided to try out a local facility to see how it compared with the one in Atlanta, and my eyes were really opened. For one thing, the checkup in Atlanta cost about $3700 in total; in contrast, the one in Bangkok was only about $450. But the Bangkok facility was much nicer, the exam more thorough, and I had test results in a day instead of a week or more.

I eventually decided to "become a little wiser" and look into this as both a cost- and health-saving technique. So I began meeting with hospital administrators in Bangkok and Singapore, where I picked up a lot of general information on medical tourism, but had some difficulty with more specific kinds of details.

My experience with the Bangkok checkup was that these were more professional services than in the 'States; here, "preventive medicine is immature;" we're more geared to the reactive and the preventive.

IB: That's very interesting. So when you started putting this together, and as you continue to grow, how do you "vet" providers? We've interviewed the folks at Companion Global, who offer similar services, and they use Joint Commission International accredited facilities.

MT: As we sign up new providers we provide a clear listing of each provider in our directory. There, we outline the medical accreditations and if they are a member of the medical tourism association, as well as clearly state each provider's area of specialties. I think that they do their work thoroughly as we seek patient feedback regarding their interactions and satisfaction with providers, and in over two years we have not had a single problematic issue to resolve.

IB: We believe that ObamaCare© will have a negative impact on health care delivery here in the US. What's your take?

MT: Oh, absolutely. In fact, we recently put together a presentation on this issue, where we show that:

■ More employers will implement medical tourism as a method of cost-savings

■ As a result of the sudden increase of newly-insured, waiting times and doctor shortages will grow, making medical tourism even more attractive

■ As Medicare rolls continue to grow while reimbursement levels shrink, more hospitals here will opt out of Medicare altogether, exacerbating the situation

[ed: copies of the full presentation are available; just drop us a line]

It's really a case of simple supply and demand.

Michael, Thank You so much for your time and insights. We'll be sure to pass along any comments and questions from our readers.

Medical Migration? Medical Tourism? Medical Exile? Whaaaaaa?

Three random topics.    Or    so    I    thought.

1. Medical Migration?  A former employee of the Johns Hopkins Health System has accused the System of violating state and federal regulation by admitting out-of-state patients in preference to Maryland residents.  In other words, the Hospital is “migrating” out-of-state patients into Maryland.

Maryland sets an annual global budget for each of its hospitals.  The federal government also participates in the regulations, by requiring that the hospitals comply with the state-set budgets.  I suppose the feds’ interest is that they finance Medicare and share in the financing of Medicaid.  But the global budgets apply only to residents of Maryland.  Hospital revenues from out-of-state patients – “medical migrants” - are outside the global budgets and thus produce unregulated additional revenues for the hospitals. 

Hopkins’ former employee alleges Hospital management pressured staff to migrate out-of-state patients into Hopkins Hospital, taking beds that might otherwise have been available to Maryland residents, and generating revenues that Maryland residents would not have generated.  Hopkins has responded that “Our census shows that the majority of our patients are from Maryland and that the number has steadily increased over the past several years” - which is fine as far as it goes, but does not directly or fully answer the issue.  A judge will have to sort all this out.

2.  Medical Tourism?  This term describes a growing international trend among patients seeking medical care outside their own country. It has been a recurring topic at InsureBlog over the past few years - here is an old post from 2007; there are many others. 

Medical migration is similar to medical tourism because both have similar motivations and similar ends:  the unbreakable linkage between money and medical care, and access to medical care that may not be locally available. The Johns Hopkins situation is not exactly medical tourism because it involves movement between states in the same country, not between two different countries. Yet it may be evidence that U.S. patients are becoming more willing to travel for their medical care.   And, of course, it’s also evidence of hospitals’ continuing creative efforts to improve their revenues.  

3.  Medical Exile?  On December 30, British media source The Telegraph reported that “SNP [Scottish National Party] ministers are under pressure over their ‘mismanagement’ ofScotland’s NHS after it emerged the number of patients being sent to otherparts of the UK for specialist treatment has increased by almost 50 per cent.”

 What’s that?  Scotland is “exiling” certain patients to other countries in the U.K. for medical treatment? 

It’s complicated.  It seems Scotland has allowed at least 460 NHS specialist positions (plus an additional unspecified number of nurse positions) to go unstaffed.  As a result, a growing number of Scottish patients face unexpected travel for specialist or routine nursing care.  NHS Scotland is sending these patients to England, Wales, or Northern Ireland.  NHS actually anticipated this as an infrequent contingency, so there are funding and administrative means in place to handle referrals.  But the recent, sharply increasing volume of such referrals was not anticipated.  Scotland has apparently been managing – or mismanaging - its understaffing problem by “exiling” patients to obtain care outside their own country, rather than filling the vacant specialist positions inside Scotland.  

The available information is hard to interpret.  For example, how does Scotland reimburse other U.K. specialists?  How does the sum of those reimbursements compare to the sum of the salaries and other employment costs for the 460 specialists the Scots would otherwise employ?  I can’t help but suspect one of those numbers is a fair bit larger than the other.

So why tie these three phenomena together?  Movement. 

Specifically, the movement of a growing number of patients willing - or obliged - to travel far from where they live, in order to access medical care.  Movement of patients within the U.S. to access medical care has been a  slow-growing thing for some years.  But in other parts of the world, such patient movement seems to be growing faster, and is more common across national borders.  And the worldwide phenomenon is not exclusively physician- or patient-driven. Governments are facilitating and, in some cases (i.e. Scotland), are requiring such travel. 

Is patient movement likely to improve care? Will it improve access? Balance patient loads? Result in better match of patient needs with services across local, national, and international medical care delivery systems?  Or will it be not so beneficial?  Will these trends instead end up exposing a world delivery system largely unprepared to meet the rising demand for medical care? Is this the start of some classic B-movie, in which a flooding river causes the dam to spring small leaks, as rising waters spill around and over the dam, and no one is listening to the few townspeople who notice what is happening?

Time will tell.  Meanwhile these phenomena are related, and do bear watching.

To boldly go where no patient has gone before

Here is a previously-unreported flavor of the “medical tourism” phenomenon.

InsureBlog has occasionally reported on medical tourism over the past several years.

The new flavor is "circumvention medical tourism" - - medical tourism for services that are illegal in the patient's home country but legal in the destination country.

The author of the linked circumvention article further believes that the “home” country should criminalize this behavior – which I suppose means that when the tourist comes home, she would be subject to prosecution.

I disagree, because I think there are practical as well as legal problems. However the suggestion does reminds me of a baseball story. A batter called out on strikes hurls his bat into the air. The umpire watches the bat spin upwards, then tells the player, “son if that bat comes down, you’re out of the game!”

Foreign Serendipity

My better half has long cautioned me that "there are no coincidences," but what am I to make of this?

First, my office email brings word from Golden Rule (Health) Insurance outlining "3 Reasons You Should Add International Health Insurance to Your Portfolio."

Among these are the opportunity to provide "an additional service to your current clients, and attract new ones, when you offer international health insurance ... International health insurance is a growing market and ... you can add a quoting link to your website that practically does all the work for you!"

WooHoo!

But where would these droves of new (international) clients go for medical care?

The King and I know (no, not that King):

"The Tourism Authority of Thailand’s Medical Tourism Blog Contest kicks off with cash and prizes worth nearly US$20,000 up for grabs, including a seven-day all-inclusive medical tour of Thailand for 12 finalists."

Yep, the Thai Tourism agency is sponsoring a blogging contest, with many valuable prizes. Me, I'd settle for a nice dish of pad thai , but I'm a simple guy. But say I was interested (or maybe Bob, Bill or Mike would like a round-trip to an exotic foreign land); what's the deal?

"In order to win, finalists must write the best blog post and attract the highest number of unique visitors."

Hmmm. Could you be more specific?

"The competition is open to anyone who has experience writing blogs related to tourism or medical tourism in English language or containing English language."

Ah hah! Thanks for clearing that up.

So, any takers?

Medical Tourism Coverage: Why in the World?

We've certainly blogged about Medical Tourism - traveling out of one's home country for medical care - but we've never really talked about how one pays for such care. Generally, these trips aren't covered by one's insurance, so they're primarily self-pay. That's fine if one has a few thousand extra dollars laying around, or can arrange financing, but what about us "regular folk?" Turns out, there's a whole cottage industry that offers to help fund these ventures, and I was fortunate enough to interview the president of one such company, Companion Global Healthcare's David Boucher. I spoke with David late last week, and asked him about how this kind of coverage works.

David's the former CEO of a hospital, and has extensive private sector experience from both that perspective and as an executive with Blue Cross of South Carolina.

IB: David, thank you for speaking with us about Medical Tourism Coverage. One of the major concerns folks have is the quality of the facilities available.

DB: Well, we don't use just any hospital; all the ones we use are JCI-accredited [ed: this is the Joint Commission International, which FoIB Rick Byrne tells us is " the same organization that Medicare requires American hospitals to be accredited by if they are to receive Medicare reimbursement."] We do an extensive onsite survey of each facility to make sure they meet - and continue to meet - our standards, not just JCI's.

IB: We've blogged about Canadians accessing American health care when their own system can't, or won't , help them. How does this impact that kind of care?

DB: It's not just Canadians, and they're not just driving to Detroit for care. Why should they, when they can get world-class care in Bangkok, and have a wonderful travel experience in the process? Our goal is the "no nurse call" metric; that is, a patient should never have to press that button. If they do, it means we haven't done our job.

Of course, we can't guarantee this every time, but our members consistently have a better experience in our foreign facilities than many American hospitals. And, of course, there are significant cost savings in using these types of facilities.

IB: That's great, but I'm looking at this as an agent, and I'm having a hard time picturing myself going to a small group client and saying, "hey, you should add - and pay for - this extra benefit." For one thing, even if MT saves on claims, why should my small business client care? His claims aren't really based on his group's experience.

A large group, especially one that's self-funded, might see some decent savings, but that's not the majority of businesses here. And from the employee's standpoint, there's even less incentive: he's got a deductible and co-insurance to pay regardless, what does he care of it saves the insurance company thousands of dollars on the other end?

DB: That's right, there'd be no real savings for small groups if we just treated this as an ancillary product, like dental or short term disability. But our plan is to package the product as an integral part of the group medical plan, and to convince carriers to add it to their portfolio as an additional benefit, a way to differentiate their policies from their competitors. We'd also like to see them make it more attractive to the employee; for example, by waiving the deductible or the co-insurance of that employee chose to use one of our overseas facilities. 

We're already seeing this pay off for our individual clients, by the way; our plan is included in Companion's mini-med product. If one has a limited benefit, which by definition these products do, then one's dollars can go a lot farther by traveling for care. A $2000 daily hospital benefit goes a lot farther in Costa Rica than Dayton, for example.

And it's not just medical care. We have a Global Dental product that provides the same kind of services and pricing. And it really shines because most of the big-ticket dental items are out-of-pocket for the consumer. Dental plans typically have a $1000 or $1500 annual maximum that they'll pay; if one is looking at a procedure that costs $15000 in the states, but $6000 in, say, Costa Rica, why wouldn't you take that trip?

IB: That's a lot to consider. Thanks for all your time, and we'll pass along any questins or comments our readers might have.

Medical Tourism and the ObamaTax

Now that the ObamaTax has been affirmed, it's time to look ahead. This means a shortage of providers and major increases in both premiums and health care costs. There's not much one can do about the increased premium side of the equation, but there are indeed ways to mitigate both the provider shortage and increased cost of care.

While medical tourism has been around a while (we first posted on the phenomenon over 6 years ago), it seems poised to really take flight under the ObamaTax regime:

"US patients obtain health care treatment in foreign countries well below US rates. Treatments include dental implants, hip and knee replacements or bariatric surgeries. Americans also go abroad for more complicated procedures such as heart operations and cancer treatment, or alternative therapies such as stem cell treatment unavailable at home."

And that's already occurring. As folks begin to see hospital waits getting longer and longer, and the costs of care getting higher and higher, it doesn't seem far-fetched that those who can will opt for a short (or long) plane ride, the expenses of which are potentially more than offset by the savings (and, of course, the actual delivery of care).

Pipe dream much, Henry?

Perhaps, but then again:

"Some US businesses already persuade employees to travel for treatment. Medical tourism experts see that becoming more common in the future. With incentives like deductible waivers, the plan saves money for the insurance company, the business and the employee."

And there's nothing preventing carriers from offering optional med-tourism riders or supplements. And competition among foreign providers for American patients may also prove enticing.

Time will tell.

ADDENDUM: Can't believe I missed something so obvious, but of course the Independent Payment Advisory Board (IPAB) Death Panels will also be a major driver of MedTourism. After all, if you or your loved one (or ones) face a literal death sentence, then a quick jaunt to (say) Costa Rica may seem pretty reasonable.

Evolution of Medical Tourism

It's been a while since we looked at medical tourism in-depth, although we did mention it yesterday when we noted that upwards of 60,000 Candians sought care outside that country's failing government-run health scheme.

And, perhaps more to the point, we reported in January that the "cost of international private medical insurance is climbing globally, with an inflation rate of 9.2 percent reported for 2016."

And, of course, the ACA has been steadily chipping away at physicians' incomes here at home.

Okay, Henry, very interesting, if disparate, items. What's your point?

Well, FoIB Dr Valerie Jones alerted us to this rapidly growing opportunity that uses virtual medical tourism to help boost actual physician income:

"This Startup Connects U.S. Doctors with Patients in China ... that deal in the domain of telemedicine, sometimes called telehealth, which uses technology to remotely connect doctors and patients otherwise separated by physical distance."

After all, what difference does it make if the patient is 10 miles away, or 6000? Other than the slight inconvenience of time-zone shifting, why not? And it's certainly a potential money-making powerhouse:

"Estimates on telemedicine’s market size vary  ... projects it will more than double from $25.53 billion in 2015 to $57.92 billion in 2020."

That's a lot of revenue for a few minutes on the phone (or Skype, etc).

Telehealth itself isn't all that new, but this application of it seems to be burgeoning. Definitely something to keep an eye on.

ObamaCare© Travelin': Medical Tourism under PPACA

Steven Lash, President of Satori World Medical, thinks that there's a silver lining in ObamaCare©: it's his belief that it will continue to fuel, and in fact increase the demand for, medical tourism. He bases this belief, in part, on the fact that this train-wreck has already begun to show the stress fractures in our system as a result of increased demand without adequate supply.

With Steven's permission, here's his take:

The changes in legislation [ed: ObamaCare©] will offer both positive and negative impacts to U.S. businesses. One of the benefits of the legislation is that we now know how the future of health care is going to be shaped. There are a specific set of deliverables and timetables that have been set.

With the completion of PPACA, businesses are focused again at looking for measures to save on rising health care costs. Because of this, businesses are starting to see a place in their employee benefit plans for medical travel.

With the addition of 40 million Americans having access to health insurance, there will be increased demand for health care services. Couple that with an existing shortage of nurses and doctors, queuing for medical care will be a natural by-product.

As the time to see a specialist increases, more individuals will seek to get immediate help through medical travel. Employers and employees will come to understand the high-quality health care that is available to them internationally as they look to end pain and ill health.

The PPACA utilizes similar features as the state-wide Massachusetts plan, which was implemented several years ago. In the Massachusetts plan, queuing for primary and specialty care has more than tripled the wait time for appointments and treatment.

As the low cost option, medical travel will be an attractive network option for employer-based medical plans.

Thanks Steven!

Medical Tourism Gone (Horribly) Wrong

It's been a while since we've covered Medical Tourism, but this one's a doozy.

For folks just tuning in, Medical Tourism is (basically) leaving one's home country to obtain care, often surgery or dental work, in another country where costs are lower. Unfortunately, he learned the hard way that "you get what you pay for:"

"Australian man dies days after traveling to Malaysia for cheaper plastic surgery"

Seems that 31 year old Leigh Aiple had traveled to Malaysia for a "tummy tuck, liposuction, an upper eye lift" and other appearance enhancements. What he got, though, was  "gaping holes, there was stitching everywhere."

How's that saying go? Oh, yeah.

Medical Tourism Update: Hold the Plane!

Despite the efforts of some carriers to promote so-called "medical tourism," the floundering economy is taking its toll on the nascent industry. Today's McPaper reports on a study "by the Deloitte Center for Health Solutions, a research center focused on trends in the health care system":

"From 2007 to 2009, the number of Americans traveling abroad for elective medical procedures is expected to have fallen as much as 13.6%"

That's quite a drop in such a short period. Of course, it's kind of a double-bind: folks look to overseas providers in order to save money on health care costs, but find that any savings is offset by incrweased travel costs and decreased assets.

Of course, this may be just a short-term hit; if and/or when the economy rebounds, one would expect that these folks will once again find that traveling abroad for certain procedures is a net savings. Indeed, the Center expects that "the number of American medical tourists will rise by 35% each year through 2012," due to "[p]ent-up demand and improvements in international medical care."

My Magic 8-Ball (on loan from Bob), though, says "Maybe."

A New Twist on an Old(er) Idea?

We've been blogging about Medical Tourism for going on 8 years. Generally, we've referred to two "flavors:"

1 - Foreign nationals taking advantage of what they perceive to be superior health care here in the US, and

2 - Americans traveling abroad for less expensive treatment, ostensibly as good as what's available here.

But there seems to be a new and growing trend: inter-state medical tourism.

Hunh?

Here's the idea:

"The phenomenon of this new trend in medical travel -- inter-state to Centers of Excellence (COEs) throughout the country and inbound to the U.S. – is largely the result of the impact of U.S. health reforms, employer receptivity to introducing a medical travel benefit, consumer willingness to travel to other parts of the United States to access quality care with improved outcomes, and increased demand for more cost-effective care"

Nate's discussed this idea before, that higher cost doesn't necessarily translate to better outcome. And there's a growing sense among employers that this is an area that can be addressed. Currently, it appears that only self-funded plans will be able to easily add this benefit, but one wonders if there'll be a move among the fully-insured crowd to do so.

One obstacle, of course, is the ObamaTax and its requirement for plan conformity. Perhaps this could be marketed as an "ancillary" benefit, available to groups (maybe even individuals) who are willing to pay for it.

Medical Tourism Rising

First, consider this:

"In choosing Berwick, the Obama administration is implicitly admitting that the health care law passed by the Democrats in March will lead to the rationing of health care ... seemed to acknowledge that the new health care law would simply ration care in a transparent way."

[Hat Tip: RWN]

Let's dispose of the silly meme that health insurers "ration" care in any way. They cannot make a person undergo a procedure, nor can they withhold treatment. Insurers can only decide, within the contractual terms of the policy, whether or not they will help to pay for any such care. And let's remember, the most egregious claims denier of all is not Aetna, or Blue Cross or United Healthcare. It's Medicare. It's worth noting that Medicare itself rations care (through, for example, its power over providers).

In the event, once we officially transition to a nationalized health care scheme, folks will still need care, they just won't be able to find it here. So what to do? Well, we've discussed medical tourism many times here, but one question that keeps cropping up is "okay, smart guy, I get it. But how do I find where to go?"

And that's where this handy new tool comes in:

"AllMedicalTourism.com has been founded by veterans in the consumer internet and healthcare fields to provide a trusted source of health information for consumers considering medical treatment abroad."

And so they have; click over to their site for a wealth of information on such things as fertility, heart surgery, even cancer treatment. Regular readers know our obsession with transparency; this site lists not only providers, but how much they charge. Is this the future of health care?

Time will tell.

[Hat Tip: SoIb Gail S]

The New Medical Tourism

It's a fairly common story these days:

"Thousands of "health tourists" are going as far as India, Malaysia and South Africa for major operations – such is their despair over the quality of health services."

But they're not leaving Hoboken or Kokomo, or even LA:

"The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration with NHS waiting lists are fuelling the increasing trend."

What's interesting is that we see "medical tourism" here, as well, but it's all about price. There are no waiting lines, and few concerns about quality of care. Americans are famous bargain hunters, and medical care doesn't seem immune.

But for our cousins across The Pond, it's quite obviously not about price (after all, it's "free"), but the very real lack of care, both in quantity (waiting lists) and quality (lack of sanitation, for example).

"More than 70,000 Britons will have treatment abroad this year – a figure that is forecast to rise to almost 200,000 by the end of the decade."

That's a lot of "tourists."

Medical Tourism (with a twist)

Medical tourism (that is, traveling outside the country for medical care) has been a recurring theme here at IB. The rationale for this phenomenon has been almost exclusively for price; quality of care has been, if considered at all, an afterthought.

But what if that quality of care was the primary reason to travel outside one's native land for needed health care?

"[Canadian] Liberal MP Belinda Stronach, who is battling breast cancer, travelled to California last June for an operation that was recommended as part of her treatment."

And just why did the Hon Ms Stronach make the trip? For treatment of a "later-stage" operation in the U.S. after a Toronto doctor referred her.

But hold on there, pardner. I thought that the "free" Canadian health care system was far superior to our own "broken" one. Why would a leading Canadian pol make the trip stateside if that were true?

Well, one might suppose that since it was her very life on the line, she knew that she could trust good old American know-how over her fellow countrymen's less effective level of care.

Granted, Ms Stronach has some political "issues" of her own (as chronicled by the indefatigable Cap'n Ed), but she apparently knows a good thing when she sees it:

"MacEachern said the decision was made because the U.S. hospital was the best place to have it done due to the type of surgery required."

"The best place."

Hmmm...

Medical Tourism: Maybe not ready for Prime Time, after all

Over the years, we've been cheering on the relatively recent phenomenon of medical tourism. On the one hand, it's been a real blessing for folks stuck in a mediocre health care system. There, the question isn't price so much as quality (or lack thereof at home).

But what about folks with access to high quality, but perhaps also high cost, care?

As we predicted a few years ago, ObamaCare seems to have increased interest in less expensive, foreign-based solutions. These are not, however, without their own problems:

"[S]ometimes, cheap medical work can come with a high price -- as the recent case of a Florida woman illustrates ...  the implanted teeth were too large and were poorly aligned. Today, she claims, she is in constant pain, has bleeding gums, and can't eat solid food."

In fairness, we have but one side of the story here, and sometimes you get what you pay for.

Has Medical Tourism Jumped the Shark?

Over the years, we've written many times about medical tourism: from folks traveling to the US for treatments to folks who found better options abroad.

But this, this boggles the mind:

"The number of foreigners traveling to Switzerland to commit assisted suicide doubled over a four-year period"

Europeans made up the bulks of their "customers," the article didn't mention how many Yankees participated.

Tacos, Tequila and (Medical) Tourism

Medical Tourism has been a frequent topic here at IB, so this tweet from FoIB Dr Kris Held caught my eye:

Yesterday I saw a precious lady patient who suffers with severe pain from rheumatoid arthritis.She told me she had to seek care just across the border in Mexico recently, because she could not find a rheumatologist who could see her before July! Unreal. @AAPSonline @SeemaCMS

— Kris Held,MD (@kksheld) February 20, 2018

Perhaps not-so-coincidentally, I recently received this in email:

[click here for full graphic]

There are, of course, downsides to traveling to foreign lands for health care, and one wonders how (or even if) such care is covered under one's insurance. But there's no question that actually receiving timely care seems to be a lot more important than owning an insurance ID card that doesn't actually provide it.

[Hat Tip: Lisa B]

Singer Quits, Medical Tourism Wins

Longtime entertainer and 4-time Grammy Award winner Michael Buble, whose hits include "Haven't Met You Yet" and "It's a Beautiful Day" has put his career on hold to care for his liver cancer-stricken son, Noah:

"Going through this with Noah, I didn’t question who I was, I just questioned everything else. Why are we here? 'Is this all there is? Because if this is all there is, there has to be something bigger."

A selfless act by a successful musician. Yasher koach, and may Noah experience a full recovery.

Which is all very noble, Henry, but what the heck does it have to do with insurance, let alone medical tourism?"

Well, as regular readers know, we have pointed out many times over the years that CanuckCare© may be free, but that doesn't mean it's terribly good. And how do we know this? Because folks with the resources to do so choose American health care when lives are at stake:

"Both he and Luisana put their careers on hold to be there for their son - they jetted to the US so Noah could undergo treatment for hepatoblastoma." [emphasis added]

Of course, with a $46 million a year income, he and his family can afford to do so. But what about average Joe Poutine?

Gives one pause, no?

[Hat Tip: FoIB Michael Bertaut]

Medical Tourism Update

Earlier this year, Mike reported on a relatively new (or at least seldom reported) phenomenon known as "circumvention medical tourism." This refers to cases where the patient seeks treatment that would otherwise be illegal in his own country.

But here's a more compelling reason to travel abroad for health care:

"If you're willing to hop on a plane, you can find significant savings abroad."

And it's not just about cost, but choice:

"Some procedures lend themselves to international travel ... The five most-popular overseas procedures ... are cosmetic surgery, dentistry, orthopedics, in vitro fertilization and other reproductive services, and weight-loss surgery."

Obviously, some of these would be excluded from insurance coverage here (eg IVF and certain weight-loss procedures). But the point is that careful consumers could save money and (in some cases) receive higher quality care by hopping on a jet (or taking a cruise, one supposes).

Of course, not all procedures lend themselves to this method:

"Cancer is a gray area, with travel dictated less often by potential cost savings and more often by the desire to undergo treatment close to friends and family."

And the cost of the actual care doesn't include ancillary expenses (such as airfare and hotel rooms). Most insurance plans aren't going to help pay for this, unless one's plan specifies that it's covered, or one has a supplemental plan for the purpose.

And there's this: many folks also participate in "alternative benefits" plans (HSA's, HRA's and FSA's). According to our favorite Alternative Benefits Gurus, as long as the procedure would have been eligible had it been performed in one of the 58 states, then it should also be eligible if done elsewhere. So, for example, a purely elective cosmetic surgery that wouldn't be eligible here wouldn't pass muster if performed "over there," either. But, as in the back surgery example cited in the JWR piece, one could use some of one's Health Savings Account (for example) dollars to offset the costs.

Margaritas (probably) not included.