magine this
scenario: An employee schedules a meeting with you because she needs immediate spinal
surgery and can’t cover the out-of-pocket costs. She informs you that she is thinking
about taking a trip overseas and having the procedure done by an accredited hospital
and physician in India. She wants to know if the company will cover any of the costs.
If it hasn’t happened already, it’s only a matter of time before someone in your
organization asks you about the company’s policy on medical tourism.
Employees covered under high-deductible plans or those
with no insurance at all can save a great deal of money by seeking medical care
abroad. According to the Medical Tourism Association, most procedures abroad cost
half of what they would in the United States.
The cost of a heart bypass in Thailand costs $11,000,
compared with up to $130,000 in the United States. Spinal fusion in India costs
$5,500, compared with $60,000 stateside. A knee replacement in Singapore is about
$17,800, or around half the U.S. price.
In 2005, an estimated 500,000 Americans went abroad
for health care. In 2006, the medical tourism industry grossed about $60 billion
worldwide. McKinsey & Co. estimates that this total will rise to $100 billion by
2012.
Insurers and employers have slowly begun to accept the
international practice of medicine by forming medical tourism subsidiaries and considering
policies to cover workers who travel to a foreign country for treatment. For example,
insurance companies are beginning to form subsidiary companies that provide international
coverage and manage travel arrangements for beneficiaries seeking care abroad.
These developments have raised concerns among HR directors
and benefit managers. Their questions include issues of proper credentialing, comparative
provider training and access to quality post-operative care. They want to know how
the quality of care is measured. How are physicians credentialed? How are provider
hospitals regulated? What happens in a post-operative emergency? What is the employer’s
liability if something goes wrong?
The global economy is allowing for some answers to these
concerns. Foreign health care providers often have physicians with international
credentials, and many were in fact trained in the United States. More than 120 hospitals
abroad are accredited by the Joint Commission International, which accredits American
hospitals participating in Medicare; another 20 are accredited through the International
Standards Organization. Other countries have begun creating independent accrediting
rules and regulations.
The U.S. health care consumer today also has different
perceptions regarding "cheap" health care abroad. The informed consumer now realizes
that prices for treatment are lower in foreign hospitals for a number of reasons.
Labor costs are lower, third parties (insurance and government) are less involved
in health care delivery, or are not involved at all. There is less regulation and
malpractice litigation costs are significantly lower.
Because there are solid market justifications for the
significant price difference in health care services overseas, some fail to assess
the impact that the lack of regulatory oversight may have on provider services.
Employers and employees need to be aware of the level of regulation and conduct
additional research in any country they may be considering as a treatment location.
When it comes to post-operative care, which is another
area of concern, telemedicine is providing answers. Because potential medical tourists
must first be evaluated remotely, most medical intermediaries for patients use electronic
medical records to store and access patient files. Patients can then discuss the
procedures with potential physicians via conference call.
Patient electronic medical records can be transferred
back and forth, managing the continuum of care from pre-operative assessment to
post-operative care. Such modes of communication enhance the continuity of patient
care and can eliminate concerns about a patient’s recovery at home from an overseas
procedure. In the United States, by contrast, only about one out of four U.S. hospitals
store medical records electronically.
So how would you advise the employee described at the
beginning of this article? The facility abroad is highly accredited. The physician
is U.S. trained. Staffing levels are greater. Her records can be transferred digitally
for post-operative care. And the employee’s costs will be reduced significantly.
With globalization quickly moving into health care services,
employers providing health care benefits must begin to reassess their approach to
this new treatment option. Employees know about medical tourism—they’ve seen it
on the news, or perhaps they’ll even read about it in one of this summer’s beach
books, Robin Cook’s Foreign Body (where a New Delhi hip replacement doesn’t
turn out that well).
And although only 11 percent of organizations offer
medical tourism as an option for covered medical care now, more will likely join
the trend. It appears to be a viable, safe option—under the proper circumstances.
Your organization should be in a position to tell employees why you do—or don’t—want
to make it an option for them.
Workforce Management Online, June 2008 --
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