Change in the medical tourism climate based on Keith Pollard

The article gives some insight on how medical tourism industry growth from a UK perspective and how it might have reached the maturity phase.  The article claims that many investors lost money amid the hype of the potential of the market which did not pan out and the protectionism. However, those that understood the market and were best equipped, informed and organized were successful.  Even with the changes in healthcare through ACA, the economic downturn, and rising costs for travel, it seems there is still the demand to provide affordable healthcare and thus payers and goverments are having to reconsider cross boundary options for healthcare.  The article states that this future model might be more regional rather than global.

http://www.imtj.com/articles/2011/blog-after-the-gold-rush-40165/
http://www.imtj.com/articles/2011/medical-tourism-trends/


In my opinion, we might be going from one growth curve, to another as in the diagram below:

Survey results from Journal of General Internal Medicine by Alleman, Luger et al.

This article agrees with the lower number of around 13,500 US travellers going abroad. This gives an approx. landscape of 45 medical tourist facilitators, each sending approximately 300 patients abroad. 65% of these facilitators were paid by the physicians, while the remaining received compensation from the foreign provider.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077479/

Article on the shriking Medical Tourism market by Ian Youngman

More from a UK perspective, this article states that people will travel less for major surgeries and more for faster access. This is likely the case for european countries where the government sponsored health system creates wait lines as also seen in Canada.

http://www.imtj.com/articles/2011/the-medical-tourism-world-is-shrinking-30099/

Survey conducted on US based medical tourism facilitators by Christina Peters and Katherine Sauer

The authors described an increasing trend in the inquiry by US patients for medical services abroad. The actual number of trips taken was 13% of the inquiry. Results on the various factors for travel abroad for medical services is also shown.

http://www.na-businesspress.com/jmdc/sauerweb.pdf

Paper by Maryam Khan

Author presents various arguments for medical tourism specifically cost savings of up to 90%, where not only individuals but employers and insurance companies are considering providing medical tourism as an option to their employees or insured. She mentions the Blue Shield of California Access Baja Plan that offers people living close to the border option to get treated in Mexico. The article mentions that according to International Federation of Health Plans  almost 11% of US employers are currently offering medical tourism and about 73% of US companies might offer Consumer Driven Health Plans that allows for a medical tourism choice. It states that medical tourists typical take a companion and half get their information off the internet. Again half used a medical travel facilitator and were mostly happy with their experience.

The paper mentions extra options hotels are providing including private entrance, floors with nurse stations, wheelchair accessibility etc.

The paper also indicates that there are many hurdles to medical tourism including coverage by their insurance policies, visas, post surgery complications, language barriers, sanitation, and lack of legal recourse. Issues with the long travel itself are also discussed.


http://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1371&context=refereed

Disruptive Innovation Article by Clayton Christensen

Clayton Christensen's book "The innovator's prescription" talks about solutions to the healthcare crisis.  Its primary premise is that the hospital system of today contains 3 mutually exclusive and competing business models.  In order to create efficiencies, increase quality and reduce costs, it is important for the healthcare system to recognize this, and split the models.  We have already started to see this happen in some cases, with some hospitals focusing on integrated cancer treatment, while offshore clinics providing value-based, fixed cost for routine procedures.  This article is a good summary of the book and talks about matching clinician skills to the difficulty of the medical problem.

http://hbr.org/web/extras/insight-center/health-care/will-disruptive-innovations-cure-health-care

World Health Organization Bulletin on movement of patients across borders

This article referes to the need for the uninsured to seek medical tourism from the US, and that insurance companies have started to offer options to seek medical procedures abroad.


http://www.who.int/bulletin/volumes/89/1/10-076612/en/

Paper on impact to providers and plans by Mark S. Kopson

A very broad summary of the medical tourism market including key statistics from the Deloitte and McKession studies.  Also includes specific and detailed examples of US plans and their actions in relation to offering options outside the US.


http://www.healthlawyers.org/events/programs/materials/documents/am09/kopson.pdf

Article on Industry reaction to Medical Tourism by Candace Gwaltney

Author mentions that inurance company WellPoint announced a pilot program for Medical Tourism which prompted the Indiana Legislature (Bill 1084) to take a protectionism stance by Rep. Craig R. Fry and echoed by Dr. Richard Feldman.  The points made by Feldman around his concern are valid in that forcing frail patients to travel abroad is not desirable, however, he did not have objection to patients going abroad on a purly elective basis. This is actually the case in the Wellpoint program as described in the article. The insurer mentioned that is providing medical tourism as an option to a select company is Aetna. BCBS SC's new initiative is also mentioned.

The author also cites a facilitator stating that they are seeing more cases for carida, spinal, orthopedic and dental procedures.

http://www.bizvoicemagazine.com/media/archives/09mayjun/MedicalTourism.pdf

The actual Bill 1084 mentioned in the article can be found here:
http://www.in.gov/legislative/bills/2009/HB/HB1084.1.html

Gallup Poll

The poll shows that the likelihood of using a foreign option increases to above 50% if the person surveyed did not have insurance, was told the quality would be equal or better and the costs would be lower.

Considering there were 48 million americans without insurance in 2009, this is a significant number that, if requiring treatment, might be likely to look abroad for options.

http://www.gallup.com/poll/118423/americans-consider-crossing-borders-medical-care.aspx

Deloitte paper on Medical Tourism by Paul Keckley and Howard Underwood

Detailed analysis by the authers includes Medical Tourism pilot programs and their details. It mentiones state legislation including the West Virginia bill that encouraged covered employees to seek medical care in foreign JCI accredited instituations and to waive copayments and deductables and which died in committee. IT also mentions the Colorado bill that was postponed.

The article projects almost 1.6 Million US outbound medical travelers by the year 2012.  Key point here is that the article includes the more than half of the US workforce which will be of second of third generation foreign decent in the next 25 years which would likely seek medical procedures abroad if given the option by their provider.

http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20assets/documents/us_chs_medicaltourism_111209_web.pdf

Article on various disruptive innovations in healthcare by Maureen Glabman (reference to Clayton Christensen's theory)

The article describes various disruptive trends in healthcare based on Clayton Christensen's theory on Disruptive Innovation.  It also mentions Medical Tourism and digs in deeper into the reaction of local hospital chains to insurer's providing medical tourism as on option. The author mentions the example of a local self-insured company that offered a low cost option to its employees using an Aetna plan.  The local hospitals in reaction, lowered their price to meet the Singapore price.  There appear to be a number of barriers, backlash and fear dealing with medical tourism which include costs of complications, extended stay, political instability and lack of legal recourse if a procedure goes wrong. A lot of these risk could hit the employer providing this option. The author cites literature that shows more than 100 employers and insurance companies have already included medical tourism in their programs reaching savings of 90%.

http://www.managedcaremag.com/archives/0901/0901.disruptive.html

McKinsey prticle on mapping the market for medical travel

An early but very interesting article that shows analysis done by McKinsey on the percentage flow of travelers from one part of the globe to another.  The key points made are that only 35-45% of the international patients are actually medical travelers. Of this number, which is stated at around 50,000, the approximate number travelling to the US for advanced technology is around 20,000 annually. Lower cost seeking travelers are a minority at about 15% of the medical travelers and consist of mostly travelers from the US that either go for orthopedic or general surgery. Those that go for discretionary procedures travel to smaller specialized providers. The number of US patients going abroad annually is predicted at 5,000-10,000 annually however, it could be higher if payers included international providers in their networks.

According to the article, prices charged by providers are affected by perception of the value based on reputation, location, regional economics and safety. The key dynamic here is the acceptance by the payers.


http://cureandcareindia.com/writereaddata/McKinsey-9547270771.pdf

Detailed Deloitte report by Paul Keckley and Howard Underwood

A detailed report by the authors predicts a much higher trend of up to 10M Americans travelling abroad by the year 2013. A number of different markets are identified in a map which already includes millions of tourists to each location from other countries as well.  Reasons for travel are indicated to be lack of insurance or coverage of procedures, cosmetic, Non-FDA approved treatement and seeking treatment back in their native country.  The article also mentions a number of US providers with international footprint including the Clevelant Clinic, Cornell Medical School, Duke, Harvard, Johns Hopkins etc.  An excellent decsion process map is also discussed for pre- and post procedure and the makeup of medical tourism facilitators. The key point is that facilitators provide a one-stop shop to address travel concerns, provide negotiated rates with providers and help with logistics, arrangements and post procedure questions. Procedure prices are also quoted from Josef Woodman's book and are anywhere from 6% to 33% of US prices.


https://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_chs_MedicalTourismStudy(3).pdf

Article by Michael D. Horowitz, Jeffrey A. Rosensweig and Christopher A. Jones

The authors estimate based on citation that 750,000 americans will travel abroad to seek medical care.  The article also contains a table of the countries visited and the procedures sought.  One insight in the article is that the demographic of the tourist is a middle-class adult seeking elective surgery who might not have adequate insurance and is trying to prevent impoverishment due to the local high cost of healthcare.  One reason quoted for the lower cost of medical care outside the US is the fractional cost of medical liability insurance.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234298/