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