Medical tourism gets a lot of buzz these days, estimated to be a $60 billion industry. Aggressive projections forecast the industry will reach $100 billion in 2012.The U.S. being an employer-based insurance system for health, employers are the primary conduits of health insurance in the U.S. (along with government).

As many consider incorporating medical tourism into benefit plans, it makes sense that the National Business Group on Health has prepared a primer to medical tourism.The NBGH’s Issue Brief, “Medical Tourism: What Employers Need to Know,” lays out the latest statistics on the global market for health care services, and some steps for employers to consider when pondering adding the benefit to the health plan portfolio.

The most common services sought off-shore include:
  • Heart procedures, such as coronary artery bypass graft, heart value replacement, heart pacemaker, percutaneous transluminal coronary angioplasty (PTCA) with stent;

  • Orthopedic procedures, including spinal fusion and hip and knee replacement

  • Laparoscopic surgeries for gall bladder and hysterectomy

  • Transplants and, perhaps the long-favored overseas procedure category,

  • Plastic surgery.
The NBGH estimates that costs for these procedures are reduced by as much as 60-85% per procedure when compared to the equivalent service delivered in the U.S.

The most popular countries for medical tourism for Americans are England, India, Mexico, Singapore and Thailand. Mexico is popular with Californians and border-citizens; India is a major destination for cardiac surgery and transplants, among others. Many of the providers in these countries have received accreditation by the Joint Commission International, the global arm of the Joint Commission which provides a kind of Good Housekeeping seal for hospital quality through its in-depth audits of operations, clinical and safety procedures.

Furthermore, several overseas institutions have affiliations with big American health care ‘brand-names’ like Harvard (India’s Apollo Hospital), Cleveland Clinic (facilities in Canada, Vietnam, Austria, and the UAE), and Johns Hopkins (Panama’s Hospital Punta Pacifica and Singapore’s International Medical Centre).

Health plans have begun to feature medical tourism for specific coverage; Blue Cross Blue Shield of South Carolina, United, and Health Net have been among the first plans to deal with medical tourism.

There are several challenges to consider beyond quality and price when it comes to medical tourism. The obvious legal issues, such as medical malpractice, information privacy, and disability discrimination are all risks for the lawyers to debate.

Beyond the cost-savings that may seem transparent, consumers with HSAs need to sort out whether their plans would cover non-urgent or -acute situations, such as elective plastic or dental procedures. There is a lot of fine print to review in this early stage of market adoption, and not a lot of case law developed.

Health Populi’s Hot Points: Hannaford Bros. Co., a northeastern US organic grocery chain, offers medical tourism as a health benefit for employees who need hip or knee replacement. The company has been working with the National University Hospital in Singapore for this service, in coordination with Aetna who provides the administrative services for this benefit. Hannaford covers the entire medical bill including deductibles and copays, and travel for the patient and a companion.

While Hannaford’s experience with this program has been positive, and patients are benefiting from quality, cost-effective procedures, there’s been an unanticipated outcome: some U.S. providers have offered to perform knee and hip replacement procedures for the off-shore price.

This is a clear example of what happens when transparency enters a market.