Last week as I was seeing off yet another satisfied customer back home to relay the amazing experience to his friends, family and generally anyone who will listen, I thought back over our patient experiences to the common theme that “wows” each and every one of them… The Medical Tourism Care Factor.

While much is out there on Medical Tourism accreditation, quality outcomes, medical training etc, the importance of ‘care’ seems somewhat swept under the carpet. Don’t get me wrong, quality assurance markers are extremely important; but in my experience, in patient testimonials, they are not saying “Wow, the hospital is internationally accredited” or “The surgeon has one of the lowest post-op infection rates out”. However, it is pretty common to hear “the surgeon made me feel so comfortable”,  “I felt like I was more than a number” or “The nurses were so attentive and caring”.

My suspicion as to why the care factor is not broadcast more widely is that it is beyond most Medical Tourists imagination. Remembering, that in many cases the starting point to seek treatment abroad is the disillusionment that they have experienced trying to access affordable care within their own health system. To tell someone in this situation that, not only will they receive excellent medical treatment at a lower cost, but they will also feel important and cared for while they are doing so, is like trying to explain Filet Mignon to someone who has only ever had burgers. While they know it is special, they can only really know the difference by experiencing it themselves.

This ‘Care Factor’ goes beyond one person to the whole experience; the call and guidance their facilitator gives them while they are deciding, the pre-operative experience with the surgeon, the hospital and nursing care, recuperative care, right through to the follow up once they return home. Get it right, and it is a recipe for health care success.

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Much has been written about the ebb and flow of opportunities around Medical Tourism as an attractive option for Americans seeking cheaper health care outside their own borders. From predictions of stellar growth by Deloitte in its 2008 report on the Medical Tourism market in the US, to significant downward revisions of forecasts due to the economic environment; authored by Deloitte in the 2009 installment.

Opinion generally around the fortunes of Medical Tourism are polarized, ranging from examples like; USA Today picking medical tourism in the USA to be one of the top 10 trends during 2010, to an article by Keith Pollard “Treatment Abroad” that points to medical tourism remaining in the margins for the foreseeable future. http://www.imtjonline.com/articles/2010/the-outlook-for-medical-tourism-30034/

Apart from feeling the need to reach for a bottle of Prozac and a stiff Gin after reading parts of Keith Pollard’s article, the issue I have with his opinion, is that it implies that Medical Tourism was originally prophesied as a Holy Grail, mainstream, overnight solution to the current issues facing the US health care landscape. In reality, Medical Tourism is a channel option within the business mix and will always be so. As such, being in the margins is probably a sound footing from which to continue to build on a beachhead industry, moving it towards a longer term goal of wider understanding and acceptance within the US health care landscape. As trite as it may sound, Rome wasn’t built in a day, or for that matter, a year.

Of greater interest, and proving that a week can be a long time in politics, was the election of Republican candidate Scott Brown to the US Senate. In doing so ending the 47 year stronghold by the Democrats in Massachusetts by the late Senator Kennedy, and preventing the Democrats from passing major reforms through the Senate unimpeded. A key reform Health care now appears stalled as the Republicans, with new found power, push back in response to, what appears to be, resounding public opinion. Watch this space, as it now appears that the already watered down health care reforms will be further watered down and in the process perhaps further opening the way for opportunities in Medical Tourism… watch this space.

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This recent article in the New York Times clearly highlights the disconnect between consumers and the US health system. These individual stories not only highlight the personal issues that these people face, but the economic concern that these people should be recognized as presenting to the US economy. These are stories about people in their economic prime who instead of being able live life and focus the contributions they can make to their families, communities and the wider economy through their work, worry more about the risks and complications of  living with or without Health Insurance, knowing that they are probably quite literally one medical incident away from potential financial disaster.

The New York Times introduces the story as follows and I quote.

“Much of the debate about health care reform focuses on people who don’t have insurance. But as Karen Barrow explores during the latest Patient Voices series, even people with insurance coverage are struggling with bills, confusing policies and red tape.

Six men and women share their experiences with health coverage and insurance issues. You’ll meet Tasha Huebner, 41, who found dealing with the insurance company worse than dealing with breast cancer. “With insurance, it was always a big surprise, what are they going to deny next?” she says.

Once she called her insurance company to find out why a $5,000 surgery bill had been denied. She was told it was because she had one too many nurses in the operating room during her surgery. “At that point I hung up on my insurance representative that I was talking to,” she says. “I didn’t even know what to do with that.”

Zoraida Reyes, 46, is a small business owner who was forced to cut health insurance, including her own. “I work six days a week, and I can’t afford insurance,” she says. “You can imagine the people who have a lot less than me, they’re probably worse off.”

And there’s Carl Arrington, 58, who lost his health insurance after his Internet company closed. Instead of paying for health insurance, he decided to invest in his health, changing his diet and exercising more. “If you’re in your 50s or 60s and you don’t have medical insurance and you don’t get it through your employer, it’s going to cost you two or three thousand dollars a month. With that kind of money I could see a doctor every week.”

Adrienne Schroeder, 31, has high-deductible health insurance through her husband’s job but is saddled with medical debt as a result of four pregnancies in six years, including two that ended in miscarriages. “Since we have insurance we should not be worried about having a baby or having a miscarriage and be stressed about how long it takes to pay it off,” she says. “Our daughter is near 18 months, and we’re nowhere near paying off these hospital bills.

The majority of the people in this story are representative of a Medical Traveler demographic that are coming to New Zealand in gradually increasing numbers for non-urgent or elective medical procedures as an alternative to the high cost of care in the US.

Jorgensens article How Companies are Changing Healthcare Costs certainly raises some questions.

I applaud Hannaford on leading the way in giving their employees an affordable option for elective surgery. By doing this they not only managed to save themselves some pennies, save their employees many pennies, but have also called the local providers bluff in regards to pricing.

The big question is…  if a hospital can reduce its prices from 50,000 to 18,000 for a hip replacement, then where was the other 32,000 coming from in the beginning. That is one mightily hefty margin!!

You have to ask:

If they can do this for the masses who is paying for it?

What would be the cost for an uninsured patient?

Why are other large companies so slow to catch on?

The Towers Perrin’s latests survey that US employers who insure their employees will shortly face an average annual per employee cost for healthcare coverage of US$10,000 must come at a time when companies must wish they had only to focus on increasing profits not reigning in healthcare costs.

One is somewhat surprised therefore in the slowness of the uptake of a product that if chosen and implemented correctly, will not only be desirable for employees, maintain high standards of healthcare but deliver significant cost savings, namely medical travel.

Nothing in the healthcare reforms to date has talked about addressing cost; its all about coverage. The question will therefore be will reigning in the costs of healthcare be left in the hands of the hospitals and insurers with the self -insured companies left to either pay higher costs or lay off staff? Spending time considering medical travel looks like a viable and progressive third option

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