In October, KCET Channel 28 interviewed me about medical tourism. While many physicians who hear the term medical tourism may think of continuing medical education programs held in vacation locales, that is not the type of medical tourism I was asked to discuss. Rather, there is a growing trend of patients seeking medical care overseas to avoid the higher cost of healthcare in the United States.

According to a report presented at the American Medical Association annual meeting in June 2007, an estimated 500,000 Americans travel out of the country seeking medical procedures. Many of these individuals are uninsured, so to afford the care they require, they go to a less expensive healthcare environment in India, Singapore or Thailand. Others have medical insurance, but are incentivized by their insurance carriers to seek care in another country. For example, programs here in Southern California encourage insured patients to cross the border to Mexico to obtain covered medical care with a lower co-pay.

Medical tourism used to be confined to countries with single-payer systems, such as Canada or England, where long waiting lists for routine procedures caused patients to go elsewhere. Those in our country who continue to advocate for a single-payer system need to keep in mind the need for citizens of other countries to escape from their own healthcare system in order to receive the care they were entitled to and taxed for!

Of course, the motivation for medical tourism in the United States has more to do with cost. With 40 million uninsured, many cannot afford to pay and consequently they search the Internet for alternatives. The Internet provides a variety of firms and resources for the global medical tourist. The numbers themselves are compelling. For example, a mitral valve replacement that costs more than $150, 000 in the United States may cost only $9,000 in India. Oftentimes, there is still a huge disparity in cost even when including the cost of first-class travel for the patient and a family member and the cost of recovery at a seaside resort. As a result of these huge savings, U.S. corporations are now often encouraging their employees to seek care outside the United States in the same way that those firms might outsource their manufacturing jobs to China!

So why should we be concerned? First, continuity of care may be jeopardized. Medical tourists will seek follow-up care at home and critical communication with overseas physicians will be difficult. Second, there are always patients who experience complications, have unintended results or who develop additional ongoing problems. How will this be handled and who will cover the costs? Third, there is growing concern about infectious disease migration and the emergence or transfer of resistant organisms or bacteria with different sensitivity profiles.

Finally, on a competitive basis, U.S. physicians can never compete on cost with doctors in emerging countries, where the cost structures of labor, housing, food and supplies are so wildly different and where there is no predatory legal system that impacts healthcare delivery.

While we monitor the increase in medical tourism, it behooves us to ensure that this is not one more area where insurance carriers use their monopoly power to force patients to seek care overseas regardless of the quality or the cost.