Medical Travel's Great Unknowns

Rick Johnson, for HealthLeaders Media , November 11, 2008

Are you a true believer or a skeptic that medical travel will have a significant impact on the U.S. healthcare industry? I've talked to people on both ends of the spectrum and the spaces in between. While some predict emerging global options are the health system's new revolution, others say the barriers between consumers and offshore providers are too difficult for most to overcome.

No matter where you stand on the issue, at this point I haven't heard or read a convincing argument that the opportunity for widespread medical travel is not at least possible. We have plenty of cases of consumers traveling to the other side of the globe to receive surgical procedures that 10 or 20 years ago would have required long and involved inpatient care.

Frequently proponents of globalization cite the high cost of healthcare in America relative to overseas providers as the incendiary factor for medical travel's explosive growth. In the next five to 10 years we'll know for sure, but we'll need to see if these four aspects of the industry evolve enough to support outbound medical travel.

Technology coordinates care

The issue is not whether the technology exists; it does. The know-how and equipment necessary to monitor patients in remote locations, for providers dispersed across the globe to exchange data and ideas, for patients to access and use their health information. We have or can develop all of that. The real questions are: Will enough providers adopt the technology to support distance medicine? And will enough consumers use EHRs in meaningful ways to make healthcare choices?

Employers stop sponsoring healthcare

We've been seeing this one coming for a while now, and a shaky global economy only gives employers another reason to get out of the business of sponsoring healthcare. A recent example is yesterday's headline in the New York Times that GM needs to drop retirees' health plans. Employers are saying they can't support skyrocketing healthcare costs and stay competitive against global competition. The high cost of care isn't likely to come down anytime soon, so we'll see more employers attempt to delicately remove themselves from providing the benefit. At the same time, employers have a vested interest in their employees' health and could coordinate DM and individual plans for employees.

Healthcare consumerism finally takes hold

If employers coach employees out of sponsored insurance and into individual products with high deductibles, the thinking goes that since they've got skin in the game we will end up with real healthcare consumers. These consumers will shop for healthcare procedures the way they shop for cars, homes, and vacations. They will use the Internet to gather and compare information on price and quality and make informed decisions. And if the comparison is a $40,000 knee replacement in the U.S. versus $9,000 at a JCI-accredited hospital in India (including airfare), the barriers for medical travel won't seem so great anymore.

U.S. providers mount a response

Now if all of the above fall into place as some analysts predict they will, the last area to consider is how U.S. providers might respond. If pre- and post-operative opportunities emerge, one response could be that American providers see that they cannot compete on value and find ways of joining with offshore hospitals to provide a continuum of care for patients that choose the medical travel option. Another possibility is that we see more cases like Hannaford Bros Co., in which the supermarket chain added a medical travel option and soon found U.S. providers willing to make counteroffers.

There are a lot of ifs in this week's forward-looking column. While I've stated before that I don't yet consider U.S. outbound medical travel a major trend, it is a development worth watching very closely. In the healthcare industry especially, time is fleeting and these changes could be confronting us even quicker than we thought. As I consider these factors, I find myself becoming a believer more and more.

Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at
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