Editor's Note: This is the third of three contributed features submitted by members of the International Medical Travel Association's Board of Directors. The IMTA is a not-for-profit global organization of stakeholders in the international medical travel industry.
The time has come for leadership in the medical travel industry to focus on one of the most important issues facing all stakeholders: continuity of care. It is a major concern, and rightfully so. Everyone wants to know how patients will access follow-up care after they have undergone a procedure, surgery or other treatment outside of the United States.
Today, there are some major challenges, primarily centered on a lack of communication between caregivers, liability concerns, and sharing patient records.
Some physicians may reluctantly provide follow-up care to their patients who decided to access high quality, low cost surgery in a foreign country. These physicians may find it challenging to communicate with doctors outside the country as easily as they would with a U.S. colleague, the result of language barriers and time zones differences.
If the patient is uninsured or does not have a U.S. physician, it may be necessary for this patient to pay for copies of their medical records in the foreign country—including x-ray films. They will also need to transport these records back home in order to provide them to a new U.S.-based physician that is handling follow-up care. This is recommended, particularly when foreign providers do not have electronic medical records or the digital capabilities to transmit written records. Conversely, when patients need to send their medical records to a foreign physician, there are HIPAA challenges that must be addressed by the U.S. physician.
Additionally, there may be malpractice risks for U.S. physicians, a factor that has generated considerable attention. However, there is limited available evidence of any prevalence of malpractice regarding follow-up care, and few studies have been conducted.
While these challenges may be of concern, they can and should be overcome. The opportunity is to take the long view approach and understand that the globalization of healthcare will ultimately lead to more choice and options.
Defining the problem
While government officials and voters debate the politics of the U.S. healthcare system or the injustice of one of the wealthiest nations on Earth having nearly fifty million of its people uninsured or underinsured, thought leaders in medical travel must address the reasons why U.S.-based physicians are reluctant to treat individuals returning to this country following medical care or treatment outside U.S. borders.
Today, many studies show a growing number of highly-complex procedures being performed abroad, including neurology, orthopedics, bariatrics, and cardiology. The list of diagnoses and procedures for which U.S. citizens go elsewhere for care is growing. According to a 2008 Deloitte Study, most are elective procedures that require follow-up care for a period of weeks and involve a surgical intervention. Common medical tourism procedures that consumers choose are dental, cosmetic, orthopedic, and cardiovascular.
Furthermore, last year the AMA published a set of guidelines for medical tourism and stated that "coverage for travel outside the U.S. for medical care must include the costs of necessary follow-up care upon return to the US."
Strategic partnerships and alliances to ensure continuity of care
As the quality of care and improved patient safety level the playing field between the United States and international providers, and as the size of the medical travel market increases, there will undoubtedly be a number of progressive physicians, large insurance providers and other healthcare businesses leading the way. It's not difficult to imagine that by working in partnership with leading accredited foreign hospitals, these U.S. providers will be able to offer a complete uninterrupted continuum of care for a reasonable price.
Beyond the partnerships of top U.S. healthcare providers with management responsibilities in foreign hospitals that we see today, there are the yet unseen service partnerships that may take many forms:
- U.S. cancer centers that provide several portions of specific and otherwise very expensive therapy regimens can done in combination in the US and done abroad
- Large U.S.-based specialty centers that offer value to their clients by performing high cost procedures abroad—and then returning to the US for further follow up care
- U.S. based specialty clinical laboratories that ship specimens abroad to clinical laboratories for testing
- Insurance companies that extend their physician and hospital networks to other countries.
We may also see the use of low-cost, in-home monitoring devices and online tools that would reduce the need for return visits to foreign countries, allowing individuals to be more active in their care while being monitored remotely by their physician abroad. We may also witness foreign providers partnering with U.S.-based home health agencies to monitor patients after their return home. The potential of foreign partnerships is endless.
A call-to-action for U.S. providers
The question remains: Why should US healthcare providers partner with high quality foreign counterparts? In response, consider the following: the Deloitte study as cited above asserts that U.S. healthcare providers lost billions in 2007; if their predictions fall true, these providers will lose almost $70 billion to outbound medical tourism by the year 2010. The number and rate of foreigners coming to America for healthcare services is not growing as fast as it once did.
Currently, many U.S. hospitals use the high priced fees paid by foreigners to help offset their operating deficits. It's not difficult to predict that this windfall is likely to decrease if foreigners choose high quality, accredited hospitals in their home country rather than traveling to the United States for medical care. The United States also benefited for years from an influx of foreign-born physicians, who chose to practice in the here instead of in their homeland. If more of these physicians either stay home or return home because the healthcare facilities are comparable to the U.S., there may be staffing constraints for U.S. providers.
History has shown that when there is a need, solutions always present themselves to meet those needs. Although these solutions may take several different forms, each will fill a niche in the continuity of care of an international patient.
Joseph S. Barcie, MD, PhD, MBA, is the President of Centralized Services for the Dallas-based International Hospital Corporation. He may be reached at jbarcie@intlhosp.com.