Risk Management for Medical Travel

Editor's Note: This is the first 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.

In 2008 our country witnessed the largest drop in home prices since the 1930s and The Great Depression—a decrease of about 8.2%—while a conservative estimate for medical inflation in America was 7% during 2008. This 15% swing and the seemingly unstoppable inflationary trend are causing many individuals and employers to pause long enough to at least consider the benefits of international medical travel.

Of course, they also contemplate the risks along with the benefits. An increasing number of employers are progressively getting more comfortable with surgery overseas—especially at JCI-accredited facilities. But employers thinking about amending their benefit plans to encourage employees to travel to JCI-accredited hospitals abroad are considering the possibility of unintended consequences—either as a result of the procedure or in making the international journey to receive medical care. Employers want to make sure they have a solid risk management plan to protect 1) their employees and 2) themselves.

Some employers and individuals may have concerns with the international legal process if they find it cumbersome to sue a provider in an overseas locale. Certainly, the naysayers of this trend are quick to point out its deficiencies, as a spokesperson for the American Hospital Association recently commented, ". . . medical tourism isn't without risks. Should something go wrong with your surgery you have no legal recourse as you do at home." We know, of course, that this is not entirely true, and that seeking damages for malpractice may vary from country to country. Additionally, employers want to be sure they and their directors and officers are protected if the employee decides to file a lawsuit.

After substantial research, many have learned that there does not seem to be a legal precedent to guide injured parties regarding who is responsible for unintended outcomes as a result of the employee’s decision to select an international care benefit option through an employer plan. Even though many facilitators include only JCI-accredited hospitals in their networks, the risk for unintended outcomes—as it does here in the United States—still exists. Overseas hospitals have worked hard to accommodate Western expectations and limits. However, overseas court systems may not be as rewarding as American juries, and access to them may not be as easy.

From a risk management perspective, the entire continuum of services for international medical travel needs to be examined and attention paid to each opportunity to minimize exposure: 1) Provider selection and credentialing, 2) Care management processes, 3) Travel services, 4) Aftercare, 5) HIPAA privacy and security. Layer on top of this the need to monitor political events, currency, weather, and events like swine flu pandemics, and employers may quickly conclude that it makes sense to engage a trusted medical travel facilitator. With care and focus, each of these risk exposures can be addressed.

While there are no current "gold" standards for members and employers to consider for insurance coverage, there are a number of options to consider that are emerging for both. No-fault medical travel insurance policies can now be purchased by either the employer for the employee/dependent or directly by the medical traveler. These are low-cost policies that cover unintended medical consequences, damages due to travel accidents, and other significant mal-events that may occur in connection with this international medical care.

For employers sponsoring an international medical care option on their self-funded group plan, there are now liability insurance policies available. These products are a melding of professional liability and managed care liability policies intended to protect the employer if they are deemed liable in a medical travel accident. Limits are available readily to $5 million, and excess limits can be purchased in some instances. U.S. employers will have little trouble gaining access to the product, and Canadian employers will need some local representation to assist with the placement of this policy. In any event, select brokers can help guide employers through this process.

In conclusion, whether the accidental injury is a result of a medical procedure, an airplane, or another unforeseen accidental injury, reasonably priced insurance is now available to manage the risk for both employees and employers. Only time will tell if these insurance products are the catalyst that helps moves this trend to the mainstream of U.S employer benefit plans. However, both coverages have helped to eliminate perception barriers.