The rise of medical tourism: Commercial insurers jumping in

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Medical tourism is on the rise: people are traveling from their homes to other cities and other countries for medical care.

One thing I just learned: big insurance companies are working on medical tourism programs — something we’re interested in learning more about. We have heard a lot about domestic medical tourism — U.S. patients traveling to other U.S. cities for treatment, often under arrangements made by their companies. Walmart and Lowe’s in particular have been making such deals.

Some of the best work I’ve read about medical tourism comes form a Harvard Law School prof, I. Glenn Cohen. Here’s a piece about transplant tourism he wrote, focusing on the practice in Pakistan, Bangladesh and India, and delving into the obvious questions.

Are people who sell organs donors or sellers? Sellers, obviously. Is the practice corrupt, or dehumanizing? Well, yes. Are poor sellers coerced into selling their organs by brokers? Yikes.

Should organ-selling be regulated, and by whom? By the home country of the seller, or the home country of the recipient? Should insurance companies discourage their citizens from transplant tourism by making such patients ineligible for insurance coverage relating to an illegal transplant?

Other kinds of medical tourism than transplant tourism raise less obvious questions: if you can get a hip replacement for $13,660 in Belgium, as opposed to nearly $80,000 in the United States, as The New York Times reported recently, there’s less of an objection on moral grounds.

“A desperately ill Minnesota man flies to Bangladesh to buy a kidney from a willing seller, rather than waiting for a donor and surgery at his local hospital. A parent in New York takes her severely autistic child to China for an unproven, even dangerous, experimental stem cell treatment that’s not offered in the United States. A dying woman in Maine flies to Switzerland, where a suicide clinic helps her end her life. An infertile couple in Florida have their sperm and eggs implanted in a woman in India whom they pay $4,000, a fraction of the price of surrogacy in the U.S. And a health insurance company urges its American customers to travel to Malaysia for cardiac bypass surgery, offering all kinds of incentives, including free airfare and hotel for them and a travel companion,” Elaine McArdle, writes on the Harvard Law School blog,  Patients without borders: I. Glenn Cohen on the rise of medical tourism.

“Once the province of the uber-wealthy seeking radical cosmetic surgeries or treatments unavailable in the U.S., medical tourism has become an attractive option for many, especially the uninsured, since the cost savings are so dramatic. According to some estimates, about 2 million Americans a year are traveling overseas for major health procedures, from knee replacements to neurosurgery, with the number growing rapidly. And with the advent of the Affordable Care Act, better known as Obamacare, medical tourism will increase as insurance companies look to cut costs, predicts I. Glenn Cohen ’03, a Harvard Law professor and one of the world’s leading experts on medical tourism.

“The four largest commercial health insurance companies in the U.S. have already launched or are considering medical tourism programs. It’s possible that in a few years, a significant number of Americans will travel abroad for their medical needs, a prospect inconceivable a decade ago, when U.S. medical care was perceived as the gold standard, and the thought of surgery in Mexico or Brazil seemed dangerous and strange.”