The Chicago Tribune has an AP story about how WellPoint is going to start a pilot program of medical tourism where it will send some non-emergent patients to India for surgeries in order to save money. A knee or hip replacement costs between $65,000 and $80,000 in the U.S., but only costs between $8,000 and $10,0000 in India. As a carrot to get patients interested, insurers will pay for travel, lodging, and the medical procedure for a patient AND will pay travel costs and lodging for a companion.
I think medical tourism is a good idea. I especially like the concept because it cuts out the middle man. Patient pays for care, doctor and hospital provide care. Maybe patient and provider haggle over price. Maybe patient calls around to different hospitals and comparison shops – not unlike reading through the Sunday paper and comparing grocery ads.
It concerns me that now a “middle man” wants to get involved.
I also foresee all kinds of new issues popping up once American insurance companies actively engage in sending people to other countries to have medical procedures performed.
Right now (and this is pure conjecture on my part), unless there is a catastrophic injury I believe that medical tourists effectively give up their right to sue a foreign doctor for malpractice. The patient will have to submit to another country’s malpractice laws. Doubt that the payouts would be anywhere near as big as they are in the US (although the docs might get jail time and 1500 lashes with a whip). To get started, the patient would have to retain an attorney (or attorneys) experienced in both malpractice and in international law. Think you’ll be able to get some of those on contingency?
Will the insurance company be liable in the US if there is malpractice in another country and the insurance company “brokered the deal”? Maybe you can’t sue the insurer for medical malpractice, but can you sue the insurer for negligent contracting? Will the ERISA shield apply to these types of lawsuits against insurers?
What happens if there are surgical complications? In the US, the price for surgery includes a certain amount of follow-up care (30-90 days?). With foreign surgeries, does the patient stay in India until the complications are resolved? Will the insurance company pay for that care as well? What if there is a complication and family wants to visit? Who picks up the travel and lodging tab?
What if the patient is OK when leaving India, then returns and develops a surgical complication? Surgeons in the US are often hesitant to “become involved in someone else’s screw up” (as I have heard more than one surgeon put it). A “screw up” is already more likely to end up in court. If a US surgeon tries to fix an Indian surgeon’s screw up and the patient doesn’t get better, then the US surgeon may be stuck holding the bag in the event of a lawsuit. If there is a “screw up” do the patient and a companion get shipped back to India to make good on the care?
What happens if, during the trip, the patient has another medical problem?
What happens if the surgery has to be canceled? Free trip for two to India?
Aaaaack! What happens if there is a “never event”? Free care?? Or do those never event thingees only happen in American hospitals?
The most pressing question of all is: Who gets to keep the frequent flyer miles?
The Chief Medical Officer interviewed for the article hinted that insurers are trying to use medical tourism to put the squeeze on doctors to lower their prices for non-emergent procedures like joint replacements. “It may change the game in terms of local contracting conversations,” the CMO said.
Here come those unintended consequences. If doctors get pinched on performing non-emergent surgeries, how are they going to make up for that monetary loss? You got it. Guess what’s going to happen to prices for surgeries that can’t be sent overseas.
That acute cholecystectomy just got more expensive. Don’t want to pay it? Fine. Get on an airplane with your companion and go register in one of those insurer-approved New Dehli “ERs”. Just hope your gall bladder doesn’t explode somewhere over the Bay of Bengal.
Have a hip fracture? Hope your travel companion is someone qualified to administer narcotic pain medications because sitting in an economy class seat with a busted hip for 20 hours is going to hurt. Then again, maybe a hand full of Vicodins will be part of the insurance travel package.
These are all issues that can occur regardless of whether the trips are brokered by an insurance company.
The problem occurs when a third party tries to squeeze in the middle of the doctor/patient relationship – making the consumer pay more and making the provider accept less – so that the third party can make a profit. Some aspects of insurer-brokered medical tourism may work. Ultimately I think that issues like those above will become the tail that wags the dog.
UPDATE MARCH 30, 2009
CNN published an article on medical tourism echoing several of the points above.