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Dr. Arlen D. Meyers
While medical tourism represents a small sliver of the total US healthcare sector, it will continue to expand and surgeons should be aware of this emerging industry for three reasons. (1) It is already having an impact on their practice. If doctors don’t understand and accommodate medical tourists, they will go elsewhere. (2) Inbound global referrals will continue to grow. Not changing will result in losing those referrals. (3) Business processes and healthcare information communications technologies will need to accommodate inbound and outbound global referrals. Failure to do so will result in missed opportunities to grow your practice.
Medical tourism, defined by Deloitte as the process of “leaving home” for treatments and care abroad or elsewhere domestically, is growing rapidly. The recent US healthcare reform debate has heightened awareness of global care that is affordable, high quality, accessible, and, in some instances, not available or approved in the US. These options are so attractive, that, according to Deloitte, an estimated 750,000 US citizens traveled abroad for medical care in 2007 and the number is expected to accelerate. Another 400,000 people came to the US for care.
Patients seek global healthcare options due to the value that they may find, they are more accessible, treatments are not available or approved in their home country, they desire privacy or they want to combine care with a travel component. As a result, doctors are seeing patients who want information about international alternatives, seek referrals to trusted overseas providers and ask that their caregivers participate in the process. Some physicians and surgeons refuse to do so. They are afraid of liability, don’t want to take care of patients when they don’t get paid for doing the surgery, and they dislike working with “high maintenance” patients. They already feel overworked and have no interest in cramming more patients “cruising the Internet for care” into their busy schedules. What’s more, with the looming threat that millions more Americans will be getting government subsidized care, things are likely to get even worse.
In addition, surgeons feel uncomfortable with a different model that redefines continuity of care. Some patients are looking for providers at home who will assume their care after they are treated elsewhere. While this is no different than what happens when a patient returns home after treatment at a specialized domestic facility, like an internationally recognized cancer or radiation therapy center, unfamiliarity with the quality and reputation of overseas centers, bias, and legal concerns linger. In addition, the reimbursement for pre- and postoperative care may not be high enough to justify getting involved.
Inbound global referrals will continue to grow. Not changing will result in losing those referrals.
Fluctuating global exchange rates, the internationalization of healthcare and of medical societies, easier access to information, access and cost pressures on foreign health systems, the reputation of the quality of US healthcare and transparency in quality and price are a few of the drivers of inbound or domestic referrals.
Some hospitals and their medical staffs, seeing this as an opportunity to grow and capture market share, are creating the facilities, policies and procedures to accommodate foreign patients eager to pay out of pocket for readily available, high quality care and services. A critical success factor for inbound medical services is the cooperation of the medical staff in accommodating the sometimes unique needs and desires of foreign patients. There may be little or no incentive to do so.
Business processes and healthcare information communications technologies will need to accommodate inbound and outbound global referrals. Failure to do so will result in missed opportunities to grow your practice.
Physicians will need to design their business processes and information systems to accommodate patients either coming from other countries or wanting to go elsewhere for care. Telemedicine consultations, online interactions and global information exchange will increasingly be the norm.
Doctors will need to deal with postoperative care insurance, alternative reimbursement mechanisms for delivering care that is not face-to-face, and healthcare insurance companies offering a medical tourism benefit to their patients. This will force doctors and their staffs to learn to work with new entities like medical tourism facilitators, case managers and international health office representatives.While medical tourism is growing, there are significant barriers to widespread adoption. These include, among others, establishing normalized quality of care measures, malpractice issues, health insurance coverage, continuity of care challenges, international health care information exchange, security and confidentiality, global infection disease control, and the challenge of developing trusted international referral relationships. New reimbursement models, for example, paying for doctors to communicate with foreign providers by email, telemedicine or other electronic medical records systems will be necessary to create an incentive to participate.
While these obstacles are daunting, I believe they will be rapidly overcome and medical tourism will continue to emerge as an attractive option for a small but significant part of the healthcare marketplace. Surgeons should educate themselves and prepare for the change. They can do so by staying abreast of the growth of medical tourism and the issues it presents, change their practice habits to incorporate internet facilitated care, and work with practice partners, such as their hospitals, medical tourism facilitators and medical specialty societies to incorporate inbound or outbound referrals into their practices.
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