JAMA Forum: Taking a Look at Medical Tourism

Image: targovcom/Getty Images

Just a few weeks ago, I was in Malaysia, as part of a course in the Business of Medicine Program run by Indiana University’s Kelley School of Business. We were in Kuala Lumpur to learn about medical tourism.

On the last day there, we were visiting the Batu Caves, a Tamil shrine dedicated to Lord Murugan, the Hindu god of war. You have to climb 272 steps to reach the caves. On the way down, a monkey stole my eyeglasses.

I still had my prescription sunglasses, but I wasn’t happy at the prospect of wearing them to dinner that night and the entire way home the next day, which was going to take more than 24 hours.

A colleague convinced me to at least try a local optometrist at a store in the mall near our hotel. The optometrist there took my sunglasses and read the prescription from them. Then he checked my vision manually to make sure no adjustments were necessary. I picked out a frame from the clearance rack, and asked for simple lenses. Unfortunately, my vision is bad enough that the discount lenses wouldn’t work—they’d be too thick. I had to opt for more expensive ones.

Still, the entire price for my new eyeglasses was less than $100, and the store made them in 10 minutes. They even threw in a new case for my sunglasses, free of charge.

It’s ironic that on a trip to learn about medical tourism, I became an unwilling participant. However, it was instrumental in giving me a better understanding of the process and why it’s so tempting for many.

The Appeal of Medical Tourism
Patients engage in medical tourism for a number of reasons. They may be trying to obtain services they wouldn’t be able to get at home. They may be looking to save money if care costs too much at home. They may also be looking for higher quality of care than they could get locally.

Malaysia’s medical tourism industry, run by its ministry of finance (not health), attempts to address all 3 of these incentives to seek care abroad. It draws patients from surrounding countries like Singapore, China, and Australia, where some services aren’t necessarily available. It also provides care much more cheaply than can often be obtained in those countries. It specializes in areas like infertility and cardiology, where they tout higher success rates and use cutting-edge technology.

To compete for patients, the hospitals offer pretty fancy accommodations. They have translation services in a number of languages. They also offer enhanced communications with physicians in home countries to maintain the continuity of care.

Having toured facilities in a number of hospitals in Malaysia, I came away impressed with what’s offered. Still, it was hard to overcome my biases. Here in the United States, we often hear warnings about engaging in the practice. The Centers for Disease Control and Prevention warns of a number of risks that medical tourism brings. They argue that communications can be a barrier. They note that medications from other countries can be of lesser quality or even counterfeit. Antibiotic resistance may be more common in other countries. Flying after surgery also leaves patients at higher risks of clots.

US Medical Tourism
Of course, many of these things can be true in the United States as well. We don’t think twice about engaging in medical tourism here, though.

For example, people diagnosed with a rare condition may need to travel some distance, even out of state, to see a specialist with experience in that condition or to get a second opinion. That means they’ll need to arrange their own travel, including a stay at a hotel. They’ll have to arrange for the medical systems to exchange records and pathology samples, which can be harder than you might imagine. They also need to make sure that the specialist communicates with their local team back home.

This is also medical tourism, needing better care than what is available locally. If the care is within the United States, no one bats an eye that it’s dangerous. If a patient flies north to Canada, many might be concerned. Both options are often expensive, because they usually are “out-of-network” and therefore require more out-of-pocket payments.

Medical tourism to Canada happens. Senator Rand Paul recently made news by choosing to travel there to have hernia surgery. It was reported that the procedure could cost $5000 to $8000, significantly less than what it might cost in the United States.

Canada, of course, experiences medical tourism in more ways than just this. Canadian patients sometimes travel for medical reasons, too, either to gain earlier access to procedures or get better care than they think they might get at home. Sometimes, they even travel with Canadian surgeons to get cheaper, faster procedures.

Between 100 000 and 200 000 people fly to the United States each year for health care. We have no trouble believing this. But even more, between 150 000 and 320 000 Americans fly abroad for health care. Most go to South America, Central America, and the Caribbean—but that’s likely because it’s easier. Almost a million people in California alone drive to Mexico each year for care, about half of whom are Mexican immigrants.

Of course, medical tourism is limited to those who can pay out of pocket because insurance most often doesn’t cover it. But as deductibles rise and people have to pay more and more out-of-pocket for care, that barrier is becoming less of an issue.

When I returned to the United States, I made an appointment with my eye doctor, who was able to squeeze me in a week later. I have pretty good vision coverage, which reduced the amount I paid for my glasses from $750 to $186. It will take 2 weeks for me to receive them.

I’m forced to wonder if the pair the monkey stole are really that much better than the $100 pair that a Malaysian made for me in 10 minutes.

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About the author: Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist, makes videos at Healthcare Triage, and tweets on Twitter at @aaronecarroll. (Image: Ted Grudzinski/AMA)

 

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.

 

 



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