Medical Tourism: A Look at How Medical Outsourcing Can Reshape Health Care

SUMMARYINTRODUCTION 583I. AN OVERVIEW OF MEDICAL TOURISM 584II. THE BENEFITS OF MEDICAL TOURISM 587III. THE RISKS OF MEDICAL TOURISM 591IV. THE UNKNOWN FUTURE OF MEDICAL TOURISM 594V. AUTHOR'S RECOMMENDATIONS 597A. Recommendations for the U.S. Federal and State Governments 597B. Recommendations for Employers and Insurance Providers 598C. Recommendations for Patients 598D. Recommendations for Destination Countries 599CONCLUSION 600INTRODUCTIONIn a world where millions of people face healthcare costs beyond their means or years-long waits for procedures, an increasing number of patients are traveling internationally to receive treatment. This phenomenon has been coined medical tourism.1 Medical tourism offers many benefits to the internationally traveling patient, but the inherent risks may not be fully realized. This Note will give an overview of tourism then enumerate its benefits and risks. Next, the Note will discuss some factors that may shape the future of tourism. Finally, the author will recommend actions to be taken by both home and destination countries to regulate tourism and to capitalize on the opportunities it presents.I. AN OVERVIEW OF MEDICAL TOURISMTraveling abroad to receive care is a concept that has been around since the Roman Empire.2 In recent years, however, the demographics of tourism have been changing. Until recently, tourists were mostly residents of developed countries traveling to receive inexpensive cosmetic surgery.' As the cost of healthcare began to rise in industrialized countries, particularly in the United States, the face of tourism began to change to include individuals seeking affordable and timely alternatives to surgery or treatment in their home countries.4 Today, tourism is estimated to be a USD 100 billion industry, and hundreds of thousands of patients are traveling abroad for treatment as the globalization of healthcare continues.5Howard Bye lists six reasons people seek care abroad: (1) to receive specific treatments not found in their own countries; (2) to obtain more immediate surgery or other care; (3) to receive lower-cost dental and services; (4) to get treatment not covered by their health insurance; (5) to purchase cheaper prescription drugs; and (6) to shop for procedures not approved by regulatory bodies in their home countries, such as the Food and Drug Administration.6 Medical tourists commonly seek nonemergency surgical care,7 elective cosmetic surgeries,8 fertility treatments,9 and alternative, or holistic, medicine.10While the motivations of tourists are varied, most tourists today fall within one of a few general categories. Some are from countries that ration healthcare, such as Canada and the United Kingdom, and are looking to avoid long waiting lists for treatment in their home countries. Others are uninsured or underinsured Americans, including U.S. retirees who do not yet qualify for Medicare.12 A third group is composed of middle-class Americans seeking cosmetic surgery that is not covered by their insurance or that is cheaper than their insurance deductibles.11 The final group is the affluent upper-class of developing countries, which seeks care in the United States or other developed countries in order to receive a higher quality of care than the patient-tourist would receive at home.Other ways of categorizing tourists include differentiating them based on how they pay for their care abroad and based on destination. Tourists pay one of three ways: (1) out of pocket, (2) through private insurance that has innetwork foreign providers, and (3) through government insurance that has partnered with foreign providers. …

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