A risk worth taking?
Petra Kendall-Raynor examines how medical tourism an increasingly popular option as an acceptable alternative to elective care and what insurers and patients can do to ensure they are properly prepared
First published in ITIJ 113, June 2010
Petra Kendall-Raynor examines how medical tourism an increasingly popular option as an acceptable alternative to elective care and what insurers and patients can do to ensure they are properly prepared
Three years ago 750,000 Americans travelled abroad for medical care; however, in a 2009 update report, Deloitte revealed that outbound medical tourism in the US could reach 1.6 million patients by 2012 with sustainable annual growth of 35 per cent, while the Deloitte 2008 Survey of Health Care Consumers found that outbound medical tourism would experience an 'explosive growth' over the next three to five years. People, it would appear, are willing to travel for treatment for everything from dental and cosmetic operations to correcting serious cardiac problems, particularly as medical care in countries such as India, Thailand and Singapore can cost as little as 10 per cent of the price of the same treatment in the US.
What’s more, if prospective medical tourists want to check accreditation of the medical facility they are considering attending, they can go to the Joint Commission International (JCI), which was set up 13 years ago and has a focus on improving the safety of patient care through the provision of accreditation and certification services – it also provides an advisory role. The commission accredits hospitals along with various organisations such as clinical laboratories, medical transport organisations and primary care services.
Karen H Timmons, president and chief executive officer of JCI, said: “A host of care issues confront patients who travel abroad to undergo treatment then return to their home countries. JCI applies standards specifically developed for international application and with the input of experts around the globe to access and accredit health care organisations in nearly 40 countries.” Timmons stated that the commission was created to meet the growing demand for a standardised method of evaluating patient care and to demonstrate a commitment to continuous quality improvement. “As with JCI accreditation in the United States, facilities accredited by JCI must constantly strive for and demonstrate improvement in patient care performance and reduced risk,” she continued.
While JCI's patient centred standards are the same across all countries, the accreditation is designed to accommodate specific legal, religious and cultural factors in a country. Accreditation is a voluntary process, but Timmons says it is important that patients look for credibility of a healthcare organisation before travelling there for care.
In Dehli, Apollo Hospitals is India's first JCI accredited hospital, boasting a Platinum Lounge that facilitates the needs of international patients who can have their appointments scheduled, hotel accommodation arranged, and queries relating to international medical insurance answered – a translator service is also offered. Statistics from the Apollo Group appear impressive and the provider claims to have 90,000 heart surgeries performed at a 99.6 per cent success rate.
medical care in countries such as India, Thailand and Singapore can cost as little as 10 per cent of the price of the same treatment in the US
Dick Atkins, a Philadelphia attorney and specialist in the travel insurance industry, believes medical tourism will continue to grow and that healthcare costs in the US are likely to rise, despite President Obama's plans for reform. “The number of people who are under insured or uninsured is only going to get greater; we also have millions of people losing their benefits,” he said. “If they are able to borrow US$10,000 or $15,000 for an operation abroad rather than $100,000 or $150,000 for the same operation in the US, then they will do it.” Atkins added that people who travel abroad for operations in this way very rarely think about the consequences and believe it will work out well.
Hope for the best
In fact, although it may seem surprising to some, Atkins says that things almost always do work out for the patient. He said: “There have been virtually no instances of patients suing. Many places are accredited and are really very good. Qualified staff will make sure the appropriate release forms are signed; they put every safeguard in place so that they cannot be sued.” Patients who are insured form a small, but rising category, he continued.
Akins went onto explain that the few employers who have adopted medical tourism in order to save a substantial amount of money in medical care, may offer employees the chance to travel abroad with a partner and stay at a resort while receiving treatment. “Mexico, or even a ticket to Thailand for treatment, may end up being cheaper for employers,” he commented. “It was assumed that people would jump at the opportunity, but they also have other things to take into consideration such as their children.”
Some medical facilities have decided to remove the threat of legal complications themselves.
University Hospital Zurich, known as one of the largest teaching hospitals in Europe, offers state-of-the-art treatment from over 4000 specialists for a range of illnesses. A hospital spokesperson said that the medical facility is not accepting US and Canadian citizens as elective inpatients and/or outpatients unless they are resident in Switzerland and, therefore, covered by a Swiss health and accident insurance plan.
The rule, however, does not apply to patients from the UK, which, according to the spokesperson, is due to legal concern. He went onto state that the hospital is obliged to accept patients, independent from their nationality or insurance status, in cases of emergency, such as tourists who are affected by an acute illness.
Be prepared
There are a number of insurers who want to make sure they are ahead of the game for the minority of patients who want to err on the side of caution. Since the end of 2008, US travel insurance company Seven Corners has been offering a medical insurance procedure product that offers medical complications coverage of up to $50,000 while the patient is abroad, and once they return home. There is also $50,000 of medical coverage for acute illnesses and injuries, which may occur on the ‘medical tour’ of the policyholder and their companion.
Seven Corners’ co-founder, principal and executive officer, Jim Krampen, says the product targets those who may not have a domestic insurance plan that covers them. Not only does the product cover them for the trip and any eventualities that may occur, he continued, it uniquely protects them for up to 60 days following treatment should any complications arise. Krampen stated: “People may travel abroad for an operation, without realising that if they have a stroke or heart attack on the operating table, they will have to pay for any subsequent care for that also. What happens if you go to India for treatment then develop an infection upon returning home? You're not going to go back to India to treat the infection.” He also said that the company has had a few claims with the policy but admits they have not sold more than 70 policies in one year. Undeterred, Krampen mentioned that there may be some changes to the product this year and he believes he has few competitors in the UK offering something similar.
people who may be considering treatment abroad … should act like consumers not patients
UK citizens are also taking advantage of opportunities to receive medical treatment abroad for a fraction of the price and at a time that suits them. Keith Pollard, managing director at Intuition Communication Ltd believes that there are two sides to medical tourism insurance for insurers – travel and health insurance. He explains that until recently, there has been a gap in the market for medical travellers who need travel insurance, but due to the fact that regular policies do not cover those who wish to travel abroad for treatment, several policies have been developed to fill the gap. Pollard mentions Seven Corners, but also Angelis, Health Traveller and Free Spirit, saying: “In terms of health insurance, UK health insurers do not cover their subscribers if they opt for surgery overseas.” He then continued to state that there has been discussion within the industry as to whether the introduction of the European Directive on Patient Mobility will change this. “If an NHS patient has the right to opt for surgery in Brussels rather than Birmingham, then a private insured patient has the same right,” he commented, “We may well see the introduction of health insurance products that are based around medical tourism which will offer significant costs savings on traditional PMI.”
Pollard warns people who may be considering treatment abroad that they should act like consumers not patients, research ratings, reviews and check accreditations. Importantly, he highlights that all costs should be compared.
Matthew Aston, international marketing manager at AXA PPP International/AXA PPP Healthcare, commented that the medical tourism industry is still an unknown quantity and presents an opportunity for some insurers, although not all. “There are a lot of considerations to take into account,” he said, “such as level of risk involved in certain territories across the world. Some insurers lack of knowledge and understanding of international markets may put them off.”
Aston continued to state that the recession has hit UK PMI insurers hard, with more people now deciding to rely on the National Health Service for treatment, or self-fund if a situation arises. “This, combined with a population who still have PMI increasing their propensity to claim, means that some insurers in the market have had to look at innovation to stabilise their businesses,” he argued.
Aston echoes Pollard's comments and says that people need know if things go wrong and should be aware of the limitations and aftercare available to them. Aston also states that although some insurers are considering offering protection for post-operative complications, it is not considered an opportunity for AXA PPP healthcare at present.
Some patients are also considering travelling between countries like the UK and the US for treatment. Alvan Haywood (84), from Fulham, London, has dual US and UK citizenship and was prescribed a significant amount of medication in the UK for an apparent ongoing medical condition for which he underwent a bone biopsy. Mr Haywood suffered complications and his family, unhappy with the treatment, urged him to travel to California in the US for further medical investigation.
The number of people who are under insured or uninsured is only going to get greater
Mr Haywood said of the situation: “My family sorted out the paperwork for treatment. I stopped taking my tablets, had a detoxification process and lots of tests.” Following an operation, his condition improved considerably and he returned to the UK. “I informed my GP of the treatment, spoke to him on the phone and he said I sounded like different person,” continued Haywood. “The doctor then visited me to observe my improved condition for himself.”
At the time of writing, Mr Haywood had returned to the US for follow-up treatment, but still believes he received better care away from the UK and appreciates the fact he had a choice. “When you get to a certain age in England I feel the medical profession writes you off, in America that does not seem to be the case,” he concluded.