The rise and risks of medical tourism

Medical tourism is a booming industry dominated by Asian countries including India, Thailand and Singapore. India alone saw 2.5 million medical tourists in 2012 and one Thailand hospital serves 400,000 patients annually. This trend shows no signs of abating. According to Transparency Market Research, in 2012 the global medical tourism market was $10.5 billion and is estimated to reach $32.5 billion by 2019. Scarcity of medical resources, improved communication between countries, globalization of health care, internet marketing and ease of travel have also boosted the industry.

As medical travel grows in popularity and expands to other countries, U.S. employers need to be educated on the ins and outs of tourism to ensure safety of their employees and avoid fraud. It’s also important for patients to do their own research, and be prepared to think about the downsides of medical tourism.

Buyer beware

Throughout the Western world, medical tourism may well offer a lower cost option for medical treatment without compromising on quality, but there are important considerations to research.

This starts with choosing the destination. Whenever possible, travelers are advised to talk to their local doctor first, and find out what questions to research for their condition and who credentials those providers abroad. Also consider the language spoken where care would be received. Research the country’s requirements on visas or proof of ability to pay before receiving treatment. Patients should allow enough time in travel plans to receive the necessary follow-up care — often days or weeks beyond the procedure. The treatment itself may be low-cost, but travel expenses also need to be added. In addition, traveling post-surgery may increase complications and infectious disease standards vary.

Upon return, there may be new complicating factors. In the most extreme cases, legal recourse for malpractice claims or lawsuits may be minimal or nonexistent. In the worst cases of “botched” procedures, patients may have to pay a U.S. surgeon to fix the original surgery.

Finally, employers need to be aware of the scams. It’s easier to fabricate services not rendered, disguise cosmetic services as medically necessary, inflate charges, and misrepresent experimental or elective care when everything is in a foreign currency, documented in a different language, and care delivered 8,000 miles away (it’s less likely a U.S. claims payer would ever do an on-site billing audit).

Internet marketing has spawned scam artists (i.e., alleged cures for cancer), and medical travelers don’t always make informed decisions. Be wary of clinics not accepting insurance, customer service departments looking for advance or quick payment, doctors overcharging patients for consultation or recommending unnecessary procedures, and corruption.

Claims administrators should look for addresses that are really P.O. boxes or near a U.S. border, high dollar member reimbursements being requested with no true proof of payment, misuse of medical terminology, or a diagnosis that doesn’t make sense for the length of stay.

Advanced analytics can play a role here, in mining through text data to uncover medical documentation that has been altered, or collusive schemes with organized crime that crosses country borders, but no analytical method replaces doing your homework before the care is delivered.

Encourage employees considering medical travel to do research. Do the homework, so as not to end up in the headlines, or with compromised care.

Future of medical travel

The medical travel industry will likely get a boost from the growing number of Americans over the age of 65 at risk of outliving their retirement funds. With longer life expectancies, fewer company-provided pensions, and likely cutbacks in Medicare coverage, they will be seeking lower cost alternatives for the latest medical advancements.

While health care reform has made access to care in the U.S. more readily available, the shortage of doctors, nurses, and hospital beds may not meet increased demand. 

Convention bureaus and marketing partners promote destination travel based on the availability of inexpensive procedures and accommodations wrapped in a vacation package. But do they have the expertise to help make informed decisions when selecting a doctor or medical facility? It’s up to the patients to do their own research.

Accrediting bodies such as the Joint Commission International — the international arm of the organization that reviews and accredits American hospitals — send teams to accredit/re-accredit hospitals every three years. Sadly, though, as of this writing, only 634 hospitals worldwide had been accredited. In Mexico, only seven facilities met the standards, yet Mexico is a popular medical tourist destination, likely due to its close proximity to the U.S. and abundance of vacation spots. A potential medical traveler should also contact the destination’s government health authority websites and check licensure.

At the end of the day, only employees who do the appropriate research can make the most informed decisions and have the best chance at a good outcome at the lower cost they desire.

Caveat emptor.

Julie Malida is the principal for health care fraud solutions in the security intelligence practice at the SAS Institute Inc. She is a 30-year veteran of the health insurance industry and is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries.