The story of modern medical tourism in the United States, as told by the media, has changed over time and now comes in a package of inevitability. It hit home for me last week, when the American Medical Association acknowledged medical travel and tourism and set some broad guidelines (reported here) and, again today, with a significant story by MSNBC Health Writer JoNel Aleccia that advances the storyline for consumers very nearly to a frontier that, until recently, was the province of industry insiders.

Hip surgery in India? Insurance may pay:
Burgeoning benefits could send hordes of U.S. patients abroad for care

The paragraph that jumped off the screen at me was this:

Once the province of the poor and uninsured, medical tourism is gaining attention of industry giants such as CIGNA, Aetna and Blue Cross/Blue Shield, who say they either have begun or are considering pilot programs that provide limited coverage for foreign care. One Montana firm, Employee Benefit Management Services Inc., recently began offering medial tourism plans to its 120 self-insured clients in the Northwest.

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If anyone still doubts that medical travel and tourism are having a serious impact on discussions about the future of healthcare delivery in the United States, perhaps they should click on over to this “Let’s Talk Health Care” blog post by Charlie Baker, president and CEO of Harvard Pilgrim Health Care, Inc., one of New England’s leading non-profit health plans. I know the discussion about medical travel has been going on within Harvard Pilgrim for some time, having discussed it last year with Jim Sabin, chairman of the company’s Ethics Advisory Group, who has also blogged about the subject.

Baker notes that — according to a study by the Deloitte Center for Health Solutions — the number of people leaving the U.S. to access care in other countries is now growing at a faster rate than the number of people coming from other countries to the US to seek care. “A lot faster,” he says, and he goes on to discuss the profound implications this may have for healthcare in America. The Deloitte study suggests that U.S. healthcare providers will lose almost $16 billion in revenue in 2007 to outbound medical tourism.

“If Deloitte’s trends are correct, the size of that loss will grow to almost $70 billion by 2010 — as much as 10% of total revenues by 2010,” Baker says.

Vic Lazzaro, CEO of BridgeHealth International, thinks that the Deloitte conclusions are perhaps alarmist

“That under this scenario there will be a loss of revenue to hospitals and facilities in the U.S., over time, cannot be denied,” Lazarro commented. “We also would be surprised, though, if that impact was significant for any one hospital or physician.

“We would hope those factors in the U.S. would result in increasing focus on quality, outcomes reporting, service and cost reduction, as this is now what is being delivered at the international hospital destinations.”

The Deloitte study found that nearly 40 percent of American healthcare consumers would be willing to travel outside the country for care if the quality was comparable and the cost was cut in half or more. Highlights of the study include:

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The American Medical Association (AMA) has taken a formal stance on medical tourism, and the biggest news is, perhaps, this: They aren’t against it.

“We need to address the cost of care in the U.S. and cover the uninsured so that every American who needs health care can get it right here at home,” said AMA Board Member J. James Rohack, M.D. “Until there is significant action at home, patients with limited resources may turn elsewhere for care. It is important that U.S. patients have access to credible information and resources so that the care they receive abroad is safe and effective.” (Emphasis added by the moderator)

Rohack’s statement was part of a news release today coming out of the AMA’s annual policy meeting in Chicago. The association said its nine principles regarding medical travel and tourism “are the first-of-its-kind, and outline steps for care abroad for consideration by patients, employers, insurers and third-parties responsible for coordinating travel outside of the U.S.”

“For those patients considering medical tourism, the new AMA principles are an important starting point for consideration before making the decision to go abroad for health care,” said Dr. Rohack.

In a preliminary statement, Stephanie Sulger, RN, MS, vice president of the consumer division of BridgeHealth International, said she “is very pleased to see the AMA addressing this issue.”

“The guidelines the AMA has put out are comprehensive and show that they have given a lot of thought to the implications of medical travel for the U.S. healthcare system and, most importantly, for patient safety and well-being,” Sulger said. “We welcome the AMA to the discussion of how to make sure patients who travel for medical care, often for financial reasons, get the best possible care.”

To ensure that insurance companies and others that facilitate medical tourism adhere to the new principles, the AMA said it will introduce model legislation for consideration of state lawmakers.

The nine principles given by the AMA are:

(a) Medical care outside of the U.S. must be voluntary.

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Most medical patients aren’t aware of their rights, other than generally. In the United States, particularly, they can be excused — patient rights vary depending on the state in which a person lives and what protections and recourse that may be offered by an insurer or HMO. Patient Bills of Rights passed both the U.S. Senate and the House of Representatives in 2002, but they were different versions and, ultimately, no bill was able to pass both bodies.

The President’s Advisory Commission on Consumer Protection and Quality adopted what amounted to a consumer bill of rights and responsibilities (note that with the rights come responsibilities) in 1998 which is, as the name of the commission suggests, only advisory in nature. Many, but not all, health plans and healthcare organizations formally subscribe to the principles in the commission’s final report. It is ten years old, and non-binding, but it is better than nothing.

Medical travel and tourism was barely heard of in the United States by 1998, and was not a consideration in the debate over a federal Patient Bill of Rights in 2001-2002. Medical tourism has only more recently come under scrutiny in Congress. Regarding their rights, medical tourists and travelers have mostly been told: “You’re on your own.”

So it’s good to see medical tourism companies grappling with the concept of patient rights and responsibilities, as BridgeHealth International has. The company today released “Clients’ and Traveling Patients’ Rights and Duties,” a statement that is meant to represent the company’s values as well as representing, broadly, the rights that a BridgeHealth client can expect when traveling overseas for medical care.

Reading through the document, it occurred to me that in it are embodied the rights that any patient should expect to have anywhere — not just when traveling abroad — but that several of the enumerated rights are not common in the United States. In particular, do patients have a timely, thorough and documented process for registering complaints? And do they always receive a detailed statement of account with an explanation of all expenses incurred during treatment? Perhaps both are routine in some facilities, but I think the perception is that neither is commonplace.

I’d love to hear what readers think. Is the BridgeHealth statement of rights and duties on the money? Does it go far enough? What, if anything, would you add to it?