Dr. Andrew Weil, MD, is a prolific author, perhaps best known for establishing and popularizing the field of integrative medicine, which combines conventional medical treatments and alternative treatments for which there is some high-quality scientific evidence of their safety and effectiveness. His web site, DrWeil.com, is among the most visited medical sites on the Internet. The “Ask Dr. Weil” column, from the site, is a cottage industry unto itself; “Dr. Weil has raised dispensing health advice to an art form,” says reviewer Erica Jorgensen at Amazon of his bestseller Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being.

But I didn’t know until yesterday that Dr. Weil had ever had anything to say about medical tourism. I really should have known better. In an “Ask Dr. Weil” column from last fall, he confronts the issues involved in medical travel head-on, concluding:

Keep an eye on the growing trend of medical tourism. I predict it will become more prominent in coming years.

This, in response to a writer who said he was “appalled” that a friend was going to India for heart surgery.

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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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