One of the world’s most respected journals, The Economist, suggests this week that Medical Tourism is the proverbial tide that lifts all boats. In an article headlined “Importing Competition,” the magazine says the “coming boom in medical travel could help both rich and poor.”

By “rich,” they mean the United States and the developed economies of the west — not wealthy individuals. By “poor,” they mean the Latin American, Asian, Eastern European and African countries that are becoming medical tourism destinations.

The argument in “poor” countries against medical tourism is that providing private medical infrastructure for foreign patients will divert resources from improving health care locally. But The Economist asserts:

But the private sector cannot be blamed for the failings of state-run health bureaucracies in developing countries, which neglected the poor long before medical tourists arrived. And the foreigners’ arrival could improve things in developing countries, for the poor as well as the rich. Although the hospitals that cater to medical tourists will of course employ local staff, they will also create jobs, tempt home émigré doctors and nurses, encourage locals to train as medics, spread know-how and treat local people.

An argument against medical tourism from the point of view of the “rich” is that the United States (for example) needs to focus on cutting costs and improving efficiency of its own healthcare system rather than having patients go overseas. The Economist suggests that medical tourism is part of the solution, not part of the problem:

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I’ve been told time and time again that medical travel and tourism is under discussion at the highest policy-making levels of the U.S. government and have not doubted the assertion when I have heard it. Yet last week, I was briefly stumped when someone asked me for proof that medical tourism is important enough for Congress and the White House to be interested.

I pointed at hearings conducted by the United States Senate Special Committee on Aging in June 2006:

The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?

… but my cynical correspondent pointed out that U.S. Senate committees conduct hearings all the time, perpetually gathering testimony on all manner of issues that they promptly forget about; and indeed, I had to acknowledge that there is to date no public sign of a government task force on medical tourism or any type of follow-up. The leadership of the Senate changed in late 2006 and committee staff has changed as well.

So I did a little more digging to back up my point and found that U.S. Health and Human Services Secretary Mike Leavitt has a very public curiosity about medical tourism and travel, and even discussed it on his own blog, as recently as April, after a trip to the Far East that included a stopover in Singapore. Of Singapore’s healthcare system, Leavitt had this to say:

“So, what about the quality you say? Aside from the statistics on life expectancy already cited, let me suggest we think about this. The Government of Singapore estimates that, in 2008, over 600,000 people, including many Americans, will engage in medical tourism. They will fly to Singapore to get their care at a fraction of the price. The Singaporean Government believes by 2012 the number will exceed a 1,000,000 people a year. In order to attract these people, they are transparent with both cost and quality outcomes. Patients have more information about care in Singapore than about care they would get from their local hospital. Hmmmm.”

Hmmmm, indeed.

During a trip to India in January, Leavitt blogged:

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It took me a full day to decide whether or not the above headline worked for me at all. Undeniably, the European Commission, which has broad power over economic policy for most of Europe, is supporting transnational regulation for healthcare in the 27-member European Union (EU). (News link)

Almost immediately upon the announcement of the proposal, Britain’s National Health Service (NHS) was freaking out.

“Millions of patients will be able to travel abroad for free medical treatment within three years under European plans,” was the breathless lead in The Telegraph, which went on to say:

The new rules will allow patients to buy hospital, outpatient or dental treatment in any EU country and send the bill to the National Health Service.

Experts predicted that the rules could spark an exodus of patients from the NHS due to concerns about long waiting times and hospital superbugs.

Once adopted the new laws will give patients the right to claim back the cost of any medical procedure up to the amount it would have cost in their home country.

Further down in the article, the NHS had its say:

“… Health Secretary Alan Johnson is fighting for the right to make patients obtain NHS permission in advance for major operations.

The health department said: ‘We are absolutely committed to ensuring that the NHS retains the ability to decide what care it will fund.’

The proposal represents a potential boon to medical travel and tourism businesses and facilities in Eastern Europe especially, along with perhaps Portugal, Spain and those Western European countries that have lower costs than Great Britain — along with no waiting lists, for which the NHS is notorious. The reaction from India was also immediate — the EU proposal was called a “major setback” to Indian medical tourism, which has been courting NHS outsourcing for years now.

Can the NHS and Britain buck the Commission? Perhaps. The proposal isn’t set in stone. But there is a certain aura of inevitability about medical tourism in Europe …

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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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