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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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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Erik Steele, D.O., a physician in Bangor, Maine is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He has a terrific article in the Bangor Daily news, headlined, “Consider medical tourism a warning.” in which he discusses the recent news that Hannaford Bros., a supermarket chain with 27,000 employees, is offering a medical travel option as part of employee benefits. The story, initially reported out of Maine, was picked up by the Associated Press and made national news. (Link here.)

Says Dr. Steele:

“Rather than curse Hannaford for its self-interested decision, we would do well to see Hannaford as a corporate canary chirping frantically about the deteriorating conditions brought on by high health care costs in the coal mine of American business. Its action is a warning of things to come. If unheeded, it will not be Hannaford’s action that has brought about the ruin of some hospitals, but the failure of health care and other leaders in this country to listen to the canary.”

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