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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There is a lot of educated guessing in business and in the media about what motivates medical travelers. I call it “educated guessing” because the evidence available is largely anecdotal — there are no broad-based, scientific surveys of medical travelers. There isn’t even a generally agreed upon definition of what a medical tourist *is.* Are you a medical tourist if you live in San Diego, Calif., and take the trolley and a cab to your dentist in Tijuana, Mexico? I’d say yes … but others, in an effort, perhaps, to better define a market for medical services to which insurers and employers can relate, only count those who travel much further, and for medical care, procedures and surgery that might be (or is) insurable.

I bring all this up because it can get very confusing to try to figure out what matters to medical tourists when there are different definitions of what a medical tourist is. A recent McKinsey Quarterly study, Mapping the Market for Medical Travel, says “only 9 percent of the (medical) travelers seek lower costs for medically necessary procedures …”

That statement is taken somewhat out of context from a report that we’ll be talking about more in coming days and weeks. Most people in the United States with knowledge of medical travel agree that cost is a paramount factor in a decision to seek surgery or other medical care overseas. And the McKinsey article acknowledges that “US patients make up 99 percent of the people in this group.”

So … again, what motivates medical travelers depends on what a medical traveler is, and which ones you’re talking to. As a guide to helping potential medical travelers decide what is important to them, BridgeHealth has released a list of ten key value criteria for choosing a medical travel company. A patient’s motivations, reasonably, can be mapped to the list:

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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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Vic Lazzaro, BridgeHealth International Inc.’s CEO, was featured recently on the EBA Raw Bar, which is the regular podcast of Employee Benefit Adviser. The Raw Bar features “daily in-depth interviews and discussions with the leading employee benefits minds of our time,” and I’ve no doubt Vic is a little amused to be described as among such company. But that’s what happens when you’re ahead of the curve.

In the interview, he describes the role a strong network plays in creating confidence in care abroad and sheds light on the provider selection process. You can listen below — just click the arrow to play the sound file.