Today’s New York Times has a fascinating look at how U.S. Sen. Edward Kennedy, D-MA, arrived at the decision to have surgery for a malignant brain tumor. Reading it, I was struck by the fact that, in many ways, Kennedy’s process was apparently much like that which is recommended to medical tourists and travelers. Initially, doctors and surgeons in Massachusetts suggested that the tumor, discovered May 20 after the senator suffered a seizure, was inoperable. Ultimately, Kennedy gathered opinions from leading experts from six or more medical institutions and chose to have surgery. He did not have it in Massachusetts, but rather flew to North Carolina for surgery at Duke University on June 2. According to The Times, “… whether the surgery was justified or not, that Mr. Kennedy had it at Duke embarrassed the Massachusetts General Hospital, a Harvard teaching institution.”

Further, from The Times:

“Several doctors not connected with Mr. Kennedy’s case said in interviews that they admired his resourcefulness in getting more opinions simultaneously. At the same time, these doctors said many average patients gained competent advice, without a command performance, by sending pertinent records to experts for their opinions.

“Many patients search the Internet for medical information and ask that their scans and other data be sent electronically or by overnight services.

“Then such patients visit, call or write the consultant.”

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The United States healthcare system in 2008 gets an overall grade of 65 out of 100, according to a study relased late last week by the Commonwealth Fund’s Commission on a High Performance Health System. The U.S. ranked last among 19 nations surveyed in the number of deaths that may have been avoided with the proper care in 2002-2003, falling from 15th place in 1997-98.

I wince when I type sentences like that. Anyone familiar with my work knows that I’ve gone out of my way on more than one occasion to NOT say that healthcare in other countries is somehow “better” than that available in the U.S.  I note U.S. strengths in high-end care and technology and its leading role in medical research. I know overseas surgeons who have told me that, all other things being equal, they consider their peers in the United States to be the most advanced.

The problem is that all other things are not equal. The United States lags behind, badly, in the commission’s 37 different indicators of healthy lives, quality, access, efficiency and equity, compared to other countries.

Here’s some coverage of the study by major media:

• While the U.S. Spends Heavily on Health Care, a Study Faults the Quality (New York Times)
• U.S. health system scores a D in new report card (CBS Marketwatch)
• U.S. Health Care Still Ill, Survey Finds (HealthDay, Washington Post)

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Sometimes, you can’t go it alone and get satisfaction. Individual consumers with complaints, however valid, are rarely a match for the sort of colossal indifference that a big corporation or government entity can routinely bring to bear on a problem.

And most medical tourists and travelers go it alone. I know I did, in 2004. I did my research. I talked to other people who had been overseas for healthcare. I vetted my doctor. And I went, and I had a great experience.

But what if something had gone wrong — if I had been unhappy with my treatment or had complications? I like and trust my doctors; I know they would have done everything they could to “make it right.” But I have no way of knowing what would have happened, really.

Earlier this week, the Washington Post ran a story about a patient, Betty Meisel of Portland, Oregon, who went to Thailand in 2005 for plastic surgery and had things go wrong. The hospital, perhaps the best-known destination for international patients, claimed three years later to have not received the email she says she sent back then regarding her terrible surgical outcomes. When contacted by a reporter in April, the hospital did write to Meisel and issued a refund.

Which didn’t make everything OK, of course, though it was something.

Years ago, stories like Betty’s were more the rule than the exception, when reporters wrote about medical tourism. This was not because the medical facilities and doctors overseas were bad, but because reporters didn’t know enough to place a single bad outcome in context. The “news value” would be the oddness of someone going overseas for surgery, and the media treated bad surgical outcomes almost with a “what else would you expect?” kind of demeanor. The media learned, over time, and stopped reporting the small percentage of bad results as the norm. Bumrungrad International, in fact, has a reported complication rate that any U.S. hospital would be proud to match.

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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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