Ins and outs of outsourcing plastic surgery.

In business terms, the ideal model that can be effectively outsourced is one that is easily transportable, offers low risk, and is standardized, focused, and cost effective. Beginning with the export of information technology and call center jobs, outsourcing has now expanded its grip to include surgery, even plastic surgery. Several developments have facilitated this trend. Prohibitive health care costs at home, long waiting times, denial of insurance claims, increasing overall demand for plastic surgery, the availability of trained surgeons abroad, and, lastly, cost savings have all paved the way. Under the umbrella of “medical tourism,” the outsourcing strategy (a business decision) has been applied to plastic surgery (a profession). This aberration makes for an uncomfortable match. On the one hand, both the uncertainty of quality of care and the risks associated with poor outcomes and complications make the risk not worth taking. On the other hand, the huge cost savings shine an irresistible lure. It is imperative that we gear up to the challenges this expanding phenomenon poses to our practice. Anything less would be too little and too late. The magnitude of this outflow is telling. While the number of cosmetic procedures performed in the United States increased by 44 percent in 2004 (American Society for Aesthetic Plastic Surgery), the glaringly less noticed fact is that the number of plastic surgical procedures performed abroad on Americans traveling internationally has tripled. Thailand, Singapore, and India rank among the top three destinations, with up to 150,000 to 600,000 foreign patients in each country being operated on for plastic and other surgical procedures.1 An independent study by McKinsey and the Confederation of Indian Industry predicts the growth of outsourced health care to reach an annual revenue of $2.1 billion by 2012.2 An analysis of patient surveys yields three recurring elements that patients are most impressed with: personalized and “caring” health care delivered by U.S.-trained physicians at rockbottom prices. In addition, the package covers extras such as tourist attractions, spa access, free transportation, and hotel arrangements. Local governments pitch in by providing loan incentives for entrepreneurs to set up medical tourism facilities, called “medical cities,” that attract outsourced foreign currency in terms of health dollars. Even airlines provide a concession by offering a special package for follow-up visits when they are necessary. It seems that the entire system is geared toward attracting foreign patients, in order to facilitate the outsourcing model. In sharp contrast, our situation here seems lamentable. Rising costs of health care, inflexible hospital systems, ever-expanding regulatory burdens, sky-rocketing medical malpractice premiums, frivolous litigation, and decreasing insurance reimbursements have all served to increase the cost of care to the patient, in either higher direct fees or higher hospital charges. On the face of it, the competition could soon become insurmountable for physicians in the United States. What, then, are the solutions to stem this hemorrhage?