Emerging Trends in Outsourcing Healthcare: Medical Tourism

The terms “health tourism,” “medical tourism,” or “health services outsourcing” are often interchangeably used to describe health service provision in another country. The more encompassing concept—“health tourism”—includes all health-seeking behaviors by consumers into another country. This definition includes getting health services, tourism for indigenous and alternative medical treatments, and any other form of tourism undertaken with the purpose of addressing a health concern, usually motivated by seeking cheaper care.1 The phenomenon of medical tourism has attracted much attention in the lay press across the United States and holds many implications for our own healthcare system.2,3 In June 2007, the American Medical Association issued a report titled, Medical Tourism Outside the U.S., which was intended to “study the trend of ‘outsourcing’ health care overseas,”4 motivated in large part by the concern for postprocedure follow-up of patients returning to the United States.4 Private sector development in emerging economies—such as India, Thailand, Singapore, and certain Latin American nations—attracts foreign patients for relatively cheaper care: the uninsured, the underinsured, or those who prefer not to wait for treatment under a national health insurance system or under arrangements where an employer or private health insurance schemes are seeking “bargain care” over US healthcare prices.5 Such conditions have fostered a thriving medical tourism industry of late. In addition, other health alternatives—complementary medicines, some uncovered procedures that have not yet been approved in one's home country, and indigenous treatments—all form part of the lure that is attracting thousands of health tourists globally each year. While the private health sector in developing countries begins to thrive, the public health sectors all remain at a much lower rate of growth amidst mounting unmet health needs.6 This new section of the journal will address the advent of health tourism, its varying impact on certain societies, as well as the implications for patients and payers. Topics to be addressed under this emerging trend will provide a variety of perspectives to different stakeholders about medical tourism, including: The coverage in US national and local newspapers7–9 An examination of the costs and quality of various medical procedures in different countries available for “medical tourists”10 Potential risks and benefits of traveling abroad for medical care11 Role of middlemen and websites that attract American consumers12,13 Alternative therapies and spa treatments14 US insurance companies' and health plans' reactions to medical tourism15–19 Review of specific nations that are creating a market for European and American patients, such as Thailand, Singapore, India, Mexico, Brazil, and Costa Rica.6,20,21 Relevant questions for US health plans regarding medical tourism include: What is known of these various foreign healthcare systems? What about their professional quality? How are their facilities being accredited? What are the medical malpractice and legal frameworks? Other topics of interest include concerns by consumers and clinical cautions, along with potential repercussions for medical follow-up and benefits coverage for patients returning to the United States after a medical treatment abroad.22,23 The goal is to place the emerging medical tourism in its context of globalization, travel, and the consequences of medical and pharmaceutical outsourcing.6,24–26