Medical Tourism in Developing Countries

152 ● Medical Tourism in Developing CountriesPublic Health Insurance in Source CountriesAccording to U.S. federal and state regulations, reimbursement of medicalexpenses can only happen if treatment is received in licensed facilities inthe United States. Medicare and Medicaid forbid reimbursement for medicalprocedures that have been performed abroad. 46 Medicare covers no servicesdelivered abroad 47 with the following exception. If a resident in aborder area lives closer to a foreign hospital than a U.S. hospital, then treatmentis covered. 48 Also, supplementary coverage for Medicare patients,called Medigap, covers emergency treatment abroad (but only for the first60 days of travel).The rules that apply to Medicare and Medicaid are shared by numerousother countries (including, for example, Bulgaria and Poland). 49 Canada hassimilar rulings although it makes greater exceptions (for example, somecancer treatment can be received in some states of the United States). Chile,as part of the MERCOSUR customs union, enjoys an agreement pertainingto health insurance that allows exchange of services between health servicecooperatives in member countries. 50 In Costa Rica and Jordan, citizens areallowed to get treatment abroad at the expense of the national health insuranceonly if such treatment is not available domestically. Using the samelogic, the German health insurance pays for single occupancy at theMövenpick Resort and Spa Dead Sea in Jordan for those who suffer frompsoriasis and other skin conditions, as such treatment is not available inGermany. 51 But Mövenpick is a German company. Would the rules bedifferent if the health-care provider were of a different nationality?The European Union (EU) allows its citizens that reside, or are otherwisein a foreign country to get sickness benefits. In other cases, bilateral agreementshave been signed that allow portability of health insurance betweencountries. The extent to which residents in EU member states have a legallyenforceable right to access health-care services in other EU member countriesis not clear (see discussion below). It is clear, however, that the rightdoes not extend to countries outside the EU. 52Private Health Insurance in Source CountriesAlthough both public and private insurances in Western source countriesprohibit coverage outside their countries, their motivations and degrees offlexibility are different. Indeed, it is unlikely that private insurers would beprotectionist but, rather, they would focus on the bottom line. Also, whilemost insurance covers out-of-country health care only in case of emergency(namely the incidental medical tourists described in chapter 3), there are a