Medical Tourism in Developing Countries

Promoting Medical Tourism ● 155a lower fee is a lower payment (the example given was a hernia repair thatcost $5,000 in the United States and $1,300 in Hungary, plus $600 in travelcosts). Whether all the gains from trade are accrued to the insurer or someare passed on to the consumer (in the form of lower premiums) are detailsto be worked out. Moreover, they calculated that the United States wouldsave $1.4 billion annually if even only one in ten U.S. patients underwenttreatment abroad. 65 They conclude that private insurance coverage shouldbe neutral with respect to the location of the provider, and that reimbursementshould include travel costs.What about the public sector? It has been argued that it is understandablethat governments would have protective inclinations and prevent publichealth insurance to pay for treatment overseas. 66 Yet, while this mightbe true for the United States, it is not true in the UK and Canada whereprotectionist bias might be subservient to the realities of overburdened andoverstretched national health plans. They may in fact seek outside medicalservices as a way of alleviating their burden and decreasing their totalhealth-care bill. It may raise numerous questions (such as the equity issuesinvolved in covering medical tourism abroad may allow Canadian andBritish patients to jump the queue).Encouraging Portability: Efforts by Destination CountriesAuthorities and providers in developing countries are anxious to do theirpart in order to achieve portability of source-country insurance. To thatend, they are continuing bilateral negotiations with selected institutions andinsurances. For example, in India there are ongoing negotiations withBritain’s National Health Service (NHS) to work as a subcontractor, doingoperations and medical tests at a fraction of the cost in Britain. 67 TheRockland Hospital in India has begun talks with the UK as well as severalother countries in order to become registered with them so as to attractmore patients from those countries. 68 Such negotiations will only increasein the aftermath of the influential CII-McKinsey report that suggested themedical tourism industry in India approach large payers in developed countries(such as private insurances, the NHS, and others) and negotiate withthem, preferably as a group of providers rather than individual hospitals. 69Moreover, destination countries are speeding up their efforts to achievehospital accreditation and international medical staff licensing. Such signalingof quality is an important step on the road to insurance portability.American insurance companies might seek JCI accreditation and successfulpassing of the USMLE and NCLEX-RN exams and LDCs should be readyto comply.