Insured Americans are starting to see some unusual options in their health-provider networks: doctors and hospitals in Singapore, Costa Rica and other foreign destinations.
In an effort to control costs, a small but growing number of insurers and employers are giving people the choice to seek treatment in other countries, a practice known as medical tourism.
Until recently, most Americans who traveled abroad for medical care were uninsured, or were seeking procedures not covered by insurance, such as cosmetic dentistry or aesthetic surgery. Now, a handful of plans are beginning to cover treatment overseas for heart surgery, hip and knee replacements and other major surgical procedures.
While medical tourism isn't expected to solve the country's soaring health-care costs, the practice is intended to produce savings for insurers, employers and workers. Open-heart surgery, which can cost roughly $100,000 in the U.S., can be done at an internationally accredited hospital in India for just $8,500, for instance.
Proponents note that many international hospitals are staffed with American- and European-trained physicians. Many facilities also are accredited by an affiliate of the Joint Commission, a nonprofit group that is the main accrediting body for U.S. hospitals.
Some U.S. health practitioners remain concerned about such issues as the safety of blood supplies for transfusions and tissue for bone grafts. Long-distance travel also poses special risks to patients, including blood clots from airplane flights and lack of legal recourse for negligence and malpractice, critics say.
Follow-up care can be difficult to find once a patient returns home; many U.S. physicians and dentists are reluctant to treat such patients for fear of being exposed to malpractice lawsuits because of possible poor treatment abroad.
To make travel abroad more attractive, plans that offer medical-tourism programs often throw in a bonus for employees if they agree to undergo elective surgeries abroad, or they offer to split the cost savings between the employer and worker. Travel and accommodation costs also are sometimes reimbursed.
Blue Cross & Blue Shield of South Carolina created a subsidiary for medical tourism called Companion Global Healthcare Inc. that maintains a network of international doctors and hospitals. Among the listings: Bumrungrad Hospital in Thailand, and accredited institutions in Costa Rica, Ireland and Turkey.
Medicare, the federal insurance program for older and disabled people, generally doesn't cover treatments abroad.
Some individual policies offer medical-tourism options. Ben Schreiner, a retired executive for Bank of America, recently traveled to Clinica Biblica in Costa Rica for a hernia operation that cost $3,900. His policy with Blue Cross & Blue Shield of South Carolina has a $10,000 deductible.
Surgery would have cost about $13,000 in South Carolina, he says, so he saved about $6,100. The 62-year-old traveled free using frequent-flier miles. “The hospital is state of the art. The stuff is really up to date and modern and the doctors couldn't have been better.”
Maine-based supermarket chain Hannaford Bros. Co. this year began allowing its 18,000 insured workers and dependents to travel to an internationally accredited hospital in Singapore for surgical hip and knee replacements. The company's self-funded plan, which is administered by Aetna Inc., waives out-of-pocket expenses, which can save patients up to $3,000, and reimburses all travel costs.
Hannaford, a unit of Belgium's Delhaize Group, expects the plan will reduce the cost to the company of each procedure by about 10 percent, says Peter Hayes, director of health-care strategy. He said a hip-replacement surgery in the U.S. averages $45,000 to $50,000 but can be performed for $12,000 in Singapore. Mr. Hayes said the program is still new, and no employees have yet opted to have surgery abroad.
Estimates vary of the number of Americans who travel abroad for medical care. The Deloitte Center for Health Solutions, a consulting group, figures 750,000 patients traveled abroad in 2007 for in-patient and outpatient procedures, including cosmetic and dental care.
ParkwayHealth, the largest private health-care provider in Singapore, says it treated 407 U.S. patients last year, nearly double the number from a year earlier.
The American Medical Association in June unveiled its first set of medical-tourism guidelines to state lawmakers, suggesting them as model legislation. The guidelines would require that travel be voluntary, and that financial incentives not limit patients' alternatives. They also would require patients to be advised of the medical and legal risks, and that provisions be made for follow-up care at home.
“The AMA is not at all opposed to having people go overseas to get medical care. Our major concern is that they do it in a safe, high-quality way that doesn't take away their ability to get the best care they possibly can,” says Joseph Heyman, chairman of the AMA board of trustees.
Labor unions have opposed some efforts to set up medical tourism programs. “You create a slippery slope where medical tourism starts out as an option, maybe even an attractive option, but over a short period of time I believe will become mandated,” says Stan Johnson, a union director in Nashville.
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