The third in a series of articles on the US medical tourism market.
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With the continuing problems in the US healthcare system, how many American citizens are considering overseas treatment as a realistic option to meet their healthcare needs?
This article is written by Ian Youngman, a specialist researcher and publisher of detailed research reports on insurance and medical tourism.
The number of Americans who would consider going abroad for treatment is a subject that comes up regularly. Many people who talk figures are only using wild guesses. Others rely on dubious research, designed to guarantee an answer that supports their sales pitch. The research trade calls these loaded questions ‘when did you stop beating your wife’ questions. This year we have two new independent surveys, not commissioned by anyone in medical tourism, but by top international researchers. The most recent is from Gallup. Results are based on telephone interviews in April 2009 with 5050 adults
the Gallup Poll found that up to 29% of Americans would consider travelling abroad for major medical problems. 24% would seek cancer diagnosis and treatment abroad. Americans are less likely to say they would consider travelling abroad for hip or knee replacement (15%), heart bypass surgery (14%), or cosmetic surgery (10%).
When the same question was asked, but on an assumption that costs are cheaper and the quality of treatment equivalent to the USA, the percentage prepared to travel increased to:
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40% major medical problems
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37% cancer diagnosis/treatment
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27% hip or knee replacement
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27% heart bypass surgery
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20% cosmetic surgery
Asking the above of people with no health insurance increased to:
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51% major medical problems
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46% cancer diagnosis/treatment
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41% hip or knee replacement
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36% heart bypass surgery
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30% cosmetic surgery
People in the Midwest are the least willing to consider obtaining treatments outside the country; those in the West are the most willing. Southerners are also below average in their willingness to obtain treatments outside the country, with the exception of hip or knee replacement.
The data suggest the 50 million Americans without health insurance are motivated by costs and would be more likely than those with health insurance to consider seeking medical care abroad. A sizable minority of Americans view th healthcare diagnosis and treatment available beyond national borders as something they would consider using.
A survey a few weeks ago differs from Gallup. The results of the “2009 Deloitte Survey of Healthcare Consumers” are also vastly different from the previous year’s, which showed that Americans would consider travelling overseas for treatment - particularly if they can achieve 50 percent savings on international-standard healthcare.
In this year’s results, 43 percent of the 4,000 Americans – aged 18 and above – say they are prepared to travel out of their local area to undergo a test, procedure, or treatment if it would cost 50 percent or less than when done in their home city. In fact, eight percent have travelled for care outside of their local community as medical tourists. However, out of local area does not automatically mean going overseas.
Only one percent say they have gone abroad for treatment, a similar result to 2008. But while last year’s study said 40 percent would consider treatment abroad, the figure plummets to 10 percent for the 2009 survey.
The results for 2009 also vary by category. Among uninsured patients, 20 percent would consider medical tourism. Receptivity to medical tourism is highest among younger adults at 10 percent to 12 percent, compared to only six percent for seniors.
The Obama effect
Any pre-2009 survey was before Obama. Bush made noises about reforming healthcare but backed off for a variety of reasons. Congress is preparing to overhaul the United States' troubled healthcare system and President Barack Obama hopes to sign legislation before the end of the year. Obama says he wants to cover more or all Americans but has not indicated how. Options include expanding Medicare and Medicaid, creating a public insurance pool, tax breaks for employers to offer coverage and requiring insurance companies to cover more people. The best guess is that it will be a mixture of public and private insurance.
U.S. government economists predict that public and private health spending will hit $2.5 trillion this year, taking up a 17.6 percent share of gross domestic product. Americans spend more per capita on healthcare than any other country at $7421 per person, the U.S. Centers for Medicare and Medicaid Services reports. Yet studies suggest Americans get poorer care than people in other industrialized countries that have national healthcare plans. Private insurance pays 35 percent of this; Medicare, the federal health plan for the elderly and disabled, pays 19 percent; Medicaid and the State Children's Health Insurance Program pays 15 percent; 12 percent comes from other public funds; 7 percent from other private sources, and 12 percent is paid out-of-pocket by patients.
The U.S. Census Bureau says 46 million Americans, or 15 percent of the population, have no health insurance. Newer estimates say this now exceeds 50 million. About 63 percent of U.S. employers offer health benefits to workers, according to the Henry J. Kaiser Family Foundation. Those who work at large companies are much more likely than those who work at small businesses to have health coverage. The self-employed must typically pay much more for coverage than those who get insurance through an employer. Employers on average pay about 75 percent of that cost. Major medical plans are too expensive for many Americans. Other health plans and mini-medical plans are more popular but they rarely cover non-emergency operations; some are little more than a discount card. Few insurance policies will pay for medical tourism.
Dean Baker of the Center for Economic and Policy Research suggests that Medicare beneficiaries should be allowed to buy much cheaper healthcare in other countries. The government could split the savings with the beneficiaries, allowing them to pocket thousands of dollars a year, while saving the government the same amount. Baker argues that savings can easily offset the cost of travel for the patient and several family members. But he argues that before government could sanction this, overseas facilities need to be regulated and clear rules established for legal liability.
Whatever happens, those seeking cosmetic surgery will still look overseas, but for major operations, how many Americans will consider overseas treatment in 2010 will depend on how Obama reforms the healthcare system.
Ian Youngman is a writer and researcher specialising in insurance and health. He writes regularly for a variety of magazines, newsletters, and on-line services. He also publishes a range of insurance reports and undertakes research for companies. An ACII, with an honours degree in Economics from the University of Liverpool, Ian was a co-founder of The General Insurance Market Research Association. He also has widespread experience within the insurance industry at management level, working for brokers, a bank and an insurance company.
