Dr. Bob Lee and Dr. David Groves from Bowling Green State University, Ohio and Dr. Julie Lengfelder from the University Of Toledo consider the changing landscape of health care in the United States and its potential influence upon medical tourism.
With the passage of the healthcare legislation (The Patient Protection and Affordable Care Act of 2010 (Pub.L. 111-148) and The Health Care and Education Reconciliation Act of 2010 (Pub.L. 111-152)) 1 , it is evident that medical care has become politicized and the landscape has changed significantly
There are many interests in the US healthcare system: patients, doctors, hospitals, insurance companies/ PPO and HMO, insurance administrators (Medical Care Management), pharmacy companies, federal, state, and local governments, and lobbyists such as the American Medical Association, and the American Academy of Family Physicians, AARP (There are over 120 lobbyists in the primary category.) The complex fabric of the healthcare industry has quickly polarized around legislative efforts. In the past, the healthcare system had been primarily influenced by the free market, except Medicare and Medicaid, severing the elderly and the poor. The old healthcare system had problems because there were major segments of the population that were not being served effectively. However, there were definitely different perspectives on how to solve these problems from a spectrum of thoughts that suggest either little involvement or interference to a system that needs to be regulated and controlled.
The basic model being used for the new act is Medicare which expands government health care to the general population. The arguments from all factions became segmented and there has been tremendous polarization of views. This was the primary political issue during 2009. The divisiveness was extreme on all sides and led to an extensive law that is difficult to understand and will be left to administrative agencies to interpret the vague language in the legislation.
The arguments have continued since the act was passed, and the political factions have gathered to continue the battle. The disagreements will continue with the legislation becoming a campaign issue through November, 2010. The politicization of medical care in the United States will be in limbo until this system is implemented in the out years of 2014 and beyond. The logic of developing a comprehensive system, based upon patient/doctor relationships has been forgotten in terms of providing quality of care for the spectrum of populations within the United States. There is little doubt that the system needed to be improved and all reason has been lost to the emotion of the political process.
Status
The World Health Organization "World Health Statistics 2009" report indicated that the U. S. was third in health care expenditures per capita ($3,076). (2) It was first in national health care spending as a percentage of Gross Domestic Product (GDP) (15.8%). 2 The World Health Organization's ranking of the world's health systems was last produced in 2000, because of the complexity of the task. The ranking in 2000, for the U. S., was 37 th . 3 The best indicator of health performance today is life expectancy as researched by Le Duce Media. The U. S., in the recent report, ranked 30th with an age of 78.1. 4 The health system in the United States, in recent years, has been plagued by increased costs higher than the rate of inflation. Its rank, in terms of the quality of health care, has not matched expenditures. It has been characterized by widespread fraud, especially in the Medicare and Medicaid systems. There have also been questions raised about several of the actors exploiting the system for more than reasonable costs and profits. These conditions are what have given rise to a desire and a demand to improve the system, based upon cost and quality. Certain factions within the political structure have wanted to develop a system of government regulation and control for the past 100 years. There have been numerous legislative efforts tried, but all have failed until now. With the election of President Obama and the democratic Congress, their dreams have been realized. They have used the dissatisfaction with the current system as a springboard to redesign and change the basic infrastructure to one that is more centralized.
Medical tourism, because of the increased cost of certain services in the United States, has been growing. The cost has been a positive attraction to clients who have the necessary dollars and understand that the medical services in tourism destinations is as good as they can receive in their own communities. In fact, one of the attractions in outbound medical services has been the personalization of services.
Instability
The real question, at this point, is how the landscape created by the politicization of the health care system will change. It is evident that there will be instability because the legislation will not take effect until 2014. The struggle to modify, change, or implement the legislation will also bring great uncertainty. Each of the actors will try to solidify their own position and influence over the administrative structure. The struggle is the basic element that will lead to the volatility.
There obviously will be several periods of adjustment between now and 2014. The first period of adjustment will be the struggle for power and position within the new system. This period will be characterized more by emotion than rationality. After this initial period of struggle, there will be a period of positioning, based upon strength and understanding the administrative procedures developed from the legislation. Those who have lobbied effectively will be the winners and the other actors will be reduced to an auxiliary or support position. The next period will be implementation and it will depend upon satisfaction or dissatisfaction of patients/doctors, based upon cost and quality of services. In this struggle for power, innovation and quality will be lessoned. In this cycle, their will be continuing friction in the system for position, and the opportunity to look to change the position of each of the actors. The focus upon patient/doctor relationships will have been lost and there will be great dissatisfaction until some type of stability can be achieved.
The previous system was competitive and the new system will be even more competitive. What is needed is cooperation and a new systems approach that will give rise to maximizing the effectiveness of each to the actors and how they fit together to deliver a quality service that is better than the sum of the parts. This cooperation is what is needed to design a better system and take the politics out of health care. The actors in the system may eventually come to this conclusion, but it will not be in the immediate future.
With respect to chaos in health care, medical tourism is emerging as a viable option for U.S. citizens. This is an opportunity for medical tourism to exploit the dissatisfaction among patient/doctor relations and to develop a perspective that builds upon personal services. These services need to develop faith and confidence in traveling abroad to obtain medical services. Those who seize this opportunity will be in a position to increase their market share.
Trends in medical tourism
Medical tourism, where patients and tourists travel outbound for medical services and vacations, has emerged into an industry. 6 The change in the U. S. landscape will provide for the evolution of the industry through the addition of numbers and more sophisticated clients. A patron usually travels a great distance to obtain medical, dental, or surgical treatment while taking a vacation in the selected destination. As the market expands, new destinations will be added to the mix. Medical tourism is an emerging trend that has reversed the old fashion of wealthy families traveling to developed countries for quality medical services and better health care. There will be an increasing number of middle class travelers to outbound destinations, more likely countries such as, India, Thailand, and South America. The reasons for rapid growth in medical tourism, in the past decade, were due to the rise of health care costs in wealthy countries, people’s preferences for privatization of health care, affordable medical expenses offered in selected destinations, exotic cultural attractions, quality improvement of medical care systems in the selected country, and communication technologies. These trends will increase in the future as the industry improves the sophistication of its products.
However, many factors, elements, and variables that influence the decision-making process in medical tourism still remain unknown and need further research. For instance:
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How a client determines a destination for medical travel
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How many days to stay at the destination
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What are their leisure expectations beyond treatment
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Number people in travel party
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Expenses expectations
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Preferred time of year to travel
Obviously, research is warranted in exploring these areas to help in the development of perspectives in governing and policy-making. Those markets with the best information for decision-making will increase their market share.
Ways to expand opportunities
One of the ways of achieving these opportunities is by exploiting patent/doctor relationships. The primary focus of most marketing efforts has been upon patients and the affordability of services. New frontiers can be opened by inviting doctors and their family’s to desirable destinations to practice on a temporary basis. A time frame will directly depend upon the doctor and his/her family. It must be marketed as a vacation experience and a new opportunity for education and work. The doctors, in this model, will be the primary recruiter because he/she will bring the patients with them and their confidence will be solidified. The patients will get to know a new medical service team that will include physicians from the United States.
Another way to exploit the instability is, as the system is implemented with greater control, there are some procedures that will be denied, especially for senior citizens. 5 A significant amount of money will be cut from Medicare and the system will have to be more restrictive. This is an opportunity for medical tourism to fulfill this need for services. The key element is the gap in care and understanding where the weaknesses are in the system, so that the services can be provided at a reasonable cost on an ongoing basis to underserved populations. The focus here is one of an opportunity to establish relationships and bring quality services to underserved populations, especially the seniors.
The new medical landscape in the United States is going to increase the opportunity for greater medical tourism and greater cooperation among medical institutions. The examples listed are only a few ways that can be used to exploit the instability.
Future
This may be the time for the development of cooperative structures within the United States healthcare markets. This type of cooperative effort may bring the external pressure necessary to open the U.S. markets and develop bridges for a global integrated network to eliminate boundaries and barriers.
References
1.
http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm
2.
http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf
3.
http://www.photius.com/rankings/world_health_systems.html
4.
http://worldlifeexpectancy.com/sort.php#WORLD RANKINGS
5. Cooper, M. C. “The Elderly Travelers”. Travel Medicine and Infectious
Disease (2006) 4, 218–222.
6. Connell, J. “Medical Tourism: Sea, Sun, Sand, and
Surgery”. Tourism Management (2006) 28, 1093-1100.
Profile of the author
Dr. Lee currently teaches tourism administration at Bowling Green State University. With more than 6-year clinical service experience, he also works as a supervisor for the program of Therapeutic Recreation and wrote extensively in the area combining travel and tourism with health improvement.
Dr. Groves is an emeritus professor at Bowling Green State University, teaching tourism and event planning for more than 30 years. He made numerous publications covering a variety of topics in tourism management. He also operates a travel agency in intermediary services.
Dr. Lengfelder has been teaching travel and event planning for both of Bowling Green State University and University of Toledo. She was a leader of a research project-- Leisure Wellness for Recovering Addicts
