A new study “Medical Tourism Services Available to Residents
of the United States” published in the Journal of General Internal Medicine casts
doubts on many of the claims made about the size of the medical tourism market
and concludes that “the number of Americans travelling overseas for medical
care with assistance from medical tourism companies is relatively small”.
Published in December’s issue of the Journal of General
Internal Medicine, “Medical Tourism
Services Available to Residents of the United States” is a report on the
businesses and business practices of companies promoting and facilitating
medical tourism to US patients and the types and costs of procedures being
offered. In late 2008, the researchers conducted a telephone and email survey
of businesses engaged in facilitating overseas medical travel for US residents.
They collected information from each company including: the number of
employees; number of patients referred overseas; medical records security
processes; destinations to which patients were referred; treatments offered;
treatment costs; and whether patient outcomes were collected. 63 medical
tourism companies were selected for inclusion and 45 (71%) completed the
survey.
13,500 US medical tourists from 45 businesses since start up
The 45 companies involved had referred an average of 285 patients
overseas since start up (not in the previous twelve months). The survey recorded a total of approximately
13,500 US medical tourists in total for all 45 businesses since they started in
business. The most common overseas countries that companies reported referring
patients to were India, Costa Rica, and Thailand though many other countries
were mentioned less frequently including Malta, Israel, Spain and Germany. The
most common medical services utilized by overseas medical travelers were
orthopedic procedures, cardiac procedures, infertility treatment, and cosmetic
surgery. (The study specifically excluded companies that focused exclusively on
dental care).
The authors highlight the significant difference between
their grand total of 13,500 US medical tourists travelling via 45 medical
travel facilitators and the “number of articles, studies, and reports (that)
have suggested that between 500,000 and 2,000,000 Americans travel overseas
each year for medical care.” They believe that their study mirrors and supports
the kind of numbers quoted by McKinsey & Co (Mapping
the Market for Medical Travel) who estimated “the current market at 60,000
to 85,000 inpatient medical travelers a year—numbers far smaller than others
have reported.”
The study authors propose that the discrepancy in the
estimates of the size of the overseas medical market is related to the
following factors:
1.
Estimates of a much larger US medical tourism market
were proposed by parties with personal and/or financial interests in the
overseas medical travel market.
2.
Their study did not attempt to measure the
number of Americans travelling for dental care. This is believed to be quite a
high proportion of the US outbound market, particularly cross border to Mexico
and to South America. According to Sandra Miller at Health Travel Technologies,
“We process more than 600 inquiries per months, and send more than 100 patients
a month abroad........We send 20 dental patients per month to top notch dental
clinics in Mexico, Costa Rica, the Dominican Republic and El Salvador.”
3.
Their
study did not attempt to measure the number of Americans who may have traveled
overseas without using the services of a medical tourism facilitator. Estimates
of how many medical tourists use a facilitator vary widely. Some US estimates
put this as low as one in five patients who use the services of a
facilitator. (Research on UK medical
tourists put this figure as around one in three – Treatment
Abroad Medical Tourism Survey 2008).
The authors point out that even when items 2 and 3 above are
factored in, “the market may be somewhat smaller than prior studies have
estimated”. They also point out that two years after conducting the interviews,
they found that 15.6% (7 of 45) of companies that completed the initial
interviews no longer had functioning websites and thus were presumed to no
longer be in business.
It’s also worth pointing out that the survey was restricted
to medical tourism facilitators who had a US phone number. 97 facilitators were
excluded from the research for this reason. This in effect excludes many
Mexican, South American and Asia based facilitators who handle US patients.
Cost savings for medical travel less than claimed
The study’s findings related to the cost of overseas medical
travel also warrant mention. The authors report that “overseas medical costs
for several procedures were generally similar to combined hospital and
physician payments made by Medicare for the same procedures.” For example,
according to the study, a heart bypass surgery costs an average of $18,600
outside the USA. Within the USA, Medicare pays around $21,000 for the procedure.
They conclude that “the take-away message is that the expected savings from
overseas medical care is dependent on what, typically uninsured, patients might
be expected to pay if they instead purchased this care in the US” and “the fact
that overseas charges are reasonably close to Medicare rates suggests that
there may be significant opportunity for US providers to compete with offshore
facilities, in some situations, by offering highly discounted prices to
uninsured American patients.”
IMTJ comment
We welcome this attempt to put some validity on the size of
the US outbound market. The study is one of the first to approach the thorny
issue of US medical tourism statistics by asking medical tourism businesses how
many patients they actually handle rather than by creating “guesstimates” based
on what people say they might do. It also puts some of the oft quoted
predictions of “6 million US medical tourists in 2010, 10 million by 2012” etc
etc in a different light.
A similar approach was adopted in 2007 in a study by Treatment Abroad in which
facilitators, hospitals and clinics were asked to provide numbers of UK
patients treated. This study put the number of outbound UK medical tourists at
around 50,000 (similar to numbers recorded in the UK’s International Passenger
Survey data.)
However, the new study does have its flaws – sampling bias,
exclusion of dental care, exclusion of self arranged medical travel – which
undoubtedly impacts the overall number of medical tourists that it counts.
Nevertheless, even if we allow for these flaws and factor in the “missing”
patients, the study suggests that the annual outbound medical tourism patient
numbers for the USA are perhaps in the region of 100,000 to 200,000 at best,
rather than the millions that have been mooted elsewhere.
The study highlights the areas of healthcare that are
driving US medical travel – cosmetic (and obesity) surgery, stem cell
treatment, IVF treatment, cosmetic dentistry and other non-insured areas which
will not be covered by “Obamacare”. It does not analyse the clear ethnic trend
in medical travel in the USA and elsewhere
- people who are travelling from the country of residence to their own,
their father's or their grandfather’s nation of birth. This is a significant
driver of US medical travel: Mexicans to
Mexico, Hispanics to Latin and South America, Asians to Asian countries,
Koreans to Korea etc.
Although, they are now in effect two years out of date, the
findings of “Medical Tourism Services Available to Residents of the United
States” reflect what many people within the industry believe is closer to the
truth in terms of medical tourism patient numbers. i.e. thousands not
millions. Many countries, their
governments and hospital providers have come to believe that the US market
represents a rich source of patients but have been disappointed by their lack
of success. They may need to revise their expectations and rethink their
strategy.
Source article: Medical Tourism Services Available to Residents of the
United States
Authors: Brandon W. Alleman, Tana Luger, Heather Schacht
Reisinger, Rene Martin, Michael D. Horowitz and Peter Cram
Journal of General Internal Medicine, December 2010
A PDF of the full article can be downloaded from SpringerLink
at a cost of 34 Euros.
Date published: 5 January 2011
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