Developments in Medical Tourism

An article in The New York Times highlights a sea change in medical tourism: It has now been approved by some insurance plans. The piece concerned a knee replacement performed in Cancun, Mexico, by an American surgeon. The patient, an American medical tourist, not only received the therapy with no out-of-pocket costs, she also received a check for $5000 upon her return home. All of her travel costs were also paid.

The exposure to the insurance carrier was reported to be less than half of what it would have been the United States. This was made possible by the drastic reduction in fees compared to those charged by U.S. hospitals. The article noted the average knee replacement surgery in the U.S. is at least $30,000, while this particular Mexican clinic charged $12,000 USD. Of additional interest is the cost of the medical device; the implant was said to cost approximately $8000 in the U.S., while the Mexican clinic was charged $3500.

To circumvent a common complaint from medical tourists seeking therapy abroad, an orthopedic surgeon who practices in Wisconsin performed the operation. He had been flown in specifically for this procedure. The article detailed that his compensation was approximately three times what Medicare would pay for a similar procedure in the U.S.

All of this was facilitated by a for-profit company that charges a fixed amount for each case and is paid by the employee or an intermediary. The article said that, so far, 40 orthopedic surgeons from around the U.S. had signed with the company.

THE RISE OF MEDICAL TOURISM HIGHLIGHTS THE ECONOMIC DIFFICULTIES FACED BY PARTICIPANTS IN THE U.S. HEALTH CARE SYSTEM

The day before the procedure, the patient was evaluated by the U.S. surgeon. He performed the surgery the next day and flew home that afternoon. The staff of the Cancun clinic oversaw the patient’s postoperative recovery. She stayed for 10 days following the operation. Of interest, the standard charge for a night in a U.S. hospital was said to average $2000, while in Mexico it was $300 — a significant savings for the insurance carrier.

While the financial advantages are appealing, there are possible downsides to this approach. Chief among them is the standard of care and medical facilities may not meet the levels required in the U.S. If problems occur, the patient is far from home and their loved ones are frequently absent. In addition, the orthopedic surgeon said that while the procedure went well, there were momentary delays due the lack of English proficiency among the surgical staff members.

Ultimately, the rise of medical tourism highlights the economic difficulties faced by participants in the U.S. health care system. Despite the potential pitfalls, this approach is not without economic merit. As proof, many dental providers have seen patients who received care abroad for financial reasons. If insurance companies embrace this trend, the impact in terms of complication rates and long-term outcomes — not to mention case acceptance in U.S.-based practices — remains to be seen.

With all the uncertainty, one thing is clear: It will be interesting to see how this plays out.

Thomas G. Wilson Jr., DDS

Editor in Chief
twilson@belmontpublications.com

From Decisions in Dentistry. February 2020;6(2):6.