Competition from Medical Tourism

by Leona Egeland Siadek, Vice President, Government Relations

For centuries people have traveled to “cure” spots, to spas, to places of religious importance, and, more recently, to other countries that allow treatments and drugs not legal in the United States. But now medical tourism is big business, and the trend is growing. The American Medical Association estimates that over 500,000 Americans go out of the country each year for medical care. The primary reasons appear to be financial. You can travel the Mediterranean or go on an African safari, stay in luxury hotels, see exotic places, and get your procedure done—all-inclusive—for less than half the listed cost of the procedure in the U.S.

For patients seeking kidney transplants, the waiting time can be considerably shorter in countries that allow donors to get paid for giving up one kidney. In the case of livers, lungs, and hearts, there may be a financial incentive for the families of deceased donors to participate in a sale.

In November, I was in a hotel in Panama browsing through the guest magazine. It featured a prominent ad on “Medical tourism: Panama offers first-class medical treatment by American-trained doctors in hospitals that are on a par with the USA at about 50 percent less cost.” The full-page ad was shared by a consortium of doctors, the national hospital, and two dental clinics. There was no definition for “American-trained,” but the implication was certainly that the services offered are on a par with the best in the U.S.

Medical tourism agencies have started across the country. The agencies help clients determine where to obtain overseas treatments and provide them with travel assistance. They assert that “cheap doesn’t mean inferior” and state that there is no organized opposition to medical tourism, only nervousness. Some American accreditation agencies monitor the quality of foreign hospitals, but the United States government can neither intervene with foreign medical practices nor stand behind guarantees in the case of malpractice.

Sponsored medical travel is being considered by several major corporations. One company in North Carolina became the first to send its employees to India for gallstone removal and rotator cuff repair. The company’s costs for the travel, arrangements, and procedure are far less than paying for its employees to undergo the same procedures in the U.S.

Legislators in the state of West Virginia were considering H.B.2841, a bill that would provide incentives for state employees to travel to other countries for procedures. Copayments and deductibles were to be waived, and the state would have provided airfare and lodging. The bill died in committee. Blue Shield and Health Net of California are now offering lower-cost policies that allow their members to seek medical care in Mexico.

Lack of follow-up care, risks because of long flights, and nonexistent recourse for medical malpractice claims have been cited as the biggest deterrents by those exploring overseas treatment. Foreign countries have an incentive to welcome U.S. and Canadian patients. U.S. hospitals and doctors will see more competition as globalization takes place.

Federal News
The 2007 congressional session closed without any medical liability reform being enacted. Several 2007 reform bills are still technically alive and remain available for consideration. S.244 (Judd Gregg of New Hampshire) focuses on obstetrical and gynecological services, and S.243 (John Ensign of Nevada) is inclusive of all medical specialties. H.R.3509 (Michael Burgess, MD, of Texas) proposes Texas-style medical reform, and H.R.2580 (Phil Gingrey, MD, of Georgia) is a California-style reform.

S.2449, the Sunshine in Litigation Act of 2007, was introduced in the Senate on December 11 by Herb Kohl (D-Wisconsin). Modeled after a law in Florida, the bill would prevent judges from sealing court records unless the defendant can prove that confidentiality needs are greater than the public’s interest.

Election issues will be discussed further in the second quarter issue of The Doctor’s Advocate.

State Issues
In 28 states in 2007, nearly 80 bills were introduced that would have benefited personal injury lawyers. Mainly, these bills created new causes of action—that is, new ways to sue. Some also attempted to repeal existing good laws.

Except where state legislatures convene every other year, sessions are under way in most states. We expect to see legislation on the usual topics: increasing noneconomic caps, doing away with caps, expanding wrongful death, and allowing first- and third-party bad faith. We expect litigation on some new frontiers, such as state consumer protection statutes, wrongful living, and elder abuse.