Accepted Manuscript. Medical Tourists: Incoming and Outgoing. James E. Dalen MD, MPH, ScD (hon), Joseph S. Alpert MD Professor of Medicine

Transcription

1 Accepted Manuscript Medical Tourists: Incoming and Outgoing James E. Dalen MD, MPH, ScD (hon), Joseph S. Alpert MD Professor of Medicine PII: S (18)30620-X DOI: /j.amjmed Reference: AJM To appear in: The American Journal of Medicine Received date: 7 June 2018 Revised date: 12 June 2018 Accepted date: 12 June 2018 Please cite this article as: James E. Dalen MD, MPH, ScD (hon), Joseph S. Alpert MD Professor of Medicine, Medical Tourists: Incoming and Outgoing, The American Journal of Medicine (2018), doi: /j.amjmed This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

2 MS: Revision 1 6/12/18 Manuscript: Medical Tourists: Incoming and Outgoing Authors: James E. Dalen, MD, MPH, ScD (hon) Dean Emeritus, University of Arizona College of Medicine Address: N Rancho Vistoso Blvd #45 Oro Valley, AZ jdalenmd@gmail.com Phone/Fax: Joseph S. Alpert MD Professor of Medicine, University of Arizona College of Medicine 1501 N Campbell Ave. Tucson, AZ jalpert@ .arizona.edu Phone/Fax: Funding: None CofI: None Both authors participated in the preparation of the manuscript. 1

3 Medical Tourists; Incoming and Outgoing Dalen JE, Alpert JS Patients who travel to another country to seek health care are termed Medical Tourists. The term arose because many Americans seek less expensive elective surgical, dental, or cosmetic procedures while vacationing abroad. (1) Of course, US hospitals and physicians have also long cared for medical tourists from other countries. Now, many medical tourists are going the other way--from the US to other countries in order to receive health care. In 2007 it is estimated that 750,000 Americans traveled to other countries for healthcare. (1) In 2017, more than 1.4 million Americans sought health care in a variety of countries around the world. (2) The reason that more Americans have become medical tourists is simply that they are seeking less expensive health care. Since we have the most expensive health care system in the world it is not challenging to find countries that offer various procedures at 30 to 65% of the cost of care in the US. (2) Other countries can charge less because of lower pay to physicians and other healthcare workers, much less overhead because patients pay cash, and subtraction of the substantial cost of malpractice insurance. (3) The total number of medical tourists to all countries in 2017 was estimated at million year. (2) The number of US medical tourists, and the total number of medical tourists in the world is expected to increase by 25%/year.(3) The financial implications of medical tourism are impressive. The average cost for each medical visitor is estimated to be $3,800 to $6,000 (cash) per visit.(2), and the total spent per year globally is estimated at $45 2

4 to 72 $ billion US (2). The value of the entire medical tourist business per year is approximately $439B US. (3) Given the magnitude of income from medical tourism, it is not surprising that a number of cities and countries actively solicit medical tourism, for example, Dubai ( 4,5), Singapore (4) and Malaysia. (5,6) Health care brokers are readily available in the US and abroad to help arrange air travel, hotel arrangements and tourist information in addition to arranging admission to various hospitals and access to physicians throughout the world.(7-9) In 2008, there were 63 medical tourism companies in the US. (7) The total cost for hospitalization, physician fees, air fare, and hotel expenses for the patient and spouse is far less than the cost of the procedure in the US. (7-9) A number of US Medical centers including Harvard (1), Boston University (1), Johns Hopkins (1), and the Cleveland Clinic (10) have established hospital and clinics outside of the US hoping to capitalize on local and foreign medical tourists. The top ten destinations for medical tourism are shown in Table 1. They are listed alphabetically, not by frequency of visits. American medical tourists are most likely to go to South America, Central America and the Caribbean, (4) The most frequent conditions treated are shown in Table 2. Most Americans who go abroad for medical care lack health insurance, or their health insurance (including Medicare) does not cover certain conditions including dentistry, cosmetic surgery, in vitro fertility procedures, or weight loss surgery. The number one concern of Americans considering medical and surgical treatment in hospitals and clinics outside the US is the quality of the care. The Joint Committee on Accreditation of 3

5 Hospitals (JCAH) began to evaluate, inspect, and accredit hospitals outside the US in 1998 (1). By 2017, 800 foreign hospitals had been accredited, and the number is increasing by 20% per year. (12) Many overseas hospitals are staffed in part by physicians and other health professionals who were trained in US hospitals. One hospital in India has 200 US trained board certified surgeons.(1) Americans continue to be concerned about the quality of care at hospitals outside the US: Are foreign hospitals and physicians subject to malpractice suits? What if complications become apparent after one returns to the US? Will treat US doctors treat them for complications related to medical tourism, or does one have to return to the hospital that performed the care? (1) Some medical tourists even purchase medical complication insurance because of the latter concerns. (3) US income from incoming medical tourists continues to exceed income lost by outgoing US medical tourists. However the late, noted medical economist Uwe Reinhardt warned that medical tourism can do to the US healthcare system what the Japanese automotive industry did to American carmakers after the Japanese products developed a value for money and reliability reputation. (12) References 1. Boyd JB, McGrath MH, Maa J. Emerging trends in the outsourcing of medical and surgical care. Arch Surg; 2011; 146: Medical Tourism Statistics and Facts, Patients Beyond Borders 14 December borders.com/medicaltourism-statistics-facts accessed 5/31/18. 4

6 3. Braverman B. 1.4 million Americans will go abroad for medical care this year. Should you? The Fiscal Times. August 17, accessed May 29, Chambers A. Trends in U.S. travel services trade. USITC Executive Briefing on Trade. August ers_health-related_travel_final.pdf accessed May 29, Hoteller Middle East.Com. Medical tourism in Dubai rises to $390m. rises-to-390m/ Accessed May Sarwar A. Medical tourism in Malaysia: prospect and challenges. Iranian Journal of Public Health 2013; 42: Alleman BW, Luger T, Reisinger HS, et al. Medical tourism services available to residents of the United States. J Gen Intern Med 2011; 26: Pocock NS, Phua KH. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia. Globalization and Health. 2011; 7: Crooks VA, Snyder J. Medical tourism what Canadian family physicians need to know. Can Fam Physician 2011; 57: Freiden J. Medpage Today May 2, ment/72661 accessed May 3,

7 11. Stephano RM. Top 10 medical tourism destinations in the world. Medical Tourism Magazine, Feb 20,2018 htttp:// Accessed June 2, Woodhead A. Scoping medical tourism and international hospital accreditation growth. International Journal of Healthcare Quality Assurance. 2013; 26: Table 1: Top ten destinations for medical tourism (2,11) Costa Rica India Malaysia Mexico Singapore South Korea Taiwan Thailand Turkey United States 6

8 Table 2 The Most Frequent Conditions Treated in Medical Tourists (11) Dentistry Cosmetic surgery Cardiac conditions In vitro fertility Weight loss Dermatology Liver, kidney transplants Spine surgery 7