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Businesses may move health care overseas
2006-11-02
Businesses and insurance companies are starting to eye the potential savings of outsourcing health care from the world's richest country to the developing world. Muzi.com News 10025293-0 (muzi.com)"It's just one of the many ways in which our world is flattening," said Arnold Milstein, chief physician at New York-based Mercer Health & Benefits, who's researching the feasibility of outsourcing medical care for three Fortune 500 corporations. "Many companies see it as a natural extension of the competition they've faced in other aspects of their business." Muzi.com News 10025293-1 (muzi.com) With an estimated 45 million uninsured Americans, some 500,000 trekked overseas last year for medical treatment, according to the National Coalition on Health Care. Asian hospitals in Thailand, India and Singapore have long been swarmed by medical tourists looking for tummy tucks and face lifts, but many glitzy, marble-floored facilities are now gaining reputations for big-ticket procedures including heart surgery, knee and back operations. Muzi.com News 10025293-2 (muzi.com) Some American hospitals already rely on places like India for X-ray readings and other diagnostics, while also importing foreign doctors and nurses. But the U.S. health care industry has been largely immune to overseas competition -- just one reason behind soaring costs. Muzi.com News 10025293-3 (muzi.com) Premiums for employer-sponsored health coverage have surged 87 percent over the past six years, according to the Kaiser Family Foundation, putting a huge burden on both companies and employees. Family health coverage now runs about $11,500 annually, with workers themselves forking out nearly $3,000. Muzi.com News 10025293-4 (muzi.com) But just as shipping U.S. manufacturing to China and call centers to India initially created loud opposition, some critics are already preparing to fight any possible mass exodus of Americans packing their bags to go under the knife overseas. Muzi.com News 10025293-5 (muzi.com) In September, Canton, N.C.-based Blue Ridge Paper Products Inc., was set to send one of its employees to India for a gall bladder operation. Carl Garrett would have been the first U.S. employee sent abroad for medical care through an employer-sponsored pilot program, which would have allowed him to share the company's savings. Muzi.com News 10025293-6 (muzi.com) Shortly before Garrett was set to leave, the United Steelworkers, America's largest union, pulled the plug. Muzi.com News 10025293-7 (muzi.com) "We don't want to expose our members to the risks associated with providing health care in the Third World," said Stan Johnson, a union spokesman. "This is perceived to be voluntary, but voluntary programs tend to lead to mandatory programs." Muzi.com News 10025293-8 (muzi.com) Blue Ridge ultimately scrapped its plan for union members, but several other U.S. businesses and insurance companies are starting to explore the option of exporting patients. Muzi.com News 10025293-9 (muzi.com) "I get the impression that they're all waiting for someone else to take the first step," said Jason Yap, director of health care service for the Tourism Board in Singapore, another major medical tourism destination. "They're all interested in doing the homework now so they can move ahead when the time comes." Muzi.com News 10025293-10 (muzi.com) United Group Programs, a Boca Raton, Fla.-based company that sells self-insurance policies to small businesses, is already offering a plan that sends patients to Bumrungrad International hospital in Bangkok, Thailand. UGP says the plan will save employers more than 50 percent on major medical costs and slash employees' out-of-pocket expenses to zero. Muzi.com News 10025293-11 (muzi.com) Blue Shield of California and Health Net of California also both offer lower-cost policies allowing members to seek medical care in Mexico. Muzi.com News 10025293-12 (muzi.com) In June, David Boucher, an assistant vice president at BlueCross BlueShield of South Carolina, traveled to Bangkok for a close-up look at Bumrungrad. The Thai hospital began heavily recruiting overseas patients after the 1997 Asian financial crisis. It drew 400,000 foreigners last year -- including 55,000 Americans. Muzi.com News 10025293-13 (muzi.com) "I was thoroughly impressed," Boucher said. "We're taking a serious look at this as an alternative" for the health plan's 1.5 million members. Muzi.com News 10025293-14 (muzi.com) In addition, West Virginia lawmaker Ray Canterbury plans to propose legislation next year that would give government employees the option of traveling abroad for necessary procedures, which could save the state up to $2 million annually. He wants to offer incentives, including extra sick leave and 20 percent of the cash saved by going abroad -- allowing workers to actually make money on the deal. Muzi.com News 10025293-15 (muzi.com) Dodie Gilmore is a rodeo barrel-racing champion who runs a 180-acre ranch in Oklahoma when she's not bouncing across back roads selling farms. Gilmore is a spry 60-year-old who loves the outdoors, but when she could no longer straddle her faithful horse, River, she knew it was time for a new hip. Muzi.com News 10025293-16 (muzi.com) But how could she afford it? As an independent contractor for a small Coldwell Banker real estate franchise in Durant, Okla., she knew her privately purchased health plan would never pay up to $40,000 for the operation. Muzi.com News 10025293-17 (muzi.com) So she asked her boss about traveling to India where hip resurfacing alone would cost just $7,000. He not only gave her his blessing but offered to foot the bill, minus travel and hotels -- making Gilmore one of the very first Americans sent overseas for surgery by an employer. Muzi.com News 10025293-18 (muzi.com) "The doctors were wonderful," Gilmore said days after being discharged, sipping coffee at a New Delhi roadside cafe with her sister, Carol, who was along for whole trip. "The overall care was pretty darn good." Muzi.com News 10025293-19 (muzi.com) More and more patients like Gilmore -- who had never held a passport or even tasted Indian food before her trip -- are returning home and spreading the word about an alternative to America's ailing health system. Muzi.com News 10025293-20 (muzi.com) Gilmore's boss, Martin VanMeter, who owns a Coldwell Banker office with about 24 workers, wasn't obligated to pay anything toward the hip surgery. But he sees his employees as family, and if they're too hurt or sick to work, no one benefits. Muzi.com News 10025293-21 (muzi.com) "I've invested so much money in them," he said by telephone. "All she's got to do is make one transaction for us, and we've got our money back." Muzi.com News 10025293-22 (muzi.com) But even with the growing momentum, big questions must be asked by anyone considering treatment abroad. Muzi.com News 10025293-23 (muzi.com) Despite the five-star facades of some hospitals -- fountains, white marble floors, even a Starbucks and McDonald's inside Bumrungrad's lobby -- the comfort of having a major surgery near home with family at the bedside is a far cry from the experience in the developing world, where culture shock alone can be stressful. Muzi.com News 10025293-24 (muzi.com) Pollution, poverty and insane traffic are all part of the experience when visiting hospitals like the Indian-owned Max Healthcare facilities in New Delhi, where it's not uncommon to see people urinating along roadsides. Jet lag, traveler's diarrhea and strange foods also can be coupled with the unpredictable, such as September's bloodless military coup in Thailand, which ultimately had little impact on daily life. Muzi.com News 10025293-25 (muzi.com) Language and cultural barriers also can make communication with doctors and nurses frustrating for some Americans, who are used to being direct with their physicians, often peppering them with tough questions and expecting straightforward answers. Muzi.com News 10025293-26 (muzi.com) Some Asian cultures also rely more on hints and subtleties to communicate, and doctors in some countries are regarded as authority figures who often aren't questioned. Follow-up care back in the U.S. also can be an issue for some patients. Muzi.com News 10025293-27 (muzi.com) "There are a lot of risks," said Rick Wade, a senior vice president at the American Hospital Association. "What happens if something goes wrong?" Muzi.com News 10025293-28 (muzi.com) In countries like Thailand and India, medical malpractice claims are rare and multimillion dollar awards are nonexistent. Muzi.com News 10025293-29 (muzi.com) "If there's a mistake, we fix it," said Curtis Schroeder, an American who is group CEO of Bumrungrad hospital, which requires all doctors to carry malpractice insurance. "But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the U.S." Muzi.com News 10025293-30 (muzi.com) In February, Joshua Goldberg, a 23-year-old American who was traveling in Thailand, died at Bumrungrad after seeking care for a leg injury. His father, James Goldberg, has set up a Web site alleging the hospital administered a deadly drug cocktail to a patient with a history of substance abuse. Muzi.com News 10025293-31 (muzi.com) Bumrungrad insists the care given was appropriate. Thai authorities are investigating the case, as is standard with all unexpected hospital deaths. No conclusions have been reached. Muzi.com News 10025293-32 (muzi.com) "What I'm dedicated to doing is to try to alert people to at least do their homework and consider very carefully what they're getting into. Why is this such a good deal?" Goldberg said by telephone. "You might not walk away. That's what happened to my son." Muzi.com News 10025293-33 (muzi.com) It's ultimately up to patients themselves to investigate hospitals and physicians before considering surgery abroad. The Internet is loaded with resources that range from doctor bios to patient blogs, detailing the positives and negatives. Muzi.com News 10025293-34 (muzi.com) As the phenomenon grows, more countries are trying to get in on the action. The Philippines began a campaign this year aimed at attracting Filipinos living abroad and Asians within the region. Packages offering city tours, day spas and even golf have been combined with health checkups and cosmetic surgery. Muzi.com News 10025293-35 (muzi.com) Some experts predict greater access to options like these will eventually drive more people to take control of their own health care. Muzi.com News 10025293-36 (muzi.com) Medical tourism facilitators like California-based PlanetHospital are banking on it, already working to make the journey less stressful for patients traveling abroad by arranging everything from visas and airport pickup to sightseeing. Muzi.com News 10025293-37 (muzi.com) Many doctors working in facilities catering to medical tourists are trained abroad, often in the U.S. or Europe. About 100 foreign hospitals have been approved by the international arm of the Chicago-based Joint Commission on Accreditation of Healthcare Organizations, which also accredits American hospitals. Muzi.com News 10025293-38 (muzi.com) Six countries in Asia have accredited facilities, including Bangkok's Bumrungrad; five in India, with three belonging to the Apollo Hospital group; and 11 in Singapore. Muzi.com News 10025293-39 (muzi.com)
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