| For several years now, American healthcare | | | | however, and the Philippines has one. But the JCI |
| consumers, including many from other western | | | | accreditation only applies primarily to hospital |
| industrialized nations, have heard about elective | | | | management which although includes procedures |
| surgeries being performed in lesser-developed | | | | to reduce risk of infection and disease and to |
| nations and due to cost and denial of coverage by | | | | ensure patient safety, it has no jurisdiction over |
| health insurance providers have opted to go there. | | | | the actual physicians performing surgical |
| However, surgeries in the past were truly elective | | | | procedures. |
| and not medically necessary procedures that | | | | The patient is provided limited information other |
| largely consisted of face-lifts, tummy tucks and | | | | than an introductory phone call to the intended |
| gastric bypasses for cosmetic purposes. | | | | physician and having medical records electronically |
| But just in the past two years, American patients | | | | sent to the doctor or hospital via the internet by |
| are being wooed to make decisions on serious | | | | the medical tourism agency. The patient has a |
| medically necessary surgeries due to their fears | | | | choice of physicians, but unlike in the U.S. where |
| of excessive healthcare costs. And the decision | | | | there is easy access to a doctor's medical status |
| involves traveling abroad primarily to India and | | | | by medical boards and organizations, other than |
| Thailand in order to receive such hospital care | | | | knowing whether the doctor may have practiced |
| which they require. | | | | medicine in the U.S., there is little information to |
| For those self-insured, underinsured, or not insured | | | | come by. Without standardized protocols it is |
| at all, the desperation of receiving medical care | | | | difficult for the patient to make a correct |
| without sacrificing homes or assets in the process | | | | assessment. |
| is plausible, since costs of similar procedures in | | | | When decisions on a patient's health is driven |
| South Asia range from 75% - 80% less than in | | | | primarily by cost it can impair the decision making |
| the United States. But now U.S. based | | | | process. There is little argument that healthcare |
| corporations have entered the arena as well by | | | | costs in the U.S. are bankrupting corporations and |
| encouraging employees to go to India and | | | | labor unions and deceleration of escalation is nary |
| Thailand via cash incentives, free airfare and hotel | | | | in sight. With the healthcare industry being 15% of |
| stays with no co-pays due on the final bill. | | | | the U.S. Gross Domestic Product and having risen |
| Yet, just as with any large purchase consumers | | | | in cost 75% for employers and 143% for |
| must look beyond the fancy advertisements and | | | | employees since the year 2000, the system is |
| read the fine print with a Buyer Beware mentality. | | | | broken. High malpractice insurance fees required |
| Americans have become quite adept at learning | | | | by both employers and physicians, hospital |
| what to look for when dealing with car dealerships | | | | deregulation and class action medical litigations |
| when purchasing an automobile and with computer | | | | have only exacerbated the problem. |
| retailers when purchasing a new computer. But it | | | | Such high medical costs will only encourage limited |
| has taken many years to educate consumers as | | | | access to healthcare for the middle class and |
| to their rights and protections under the law and | | | | ultimately result in less preventative care costing |
| what to do when something does go wrong. | | | | taxpayers more in the long run. The problem is |
| The term "medical tourism" has been inaccurately | | | | not the medical care in the U.S., still considered the |
| applied to what is essentially the offshoring of | | | | best in the world, but its delivery system. It is |
| patients of the U.S. healthcare system to foreign | | | | when Medicare and the health insurance providers |
| countries, in order to appeal to potential | | | | became the decision makers and took that power |
| customers who are really medical patients. The | | | | away from the physicians that the system began |
| term was invented by the media and it stuck and | | | | to unravel. Added to that is the lack of restraint |
| is now being used as a marketing tool. Deceptive | | | | of costs by the pharmaceutical industry which |
| in its concept, it is an implication that a patient can | | | | charges U.S. patients more for its own |
| go sightseeing before or after a serious hospital | | | | medications than any other country in the world. |
| procedure in that foreign country. But for those | | | | But as expensive as healthcare is in the U.S., |
| who are more scrupulous it remains difficult to | | | | there are legal and safety issues which are part |
| get the necessary information needed to make a | | | | of the American fabric which Americans very |
| reasoned decision on whether to have surgery | | | | much take for granted yet expect but are not |
| performed, let alone halfway around the world. | | | | present in the undeveloped world. For example, |
| There are now organizations being touted as | | | | there are few regulatory bodies such as the |
| medical tourism agencies that have cropped up | | | | Centers for Disease Control, the Food and Drug |
| throughout the U.S. in order to facilitate such care | | | | Administration, the Federal Trade Commission, |
| overseas for individual patients as well as to | | | | various medical boards, consumer protection laws, |
| serve as a clearinghouse for corporations wishing | | | | available legal experts and the court system. All |
| to outsource their employees' healthcare with | | | | serve as a net of safeguards offering remedies. |
| them in tow. These groups include MedSolution, | | | | But unlike a car purchase, medical care is a |
| GlobalChoice Healthcare, IndUShealth, Planet | | | | complicated undertaking in which there are no |
| Healthcare and Med Retreat, to name just a few. | | | | guarantees, yet there are areas of compliance |
| And with more and more corporations adding | | | | which must be maintained. |
| select foreign hospitals as Preferred Providers to | | | | Once the patient is in a foreign country there is |
| their employees' health insurance plans, medical | | | | little protection for redress and once that patient |
| tourism companies handle the paperwork and | | | | leaves the country should they need follow-up |
| travel arrangements for their employees. Other | | | | care such as therapy or if complications arise |
| countries of destination include Costa Rica, the | | | | even during travel, they must seek medical care |
| Dominican Republic, the Philippines, Panama, | | | | in the U.S. Secondarily, if the procedure is |
| Mexico, China, Malaysia, Singapore, Turkey and | | | | performed overseas, insurance providers or |
| South Africa. | | | | Medicare may not honor the additional required |
| However, it is at this point that the patient needs | | | | care in the U.S. Still, patients may decide to take |
| to start their own due diligence. There is usually a | | | | the risks in addition to the inherent risks of any |
| requirement by most U.S. healthcare insurance | | | | surgery, but should not be coerced into |
| providers for patients to get second opinions for | | | | uninformed choices in order for their employer to |
| most complicated surgeries in the U.S., but not so | | | | save costs under the guise that they are helping |
| for offshore surgeries. And the list of surgeries | | | | to reduce the costs of U.S. healthcare in the long |
| which are being sent offshore are indeed | | | | run. |
| medically necessary but confusingly being | | | | In July 2006 the U.S. Senate Committee on Aging |
| reported to the media as elective. But you can | | | | held a hearing called "The Globalization of |
| determine for yourself whether or not the | | | | Healthcare: Can Medical Tourism Reduce |
| following are elective procedures: cardiac bypass, | | | | Healthcare Costs?" Its goal was to address the |
| cardiac stent implantation, cardiac angioplasty, | | | | subject of medical tourism, its growth, safety of |
| knee replacement, hip replacement, mastectomy, | | | | patients and possible regulation of the industry |
| hysterectomy, chemotherapy, eye surgery, | | | | itself. Its Committee Chairman, Senator Gordon H. |
| vascular surgery, among others. | | | | Smith, has asked that several federal agencies |
| And as the medical tourism agency is only an | | | | such as the Department of Health and Human |
| intermediary between the client and the hospital | | | | Services, the Department of Commerce and the |
| as well as between hotels and airlines they do not | | | | Department of State create an interagency task |
| provide any liability in the event that there is a | | | | force necessary for lawmakers to reach informed |
| medical complication or there is a mishap at the | | | | decisions that healthcare consumers themselves |
| destination hospital. Furthermore, there are fees | | | | cannot accurately make at this juncture regarding |
| which could arise not documented by an employer | | | | offshoring their medical care. |
| nor agency which could require additional | | | | And among the labor unions, the United |
| expenses upon the patient's arrival. And as a | | | | Steelworkers Union (USW) has publicly weighed in |
| conduit between patient and hospital, the medical | | | | on this issue when it learned one of its union |
| tourism business remains an unregulated industry | | | | members, employed by Blue Ridge Paper |
| in the U.S., without licensing requirements and with | | | | Products, was going to be sent to India for gall |
| most managed by non-medical personnel. | | | | bladder surgery simultaneously with shoulder |
| Similarly, and unbeknownst to most U.S. patients is | | | | surgery. Leo W. Gerard, USW International |
| that the healthcare industry in India is highly | | | | President, fired off a complaint dated September |
| unregulated. It was only in 2006 that regulations | | | | 11, 2006 to Congress by contacting the following |
| regarding the medical device industry, which | | | | committees: the House Committee on Education |
| includes surgical devices such as cardiac stents | | | | and the Workforce, the House Committee on |
| and orthopedic implants for use in hip and knee | | | | Energy and Commerce, the House Committee on |
| replacements, was mandated. Such call for | | | | Ways and Means, the Senate Committee on |
| regulation from the Drug Controller General of | | | | Finance, and the Senate Committee on Health, |
| India (DCGI) only came about as the result of | | | | Education, Labor and Pensions. |
| discovered defective drug eluting cardiac stents in | | | | The goal is not necessarily to create more |
| 2004. And although hospitals have the option of | | | | legislation but to establish guidelines. Perhaps Mr. |
| applying for accreditation through the Joint | | | | Gerard puts it best when he states, "The right to |
| International Commission established in 1999, a | | | | safe, secure and dependable health care in one's |
| subsidiary of the Joint Commission on | | | | own country should not be surrendered for any |
| Accreditation of Healthcare Organizations, used | | | | reason-certainly not to fatten the profit margins |
| for hospitals in the U.S., there is no such | | | | of corporate investors." He also contends to the |
| requirement to do so. | | | | Congress that "We remain steadfast in our |
| As of 2006 there are five hospitals in India which | | | | commitment to rebuild a domestic healthcare |
| have JCI accreditation, renewable every three | | | | system." |
| years. They include the three facilities of the | | | | Let us hope that our government and healthcare |
| Apollo Hospital group, the Shruff Eye Hospital and | | | | providers can likewise make such a commitment |
| the Wockhardt Hospital. The Bumrungrad | | | | by investing in the health and welfare of the |
| International in Bangkok is Thailand's sole JCI | | | | American people. |
| hospital. Singapore has over a dozen JCI hospitals | | | | Copyright ©2006 Diane M. |