Health care costs at hospitals in the United States are skyrocketing causing some Americans to travel outside of the country for their medical procedures. According to Kaiser Health News, over a million Americans per year are now seeking medical care outside of the U.S. for procedures they cannot get, or cannot afford here at home.  

American health care costs have been on a steep rise since 2003.  Forbes recently published an analysis from U.S. Federal Government actuaries that shows Americans have some of the highest costs in the developed world; exceeding over $3.65 trillion in 2018 alone. Rising costs have led to the growing industry of  what is referred to as “Medical Tourism.” 

In the past, medical tourism was frowned upon. Taking the chance with a life-threatening medical procedure in an unknown facility, with unknown physicians, and no idea of how sanitary the conditions would be wasn’t worth the risk. But as U.S. health care costs continue to soar, other countries are improving their quality of care and taking advantage of Americans looking for lower rates. 

Getting Paid for Medical Tourism 

A story highlighted by Kaiser Health News is a perfect example of why patients are choosing to seek health care abroad. Donna Ferguson of Mississippi received a total knee replacement in Cancun this July for less than half the cost of what she would have spent in the U.S. As a patient of the North American Specialty Hospital (NASH), Ferguson was linked with an American doctor who met her in Cancun the day of her surgery and was admitted to an upscale private Mexican hospital for the procedure. 

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*This article is not meant to recommend or deter Marylanders from seeking their health care abroad. Our goal is to represent the facts. We believe understanding the differences in health care costs can help Marylanders become strong advocates for their health and learn to take control of the treatment options available.

After a successful surgery, Ferguson was provided a physical therapist that came to her room to assist her until she was discharged the same day. She stayed in a hotel directly connected to the hospital for ten more days, where she received physical therapy twice a day before returning home.

Not only did Ferguson receive a quality surgery and pay zero out-of-pocket costs for the procedure, but her insurance plan even provided her $5,000 for choosing a facility abroad and covered all travel expenses for her and her husband. 

How is this possible?

In Ferguson’s case, the cost comparison for her procedure was astonishing: 

• Knee replacement surgery: $30,000 (U.S.) compared to $12,000 (Mexico)
• Hospital overnight stay: $2,000 (U.S.) compared to $300 (Mexico)
• Implant used for surgery: $8,000 (U.S.) compared to $3,500 (Mexico)

Ms. Ferguson saved her health insurer over $25,000 by choosing Mexico over the U.S. for her procedure. Leaving her insurance carrier in the green, even after her $5,000 bonus and travel expenses. 

In addition to the direct cost benefits, insurers are also looking at the big picture savings.  A study performed by the West Health Institute/NORC at the University of Chicago in 2018 showed millions of Americans were neglecting their health due to cost. Around 44 percent of citizens skipped a recommended medical appointment due to financial strain, and 32 percent were unable to afford a prescription or took less medication to make it last longer.  Neglecting care now translates into more severe (and far more costly) illnesses in the future. Think of the savings to an insurance companies’ bottom line if these future costs can be avoided for pennies on the dollar today.    

Top Destinations for Medical Tourism 

Medical facilities all over the world are jumping at the chance to receive American patients who are tired of going broke to stay healthy. Patients Beyond Borders listed these as the top destinations for medical tourism in the world:

• India
• Israel
• Costa Rica
• Malaysia
• Mexico
• Singapore 
• South Korea
• Taiwan
• Thailand
• Turkey

Out of these locations, more Americans are choosing Caribbean and Central American countries for treatment to stay as close to home as possible. Mexico has been rated the highest on the list. 

The above destinations were not picked at random. There are several safety factors that must be considered before referring patients to these countries, including: 

• Excellent tourism infrastructure.
• International patient flow.
• Sustained reputation for clinical excellence.
• History of healthcare innovation and achievement
• Government and private sector investment in healthcare infrastructure.
• Potential for cost savings on medical procedures.
• Demonstrable commitment to international accreditation, quality assurance, and transparency of outcomes.
• Availability of internationally-trained, experienced medical staff
• Political transparency and social stability. 
• Successful adoption of best practices and state-of-the-art medical technology

Most Common Out-of-Country Procedures 

Americans are seeking a wide variety of medical procedures and surgeries when looking abroad. According to Patients Beyond Borders, these are the most desired specialties and procedures: 

• Dentistry: general, restorative, and cosmetic procedures.
• Cosmetic surgery
• Cardiovascular: angioplasty, CABG, and heart transplants.
• Orthopedics: joint and spine; sports medicine
• Weight loss procedures such as LAP-BAND and gastric bypass.
• Cancer: often as a last resort. 
• Reproductive: fertility concerns, IVF, and women’s health.
• Scans, tests, health screenings, and second opinions.

What’s Making U.S. Costs So High? 

It would make more sense that the United States has the highest health care costs in the world because the quality of care was the best. Unfortunately, this is not the case. In a report released by The Common Wealth Fund in 2017, the U.S. ranked last among the top 11 industrialized countries in the world when it came to overall health care. 

So what is causing our health care costs to increase? According to Investopedia, some of the top reasons U.S. health care costs are so high are: 

1. Administrative Costs

The administrative costs in American health care is the number one reason for why rates are insanely high. The administrative costs to run the U.S. health system are far higher than any other country, where less staffing is usually required to do the same jobs.  

2. Drug Costs

The cost of drugs in the U.S. is higher than all developed nations. 

3. Treatment Plans

More patients in the U.S. are treated by specialists than primary care doctors. Specialists tend to see patients more often and charge higher fees for visits and services. Some patients need multiple specialists, which increase the overall cost exponentially. 

4. Branding

Health care prices in the U.S. are often set by institutions who have better branding than others. If an influential hospital lists an expensive price for a ‘top of the line surgery’, other hospitals and centers will often follow suit.

5. Wages and Work Rules

U.S. specialists charge higher fees than most other physicians in the world. Because they are so overused, their wages put great weight on the overall health care costs. 

Killer Deductibles in MD

In Maryland, residents could be seeking medical procedures abroad due to the skyrocketing deductibles required by insurance companies. You might remember back in October 2018 when Marylanders fell victim to the hope that health care costs were finally going down. According to The Baltimore Sun, state leaders were boasting about lowering health insurance premiums for the first time in years. This bipartisan deal reducing premiums up to 17 percent was meant to provide Marylanders with a sense of relief that lower medical bills could soon be on the way- this was not the case. 

What state leaders neglected to mention in implementing the new rate reductions was that health insurance deductibles would not be decreasing along with premiums. Some residents saw their deductibles increase by nearly $300 per plan. Marylanders who already had trouble paying their deductibles were crushed. Montgomery County State Del., Kirill Reznik, described the move as “irresponsible” and was disappointed in the Maryland leaders for underestimating the hardships high deductibles place on families in need. 

Know The Risks of Medical Tourism

Medical care abroad seems like a dream compared to emptying your wallet at an American hospital, but this may not be the case every time. All medical procedures abroad come with a level of risk, some more than others. Understanding all the risks before you hop on a plane for surgery can greatly reduce your chances of injury from medical negligence. 

IF YOU ARE A VICTIM OF MEDICAL NEGLIGNECE IN ANOTHER COUNTRY, YOU WILL MOST LIKELY NOT BE ABLE TO PROTECT YOUR RIGHTS IN A U.S. COURT.  YOU WILL BE AT THE MERCY OF A FOREIGN JUDICIAL AND LEGAL SYSTEM. THE RISKS ASSOCIATED WITH THIS ARE VERY IMPORTANT FOR YOU TO CONSIDER WHEN THINKING ABOUT GOING OUTSIDE OF THE U.S. FOR MEDICAL CARE. 

Other things the Center for Disease Control and Prevention (C.D.C.), suggests Americans should consider before booking a foreign procedure include: 

• Communication Barriers: English is commonly spoken in a number of countries. However, that doesn’t mean it will be the leading language where you seek treatment. Receiving care at a facility where you do not speak the local language fluently opens the opportunity for medical errors and misunderstandings that might not occur in an American hospital. 
• Fake Medications: Some countries may use counterfeit or poor quality substitutes for medication you can commonly find in the United States. These medications could lead to unnecessary illnesses and injuries, as well as life-threatening infections after surgery. 
• “Super bugs”: Although the United States is experiencing its own wave of antibiotic-resistant bacteria, some countries have more. High rates of ’super bugs’ can put patients at risk for contracting infections that antibiotics are ineffective at treating, at a time when their immune system is compromised after a procedure.
• Fly risks: You will most likely be flying to and from your medical procedures when going abroad. Some surgeries require more recovery time than others, and the pressure of flying so soon after a procedure can increase the risk for blood clots and secondary complications. 

Don’t Risk Your Life For Lower Costs 

If you are considering going abroad for your medical care, do your research first. Not every country and hospital are set up to provide the same quality care as U.S. hospitals, and not all medical professionals are in the business to help patients. 

The C.D.C. recommends the following safety measures when considering any form of medical tourism: 

• See a travel medicine practitioner (preferably the one doing your procedure if possible) at least four to six weeks prior to your appointment. 
• Get the ‘okay’ to travel to avoid complications on your way. 
• Check the accreditations and qualifications of the health care providers who will be doing your surgery. Foreign standards are not the same as U.S. hospital standards. Utilize credible resources such as the Joint Commission International, DNV International’s Accreditation for Hospitals, and the International Society for Quality in Healthcare for a list facilities. 
• Obtain all treatment plans and details in a written agreement prior to the procedure, listing what costs are covered by each party. 
• Plan ahead for language barriers by determining how you will communicate with your doctors and medical staff. 
• Bring copies of your medical records and prescriptions with you to show allergies or medical history relevant to your procedure. 
• Pre-plan your follow-up care before your trip. 
• Do not plan any vacations or recreational activities until after you consult your doctor on what is safe. 

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