The number of people heading abroad for "medical tourism" could jump tenfold in the next decade, to nearly 16 million Americans a year seeking cheaper knee and hip replacements, nose jobs, prostate and shoulder surgery, and even heart bypasses, according to a forecast by health care consultants at the Deloitte Center for Health Solutions.
Meanwhile, the number of "retail clinics" operating in pharmacies, big-box and discount stores and supermarkets has jumped from about 200 in October 2006 to nearly 1,000 this month, according to a second report from the Deloitte center. While growth is slowing and some early players funded by venture capitalists have folded or been bought out, major retailers such as Wal-Mart Stores Inc., CVS Caremark Corp. and Walgreen Co. have announced plans to open hundreds more clinics in their stores in the next few years.
The two reports, released exclusively to The Associated Press, show potential big savings for U.S. consumers -- and likely their health insurers -- would come at the cost of American hospitals and doctors losing billions of dollars a year in revenue.
"Significant numbers of people are willing to vote with their feet to try something different, whether it's retail clinics or medical tourism," said Paul H. Keckley, the center's executive director. "U.S. providers are having to pay attention."
He cites patient dissatisfaction with high costs, long waits in the doctor's office or to get a procedure, and reports about errors and quality problems in U.S. health facilities as fueling both trends.
Surgery in some of the countries that have become hubs for medical tourism, from Thailand and Singapore to Mexico and Brazil, can cost less than half the U.S. price tag, even when including outlays for air fare, hotel and meals abroad. In a few cases, procedures overseas can cost one-tenth as much, Keckley said.
Many of these countries actively market their programs in wealthier nations and have new, 21st-century hospitals. Most of their physicians are U.S.-trained and know all the latest techniques, according to Keckley and Michael Taylor, a global health consultant at Towers Perrin.
But in the event of botched surgery or complications later, who takes care of the patient?
"That's one of the two big question marks about this, and the other is liability," Keckley said.
When patients work with specialized brokers who arange the surgery, travel and hotel, contracts sometimes provide for a doctor or hospital back home to handle follow-up care and spell out who is liable if a lawsuit follows, he said, but that's very inconsistent.
"In many ways, it's still the Wild West," Keckley said.
Problems come up most often when patients make arrangements themselves, such as for cosmetic and dental surgery not covered by insurance.
About 750,000 Americans headed abroad for major health care last year and an estimated 1.5 million will do so this year, according to the report. Based on several years of data from sources including the Medical Tourism Association trade group, top brokers arranging such trips and economic development agencies in countries doing the surgeries, the Deloitte report projects the number could jump from 10.4 million to 23.2 million in 2017, with 15.8 million the most likely number.
"I think that's very optimistic," said Towers Perrin's Taylor, who thinks host countries likely are inflating their reported numbers of American patients. He thinks the trend is growing, but not that quickly.
Deloitte's projections would equate to U.S. medical tourists spending about $50 billion abroad in 2017, with U.S. providers losing about $373 billion that year, given the difference in costs.
But Taylor, whose company consults for many Fortune 500 employers on health plan issues, said although many are asking about how medical tourism might work, with the exception of one, they aren't moving to set up such programs -- a prerequisite for any future boom.
"Nobody is redesigning their benefits to specifically cover medical tourism," Taylor said. "Nobody is rushing to get their employees to do it."
Still, health insurers are looking to cut costs, and some patients may view overseas trips as a vacation, said Tom Garvey of TMG Consultants Inc., which does health care consulting work. He sees appeal for workers with limited insurance.
"This will make the sting of their out-of-pocket expenses less," Garvey said.
At least one Blue Cross/Blue Shield plan is encouraging medical tourism and U.S. hospitals are reacting to the trend, to some extent. According to Taylor, some teaching hospitals in the Midwest have been trying to match costs for foreign surgery to retain patients.
He and Keckley both note that some of the country's most renowned teaching hospitals -- Johns Hopkins, Cleveland Clinic, Harvard, Duke and others -- have started partnerships where they do the pre- and after-care at their facilities, either for consulting and other fees or in exchange for part ownership of the foreign hospital.
Big-name partnerships can be crucial in the retail clinic business, which is barely a decade old. Some small, independent groups, such as SmartCare Health Clinics have shut down.
But retail giant Wal-Mart, which entered the clinic business cautiously, recently signed deals with struggling RediClinic and various hospital systems to open co-branded clinics, with 400 planned by 2010, according to Deloitte.
In the past two years, CVS Caremark and Walgreen each bought retail clinic operators and are expanding, with CVS Caremark planning 2,500 clinics eventually. Other clinic operators are affiliating with local hospitals and doctors.
Such clinics are staffed by nurse practitioners or physician assistants, who can handle minor injuries, ear and throat infections and other problems far faster than most doctors or emergency rooms. Appointments aren't necessary, wait times usually are 15 minutes, visits often are twice as long as in a doctor's office, most services cost $50 to $75 and they accept insurance.
The clinics use electronic medical records, which can be quickly reviewed by company doctors and shared with the patient's family doctor or local hospital -- to whom the patient will be sent if more-serious care is needed.
While patients like the convenience, such clinics don't seem to be making the money originally forecast, Keckley said, but the extra foot traffic adds to sales in the host stores.
And the Deloitte consultants see big opportunity for expansion, from providing preventive care or education and coaching for patients with chronic diseases to possibly working with federal health programs and clinics to lower their costs.
No comments:
Post a Comment