Coronary artery bypass graft (CABG) surgery cost on average $113,000 in the U.S. in 2011, according to an Organization for Economic Cooperation and Development (OECD) review. The same surgery in India carried a price tag of $10,000 in 2011. Heart valve replacements offered an even better deal, at $150,000 vs. $9,500. Researchers who track medical tourism warn that these bargains come with potential health and financial risks, while others say the U.S. should view such enterprises as an example of innovative, cost-effective care.
Markets and market drivers
Historically, wealthy people have traveled to other countries for healthcare for centuries. But what differs in recent decades is the destination, with medical tourists—many with limited means—choosing less developed as well as less expensive nations for procedures such as heart surgeries.
The U.S. consumer is the No. 1 target for overseas hospitals trying to attract patients for services as varied as cosmetic to CABG surgery, says Leigh Turner, PhD, at the Center for Bioethics at the University of Minnesota in Minneapolis and author of numerous papers on medical tourism. But exactly how many Americans elect to have medical procedures done abroad remains a question.
“Finding reliable data on patient flows is difficult,” Turners says. Underscoring that point, the “Medical Tourism: Treatments, Markets and Health System Implications” review for the OECD “narrowed” its worldwide estimate of medical tourists to between 60,000 and 50 million.
As many as one-quarter of 4,000 U.S. adults surveyed by the Deloitte Center for Health Solutions in 2011 responded that they would consider traveling abroad for a necessary hospital treatment, and the majority listed cost as an important factor. Some hospitals see opportunity in this patient population, using medical tourism brokerages to draw in health insurers, employers and consumers. For instance, Blue Cross and Blue Shield South Carolina, through Companion Global Healthcare, offers plans that allow members to undergo elective procedures overseas (International Journal of Health Services 2010; 40:443-467).
When it comes to cardiac surgery, though, India stands out, according to the OECD review. Research conducted by Krishna Udayakumar, MD, MBA, which explored cardiac surgery programs in two Indian hospitals, supports that conclusion.
“Many high-end hospitals in India specialize in cardiovascular procedures,” says Udayakumar, head of global innovation for Duke Medical in Durham, N.C. “Many of them have made medical tourism a core part of their strategy to be able to provide high-quality care at international standards at a very low price point, relative to what is available in countries like the U.S. or England.”
|2011 Medical Tourism Prices in Selected Countries|
|Heart bypass (CABG)||$113,000||$10,000||$13,000||$20,000||$9,000|
|Heart valve replacement||$150,000||$9,500||$11,000||$13,000||$9,000|
|*Costs given in U.S. dollars. Price includes hospital and doctor charges. | Source: “Medical Tourism: Treatments, Markets and Health System Implications,” March 2011|
Risky or rational?
Traveling abroad for medical care has its hazards, Turner warns, including patient safety, quality of care, post-operative follow-up and financial strain. “There are many procedures [abroad] where it is less expensive, but they still require financial resources,” says Turner.
U.S. medical tourists also lose the protection of the FDA, which has stringent standards for approving drugs and devices. They run the risk of receiving drugs that might be contraindicated, have boxed warnings or are not available once they return to the U.S. Once discharged, they may embark on a long flight without medications such as anticoagulants. The OECD cited deep vein thrombosis, pulmonary thromboembolism and MI as potential in-flight risks for medical tourists during their return trip.
In-hospital and transfusion-related infections pose threats as well. Researchers report incidences of hepatitis B infection from cardiac surgery, for instance. They added that assessing quality of care, patient safety and outcomes is difficult because of lack of transparency and independent review.
Sensitive to such concerns, some hospitals use international accreditation organizations, such as the U.S.-based Joint Commission International, to show