It’s so smooth.

What health system does this describe?

One-stop shopping. Fully integrated hospital medical staff. Immediate access. No technology or quality gap. Competitive prices. A focus on service.

Not ours according to Dr. Josef Fischer.  He is decidedly on point:

Unless physicians, surgeons, hospital administrators and health insurers get together to control costs, I fear that the health-care industry in the United States will rapidly continue down the same path as our indigenous manufacturing industries. If we do not take this issue seriously, if we keep repeating the old, inaccurate mantras about the lack of quality medical care abroad, we will lose our competitive advantage. Not only will fewer foreign patients come here for medical treatment, more of us will go elsewhere.

Going Global

Another reason that the reality of health care delivery going global should be a consideration in health care transformation thinking (from the Los Angeles Times):

Low cost isn’t the only reason Americans are traveling to foreign countries for healthcare. Timmi Ryerson of Vista, Calif., went abroad looking for expertise she couldn’t find at home.

Her deteriorating hip led her to India two years ago for a procedure known as hip resurfacing. The surgery has been performed for years in Europe and Asia but was still new in the United States.

Protectionist Health Care?

Wondering if American economic protectionism will be a back door into more government intervention/universal health care/single payer/significant payment reform of our health care system.

From The Wall Street Journal:

In an effort to control rising costs, a small but growing number of insurers and employers are giving people the choice to seek treatment in other countries, a practice known as medical tourism. Until recently, most Americans who traveled abroad for medical care were uninsured, or were seeking procedures not covered by insurance, such as cosmetic dentistry or aesthetic surgery. Now, a handful of plans are beginning to cover treatment overseas for heart surgery, hip and knee replacements and other major surgical procedures.

While medical tourism isn’t expected to be a solution to the country’s soaring health-care costs, the practice is intended to produce savings for insurers, employers and workers. Open-heart surgery, which can cost roughly $100,000 in the U.S., can be done at an internationally accredited hospital in India for just $8,500, for instance.

Significant health care dollars flowing overseas is not going to sit well some people, especially those who are opposed to any kind of government role in health care and leery of free trade.

Medical tourism gains Olympic notoriety, links

American speedster Tyson Gay is expected to be in the hunt for a gold medal in the 100-meter dash in Beijing on Saturday.  But he almost didn’t make the trip.

Gay took a scary spill at the Olympic trials five weeks ago that brought his appearance in the 100 meters into question.  From ESPN:

One week after setting the American record in the 100 meters and also running that distance faster than anyone else ever has, Gay’s quest to double up at the Olympics in the 200 ended prematurely and painfully during a quarterfinal heat when he collapsed due to what was described as a “severe cramp” in his left hamstring.

Gay pulled up about a dozen strides into the race, after perhaps 40 meters. He collapsed to the ground and lay there as his competitors raced ahead and a stunned Hayward Field crowd went silent. Officials quickly brought a modified stretcher onto the track and wheeled him to the medical tent for examination.

In order to be sure the injury wasn’t anything more than cramps, Gay was treated by a physician…in Germany:

“The hamstring is 100 per cent,” he said after being treated by specialist Hans-Wilhelm Mueller-Wohlfahrt, the doctor of German football giants Bayern Munich and the German national team.

Olympic Medical Tourism—it has a ring to it, no?

Niko Karvounis’ recent in-depth look at medical tourism is worth your read at Health Beat.

Also, The Economist takes a free market look at medical tourism.

The important questions

Some have scoffed at the idea of traveling to India or Thailand for medical care.  How about New Zealand for the same reason?  They speak English and have such American necessities as McDonalds and Starbucks.  Rumor is the scenery is beautiful, too.

Medtral is hoping that an experience similar to that found in the United States will be the reason American health care travelers choose New Zealand for their next hip replacement.  From The Washington Post: “The company says it can offer procedures at boutique hospitals with follow-up personal nursing care at a fraction of the cost of the same surgery in the United States.”

Only 30 North Americans have registered with the company in ten months of existance.  The article also says that cost comparisons are difficult because of the variability in pricing across the U.S.  Medtral is focusing on a market they estimate at 75 million uninsured and underinsured Americans.

Here is the most important point, however:

“If my insurance company will cover the major share of the cost of the procedure, then I’m inclined to have it done here in California, since my biggest concern is what if something goes wrong,” says Shaw, an eighth-grade teacher from Mountain View, Calif. “I really don’t want to have to travel back to New Zealand for the sole purpose of doctor visits. That’s a bit expensive on a teacher’s salary.” If his insurer balks at the U.S. expenses, he is ready to make the case for traveling to New Zealand.

It always comes back to what patients will have to spend out of pocket.  Cost savings must be equivalent to the extra effort required to receive care in New Zealand (or any other country, for that matter). Getting a knee replaced requires significant rehab time and a few follow-up visits.  Turns out those tasks are easier to accomplish when the services are provided a few miles from the home rather than around the world.

“Will my insurance cover it?” and “How much is it going to cost me?” have been, and will continue to be, more important questions than “Who is doing my procedure?” and “Where is my procedure being done?”

That doesn’t seem right.

Free Trade in Health Care

A recent opinion piece in The Wall Street Journal: “We Need Free Trade in Health Care.

The writers break down potential trade in medical services into the World Trade Organization’s 1995 General Agreement on Trade in Services typology.  The typology:

Mode 1 refers to “arm’s length” services that are typically found online: The provider and the user of services do not have to be in physical proximity.

Mode 2 relates to patients going to doctors elsewhere.

Mode 3 refers mainly to creating and staffing hospitals in other countries.

Mode 4 encompasses doctors and other medical personnel going to where the patients are. All modes promise varying, and substantial, cost savings.

While true free trade in medical services is probably a (very) distant threat to the industry in this country, these thoughts are interesting and may hold promise if we continue down the path we are on.  Competition, real competition—not the rivalry stuff we have now, would be good for all of us.

After reading the article, read this post on the Health Business Blog by David Williams who agrees “with about half of what’s printed there.”