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January 2011

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE:

A Model for Health System Reform Environmental Scan

Medical

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform: Environmental Scan ALTARUM INSTITUTE January 2011 PAGE 1 SECTION 4 ● Table of Contents

MEDICAL TOURISM ...... 1 Medical Tourism Facilitators ...... 3 Healthbase Online Inc.: Healthcare Beyond Boundaries ...... 4 Medical Tourism /Benefit Plans ...... 1 BlueCross BlueShield of South Carolina & Companion Global Healthcare ...... 2

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform: Environmental Scan ALTARUM INSTITUTE January 2011 PAGE i SECTION 4 ● MEDICAL TOURISM SECTION ● 4 MEDICAL TOURISM

The Medical Tourism Association (MTA) states “medical tourism is where people who live in one country to another country to receive medical, dental, or surgical care while at the same time receiving equal to or greater care than they would have in their own country, and are traveling for medical care because of affordability, better access to care or a higher level of quality of care.”1 The MTA (Global Healthcare Association) is the first and only international, non-profit trade association for the medical tourism and global health care industry made up of the top international hospitals, health care providers, medical travel facilitators, insurance companies, and other affiliated companies and members with the common goal of promoting the highest level of quality of healthcare to patients in a global environment.2 In 2008, the American Medical Association adopted guiding principles on medical tourism at its annual policymaking meeting. The nine principles are the first of their kind and outline steps for care abroad for consideration by patients, employers, insurers, and third-parties responsible for coordinating travel outside of the United States (U.S.). Select principles include medical care outside of the U.S. must be voluntary, patients should only be referred for medical care to institutions accredited by recognized international accrediting bodies, and patients should be informed of their rights and legal recourse prior to agreeing to travel outside the U.S. for medical care.3, 4

MEDICAL TOURISM

INTERVENTION AREAS What does the intervention What is the research evidence How applicable to which AND Case Examples intend to address? regarding impact of intervention? types of markets?

This approach seeks to cover and There is limited research evidence on the effectiveness of Medical tourism benefits are typically used by two MEDICAL TOURISM reduce costs of care for primarily specific medical tourism insurance or benefit plans and populations: 1) employers interested in keeping medical and INSURANCE/BENEFIT international medical procedures for their impact on the larger health care system. insurance costs down and employee access to health care PLANS consumers, and cost of insurance- and However, there is a clear difference between the cost of broad, and 2) consumers and employees interested in the health-related costs for employers. many U.S. medical procedures and the costs of getting widest range of cost effective medical options. It also allows consumers alternative these done in some international locations. For example: access to a wider range of high-quality A heart bypass costing $80,000 in a U.S. hospital medical procedures. costs just $16,000 in .5 A full facelift that would amount to $20,000 in the U.S. usually costs about $1,250 in South Africa.6 A knee replacement in the U.S. costs anywhere from $30,000 to $40,000, but at Hospital Clinica Biblica in San José, Costa Rica, the cost is $10,500, including airport pickups, personal assistance at the hospital, and post-discharge nursing care.7

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform: Environmental Scan ALTARUM INSTITUTE January 2011 PAGE 1 SECTION 4 ● MEDICAL TOURISM MEDICAL TOURISM

INTERVENTION AREAS What does the intervention What is the research evidence How applicable to which AND Case Examples intend to address? regarding impact of intervention? types of markets?

Medical tourism benefits plans may be provided to employees through their employers or accessed directly by independent patients through insurers and insurers’ subsidiaries. Health benefit plans with medical tourism pilot programs include: Anthem BlueCross BlueShield (WellPoint): Wisconsin,8 9 Other Comments BlueCross BlueShield: South Carolina (case example below), BlueShield and Health Net: California,10,11 and United Group Program: Florida.12 Certain limited and short-term medical tourism and travel insurance plans may also be offered by independent companies other than traditional insurance carriers. For example, Companion Global Healthcare’s BasicPlus Limited Benefit Plan is offered through BasicPlus Insurance Services, LLC and Custom Assurance Placements Limited offers Global Protective Solutions Specialty Travel Insurance.13,14

Case example: This approach seeks to cover and There is no research evidence regarding the greater Medical tourism benefits are typically used by two BlueCross BlueShield of reduce costs of care for primarily impact of BCBS’ medical tourism insurance plan populations: 1) employers interested in keeping medical and international medical procedures for yet, but new companies have added international insurance costs down and employee access to health care South Carolina & consumers, and cost of insurance- and medical travel options through the BCBS-created broad, and 2) consumers and employees interested in the 18 Companion Global health-related costs for employers. Companion Global as recently as March 2010. widest range of cost effective medical options. Healthcare15,16,17 Companion Global partners continue to expand to hospitals in Brazil (Hospital Israelita Albert In 2008, BlueCross BlueShield Einstein), Mexico (CIMA Hermosillo and (BCBS) South Carolina launched a Monterrey), Puerto Rico (HIMAHEALTH), Spain subsidiary, Companion Global (Teknon Hospital), among others. Healthcare, to help U.S. patients plan trips abroad for lower-cost medical procedures. BlueCross BlueShield will cover patients' procedures organized through Companion Global if their BCBS plan allows the travel. The insurer also will cover two follow-up visits with physicians at Doctors Care1 centers in the State.

1 http://www.doctorscare.com/ STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform: Environmental Scan ALTARUM INSTITUTE January 2011 PAGE 2 SECTION 4 ● MEDICAL TOURISM MEDICAL TOURISM

INTERVENTION AREAS What does the intervention What is the research evidence How applicable to which AND Case Examples intend to address? regarding impact of intervention? types of markets?

Facilitators seek to connect individual Published research on the practices of medical Medical tourism facilitators appear applicable to many MEDICAL TOURISM consumers, businesses, insurance tourism facilitators is limited. groups interested in receiving or administering medical FACILITATORS carriers and agents, and third party Advantages of utilizing medical tourism facilitators tourism services (e.g., individual consumers, businesses administrators to affordable and include, but are not limited to, immediate access to and employers, and insurance carriers). innovative medical travel options, established relationships with international providers Facilitators could be particularly helpful to under- or primarily abroad. and convenient transfer of medical information. uninsured patients who have difficulty navigating and Medical tourism facilitators coordinate Disadvantages include that the quality of facilitation affording medical care. all medical tourism details, from services varies greatly from one provider to another Consumers for whom insurance is not needed and cost is and facilitators may possess biases toward certain no issue could also benefit from the concept of medical arranging surgery and financing 19, 20 options to visas, travel, lodging, and hospitals and destinations. tourism facilitators as medical travel is not just approached tourism. from a cost perspective, but can be from leisure perspective as well.

Medical tourism facilitators may be accessed directly by independent patients or may be contracted by insurers to provide facilitation services to plan members. The number of medical tourism facilitators, both U.S.-based and international, is growing. Select examples of medical tourism facilitators include: Carpatia Group: Romania;21 Other Comment Healthbase Online, Inc.: U.S.;22 (case example below) MEDICARE Travel: Slovakia;23 MEDTRAVEL: Ecuador;24 Patients Without Borders: U.S.;25 and Planet Hospital: U.S.26

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform: Environmental Scan ALTARUM INSTITUTE January 2011 PAGE 3 SECTION 4 ● MEDICAL TOURISM MEDICAL TOURISM

INTERVENTION AREAS What does the intervention What is the research evidence How applicable to which AND Case Examples intend to address? regarding impact of intervention? types of markets?

Case example: Facilitators seek to connect individual There is little or no research evidence regarding Medical tourism facilitators appear applicable to many groups Healthbase Online Inc.: consumers, businesses, insurance Healthbase practices. However, Healthbase lists interested in receiving or administering medical tourism carriers and agents, and third party testimonials2 describing positive patient experiences services (e.g., individual consumers, businesses and Healthcare Beyond administrators to affordable and and reports their sponsored procedures are up to 80% employers, and insurance carriers). Boundaries27 innovative medical travel options, less than typical U.S. hospital prices. primarily abroad. Healthbase is a U.S.-based medical tourism facilitator that arranges a variety of medical tourism services from basic consultations to full service treatment abroad.

Select Healthbase partners include Anadolu Medical Center (), Apollo Hospitals (India), Hospital Clinica Biblica (Costa Rica), Hospital Punta Pacifica (Panama), National Heart Center (Singapore), among others. Other Comments Healthbase arranges services at internationally accredited hospitals in over 10 countries (e.g., Belgium, Brazil, Costa Rica, and Thailand) and is expanding in additional areas (e.g., Argentina, Canada, and New Zealand).

SECTION 4 ● ENDNOTES

1 Medical Tourism Association. http://www.medicaltourismassociation.com. (Accessed May 12, 2010). 2 Ibid., Medical Tourism Association. (2010). 3 “AMA Provides First Ever Guidance on Medical Tourism.” June 17, 2008. Medical News Today. http://www.medicalnewstoday.com/articles/111577.php. (Accessed May 24, 2010). 4 American Medical Association. “New AMA Guidelines on Medical Tourism.” http://www.ama-assn.org/ama1/pub/upload/mm/31/medicaltourism.pdf. (Accessed May 24, 2010). 5 Higgins, Lisa A. “Medical Tourism Takes Off, But Not Without Debate.” Managed Care Magazine. April 2007. http://www.managedcaremag.com/archives/0704/0704.travel.html. (Accessed June 3, 2010). 6 Healthbase: Healthcare Beyond Boundaries. https://www.healthbase.com/. (Accessed May 20, 2010).

2 https://www.healthbase.com/hb/pages/testimonials.jsp

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform: Environmental Scan ALTARUM INSTITUTE January 2011 PAGE 4 SECTION 4 ● MEDICAL TOURISM

7 Magee, Devon. “Get Well Soon – Love, C.R.” October 30, 2008. TicoTimes.net. http://www.ticotimes.net/Legacy/Front-Page/Get-Well-Soon-Love-C.R._Thursday-October-30-2008/. (Accessed June 3, 2010). 8 Deloitte Center for Health Solutions. http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_chs_MedicalTourism_111209_web.pdf. (Accessed May 12, 2010). 9 Ibid., Deloitte Center for Health Solutions. (2010). 10 Op. cit., Deloitte Center for Health Solutions. (2010). 11 Black, Thomas. “Mexico Gets Medical Tourists as Health Net Sends U.S. Patients.” March 26, 2008. Bloomberg.com. http://www.bloomberg.com/apps/news?pid=20601080&sid=aFXAEi5eek5I&refer=asia. (Accessed June 3, 2010). 12 Op. cit., Deloitte Center for Health Solutions. (2010). 13 Companion Global Healthcare: BasicPlus. http://www.companionglobalhealthcare.com/patients/medicaltourisminsurance/basicplus.aspx. (Accessed June 3, 2010). 14 Custom Assurance Placements, Ltd.: Global Protective Solutions. http://www.customassurance.com/gps/. (Accessed June 3, 2010). 15 Medical News Today. “BlueCross BlueShield of South Carolina Launches Subsidiary to Facilitate Medical Tourism.” May 29, 2007. http://www.medicalnewstoday.com/articles/72057.php. (Accessed May 20, 2010). 16 Einhorn, Bruce. “Outsourcing the Patients.” March 13, 2008. Bloomberg Businessweek. (http://www.businessweek.com/magazine/content/08_12/b4076036777780.htm?chan=rss_topStories_ssi_5. (Accessed June 3, 2010). 17 Companion Global Healthcare. http://www.companionglobalhealthcare.com. (Accessed May 20, 2010). 18 Companion Global Healthcare. “Georgia Firm Adds Medical Travel to Cut Costs, Provide Options for Workers.” March 18, 2010. http://www.companionglobalhealthcare.com/news.aspx?article=51. (Accessed June 3, 2010). 19 Medical Tourism.com. “What is a Medical Tourism Facilitator?” http://medicaltourism.com/facilitator.php?lang=en. (Accessed June 1, 2010). 20 Jagyasi, Prem. “Medical Tourism Facilitator: The Critical Fourth Dimension.” Medical Tourism Magazine. October 1, 2009. http://www.medicaltourismmag.com/detail.php?Req=283&issue=13. (Accessed June 1, 2010). 21 Carpatia Group. http://www.carpatiagroup.com/.(Accessed June 3, 2010). 22 Op. cit., Healthbase: Healthcare Beyond Boundaries. (2010). 23 MEDICARE Travel. http://www.medicaretravel.eu/home.(Accessed June 3, 2010). 24 MEDTRAVEL Ecuador. www.medtravelecuador.com. (Accessed June 3, 2010). 25 Patients Without Borders. http://www.patientswithoutborders.us/. (Accessed May 20, 2010). 26 Planet Hospital. http://www.planethospital.com. (Accessed June 3, 2010). 27 Op. cit., Healthbase: Healthcare Beyond Boundaries. (2010). END SECTION 4

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform: Environmental Scan ALTARUM INSTITUTE January 2011 PAGE 5 SECTION 4 ● MEDICAL TOURISM

Altarum Institute Systems Change Model

For more information: www.altarum.org or contact Gloria N. Eldridge, PhD, MSc at [email protected].