Back to Mr. Smith. If he needs a knee replacement, and is uninsured, the average price of this surgery, across the U.S., is $53,500. Our clients pay $18,800 – a 65% discount. For the most part, our clients are happy with a 65% discount.

Some people though, are furious that the charge is $18,800, after the 65% discount. “I told you – I’m uninsured. I can’t pay anything” they say. “I need a 100% discount”.

Unfortunately, we are unable to help these people.

New study numbers US medical tourists in thousands not millions

A new study “Medical Tourism Services Available to Residents of the United States” published in the Journal of General Internal Medicine casts doubts on many of the claims made about the size of the medical tourism market and concludes that “the number of Americans travelling overseas for medical care with assistance from medical tourism companies is relatively small”.

Published in December’s issue of the Journal of General Internal Medicine, “Medical Tourism Services Available to Residents of the United States” is a report on the businesses and business practices of companies promoting and facilitating medical tourism to US patients and the types and costs of procedures being offered. In late 2008, the researchers conducted a telephone and email survey of businesses engaged in facilitating overseas medical travel for US residents. They collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. 63 medical tourism companies were selected for inclusion and 45 (71%) completed the survey.

13,500 US medical tourists from 45 businesses since start up

The 45 companies involved had referred an average of 285 patients overseas since start up (not in the previous twelve months).  The survey recorded a total of approximately 13,500 US medical tourists in total for all 45 businesses since they started in business. The most common overseas countries that companies reported referring patients to were India, Costa Rica, and Thailand though many other countries were mentioned less frequently including Malta, Israel, Spain and Germany. The most common medical services utilized by overseas medical travelers were orthopedic procedures, cardiac procedures, infertility treatment, and cosmetic surgery. (The study specifically excluded companies that focused exclusively on dental care).

The authors highlight the significant difference between their grand total of 13,500 US medical tourists travelling via 45 medical travel facilitators and the “number of articles, studies, and reports (that) have suggested that between 500,000 and 2,000,000 Americans travel overseas each year for medical care.” They believe that their study mirrors and supports the kind of numbers quoted by McKinsey & Co (Mapping the Market for Medical Travel) who estimated “the current market at 60,000 to 85,000 inpatient medical travelers a year—numbers far smaller than others have reported.”

The study authors propose that the discrepancy in the estimates of the size of the overseas medical market is related to the following factors:

1.       Estimates of a much larger US medical tourism market were proposed by parties with personal and/or financial interests in the overseas medical travel market.

2.       Their study did not attempt to measure the number of Americans travelling for dental care. This is believed to be quite a high proportion of the US outbound market, particularly cross border to Mexico and to South America. According to Sandra Miller at Health Travel Technologies, “We process more than 600 inquiries per months, and send more than 100 patients a month abroad……..We send 20 dental patients per month to top notch dental clinics in Mexico, Costa Rica, the Dominican Republic and El Salvador.”

3.        Their study did not attempt to measure the number of Americans who may have traveled overseas without using the services of a medical tourism facilitator. Estimates of how many medical tourists use a facilitator vary widely. Some US estimates put this as low as one in five patients who use the services of a facilitator.  (Research on UK medical tourists put this figure as around one in three – Treatment Abroad Medical Tourism Survey 2008).

The authors point out that even when items 2 and 3 above are factored in, “the market may be somewhat smaller than prior studies have estimated”. They also point out that two years after conducting the interviews, they found that 15.6% (7 of 45) of companies that completed the initial interviews no longer had functioning websites and thus were presumed to no longer be in business.

It’s also worth pointing out that the survey was restricted to medical tourism facilitators who had a US phone number. 97 facilitators were excluded from the research for this reason. This in effect excludes many Mexican, South American and Asia based facilitators who handle US patients.

Cost savings for medical travel less than claimed

The study’s findings related to the cost of overseas medical travel also warrant mention. The authors report that “overseas medical costs for several procedures were generally similar to combined hospital and physician payments made by Medicare for the same procedures.” For example, according to the study, a heart bypass surgery costs an average of $18,600 outside the USA. Within the USA, Medicare pays around $21,000 for the procedure. They conclude that “the take-away message is that the expected savings from overseas medical care is dependent on what, typically uninsured, patients might be expected to pay if they instead purchased this care in the US” and “the fact that overseas charges are reasonably close to Medicare rates suggests that there may be significant opportunity for US providers to compete with offshore facilities, in some situations, by offering highly discounted prices to uninsured American patients.”

IMTJ comment

We welcome this attempt to put some validity on the size of the US outbound market. The study is one of the first to approach the thorny issue of US medical tourism statistics by asking medical tourism businesses how many patients they actually handle rather than by creating “guesstimates” based on what people say they might do. It also puts some of the oft quoted predictions of “6 million US medical tourists in 2010, 10 million by 2012” etc etc in a different light.

A similar approach was adopted in 2007 in a study by Treatment Abroad in which facilitators, hospitals and clinics were asked to provide numbers of UK patients treated. This study put the number of outbound UK medical tourists at around 50,000 (similar to numbers recorded in the UK’s International Passenger Survey data.)

However, the new study does have its flaws – sampling bias, exclusion of dental care, exclusion of self arranged medical travel – which undoubtedly impacts the overall number of medical tourists that it counts. Nevertheless, even if we allow for these flaws and factor in the “missing” patients, the study suggests that the annual outbound medical tourism patient numbers for the USA are perhaps in the region of 100,000 to 200,000 at best, rather than the millions that have been mooted elsewhere.

The study highlights the areas of healthcare that are driving US medical travel – cosmetic (and obesity) surgery, stem cell treatment, IVF treatment, cosmetic dentistry and other non-insured areas which will not be covered by “Obamacare”. It does not analyse the clear ethnic trend in medical travel in the USA and elsewhere  – people who are travelling from the country of residence to their own, their father’s or their grandfather’s nation of birth. This is a significant driver of US medical travel:  Mexicans to Mexico, Hispanics to Latin and South America, Asians to Asian countries, Koreans to Korea etc.

Although, they are now in effect two years out of date, the findings of “Medical Tourism Services Available to Residents of the United States” reflect what many people within the industry believe is closer to the truth in terms of medical tourism patient numbers. i.e. thousands not millions.  Many countries, their governments and hospital providers have come to believe that the US market represents a rich source of patients but have been disappointed by their lack of success. They may need to revise their expectations and rethink their strategy.

One of our other network facilities in Oklahoma, put the following on their blog:

Imagine for a moment that you own a tire store.  A guy calls in and says he would like a new set of Michelin tires and would like to pay cash.  You say,”…no thank you.  We are not interested.”  What?  What kind of story is this?

That is exactly what happened at a local “not-for-profit” facility here in Oklahoma City.  A company that already sends medical tourists to Oklahoma City (to our facility and to two other specialty facilities) loves Oklahoma City’s central location and wanted to establish a relationship with a full service, large hospital here.  Keep in mind all of these patients are paying up front for whatever procedure they are going to have at rates that are profitable.  They are also people who are willing to travel a long way to get care because they are either in a Canadian waiting  line or live in some unfortunately backward place in Africa or Europe where facilities are not available or up to snuff.  Wow!  This is like a mission trip coming to you…you don’t even have to get all the shots for malaria to treat these people….and they are going to pay you up front?  And the facility that said “no” is affiliated with a church.  Ouch.

Why would they do this?  There is only one answer I can come up with.  They already have a ton of money.  They are focused on control at this point….power.  You see alot of guys that are bored billionaires that run for political office…same kind of thing…they have gobs of cash, they want to taste real power.  This hospital system and the folks that run it have demonstrated another point, though, by saying “no.”  They don’t care whether people get care or not.

I think they need to clarify their mission.  Make it more transparent.  Or maybe they just did.

This trend may well make healthcare insurance unaffordable for many Americans, driving them to downgrade their coverage to high deductible, catastrophic insurance.

Many of our clients have such insurance policies.  Often, we are able to get these people surgical care at prices well below their deductibles.

I wish we could. What we can do is offer medical procedures at deeply discounted prices from the usual and customary prices which are charged at 99% of the hospitals in the U.S.

We can offer a triple cardiac by-pass for $31,600, while this procedure costs $100,000 in most hospitals.  This is an 84% discount, which is the best we can do.  At this price, it makes little sense to search for a lower cost in Asian countries.

There is simply no reason for uninsured folks to pay top dollar at their local hospital, when discounts of this magnitude are available.

I just wanted to give you, and the surgeon you sent me to, a 5 star rating.  The surgeons in my are great too, but from what I can tell, your surgeon’s technique is second to none.

I talked to a number of people that had inguinal hernia surgery and were out of work for up to 6 weeks.  If I would have done what the local surgeon had in mind, I would have been out of work for a few weeks at least, not to mention it would have cost twice as much.  The good doctor has a great bedside manner, and is attentive over and beyond the call of duty.  The staff at his office and at the hospital were top notch too.  I will not hesitate to give out your contact info as I know a number of people are switching over to HSA’s and self-pay (we are all self employed).  Take care and keep up the good work.

Peter E.

• Mike Gallager’s national call-in radio show originating in Texas
• Janet Porter’s call-in show on a Christian radio network out of Florida
• John Stossell on ABC-TV’s “20/20″ (our second appearance)
• FOX & Friends on FOX cable TV News Network
• Peter Weisback Show on KVI Radio (Washington State)

Our clients have been interviewed on the FOX Business News channel, as well as on the Mike Huckabee show on Fox Cable News

We have also had stories printed about our organization in:

• Washington Times
• L.A. Times (September)

Finally, Richard Baker testified before a healthcare reform committee in the Capital Building, in Washington D.C. in July, 2009. While politicians on both sides of the house continue to (rightfully) decry the ever escalating costs of healthcare, nobody has come up with a solution. Rick Baker told the lawmakers that North American Surgery routinely arranges surgeries for his clients at discounts from 50% – 80% less than usual and customary changes. He urged them to consider this free-market solution to healthcare reform, rather than a complete makeover of the entire healthcare system into a government run, socialized system.

Rick Baker, founder of North American Surgery, Inc. has been invited by “Conservatives for Patient’s Rights” FacesOfGovernmentHealthCare.com to travel to Washington, D.C. on June 3rd, 2009 to testify to committees of Republican & Democratic congressmen. In their rush to implement a national healthcare policy, the U.S. government is proposing a single payer system similar to Canada’s. A single payer system (Canada and North Korea are the only current examples) has never been shown to work. Indeed, the close to 900,000 Canadians currently waiting in long queues for medical care, are testament themselves, to the dysfunctionality of the single payer system.

Baker will tell the U.S. lawmakers that should they adopt the Canadian single payer model, more Canadians than ever will inevitably die while waiting for care. At present, Timely Medical Alternatives is able to triage patients to sources of immediate care in the U.S. (Canada’s other healthcare system). “If the U.S. adopts the Canadian system” states Baker “ where will we send our clients who are in need of life saving surgery?”

In addition to addressing the congressional committees, Baker will speak at a press briefing at the National Press Club in Washington, D.C.

Self Insurance Institute of America

North American Surgery is now an accredited member of the “Self Insurance Institute of America, Inc.” As a Preferred Provider Organization, North American Surgery makes its network of hospitals providing deeply discounted pricing, available to self-insuring employers.