A new academic paper by Nathan G.Cortez on medical travel is thought provoking, "Patients without Borders: The Emerging Global Market for Patients and the Evolution of Modern Health Care”. Indiana Law Journal, Vol. 83, 2007. Available at SSRN: http://ssrn.com/abstract=982742
It addresses the unique legal, policy, and ethical questions that arise when patients travel to foreign jurisdictions for medical care. A growing number of patients are leaving the United States for hospitals and physicians in developing countries. This has generated countless media stories, but the market is developing independently of lawmakers and regulators. This is troubling because patients are effectively waiving their rights and benefits in the U.S. to seek medical care in countries that may not grant them remotely similar protection.
The article considers policy responses, such as regulating patient travel, regulating referral networks, and regulating employers and insurers.
The underlying goal is to examine how globalization is fundamentally changing health care. Medical travel is both a symptom and a solution to what ails the U.S. health care system.
Cortez argues that the US government should build on existing consumer protection laws and expand licensing regimes with a national health body that can regulate both agencies and the JCI. He argues that no US body can or should regulate all activity overseas, just because Americans are patients there. He points out that it is impossible to get governments to agree even on basic health care regulation, and that while international agreement and synchronisation are an ideal, they are decades away from being practical.
The US must co-operate with countries to harmonize healthcare standards, licensing and accreditation; but it cannot and should not seek to dictate or control the quality of foreign medical care. Attempts to prevent Americans going overseas for treatment, or limiting destinations would fail. He is concerned that the growing army of intermediaries are neither regulated nor licensed, which leaves patients susceptible to misleading advertising. He proposes licensing, but accepts that this could never extend to the activities of medical practitioners overseas, and it could simply drive agencies to relocate outside the USA. On multilateral cross-country regulation, developing countries will be reluctant to expose local healthcare providers to rules from countries with vastly different legal and medical systems. Developing countries will resist any encroachment on their jurisdiction and autonomy. Private hospitals may individually choose to voluntarily adopt standards to attract foreign patients. But even here they can choose between eight widely differing health care quality and accreditation standards.
Cortez concludes that health care is evolving from local to global, with physicians, medical technologies, and patients becoming increasingly mobile. Geographical and jurisdictional borders mean less. Western healthcare standards and money are seeping into developing countries. Cost differentials between countries are becoming harder to ignore as the quality differentials disappear. Public and private organizations are trying to harmonize standards worldwide. Patients take a calculated risk by seeking medical care overseas in regulatory systems that may not offer the rights or protections they expect. Lawmakers and regulators worry that they are helpless to respond. He proposes balances between risks and benefits; between free market solutions and government intervention; between patient autonomy and governments’ legitimate interests in enforcing their laws; and between the interests of developed and developing countries with different health care and regulatory systems.
He concludes that the US can no longer deal with health care nationally, ignoring globalization. A system in which costs are unreasonable, millions go uninsured or underinsured, and quality is falling below peer countries, is unsustainable. Medical travel is an inevitable response by U.S. patients to rising costs, declining confidence in quality, and decreased access to healthcare.
