Is it time to bring medics into medical tourism?

 

As the US economy continues its steady recovery, the psychology of fear and uncertainty will be replaced with optimism and a return to discretionary spending, leading to increases in both domestic and international medical/surgical travel.  Baby boomers will become the market drivers for this resurgence in medical/surgical procedures.  US healthcare cost which are beginning to level off from recent historic highs are still a major concern for employers and insurers who will explore the value of globalization of healthcare and medical/surgical travel in an effort to contain cost.  Although the Affordable Care Act when fully administered will add millions of Americans to the insured ranks, these individuals will continue to be underinsured and outside the umbrella of medical care in terms of bariatric surgery, cosmetic surgery, dental and in some cases orthopedic and cardiovascular procedures while others simply will not be willing to wait for access to care.  With regard to international medical tourism scientific advancements and technologies slow to gain FDA approval in the US will become a key differentiator for those entities offering these products and services abroad.

Factors that will slow the growth of medical tourism

There are however a variety of factors that could slow the growth of this emerging new field or prevent it from reaching its full potential. One of these is simply the growing pangs that all new fields of medicine and surgery go through as they mature.  Entrepreneurs dominate the medical tourism healthcare industry today, much as entrepreneurs dominated the early years of bariatric surgery and other new fields of medicine and surgery and that isn’t a bad thing.   We need entrepreneurs who are willing to take risk, to open markets and introduce the world to the real potential of new products and services, but the industry doesn’t always get the opportunity to pick its leaders. This opens the door to less than credible forces whose sights on short term returns risk long term growth.  Medical tourism will need to make the turn soon from entrepreneur driven to healthcare driven, if it hopes to capture the support of the US medical community, health insurers, employers, state governments and patients who are vital to its long-term growth.

The need to “medicalize” medical tourism

That doesn’t mean that the entrepreneurial spirit is to be restrained.  The industry simply won’t survive without entrepreneurs and honest and ethical business leaders working behind the scenes to drive medical tourism to its full potential, but ‘medical’ tourism must begin to promote the image and the principles of ‘medicine’ over tourism to gain acceptance and respect from the conservative US medical community, employers and insurers.  Those in the medical tourism healthcare industry whose business model relies solely on the capture of cash paying customers who travel without or against their personal physician’s, employer’s and insurer’s advice will face the same destiny that those early adaptors of bariatric surgery faced who failed to educate and engage the primary care community, employers and insurers.  The medical tourism healthcare industry is at a critical point in its development where medicalization is necessary.

“Let’s take the typical medical tourism agency or facilitator. Ask the proprietor for the name and qualifications of the agency’s Medical Director. Ask who develops and who signs off the clinical pathways... who deals with fitness to travel...  who is charge of the clinical aspects of case management? In 9 out of 10 cases, you will receive a blank stare. Because the agency’s focus is on sales and marketing... generating leads... turning leads into customers..... After all, it’s the hospital’s job to deal with the healthcare issues, is their thinking.”

International Medical Travel Journal: The medical tourism industry: healthcare experts needed!

As we begin to “medicalize” medical tourism and bring to this emerging healthcare industry ‘standards of medical care’, open and transparent sharing of outcome data, continuity of care clinical pathways, medical organizational oversight, and medical education we’ll take an important step in securely establishing this new healthcare field and engaging the all important healthcare gatekeepers; primary care physicians through whom millions of new traveling patients can be accessed.

We need to educate the gatekeepers

It is vitally important that the medical tourism industry takes aggressive steps to educate and engage the nearly 500,000 primary care gatekeepers in the US.  This process of education and engagement addresses the issue of perioperative risk and opens the door for new business.  Through CME approved and non-CME approved physician educational platforms both live and virtual, we can reduce fear of the uncertainty around medical tourism as we reduce risk of perioperative complications.   Pre-operative pre-travel patient assessment, education and examination will strengthen the patient-physician bond, ensure the patient is medically stable for travel and surgery and begin the preoperative care process.  Post-operative post-travel patient visits to their primary care physicians or other designated qualified physicians within the medical tourism healthcare network will greatly reduce postoperative risk, by placing a medically qualified healthcare provider in front of the patient who is acting as an extension of the destination surgeon, diagnosing and treating postoperative complications before they become costly or potentially lethal adverse events.

“When I go to medical tourism conferences, I am always surprised at how many people are in marketing. It seems like an industry much more dominated by the business and the marketing people rather than the health care people.” 

Harvard Law School (HLS) Assistant Professor I. Glenn Cohen: The rise of medical tourism

Establishing ‘standard of medical care’ perioperative clinical pathways recognized by our medical peers and tweaking these perioperative care plans to meet the individual needs of patients and their destination surgeon will ensure best possible outcomes.  Opening communication channels through physician liaisons and web-based communication portals, sharing of pre-operative ‘fit for flight’ physical exams, operative reports, discharge summaries and post-op orders through these same physician liaisons and cloud based communication tools adds an additional layer of risk reduction and comfort for the referring physician, insurer and employer.

Medical tourism drives costs down

Let’s look a bit more deeply at challenges faced by the international medical tourism industry.  First, in part due to the successful downward pricing pressure international surgical centers have placed in fields such as cosmetic and bariatric surgery, we are beginning to see an expansion of US domestic medical tourism.  Just a few years ago LAP-BAND® surgeries were priced as high as $20,000 at some US institutions while our colleagues in Mexico had the very same surgical procedure priced at under $10,000.   In response to these competitive prices and the exodus of patients to international markets, US surgeons and surgical centers today are offering LAP-BAND® surgery for as low as $8,900.  US based cosmetic surgeons are following suit and competitively pricing their ‘cash’ procedures and now offering financing options as well.   International medical tourism must find a way to offer significant cost savings and deliver concierge like services while at the same time battling the less than favorable images projected by domestic medical tourism marketers who will play on the fears of US patients, physicians, employers and insurers.

Familiarity, confidence and trust must replace fear of the unknown

Fear is the recurrent theme here that must be addressed by the International medical tourism industry.  Fear of the unknown and unfamiliar must be replaced with images of familiarity, confidence and trust.   As we medicalize international medical tourism, we’ll need to build familiar and trusting faces and names into the image of international medical travel.  We’ll also need to build confidence in the quality and credentialing of our physicians, surgeons and hospitals.  Transparent processes, clear clinical pathways and standard of medical care protocols, open and frequent communication, sharing of outcome data and risk management reporting are all necessary if we in the international medical tourism industry are to compete with domestic healthcare option.

Destination facilitators and surgeons/hospitals seemed overly focused on patient direct marketing.  I agree…. aggressive direct to consumer marketing through, advertising, Internet SEO, appealing websites and a well trained sales forces is important, but longevity depends upon the engagement of US physicians, employers, insurers and policy makers.  This model was proven out clearly in the bariatric surgical field where the number of surgeries skyrocketed once we were able to educate and engage referring physicians. 

The future looks bright for medical tourism, but much work needs to be done to medicalize medical tourism and to fully engage referring physicians, employers and insurers to ensure longevity in this emerging healthcare industry.

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