Will medical tourism drive domestic doctors out of business?

Will American physicians go the way of the Big Three automakers?

Insurance companies are subtly pushing their members towards having their surgeries performed in countries like India or Thailand, in exchange for substantial cost savings at hospitals that are comparable in quality to those in the United States.

Also on another note, many hospitals are using so-called “nighthawk” radiologists from India to interpret many of their radiology studies, again with significant cost savings.

Domestic doctors, predictably, are not happy with this move. Hospitalist Robert Wachter writes that the presence of foreign competition is akin to the threat that the Big Three automakers face from Japanese companies. Will doctors Stateside innovate to keep up with the international competition?

Thus far, their response smacks of protectionism. When a group of surgeons were asked whether they would care for complications from a surgery performed overseas, the response was a decided “no.”

As always, Dr. Wachter brings up good points, saying that the status quo cannot continue. Rather than exhibiting hostility, American doctors would be well served to provide the necessary improvements in patient satisfaction and cost savings to meet the foreign challenge.

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  • Anonymous

    “Thus far, their response smacks of protectionism. When a group of surgeons were asked whether they would care for complications from a surgery performed overseas, the response was a decided “no.””

    Another turf war over money. I’ll have to remember that my doctor really doesn’t care about me, my health or my life, only the money they can make of my misery.

  • Anonymous

    Just one problem if you Japanese car breaks down there are plenty of places to get it fixed. I know I won’t take care of anyone that has their surgery done overseas if there is a complication. There’s an old saying about about surgery if you cut it, you bought it. Same goes for the surgeons in medical tourism. I would send them back to the original country. The first employer that gets sued for a fatal PE on a plane ride will nip that in the bud. It’s also hard to imagine Granny that won’t go to Mount Pilot for care going to Bangkok.

  • Anonymous

    American doctors can also reap some benefits from this, since they can export themselves to these facilities. There they may enjoy more autonomy, less malpractice concerns, and the joy of delivering quality care.

  • Chuck Brooks

    The US health industry has not only priced itself out of the marketplace, but more damaging is working hard to keep innovation and competition away. Not only do the raw economics favor medical tourism, but technology is fast rendering follow-up and continuation easier to do. Even the US’ insurance companies’ cartel arrangements are comming under heavy pressure. None of this has gone without notice by the self employed, small companies, the otherwise uninsured with means, and not least the next wave of minute clinics. Beyond all of this is a more holistic approach to health that is beyond the bottom line fixation of US providers and policy makers.
    Chuck Brooks
    FutureWare SCG

  • Anonymous

    If i see a patient with a complication from another doctor, I am not paid or paid very minimally, so no I’m not going to
    1. cover a pissed off patient who is already angry about their care. and
    2. do it for virtually no money.

    And many times insurances won’t pay anything for complications because they say it’s part of the global.

  • Anonymous

    Kevin, here’s an article on domestic medical tourism:

    http://www.washingtonpost.com/wp-dyn/content/article/2009/01/03/AR2009010300030.html

    I wouldn’t write off the USA’s ability to compete on this field, unless the government makes it impossible. I wouldn’t put it past this coming administration.

    My pet idea FWIW is this sort of medical tourism should be done on American Indian reservation land. They are capable of exempting themselves from so much of the rules that hamstring American medicine.

    Torts, HIPAA, etc., they can write their own rules to a large extent, if they want to. Run hospitals instead of casinos. I say it would be one of the best things to happen to Native Americans in a long time.

    But you know what they say about opinions and a$$holes.

    BTW I know I already have a N=1 example of a patient who engaged in foreign medical tourism, suffered a complication, and no one in the state will touch him now.

  • Wes

    A surgery does not magically happen. In order for the procedure to take place, someone must diagnose the problem and prescribe a treatment plan.

    I am not sure who is going to do this in the US. US doctors are not likely to do so UNLESS they get something out of the deal. Additionally, follow-up is a major issue, again falling on a US physician when the patient is back in the US.

    Unless larger companies or insurance companies what to establish physician practices to do the things above, I think the US physicians still hold the keys to the kingdom on this.

    As such, I think there will be some procedures viewed as standard that go offshore and a few here and there, but by and large, procedures will stay in the US. Those do go offshore are likely to only be spillover from the lack of physicians in the US as the population ages.

    ==============================
    Follow me on Twitter at jspears1966

  • Hamza Emadeen Mousa

    “American doctors can also reap some benefits from this, since they can export themselves to these facilities. There they may enjoy more autonomy, less malpractice concerns, and the joy of delivering quality care.”

    Well , Certainly yes , especially in my country , where patients has powerless , useless papers called ” informed consents and all its about a Propaganda of a Perfect American Doctor . comes over seas

    Though my reply on this topic , is NOT all of the medical and health care can be at Tourism , especially my country itself known as 1st Medical Tourism in the area , with less care of their own civilians , but i believe , the patients will need to follow up , at their own countries .

  • Anonymous

    Internists and family physicians could get screwed by this when our patients get surgery overseas, but then need follow up or have a complication only to find all of the local surgeons (appropriately) refusing to get involved. We may be stuck with them when they appear our office and the only surgeon who’ll talk to us about them is thousands of miles across an ocean.

    We may need to ensure that the insurance company or whoever is arranging (and benefiting from) the overseas surgery has a contract for stateside followup. Otherwise, we may find these problems landing in our laps.

  • Anonymous

    And I’m sure the trial bar will find a way to make the nonsurgical primary care doc responsible for the surgical complication.

  • Daren

    You mention that insurance companies are “subtly pushing their members towards having their surgeries performed” abroad is extremely incorrect. Why would insurance companies do this? How are they addressing the legal challenges related to patient rights?

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  • http://www.surgicalbliss.com Medical Toursim

    I agree with ‘anonymous #2′, ref. the old saying. “If you cut it, you bought it.” So think wisely and consider more then just the price. Check the refs e.a.