No sooner did word of the Supreme Court's historic ruling on the Affordable Care Act come down the pike last month than industry colleagues and journalists contacted me to learn how the newly-confirmed (for the moment) law of the land would affect U.S.-outbound medical tourism.
I was immediately reminded of a Singapore-bound business trip I took more than two years ago, amidst the heated debate over health care reform just prior to the act's passage. On the first leg of that 27-hour journey, my self-confessed post-50 seatmate informed me she was traveling to Seoul for cosmetic surgery. "I cannot wait until we have health care reform," she commented, "because then I'll be able to stay home and have it done for free."
Of course, that is not actually the case; no reform I can think of will change health insurance so dramatically as to cover cosmetic procedures not deemed necessary by a physician. Yet her words do reflect the vast confusion that exists here in the U.S. and abroad about the impact of ACA on health care consumers. In other words, just how will health care reform affect those seeking treatment here at home, the more than 6 million Americans currently living abroad, and the nearly 1 million patients in the U.S. who will seek medical care outside of its borders next year?
The answer is not a sound bite -- as with so many complexities of ACA, medical travelers can be assured of a "yes," "no," and "maybe."
Near term, if health care reform is upheld (i.e., not repealed in whole or part), we'll see some 17 million currently uninsured Americans becoming covered by federal- and state-mandated health plans. Undoubtedly, most in this group would then choose not to travel for treatments newly covered under health care reform, resulting in a short-term decline in outbound U.S. medical travel. This treatment category includes procedures we have come to expect employers and insurers to provide: routine doctor visits, health check ups and annual physicals (including associated tests, scans, blood work, and screenings), cardiovascular work, orthopedic surgery deemed necessary by a specialist, cancer, and (in most cases) transplants.
Longer term, as our already-broken health care system struggles to absorb millions of new claims, I expect patients will experience the kinds of burdens on the U.S. system that we've seen placed on other economies deploying universal care. We'll likely see demand outstrip supply, creating shortages of physicians, nurses, and specialists and resulting in longer waits for diagnosis and treatment, particularly in specialty care (e.g., orthopedics, cardiology, oncology). Similar to countries with long-established universal health care, such as Canada and the United Kingdom, we can expect medical travel from the U.S. to increase -- not so much due to cost-saving opportunities, but rather in the form of patients seeking global options for more immediate care.
Most American medical travelers seeking care outside the U.S. undergo treatments not normally covered by any insurance (whether private, government, or resulting from health care reform). Such treatments include restorative and cosmetic dentistry, cosmetic and plastic surgery, restorative dentistry, in vitro fertilization and other fertility procedures, bariatrics (though some enlightened insurers are beginning to cover weight loss surgeries, most health plans do not cover bariatrics except in emergency cases), hearing and vision examinations and equipment, and comprehensive health screenings, to name a few. Thus, much of all current U.S.-outbound medical travel will remain unchanged by health care reform.
In brief, I believe we'll see U.S.-outbound medical travel dip in growth over the next couple of years, then pick up again as global options become more attractive when cost, quality, and patient experience data become increasingly accessible to health care consumers, and as access to specialty treatments begins to erode due to the natural burdens of greater demand and diminishing resources.
As one patient from the U.K. told me, "I would have died before I got to the operating table, so I went to India for my heart bypass." Let's hope U.S. policymakers and corporate captains can learn from the lessons of our international counterparts and act creatively to the good of all.
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