Managed Care - January 2009 - (Page 19)

placements in India, Thailand, and more than 30 other countries, according to Deloitte. Destination nations regard it as a lucrative source of economic development. The New York Times reported in November that the South Korean government will build a 370-acre complex of medical clinics on the resort island of Jeju. An 18-hole golf course and scenic beaches will help to lure foreigners. “Outbound medical tourism is likely to experience explosive growth over the next three to five years,” Deloitte researchers estimate in their 2008 document, “Medical Tourism: Consumers in Search of Value.” The number of U.S. medical tourists is projected to grow to 6 million by 2010, representing $16–$19 billion in lost revenue to U.S. health providers, they report. Greater transparency — more hospitals posting their prices and outcomes online — has aided the trend because consumers are slowly realizing that there are huge variations in cost and results for the same procedure. A refinement in medical tourism came when brokers like Planet Hospital, a leading medical travel planner, talked to employers and insurers and put together travel-and-treatment packages. “There is a cottage industry emerging of brokers who go to employers and health plans and say, ‘If someone mentions medical tourism, we’ll get the airfare set up, we’ll make sure people can recover in a four-star hotel and are transported to and from the airport, and we’ll see that their medical records are sent to and received by their physicians — and we’ll take a percentage of the deal,’” says Deloitte’s Keckley. With logistics under control, the remaining concern was quality, somewhat allayed by accreditation from the Joint Commission International, a subsidiary of the Joint Commission on the Accreditation of Healthcare Organizations. JCI has inspected more than 100 foreign hospitals. Though the inspections are not as rigorous as JCAHO might perform, it is a measure that inspires confidence, Keckley adds. In addition, some of America’s most trustworthy hospitals have forged alliances with foreign facilities. For example, Saint Luke’s Medical Center in the Philippines is affiliated with Memorial Sloan-Kettering Cancer Center. Employers and health plans are taking advantage of price discrepancies by sending workers to other states and countries for less costly comparable or better care. For Hannaford, a self-insured operator of 160 New England and New York supermarkets, some of its 27,000 Aetna-covered employees were offered the option of having knee and hip replacements in the U.S. and paying significant copayments and deductibles of $2,500, or traveling to Singapore’s National University Hospital for the surgeries, all expenses paid. A hip replacement costs $43,000–$50,000 in the U.S. but only $9,000– $12,000 in Singapore, says Peter Hayes, in charge of Hannaford’s health and wellness programs. Though Aetna offered to make all the arrangements, no employee took Hannaford up on its offer. After Hannaford announced the policy in early 2008, several New England hospitals told Hayes that they would match Singapore’s costs, leading some to conclude that medical tourism can spark competitive pricing, even global competition. Blue Cross & Blue Shield of South Carolina and WellPoint, in a pilot project announced in November, are offering medical tourism to members. And the West Virginia and Colorado state legislatures considered bills that would offer incentives to state employees to obtain treatment in low cost JCI-accredited foreign health facilities, but those bills failed. Predictable barriers to acceptance include a potential backlash from community providers that are unhappy that large local companies are sending employees out of town for treatment. Consumers may be concerned with such factors as filing malpractice litigation if something goes wrong, applying for visas and passports, obtaining necessary immunizations, traveling to a country that might be politically unstable, and assuring continuity of care. Some of these concerns dampen the zeal to save money. Employers have other considerations: If there are complications and patients must stay abroad longer, should an employer pay for that? Who pays for travel costs for a companion? If the patient dies, is the employer responsible for transporting the body back to the U.S.? It is no surprise that the World Medical Tourism and Global Health Congress meeting in San Francisco last June featured speakers from Cigna and United. The primary focus of the conference was integration of medical tourism into health insurance for fully insured and self funded employers. According to the conference literature, more than 100 employers and insurance companies have al- JANUARY 2009 / MANAGED CARE 19

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.