OPINION: Money Talks — ‘Obamacare’ and Medical Tourism in India

As millions of uninsured Americans begin signing up for health insurance plans now being offered through the Affordable Care Act (aka “Obamacare”), much news has been made about how India’s pharmaceutical industry stands to profit from increased U.S. demand for generic drugs. But there’s another way India might benefit as well: medical tourism.

[pullquote align=”right”]Medical procedures cost far less abroad.[/pullquote] Medical procedures cost far less abroad than they do in America’s notoriously expensive health-care system. For example, a hip replacement that costs $75,000 in the United States runs only $9,000 in India, while a heart-valve replacement in India costs only 10 percent of what it does in the United States. Even when one factors in the cost of airfare and four-star hotel lodging for the patient and a companion, the savings are eye-popping.

Even prior to the enactment of the Affordable Care Act, some American employers were already encouraging medical tourism in order to keep costs down. HSM, a North Carolina-based manufacturer of furniture and auto parts, has saved millions of dollars over the years by giving employees the option to go overseas for surgery. In a recent episode of Nightline, the show featured two people whom HSM sent to Costa Rica, one for a knee replacement and the other for weight-loss surgery. Not only was each person’s procedure free, but they received checks for at least $2,500 afterward — a portion of the money saved. An HSM executive told Nightline that he thinks that medical tourism will increase under Obamacare “because companies will be looking to reduce costs.”

Other experts also agree. In an article on Harvard University’s website, I. Glenn Cohen, a professor at Harvard Law School who focuses on medical tourism, forecasts that going overseas for medical care will increase under the Affordable Care Act because insurance companies will seek to reduce costs. The article states: “The four largest commercial health insurance companies in the U.S. have already launched or are considering medical tourism programs. It’s possible that in a few years, a significant number of Americans will travel abroad for their medical needs.”

Nothing in the Affordable Care Act explicitly prohibits medical tourism. The legislation “neither refers to nor contemplates” medical tourism, writes Nathan Cortez, an expert on health law at Southern Methodist University, in the book The Globalization of Health Care. Cortez predicts “employers and insurers will continue to experiment with foreign providers — either by adding them to their provider networks or by creating true cross-border health plans — and these plans will be used to satisfy the new individual insurance mandate and possibly also to compete in new state insurance exchanges created by the Affordable Care Act.”

[pullquote align=”right”]The American health-care system is an overpriced wreck.[/pullquote]The American health-care system is an overpriced wreck. If U.S.-based medical providers had to compete with Indian and other overseas hospitals, it would shake things up and encourage American health-care providers to be more efficient and reduce costs, thereby making health care cheaper for all Americans. “You’re going to see just huge competitive forces coming to bear on the U.S. health-care system, and God knows, we need it,” Josef Woodman of Patients Beyond Borders told Reason TV.

It would save taxpayers billions of dollars if medical tourism were promoted as an option in the insurance plans offered through the Affordable Care Act. While the American public might be skeptical, money talks: If it’ll save billions of taxpayer dollars from being spent on people who are among the Romney-termed “47 percent,” Americans will be in favor of sending these supposed “freeloaders” to India. And after a few “transitional years,” writes Laura Carabello, publisher of Medical Travel Today, people will become more comfortable with medical tourism: “as Americans become more engaged and educated health care consumers in the new reform environment — and with increased positive word-of-mouth — medical travel overseas will become more acceptable as certain culture-based fears about safety and quality begin to fade.”

[pullquote align=”right”]Fear of poor-quality care in a developing country is understandable.[/pullquote]Admittedly, there are details to be worked out. Fear of poor-quality care in a developing country is understandable. Typically, though, medical tourists go to a country’s top-of-the-line hospitals — the ones normally serving the country’s wealthiest citizens — which nonetheless are still far cheaper than American hospitals. The international accreditation agency Joint Commission International has given a thumbs-up to 22 hospitals and clinics in India, including some of the prestigious Apollo Hospitals. And if more people started seeking health care abroad, more hospitals would seek accreditation, which signifies that they follow specified standards for safety and quality.

Additionally, overseas health-care travel could include medical tourism insurance to protect patients if any procedure resulted in complications. Furthermore, it would be in insurance companies’ interest to direct people to high-quality hospitals, to avoid having to pay for follow-up care if a surgery went awry.

India would benefit not only from the revenue from medical tourism, but also from the advanced medical practices that would spill over from the United States.

Admittedly, there is one important downside to consider: Poor Indians might have a harder time finding care if Indian physicians would rather treat more lucrative Americans.

Medical tourism wouldn’t be a simple solution to the United States’ inefficient and costly health-care system. But given how dire the situation is, it at least merits attention as an innovative solution that has the potential to shake up America’s dysfunctional way of providing health care.

Preeti Aroon, a writer based in Washington, D.C., is copy chief at Foreign Policy magazine and tweets at @pjaroonFP.