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Medical Tourism: Boom or Bust?

At the annual New York Times travel show at the Javits Center in Manhattan, Klezmer dancers and Spanish chefs beckon tourists with sights, sounds, and tastes of their homeland.

Among booths representing Fodor's travel guides, Rick Steves' tours, and various government tourism bureaus, the Medical Tourism Association is handing out "medical passports" -- blue pocket-sized brochures advertising the benefits of having surgical procedures done abroad.

While you're on that trip to India, the association suggests, why not knock that knee replacement off your list?

The association's presence at the travel show implies that what was thought to be the occasional journey to Poland for some dental work, or the province of foreign VIPs seeking better quality healthcare than was available in their home countries, has become an bona fide "industry."

And that's what Renee-Marie Stephano, co-founder of the Medical Tourism Association (MTA), would have you believe. With healthcare costs rising and more Americans becoming uninsured or under-insured, she says, the demand for less costly, quality services abroad has been rising.

That's what prompted Stephano and her partner Jonathan Edelheit (both are attorneys) to found the association in 2007. Their aim: to bring together the major players in the field -- facilitators, foreign hospitals, tourism boards -- and potentially grow the industry.

Yet some question whether there's room for that expected growth, especially with the U.S. still struggling out of a major recession. Fewer people take vacations when money is tight; how could they afford to pay out-of-pocket for surgery in addition to airfare and weeks' worth of hotel bills? skeptics counter.

How Big Is Medical Tourism?

The fact is, there are no good data on the number of patients who travel outside of the U.S. for medical procedures, so it's hard to determine any trends, researchers say. Some warn, however, that medical tourism proponents inflate the numbers.

Stephano says the figure is between 120,000 and 150,000 patients a year -- about what was reported in 2007 -- when she and Edelheit started their association. Although tourists used to go abroad mainly for plastic surgery and other elective procedures, she says, more are now traveling for operations that their insurance won't cover, including hip and knee replacements.

Trips are usually made with the help of a "facilitator" like San Diego-based Satori World Medical, which promises knowledge of the best facilities abroad and creates a complete itinerary for patients, from initial sight-seeing to physician appointments, to scheduling the procedure, tacking on extra rest-and-relaxation days for recuperation.

Stephano says 87 countries have established plans for promoting medical tourism, including Costa Rica, Mexico, Brazil, Guatemala, India, Thailand, Korea, Japan, China, Egypt, and Turkey.

The MTA attempts to bring all the key players together to share information and resources, while generating consumer interest in having procedures done abroad.

One way the association accomplishes that goal is through publications -- especially it's own Medical Tourism Magazine, of which Stephano is the editor.

Another is an annual conference. This year's will be in Chicago in October and is expected to draw about 1,500 attendees, double the number who came to the first one four years ago, Stephano says.

The MTA has also launched a certification process for facilitators, although only four have completed the $2,500 process -- Debson Medical Tourism, Angels Global Healthcare, MedVoy, and SurgicalTrips. The Medical Tourism Association's seal of approval also requires a $2,500 renewal fee each year.

Association Faces Criticism

The MTA has come under scrutiny, however, largely because of funding issues. Stephano and Edelheit set up a for-profit business, WMT & GHC, less than a year after forming the MTA, and that entity now runs the sponsor-heavy annual conference, according to a Reuters report. The for-profit company pays for much of the MTA's operating costs, including the conference itself, Edelheit notes.

The same Reuters report noted that the certification program originally targeted foreign hospitals as well as facilitators, although that effort has been dropped. Also missing, according to Reuters, are many of the association's original board members.

Stephano says that despite these setbacks, the MTA is still instrumental in helping patients make good decisions about having their medical procedures done abroad.

David Jaimovich, MD, president and founder of Quality Resources International, which consults for international healthcare safety groups such as the Joint Commission International, said MTA certainly has a role as a "discriminator."

"Unfortunately, in this industry there are many facilitators who really don't know medicine at all, and the ones that don't can cause significant issues with regard to patient care," Jaimovich told MedPage Today. The MTA can at least vet good providers and offer guidelines and standards, he said.

Growing, Growing ... or Gone?

The MTA's influence, however, remains unclear -- an additional stumbling block in the face of a weakened economy.

Two of the biggest facilitators in the U.S. -- Satori World Health and BridgeHealth -- have expressed no interest in the organization's certification program.

Nor has there been much support from the medical community, as few physicians say they've encountered patients who seek care abroad, and none that we contacted say they would ever make such referrals.

James Unti, MD, of the University of Chicago, says the actual volume of patients traveling outside of their home countries for medical care is probably "far less than the industry promotes" -- and is only likely to get smaller as the economy sinks.

He also said the new Accountable Care Organizations mandated under the Affordable Care Act may keep more patients home as well, as they are implemented over the next few years.

For Unti, the Medical Tourism Association boils down to this: "a commercial industry attempting to capitalize on a problem with our healthcare system."

He's not alone in his forecasting that medical tourism isn't as much of a growth industry as once perceived.

"It will remain an option for some patients," Jaimovich said, "but I don't think there's going to be a big influx of patients traveling overseas for care."

Source MedpageToday