Root Canal and Beach Time in Costa Rica

A friend of mine worked during medical school in a call center that helped travelers deal with medical emergencies. She consoled vacationers who found themselves with broken bones or pneumonia while out of the country, and assessed whether and how to evacuate them to return home for medical care. The patients were often encouraged to avoid local hospitals, particularly in developing countries where it was hard to assess the quality of care they could receive.

Today, millions of patients board international flights each year to receive medical care. Many, including Americans, travel to developing countries where they undergo medical procedures ranging from nose jobs to open heart surgery. Among the top global destinations for medical tourism are emerging markets such as India, Thailand, Brazil, and Costa Rica. These countries are actively promoting their personal healthcare services, courting international patients, as part of their national export strategies. When patients fly in for medical services, that service is considered an export of the country where the service takes place.

Healthy Borders

All along the U.S. – Mexico border, little towns are making big business offering specialty goods and services that cater to the American consumer, including healthcare products and services. The U.S. government estimates that approximately 952,000 Californians head to Mexico each year for visits to general practitioners, dentists, gynecologists, and other doctors, and for prescription medicines. Only half of the patients are Mexican immigrants residing in the United States. Another estimated 150,000 to 320,000 Americans travel overseas via air to receive medical care around the world; more than half opting for care in South America, Central America, or the Caribbean.

“Tour and Cure”

The World Health Organization estimates $60 billion is spent annually on global trade in healthcare services. This so-called “medical tourism” market is growing at a clip of about 20 percent annually. Traveling for healthcare services is gaining popularity as patients seek out lower wait times and lower costs, and can increasingly afford to travel overseas for better health care than they can receive at home. Given the size of the market and its growth potential, many countries, particularly in Asia and Latin America, are investing to upgrade their medical facilities and offer services tailored to attract high-paying foreign patients.

Thailand has been a leader in medical tourism for decades; it now generates 0.4 percent of the country’s gross domestic product. Morgan Spurlock, the documentary filmmaker who famously ate McDonald’s three times a day for a month in “Super Size Me,” traveled to Bangkok in 2015 as part of CNN’s documentary series “Inside Man” to undergo several medical procedures at Bumrungrad International Hospital. Bumrungrad was the first Asian hospital to receive a Joint Commission International accreditation and today attracts over 1.1 million international medical tourists each year. Primed to be skeptical, Spurlock was apparently impressed by the high quality of care and the affordable price.

More than 4.2 million people entered India on a medical visa in 2016. India is also working to increase its focus on the tourism part of medical tourism. In addition to offering high-quality doctors and facilities, many companies have developed packages that include site-seeing tours and elite lodging options, so you can see the Taj Mahal and get your knee replaced on the same trip.

Egypt announced recently that it’s working to create medical tourism visas, building on its “Tour and Cure” initiative that offers low-cost treatment to Hepatitis C patients from all over the world. The new visa category will target patients from Arab and African countries.

Top Doctors Attract Specialized Cases

Developed countries — the United States in particular — are also important medical tourism destinations. The high-quality specialized care draws patients from around the globe.

For example, Abdullah Al Obaid, an aviation official from Kuwait, spent several months in Rochester, Minnesota in 2015 while neurologists at the Mayo Clinic worked to adjust and monitor his multiple sclerosis treatments. Al Obaid was among the 100-200,000 air travelers who come to the United States annually specifically seeking medical treatment (this figure excludes patients arriving from Canada and Mexico over land). The Mayo Clinic’s Minnesota campus alone reported over 8,500 international patients in 2015. The greatest share of patients to the United States come from the Caribbean, Europe, and Central America – 44, 24, and 10 percent respectively. Patients from the Middle East have traditionally sought advanced medical care in the United States, but restrictive visa requirements have limited their access recent years.

Recognizing the value of adding healthcare service exports to their portfolio, world-class hospitals and medical facilities now offer a host of services and dedicated staff to support patients and their families who travel from overseas, including language services, help obtaining information on billing and insurance, lodging assistance, community services such as banking, and more.

Pros and Cons of Medical Globetrotting

The greatest advantage of medical tourism is undoubtedly the price tag. American patients, in particular those without sufficient insurance coverage, can save anywhere from 20 percent in Brazil up to 90 percent for some procedures in India. A knee replacement can cost $30,000 in the United States, compared to $12,000 in India. For patients requiring expensive procedures and prolonged hospital stays, these savings can be very attractive. Virtually non-existent wait times are also a significant draw for patients seeking health care overseas.

But medical tourism still has its challenges. Many patients are unsure of the quality of care they will receive. Others are concerned with language barriers and follow-on care, not to mention immigration and other legal challenges. The Joint Commission is the oldest and largest health care accrediting body in the United States. Extending its mission in order to help assuage concerns over quality of care overseas, it founded Joint Commission International (JCI) in 1994, which works in five continents to raise standards of care. Over 1,000 hospitals and health care facilities are now accredited by JCI in over 100 countries, accreditation that signals to patients and their families that the facility is safe and offers reliable outcomes. Following JCI’s work, other well-respected accrediting bodies have come onto the scene in recent years.

This Service Requires a Passport and Visa

Securing the appropriate visa can pose serious challenges for some medical tourists. For example, patients requiring organ donations from a family member who lives abroad and must travel for the procedure, can struggle to obtain a U.S. visa. Unlike other medical tourism destinations, the United States does not have a dedicated visa category for medical procedures. And while the U.S. State Department may take into considerations medical needs, doctors assisting patients with visa applications say this rarely speeds up the process.

Other countries are actively working to ease travel concerns for medical tourists. India, with a notoriously cumbersome and long visa process, implemented a special medical visa category over ten years ago. The M-visas are valid for a year and are also issued to companions. Mexico does not require a visa for tourists entering the country for the purpose of receiving medical care, and Thailand has opened its doors to its neighbors, allowing citizens of China, Cambodia, Laos, Myanmar, and Vietnam to stay visa-free in the country for 90 days for the purpose of receiving medical treatment.

A Facelift for Health Services Exports

Despite its limitations, medical tourism is opening new doors for patients around the world. Whether you’re in need of a new dental crown, a facelift, fertility treatments, or a new heart valve, there are doctors and hospitals around the world who would gladly treat you, exporting their health services by offering top-of-the-line facilities with the newest technology, Western-trained doctors, comfortable stays, and reasonable bills.