Inbound medical tourism and visa reform: how increasing accessibility for foreign patients can decrease American healthcare costs.

AuthorHunt, Alex
  1. INTRODUCTION II. OVERVIEW OF INBOUND MEDICAL TOURISM IN THE UNITED STATES A. Medical Tourism Defined B. Why Do Patients Travel For Medical Care? C. Benefits of Inbound Medical Tourism D. September 11"s Impact on Immigration III. CURRENT IMMIGRATION PROCESS FOR FOREIGN PATIENTS A. Visa Process for Foreign Patients B. Common Obstacles Encountered IV. POTENTIAL SOLUTIONS TO INCREASE ACCESSIBILITY A. New "Medical Treatment" Visa Category B. International Medical Visitor Agreement V. CONCLUSION I. INTRODUCTION

    The idea of medical tourism has only recently been introduced to ordinary Americans. (1) When the average American pictures a typical medical tourist, he or she likely conjures up an image of a United States citizen who lacks adequate insurance coverage and is forced to travel overseas to seek refuge from skyrocketing prices at home. (2) In 2006, Americans caught their first glimpse at the potential rise of medical tourism, when North Carolina-based Blue Ridge Paper Products, Inc. offered an incentive in its employee benefit plan if employees elected to have nonemergency surgeries in a Preferred Provider Organization-approved hospital in India. (3) Blue Ridge eventually ended the program after an employees' union pushed back. (4) Nevertheless, the concept of lower-cost, foreign-based medical care has been an increasingly attractive and viable option for employers and insurers. (5) As a result, the number of Americans seeking medical treatment outside U.S. borders is expected to increase drastically by 2017. (6)

    Although medical tourism is typically associated with Americans going abroad for lower-cost care, inbound medical tourism presents a largely untapped resource with the potential to fill and exceed the gap in revenue lost when Americans seek treatment abroad. (7) However, U.S. immigration laws create bureaucratic barriers that make it difficult for paying patients to reach America's shores or receive treatment without experiencing the aggravations of a broken visa system. (8) Patients face burdensome paperwork requirements, lengthy wait times, and visa regulations that do not give American providers an opportunity to compete in the new global medical marketplace. As the medical travel industry continues to grow, (9) and American hospitals lose revenue overseas, (10) the federal government must reform the outdated immigration code that makes it difficult to attract foreign medical travelers.

    In Part II, this Comment presents an overview of medical tourism and its different forms, the benefits of reducing burdens for foreign medical visitors, and a brief history of the obstacles encountered by foreign patients after September 11, 2001. In Part III, this Comment discusses the current immigration process to enter the United States for medical treatment, including common obstacles encountered during the visa process. Finally, in Part IV, this Comment provides several solutions to attract foreign medical visitors, including the creation of a new medical visa category that enables easier access to American hospitals and clinics.

  2. OVERVIEW OF INBOUND MEDICAL TOURISM IN THE UNITED STATES

    1. Medical Tourism Defined

      Medical tourism is defined as the "act of traveling to another country to seek specialized or economic medical care, well being and recuperation of acceptable quality with the help of a support system." (11) The term "medical tourism" was originally created as a marketing tool to entice American patients to purchase vacation packages to foreign countries that included lower cost medical or dental care. (12) The term initially encompassed only this type of "outbound" transaction. (13) Soon, however, the concept of medical tourism developed into three distinct categories: outbound, inbound, and intrabound. (14) Outbound medical tourism refers to U.S. patients traveling to other countries to receive medical care, (15) while inbound medical tourism refers to foreign patients who travel to the United States to receive medical treatment. (16) Intrabound medical tourism refers to U.S. patients traveling within the United States to receive medical care outside their region, typically to a facility better equipped to treat their condition. (17)

      1. "Outbound" Medical Tourism

        In 2007, approximately 750,000 American "outbound" medical tourists traveled abroad for medical care. (18) As Chart 1 below shows, significant growth is expected over the next few years as healthcare costs continue to rise, more employers and health insurance companies provide incentives to utilize healthcare elsewhere, and American providers increase marketing and affiliate with more foreign organizations. (19)

        Outbound medical tourism has had a significant impact on the finances of the American healthcare system. In 2007, Americans spent $2.1 billion USD in other countries for health care. (21) This amount equals $15.9 billion USD in lost revenue for U.S. healthcare providers. (22) As more patients are expected to go overseas for medical care, outbound medical tourism represents a potential opportunity cost to U.S. health care providers of $228.5 to $599.5 billion USD by 2017. (23)

      2. "Inbound" Medical Tourism

        While outbound medical tourism is a successful and growing industry, inbound medical tourism has lagged behind. (24) In 2008, an estimated 400,000 non-U.S, resident inbound medical tourists received medical care in the United States for a total of approximately $5 billion USD spent on health services. (25) Inbound foreign patients account for approximately two percent of all users of hospital services (26) and three and one-half percent of all inpatient procedures performed in the United States. (27) Inbound medical tourists are primarily from Canada, South America, and the Middle East. (28) The leading U.S. providers of medical services to inbound tourists are Johns Hopkins Hospital, Cleveland Clinic, Mayo Clinic, Duke University School of Medicine, and Memorial Sloan-Kettering Cancer Center. (29) Many have affiliates and partners overseas. (30)

    2. Why Do Patients Travel For Medical Care?

      Americans and foreigners seek medical care abroad for sharply different reasons. While nine percent of all international medical travelers seek lower-cost care, U.S. patients make up ninety-nine percent of this group. (32) Most American medical tourists seek medical care abroad because they can save between fifty and ninety percent on common procedures. (33) More Americans are looking to foreign travel for medical care because more insurers are offering "consumer directed health plans," in which payors offer higher premiums and deductibles to encourage patients to better utilize their own health care spending dollars. (34) Many experts believe that as more health insurers move toward these types of plans, patients will increasingly employ lower cost, foreign medical facilities to save money. (35)

      In contrast, forty percent of medical travelers seek the most advanced technology and thirty-two percent want better quality care for medically necessary procedures than they could find in their home country. (36) Inbound medical tourists do not seek care in the United States because it is less expensive, (37) but because American providers offer the most advanced technologies and treatments. (38)

      American providers have started to create an atmosphere that welcomes and markets to foreign patients. Major American hospitals have established international patient departments to accommodate foreign patients. (39) Many providers offer concierge services like airport pickup, language specialists, and travel and lodging assistance. (40) Hospitals that successfully attract international patients also often have affiliations with foreign providers, and some have branch facilities overseas. (41)

      However, American hospitals seeking foreign patients are often constrained by immigration laws and regulations that make it difficult or impossible for patients to reach their facilities. (42) Although many hospitals previously assisted patients in acquiring and maintaining their visas with the U.S. government, some hospitals have found continuing those services during the economic downturn to be challenging. (43) In early 2011, M.D. Anderson, a major Houston-based cancer treatment facility with a sizable international center, (44) shut down its program that assisted foreign patients with their visas. (45)

    3. Benefits of Inbound Medical Tourism

      Reforming America's current immigration laws and visa system would provide a significant benefit for American patients. Increasing revenue from inbound medical tourists would help offset the revenue lost to overseas medical providers, which could result in lower costs for American patients. (46) Increasing prices have prompted insurers to look outside the country's borders for options. (47) Foreign treatment facilities provide a clear incentive for payors because they can often provide identical treatments for as little as ten percent of the cost of the procedure if performed in the United States. (48)

      In addition, increased accessibility for foreign patients could provide additional revenue for American hospitals. (49) That revenue could help alleviate the rising burden on American providers as a result of fewer patients being covered by private health insurance. (50) As a result of the high job loss experienced by many Americans since 2008, (51) many individuals and families are no longer covered by employer-provided private healthcare plans. (52) Uninsured patients often delay medical treatment or forego it altogether. (53) When uninsured patients do receive care, they are either (a) covered by often lower reimbursement state and federal plans, like Medicaid, or (b) lack coverage entirely and cannot compensate the provider at all. (54) As a result, financial burdens on hospitals rise. (55) To make up for lost revenue resulting from the shift from private payors to patients covered by Medicaid and similar programs...

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