Domestic medical tourism
The Wall Street Journal ran an article today (Uprooted: When Patients Seek Treatment Far From Home) on patients traveling for care within the United States. As hospitals publish more quality information patients are increasingly willing to make the trip. The example in the article is about a patient from Jacksonville, FL who traveled to Little Rock, AR when he found out the hospital there was the leader in treating multiple myeloma.
"Going to the University of Arkansas for Medical Sciences would mean spending about half of the first year of treatment in a city my parents had never visited. My now-58-year-old father would have to abandon his real-estate business - and give up most of his income - for months at a time. My 57-year-old mother would need to take time away from her job as a teacher's aide. There would also be the costs of plane tickets and hotel rooms."
"But the statistics clinched it. While surfing the Internet one day after his diagnosis in February 2006, my father pulled up data showing that the median survival rate for multiple myeloma at his local medical center was about 33 months. Then he looked up the statistics from UAMS: about seven years. "I'll take the four extra years," my father, Gary, said later."
I think a lot of people will "take the four extra years" if they can, and this bodes well for medical travel on a domestic basis as well as internationally. I look forward to the day when well-insured patients insist on gaining access to the best hospitals in the world for their condition, whether down the street, or elsewhere in the US, Europe, Asia or Latin America. At a minimum it should keep everyone on their toes, thereby improving care even for patients who can't or won't travel.
Treatment Far From Home - Is This Really Medical Tourism?
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The article "Uprooted: When Patients Seek Treatment Far From Home"Â (Andrea Petersen, Wall Street Journal, October 9, 2007) raises some very interesting points about medical tourism / medical travel.
In this article, the author describes how her father decided to get treatment for multiple myeloma at the University of Arkansas for Medical Sciences, over 800 miles from his home in Jacksonville, FL, because of that institution's superior long term results. As the author points out, patients have long traveled to top-notch hospitals in the hopes of a better outcome. It is not surprising that people with the means to do so pursue the best medical services they can find - anywhere in the world. This practice, which has never had a specific name, is meaningfully different from the newer phenomenon referred to as "medical tourism". Â
We recently performed a comparative analysis of the traditional model of medical travel vs. the medical tourism model. Using an analytic framework developed for this purpose, we compared these two models of medical travel in several dimensions. (The details of our study, which are beyond the scope of this discussion, will be presented in future academic papers.) A key insight is that the factor that most differentiates the two models is the availability of resources. In the traditional model, the availability of resources such as personal assets and insurance gives a patient access to any medical practitioners and facilities in the world. The patient described in the Wall Street Journal article was able to choose the University of Arkansas for treatment because he had good health insurance, adequate financial reserves and supportive family and friends. In the medical tourism model, patients are generally driven to travel to faraway medical centers because of the absence of some resource. Most frequently the missing resource is financial assets and/or insurance benefits.Â
The dynamics of medical travel / medical tourism are best understood with the recognition that there are actually two groups of patients. One group travels because access to resources enables them to do so. On the other hand, patients in the medical tourism group frequently travel because they do not have the resources to have care in their own community without financial hardship. Â
As the medical tourism industry matures, it will become increasingly important to thoughtfully clarify the definition of "medical tourism" (or whatever alternative term is ultimately selected). What exactly is medical tourism? What is not within the scope of medical tourism? The structure and dynamics of the evolving medical tourism industry cannot be fully understood if every patient who has medical care more than 100 miles, 1000 miles or 10,000 miles from home is included. Indeed, the discussion will become hopelessly confused without thoughtful definition of the disparate patient groups and market segments. Â
The situation is dramatically and meaningfully different when a patient travels from Baltimore to Bangalore for low cost care than it is when a patient travels in the opposite direction -- from Bangalore to Baltimore -- for care by the world's leading expert in a particular problem. I submit that insightful understanding of the numerous fundamental differences in these two scenarios will be essential for maturation of the medical tourism industry.
Domestic medical tourism will likely become increasingly popular. An article in Forbes, "Outsourcing Your Health" (Allison Van Dusen, May 22, 2007), reports that Black Hills Surgery Center (Rapid City, SD), working with a medical travel company, plans to offer hip and knee replacement surgery at substantially reduced prices. Although US providers cannot compete with developing nations on price alone, they certainly have logistical and geographic advantages. Domestic medical tourism would give a patient in Southern California who needs low cost orthopedic surgery one more choice in selecting a destination for affordable care.  In this situation, the fact that the patient has limited resources drives the decision to travel for medical care. I agree that this fits within the medical tourism model. On the other hand, the patient described in the Wall Street Journal had the opportunity to go to Arkansas because he had the resources to do so. This is very different!Â
I believe that our comparative analysis will help clarify these differences and lead to a deeper understanding of the structure and dynamics of the burgeoning medical tourism phenomenon. I look forward to interesting future discussions with many participants in this evolving industry.
You're right
Michael,
Your point is well taken. I probably shouldn't have used the term "domestic medical tourism" at all.
I don't like the term "medical tourism" itself. My main objection has been that traveling for medical care is a serious matter, not a carefree tourist experience. You've also made me realize there's another problem with the term. As you say, people traveling from the US to low-cost countries like India for medical care do so mainly for lack of financial resources. Tourism implies having acess to ample resources, not a lack of resources.
I'm looking forward to reading your papers and to the development of a better vocabulary for the emerging field.