Medical Tourism and Family Medicine

Perhaps you have heard about it from Robin Cook's latest medical thriller, "Foreign Body," or from Atul Gawande's description of the Shouldice Hernia Clinic in his book "Complications", or in news articles about Coretta Scott King's death at the Santa Monica Hospital in Rosarito, Mexico...medical tourism, the travel of patients (mostly from the USA) abroad for medical care, is on the lips and in the minds of hospital administrators, insurers, and health care professionals all over the United States of America. Two recent articles in the Economist, "Importing Competition" and "Operating Profit" (both from Aug. 14th, 2008), describe an unprecedented globalization of health care that will see 10 million people (mostly US citizens) traveling abroad for medical care, a total estimated market size of $21 billion.

So how will this new movement affect physicians and physicians-in-training domestically? The two MD's hosting the "MBA for MD's" seminar at theis year's AAFP national conference believe that, just as we have seen the outsourcing of medical transcription, record-keeping and radiological interpretation, we will see increased outsourcing of non-urgent surgeries. While these jobs will be in jeapordy in the US, they predict a surge in the need for primary health care providers to take care of these patients post-op. Perhaps the more efficient (and effective) private clinics outside of the US will, in their quest to provide the highest quality services, help to compensate primary health care practitioners at home. So, this is seemingly good news for the field of Familiy Medicine.

But what about the effects of medical tourism in the host countries? The Economist article author's predict a potential for a win/win situation. They claim that an increased demand for medical specialist services in host countries will force a reverse brain-drain, where former ex-patriot physicians will be able to return to their home countries to practice medicine. This could potentially increase funding for medical education institutions as well.

Indeed there are examples of successful Centers of Excellence abroad, including the Heart Institute of the Caribbean in Jamaica and the Arvind Eye Clinic in India. Both of these clinics use a "Robin Hood" mission to provide the highest quality specialty medical services to everybody that enters their doors (i.e. "Excellent care without exception"). Each of these clinics offer a sliding-scale payment structure, similar to many Community Health Centers in the US, to share the cost of relatively expensive services across their population; the higher-income patients pay for the lower-income patients. But do all of the international specialty service clinics share this philosophy? Is their mission to provide lower cost services to medical tourists and to the local population?

As stated in the articles, medical tourism is bringing the international competitors to the local health care market. The local hospital is in direct competition with the Bumrungrad hospital in Bangkok, which claims to be the world's largest private clinic. We are no longer able to view the fast-paced innovations in health care abroad as quaint or interesting, nor can we ignore the impacts of our domestic health problems on the exodus of our "medical refugees."

Let us know what you think about this new "flattening of the health care world."

• Will the ex-patriot doctors now returning home still be mostly treating the wealthy who previously sought treatment in the US?
• How will medical tourism affect our future job opportunities as physicians?
• Will Primary Care see an increase in pay scale over the next 5-10 years?
  
• Should FMIG host a talk/discussion to bring these issues to the table at BUSM?