The following points were stressed by Roy Ramthun, President of HSA Consulting Services, a former White House advisor on health initiatives and a key-note speaker at The First Latin American Global Medicine and Wellness Congress April 26, 2010, in San Jose, Costa Rica.
For the medical travel industry, the timing is right. U.S. Health Reform will mean (1) fines if you don’t purchase appropriate coverage, (2) higher premiums, higher taxes, and longer waiting times even if you do purchase appropriate coverage; and, (3) potential limits on access to new technology and treatments.
In addition, U.S. companies, from whom most employees and their families obtain their insurance coverage, will be under great pressure to drop coverage, shift full-time workers to part-time, or go out of business. Estimates of Americans who will lose their employer-based insurance range from 8 to 19 million.
Employers that don’t drop coverage will be under pressure to move their employees to HSAs.
The U.S. is already facing a critical shortage of physicians and nurses. Expanding coverage to 35 million more Americans will create problems access needed care by already insurance Americans. Projected reductions in payments to medical professionals by Medicare and Medicaid and lack of tort reform will only exacerbate the shortage problems.
- More patients may be willing to travel rather than wait for services.
- Americans with health savings accounts (HSA’s) are the most likely medical tourists. These are people willing to travel, internet savvy, and will be shopping abroad for value because these people are spending their own money.
- New transparency provisions will raise awareness of costs.
- Newly uninsured are looking for less expensive places to access care, for example workers converting to part-time and early retirees who lost coverage.
- Americans are looking for new technology and treatments not yet available in the U.S.
- US employers may be willing to send their employees overseas for procedures to lower the costs and avoid the excise tax.
- Insurance carriers may do the same for their members.
- Insurance companies are building relationships with foreign doctors and hospitals as they look for opportunities to sell insurance products in emerging markets.
- U.S.-based insurance carriers growing international presence may make medical tourism easier; for example CIGNA, United, and Aetna are placing a greater emphasis on growing their overseas operations. – Source: Health Plan Week, Vol. 20, No. 13, April 12, 2010.
- More wealthy seniors may retire overseas to avoid higher taxes on investments.
Heightened Awareness of Cost
“Those who opt to go without insurance will always have the option of obtaining insurance if/when they get really sick because of guaranteed issue requirements. Bottom-line: Only those who are sick will purchase insurance, driving up insurance prices for everyone.” (source Laura Carabello, publisher of Medical Travel Today)
Pain forces change…
For The Working Young
According to Ramthun, one implication of Health Care Reform is that there are 3:1 limits on rating for age. Rates for young people could increase 70%. Ouch! Now that get’s your attention right in the pocketbook. How many will rebel and choose to “opt-out” and pay a fine?
For Baby Boomers
Due to rising out-of-pocket costs for beneficiaries of Medicare, and the additional cost of supplemental insurance to maintain acceptable coverage, more retirees may consider offshore care and even choose to live abroad. Boomers pride themselves on designing their own lifestyles – “not my father’s retirement”.
Cleveland Clinic and Lowe’s have partnered on cardiac care. Lowe’s Companies Inc., second-largest home improvement retailer in U.S., struck a three-year agreement with the Cleveland Clinic. It’s the first time a multi-state national company has chosen one specialist hospital and made it available to employees.
The Cleveland Clinic has both domestic and overseas locations that will allow it to compete on costs. The incentive to employees: Reduced out-of-pocket costs to go to Cleveland for heart procedures.
One Georgia-based employer: “With the economy in the state it’s in, some businesses may consider paying the $2,000-per-employee penalty for not covering workers rather than paying higher benefit costs.” (source FierceHealthcare, April 1, 2010)
Compromised Access to Care
It’s human nature to fight to keep from losing what you’ve got – and many Americans will respond to the harsh reality of less quality care by casting their net wider – both domestically and globally to maintain their individual quality of life.
The process of “comparative effectiveness” could lead to rationing,” said Ramthun, who referenced a quote from Dr. Donald Berwick in his June 2009 interview for Biotechnology Healthcare. “The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.”
Delays in New Technology Approval
We already experience that delay in stem cell and in vitro fertilization (IVF) procedures, and the example used by Ramthun was hip re-surfacing vs. hip replacement. Our concern for loved ones will drive interest in alternative treatments abroad.
Fewer Variation of Benefits
“Some insurance companies may leave the market,” said Ramthun, “either because of age rating limitations, the restrictions on the amount of revenue to be spent on claims, or less opportunity for product differentiation. The downside is that variations in covered benefits will decrease.”
Longer Wait Times
Waiting is not something Americans do well. And when the annoyance of “waiting” is coupled with lifestyle-busting costs, more people will proactively shop for value. Insurance carriers and self-insured companies are already shopping abroad ahead of that trend.
As an individual, just how long are you willing to “wait” to make a bad situation go away? And does it make sense to blindly settle for a limited menu of treatment choices without knowledge of all available options affecting your best health outcome?
Why will there be longer wait times? A shortage of doctors and others opting to retire early – and reduced Medicare and Medicaid payments are exacerbating limited access to care.
The wait can be as long as two months. Boston has the longest wait, averaging 49.6 days (source ABC News, June 2009).
Patients in northern Massachusetts travel to New Hampshire because of the wait times (source ABC News, March 2010)
There are strong indications that reductions in Medicare payments will exacerbate doctor shortages and hence result in longer wait times as reported in the article “Medicare and the Mayo Clinic – The famous hospital will no longer take some senior patients”, published January 8, 2010 in The Wall Street Journal.
Shortage of Doctors
The shrinking number of physicians may force patients to travel or move to other areas for quality medical care. Ramthun quoted the following stat reported by many sources including the April 12, 2010 article in the Wall Street Journal “Medical Schools Can’t Keep up”:
“At current graduation and training rates, the U.S. could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges (AAMC). That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.”
According to an article “How Health Care Reform Will Affect Family Physicians”, published April 13, 2010 by The American Academy of Family Physicians (AAFP), the AAFP projects a shortfall of 40,000 primary care physicians. “currently, the United States has a deficit of roughly 40,000 primary care physicians, according to AAFP estimates. As the newly insured enter the system over the next few years, the primary care shortage is expected to worsen.”
“A survey by The New England Journal of Medicine suggests 46% of doctors may retire early,” said Ramthun, “and lack of tort reform may push others out early.”
Physician-owned Hospitals are in Peril. “The legislation virtually destroys over 60 hospitals that are currently under development, and leaves little room for the future growth of the industry.” (source Molly Sandvig, Executive Director of Physician Hospitals of America (PHA)
Disenfranchised physicians in the US may opt to open their own facilities in other countries. “Since the health care reform bill passed, you wouldn’t believe the number of doctors who have said they’ve had it and want to operate outside the system” (Dr. Brian Forrest of Access Healthcare).
Declining Value of Medicare
Not having access to Medicare was once considered the major barrier to retiring abroad. With access and benefits decreasing, a growing number of Boomers are tallying up the overall cost of living and opting to forego Medicare benefits in lieu of equally affordable and often better medical and wellness options available to U.S. seniors in other countries.
The time restrictions on appointments limit the perceived quality of a doctor visit, and the revolving door policy of only one issue to be discussed per doctor visit dramatically reduces the quality of the patient experience. It’s a burden for both the doctor and the patient to be in such a rat race.
According to Forrest, at one job interview, he was told he would be required to sign a contract saying he’d see a patient every seven minutes or have his pay cut. Most new physicians sign those contracts. Forrest, 38, wouldn’t (source May 24, 2010 Cash for Doctors article posted in The Weeklystandard.com)
As reported in the article “Medicare and the Mayo Clinic – The famous hospital will no longer take some senior patients”, published January 8, 2010 in The Wall Street Journal. The same article also suggests that 20% of hospitals may have to stop accepting Medicare because of payment reductions.
Drug Stores Drop Out of Medicaid
It’s not a good sign when national drug store chains start to drop out of Medicaid as indicated by May 16, 2010 article entitled “Walgreens: No new Washington Medicaid patients” published by The Spokesman Review.
According to Ramthun, “Medicaid expansions could make things worse as millions of new enrollees join the program.”
The Bottom Line
More people may be willing to travel or move to other areas, both domestically and abroad, for cost and quality healthcare considerations. And the increased interest in offshore care by self-insured companies and insurance carriers, is validating that trend.
I witnessed an impressive number of U.S.-based third-party representatives (TPR’s) exploring the option of medical tourism at The First Latin American Global Medicine and Wellness Congress.
Exhibit booths were visited by U.S.-based Human Resources (HR) representatives, banking organizations, insurance carriers and re-insurers, insurance underwriters and leaders of large self-insured groups like teachers unions, etc. One TPR could influence hundreds if not thousands of people to travel offshore for medical care.
The time is right for medical tourism to become a megatrend.