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Is Medical Tourism as Good as Healthcare in the US?
Shouldn't you be asking: is my local care the best I can get? Is "close enough" good enough?

Last Updated: April 16, 2017

Americans tend to assume that they have the best medical care in the world. This idea is very far from true, and research demonstrating why is not hard to find. The time the US consistently makes it to the top of the list is when the question is, “Who spends the most money?” Otherwise, American healthcare tends to rank around the middle at 12 out of 16,1 15 out of 25,1 or dead-last, at 11 out of 11. 2

It's not all bad. It's certainly possible that some Americans may have some of the best care in the world. But many Americans have little to no access to medical care at all, and even Americans with great insurance and healthcare access have cause for concern: medical error is the third leading cause of death in the US, causing somewhere between 44,000 to .4 million deaths3 and costing $17.1 billion dollars4 per year. Additionally, in 2011 approximately 1 in every 25 patients (estimated 721,800 total) seeking treatment at hospitals acquired an infection there.6 Of those infected, about 10%, some 75,000, died. One detailed account of the peril of medical errors can be found in Dr. Frederick Southwick's paper Who was caring for Mary?, in which he describes, “physicians who are too distracted by other academic pursuits to care adequately"6 for his wife, almost resulting in her death.

So what can we do? Improving healthcare delivery in America is a complex problem no one has the right answer to (or else we would have solved it already). But one thing you can do the next time you need medical care is, ask yourself a simple question:

“Is the medical care that is closest to me necessarily the care that is best for me?”

If you do, you might be surprised by the answer.

Beach
False stereotype of a medical tourist. Image credit Adam Kontor

Medical Tourism for Better Medical Care

The stereotype of a medical tourist is someone traveling to Asia or Latin America for cheaper dental work or cosmetic surgery in between bouts of relaxing on the beach. But the truth is that medical tourists travel for a wide range of reasons, including:

  • Affordability
  • Shorter waiting times
  • More patient-centered care
  • Cutting-edge or controversial treatments that are unavailable at home
  • Seeking better outcomes from world-renowned hospitals with a demonstrated record of delivering exceptional medical care

The reality is that "medical tourist" is a general term to describe a diverse group of people who might have one of any number of very different reasons to travel. The only thing linking them all together is the very general condition of leaving home because they prefer to receive medical care elsewhere.

The most common question people have about medical tourism is: “Is it safe?” This question is an example of a cognitive bias called "begging the question," because it assumes that medical care at home is the gold standard, that local treatment is safe, and shifts the burden of proof to medical care abroad. However, this assumption is irrational because US medical care suffers from myriad quality issues and is not quite as safe as people think; medical care abroad is not the only care that should be carefully evaluated. Moreover, all medical interventions involve some form of risk—people just seem to be more aware of it in the case of medical tourism.

Further, the important comparison is not between any-and-all care in your country versus any-and-all care in another, but between care you have access to. If the best specialist in the world lives next door to you, but your insurance won't cover their treatment and you can't afford it on your own, they might as well practice on the moon. Perhaps the best care in America is better than the average care in another country, or average American care is better than average care in another country (although that may not the case, as we've seen), but odds are, you don't have access to the best care in America, and you won't be going to an average hospital in another country—you may be leaving average care and traveling to the best.

Sometimes, medical tourism is about opting out of nearby subpar, or even average, health care—or lack thereof—and choosing to receive superior treatment somewhere else. If the best care abroad is better and more affordable than the average care—or no care—that you'd get staying home... in that case you may be better off traveling.

Beach
Never compare apples to oranges. Image credit LoboStudioHamburg

Comparing Medical Care

Unfortunately, questions of comparing medical care cannot be answered quickly or definitively, because there is no agreed-upon method of comparing hospitals across the world, although there have been multiple projects to try to do so. The Organisation for Economic Co-operation and Development (OECD) does compile and display international health statistics, but they tend to be on more abstract issues, like life expectancy, than anything that could guide you on specifically where to receive care. The Rand Corporation has similarly released a summary of various comparisons of healthcare quality,7 including a summary of some in-country hospital comparisons (the inter-US Medicare.gov hospital comparison, for example), but an easy-to-use international database comparing specific hospitals across the world is still a faraway dream. Until we have this data, there is literally no way of objectively comparing apples to apples—or more specifically, hospitals to hospitals, and doctors to doctors.

However, some hospitals do choose to publish their medical outcomes and mortality statistics. This is especially common in hospitals that are committed to medical tourism, and are trying to attract discerning patients from abroad. For example, top hospitals in countries like India and Thailand boast mortality (failure) rates of less than 1% for common, complex operations, “making it virtually impossible for U.S. hospitals to claim superior quality of care in that regard”.8 By making their outcomes public, these distinguished facilities are showing that they have a lot to brag about, and more broadly, making a desperately-needed commitment to transparency in the medical field. By contrast, the American medical system has been described as, “chaos behind a veil of secrecy,"9 and:

“[A]n administrative monstrosity, a truly bizarre mélange of thousands of payers with payment systems that differ for no socially beneficial reason, as well as staggeringly complex public system with mindboggling administered prices and other rules expressing distinctions that can only be regarded as weird.”10

Data research
Research all of your options. Image credit Yoel

Research All Your Options

Just as the responsible medical tourist researches the quality of foreign hospitals when considering receiving medical care abroad, we all need to apply the same due diligence in decision-making at home. Why should medical tourists be the only ones who research a hospital before receiving medical care there? Bad care and preventable medical errors can happen anywhere. Your body doesn't care about national borders. If you find yourself in need of complex medical care, ask yourself the following questions:

  • Is the care at my local medical center the best care that I can get?
  • Is "close enough" a good enough reason to settle on a treatment team?
  • Would my outcomes be better if I sought treatment elsewhere?

People are often afraid that seeking medical care in another country will lead them to some ramshackle hospital in a faraway village receiving subpar care. This is an understandable way to feel—being sick is scary, traveling to foreign places is scary, traveling when sick is extra scary. And it's certainly true that not all hospitals are the same. But something people need to consider is: receiving medical care close to home is also a choice—and probably a reflexive, ill-informed one. It's natural to be scared when facing life's challenges, especially illness. But times like that are exactly when we need to be the most rational, the most informed, and make the best choices. Sometimes, the best choice might be to to travel abroad for better medical care.



References:

1. Starfield, B., 2000. Is US health really the best in the world?. Jama, 284(4), pp.483-485.

2. Davis, K., Stremikis, K., Schoen, C. and Squires, D., 2014. Mirror, mirror on the wall, 2014 update: how the US health care system compares internationally. The Commonwealth Fund, 16, pp.1-31. Vancouver

3. Makary, M.A. and Daniel, M., 2016. Medical error—the third leading cause of death in the US. Bmj, 353, p.i2139.

4. Van Den Bos, J., Rustagi, K., Gray, T., Halford, M., Ziemkiewicz, E. and Shreve, J., 2011. The $17.1 billion problem: the annual cost of measurable medical errors. Health Affairs, 30(4), pp.596-603.

5. Magill, S.S., Edwards, J.R., Bamberg, W., Beldavs, Z.G., Dumyati, G., Kainer, M.A., Lynfield, R., Maloney, M., McAllister-Hollod, L., Nadle, J. and Ray, S.M., 2014. Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine, 370(13), pp.1198-1208.

6. Southwick, F., 2001. Who was caring for Mary?. Obstetrics & Gynecology, 98(6), pp.1140-1142.

7. Nolte, E., 2010. International benchmarking of healthcare quality.

8. Bennie, R., 2014. Medical Tourism: A Look at How Medical Outsourcing Can Reshape Health Care. Tex. Int'l LJ, 49, p.583.

9. Reinhardt, U.E., 2006. The pricing of US hospital services: chaos behind a veil of secrecy. Health Affairs, 25(1), pp.57-69.

10. Aaron, H.J. The Cost of Health Care Administration in the United States and Canada—Questionable Answers to a Questionable Question. New England Journal of Medicine 349, no. 8 (2003): 801–303.

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