International Symbol for medicineEver since pilgrims to Epidaurus sought the healing powers of Asclepius, the Greek God of Medicine, people have traveled to distant destinations to obtain medical care. Today published reports suggest that a new medical migration is taking place. Some estimate that as many as one million patients worldwide leave their home countries to be treated for everything from a toothache, to liposuction to open heart surgery. Does this trend threaten U.S. doctors and hospitals? Not necessarily. According to a recent McKinsey study, the number of medical tourists who travel outside their own country to obtain inpatient medical care is 60,000 to 85,000 per year worldwide, and many of those come to the U.S. for treatment.

The primary motive for people leaving the United States is cost. Surprisingly, it is not the uninsured (43 million), but the underinsured (100 million) of Americans with large deductibles, exclusions or low benefit limits who make up the largest segment of those seeking healthcare outside the U.S. If U.S. healthcare reform efforts produce some form of universal coverage, it will likely include cost-sharing features that could continue to drive the medical tourism trend.

Even so, there are many factors that may ultimately limit the appeal of obtaining healthcare abroad:

1) U.S. hospitals will respond competitively by specializing in procedures to deliver cost- effective care by achieving high volumes

2) Natural limits on the number of procedures that can be performed on an elective basis. For instance, cardiac bypass surgery and the repair of unstable hip fractures must always be performed on a timely basis to avoid further injury

3) Difficulties in obtaining compensation for malpractice committed in a foreign country. Foreign jurisdictions are generally not sympathetic to visitors filing malpractice claims.

4) Loss of an existing physician-patient relationship

5) Perception that health care in other countries remains inferior to the United States

6) Unwillingness on the part of many to travel for healthcare, no matter the cost savings

7) Reluctance on the part of US physicians to handle complications of a surgery performed on a medical tourist. At the October, 2008 meeting of the American College of Surgeons, an overwhelming majority answered “no” to the question: “If a patient returned from surgery abroad with a complication and came to see you, would you agree to care for the patient?”

Nonetheless, the allure of inexpensive care abroad has led WellPoint, the largest health insurer in the United States, to enter into a pilot program to provide access to medical care outside the U.S in a partnership with Healthbase, a Boston-based provider of medical tourism logistics. Healthbase will assist WellPoint members with coordination of the trip, medical appointment, scheduling, digital medical records transfer, and concierge travel service.

Before embarking on a medical tour, patients should research the proposed facility and surgeon carefully. International accreditation is in its infancy, but there are facilities who have obtained certification from agencies such as Joint Commission International the Trent International Accreditation Scheme or the International Society for Quality in HealthCare.

If American doctors and hospitals respond aggressively, they will compete effectively in the emerging international market. If not, many of today’s perceived obstacles may fade away, and medical tourism could become commonplace.


About The Author

Frank Gillingham, M.D. serves as Chief Medical Director for HTH Worldwide. Frank has led HTH Worldwide's international business development efforts in Europe and Canada and has been a guest speaker at international business conferences and has authored a series of articles on travel medicine, including pieces on travel information available on the Internet and the role of physicians working with travel insurers. Frank is a Board-Certified Internist and Emergency Medicine Specialist. He is also a private emergency physician in Southern California and a former emergency department director and member of the UCLA emergency department staff. Frank completed residency training at Los Angeles County/USC Medical Center, received his M.D. from Albert Einstein College of Medicine and his B.A. from the University of Pennsylvania .


  1. Very interesting article, having worked in the NHS for many years I am very familiar with the concept of ‘health tourism’ in medicine. In a recent article I read the reported cost of medical travel or ‘health tourism ‘ in the UK is 30millions pounds per year. It’s difficult to deny treatment when a patient needs it but when the cost escalates it does highlight the need to formulate a management strategy. Living in Australia now I think they have got it right, people that travel on holiday here have to pay for their treatment unless covered under the recipricol health agreement and everyone else pays a medicare levy for free treatment, the cost of which is dependant on whether they too have private health insurance. It works well, it prevents the medical travel spoken of here, its equal and its fair. Thank you for posting!

  2. Very informative article with relevant data about the medical industry. I also want to point out that international patient volumes did witness a slide in 2008-2009 due to a weakening economy but then soon caught up in the following year.

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