A few years ago, the novelty of Americans going overseas for treatment led to national and local newspapers, television and radio stations, websites and magazines, to produce thousands of items on the new idea. Outbound US medical tourism is no longer a novelty, and has not reached the numbers once predicted, nor achieved widespread support of employers and insurers. Now, the same media have discovered domestic intra-state medical tourism.
The domestic market is still mainly individual self-pay. Although a few employers and insurers are trying out the market, many are still wary. One reason for this is that even when companies and insurers agreed to outbound medical tourism, their employees and customers were less keen. They are also concerned that some of those organizations and individuals promoting the concept, originally promoted outbound medical tourism with the same fervour, and did not produce the numbers or cost savings promised.
Another reason is explained by Rick Baker of North American Surgery, a Vancouver, Canada-based agency that negotiates discounted surgeries in the USA for individuals who do not have health insurance. He suggests that while uninsured people are willing to travel, workers with insurance are often unwilling to travel, not just abroad, but from state to state. The North American Surgery network of U.S. health care providers offers access to high-quality surgical procedures at prices that are often 50% below U.S. hospital averages.
Employee resistance is a problem, as many do not see why they and their families should be inconvenienced just so their employer or insurer can save a few dollars. As yet, only a handful of the agencies and hospitals promoting domestic tourism have attempted to tackle incentivising the patient. Nobody really knows the size or potential of the domestic medical travel market. But by directing workers to US hospitals with high-quality care and lower prices, it could reduce employer costs by 20 to 40%, more than enough to cover travel expenses.
Home improvement retailer Lowe’s has negotiated flat-rate fees with the Cleveland Clinic for complex cardiac procedures. The retailer has a three-year deal with the Cleveland Clinic to send employees and their dependents there for open-heart surgery, valve repairs and pacemakers.
Domestic medical travel may be slow to catch on because state based insurers are wary of offering travel incentives for people to travel to another state, as it could annoy local hospitals by sending patients elsewhere for care. Employees may resist travelling any significant distance for medical care. The biggest problem is the innate conservatism of American workers, employers and insurers; the huge arguments over Obama’s health reforms proves that. Domestic medical travel will probably be driven by larger employers who are based in several states, and it could help drive down costs and improve the quality of care. Employers and insurers have sent patients to specialist hospitals for organ transplants and other complex procedures.
Some companies are providing financial incentives to workers. Several employers are known to be in discussion with hospitals. Alpha Coal West has sent employees from Colorado to Wyoming, a five-hour drive; and has arrangements with hospitals in three other states. Alpha Coal’s insurance programme reduces co-insurance payments from 20 percent down to 10 percent for workers willing to travel. It also covers hotel and travel costs for employees and their partners. To encourage workers to use the programme, Lowe's waives deductibles and covers their travel and hotel costs. Whether domestic medical tourism is a long term trend or as with the threat of overseas medical tourism, it will just persuade hospitals locally to improve standards and offer better price deals, remains to be seen.
