A firm that arranges surgeries for self-paying patients gets an increasing number of inquiries from surgical hospitals in the United States about its rates. When hospitals learn they need to provide steep discounts, four out of five never follow up, says Rick Baker. But the increasing number that agree to the discounts, ranging from 50-85%, are rewarded with substantial volumes with the bill paid completely before surgery begins. The agency, based in British Columbia, books five patients a day in U.S. hospitals for a wide range of treatments from simple hip and knee replacements, to complex cardiac bypass surgery.
North American Surgery
uses 22 hospitals in 10 states, including Maryland, Oklahoma, Nevada, Arizona, Montana, South Dakota, Washington and Kansas. Most of the sites are physician-owned surgery hospitals with underutilized operating rooms, making the extra volume worthwhile, even with the discount. North American Surgery only sends American and Canadian patients to U.S. hospitals as it argues that other countries pose greater risks, such as parasites or typhoid fever, and the long plane ride home can harm recovery.
Two-thirds of Baker’s customers are Canadians and one-third are Americans who tend to be self-employed with substantial incomes but no insurance coverage. The company was founded in 2003 to provide immediate access to surgery for Canadians, who often wait two years for surgery, cannot buy private insurance at home, so seek to pay out-of-pocket for surgery abroad. The American division launched in 2006. The company does not negotiate prices as each hospital sets its own price, but to gain referrals, its discount needs to be in line with that of other participating hospitals. The patient pays the full cost before surgery in the form
Another US agency, BridgeHealth Medical
of Colorado, originally just offered treatment outside the US, but demand has made them offer US surgery too. It says that self-insured employers can save anywhere from 15 to 50 percent by sending patients out of town. BridgeHealth uses 25 hospitals across the country for orthopaedic and bariatric surgery, heart valve replacement, and Cyber Knife, a radiation treatment. The company negotiates fixed rates with healthcare providers and then collects a fee from the insurer.
The company also has contracts with 35 hospitals in 15 countries, but is increasingly attracted by domestic medical tourism as it offers a higher comfort level for patients, with only short flights and no cultural differences. With BridgeHealth, the surgery and all after care are paid for up front at a flat rate. So even if minor complications occur and the patient spends more time in the hospital, the health plan doesn't pay any more. The advantage for doctors, hospitals and surgery centers is they don't have to wait as long as 90 days for insurance reimbursement to come in.
David Goldstein of Health Options
, another agency promoting domestic medical tourism, acknowledges that overseas hospitals and doctors may be well qualified, but argues. "There is the question of legal action, if a patient were to have a malpractice case overseas - what recourse do they have? What if you were to experience complications on the way home? Domestic medical tourism is on the rise, because American healthcare providers are trying to remain competitive in this emerging market, and are lowering their prices in order to compete. With stringent medical regulations and legal protection, the patient is protected all around, eliminating the need to travel anywhere else for affordable healthcare."