American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Medical Tourists: Incoming and Outgoing

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Patients who travel to another country to seek health care are referred to as medical tourists. The term arose because many Americans seek less expensive elective surgical, dental, or cosmetic procedures while vacationing abroad.1 Of course, US hospitals and physicians have also long cared for medical tourists from other countries. Now, many medical tourists are going the other way—from the United States to other countries to receive health care. In 2007, it is estimated that 750,000 Americans traveled to other countries for health care.1 In 2017, more than 1.4 million Americans sought health care in a variety of countries around the world.2

The reason more Americans have become medical tourists is simply that they are seeking less expensive health care. Because we have the most expensive health care system in the world, it is not difficult to find countries that offer various procedures at 30%-65% of the cost of care in the United States.2 Other countries can charge less because of lower pay to physicians and other health care workers, much less overhead because patients pay cash, and subtraction of the substantial cost of malpractice insurance.3

The number of medical tourists to all countries in 2017 was estimated at 14-16 million.2 The number of US medical tourists and the number of medical tourists in the world is expected to increase by 25% per year.3 The financial implications of medical tourism are profound. The average cost for each medical visitor is estimated to be $3,800-$6,000 (cash) per visit.2, and the total spent per year globally is estimated at $45-$72 billion.2 The value of the entire medical tourist business per year is approximately $439 billion.3

Given the magnitude of income from medical tourism, it is not surprising that a number of cities and countries actively solicit medical tourism. Some examples are Dubai,4, 5 Singapore,4 and Malaysia.5, 6 Health care brokers are readily available in the United States and abroad to help arrange air travel and hotel accommodations and provide tourist information, in addition to arranging admission to various hospitals and access to physicians throughout the world.7, 8, 9 In 2008, there were 63 medical tourism companies in the United States.7 The total cost for hospitalization, physician fees, airfare, and hotel expenses for the patient and spouse is far less than the cost of the procedure in the United States.7, 8, 9 Several US medical centers, including Harvard,1 Boston University,1Johns Hopkins,1 and the Cleveland Clinic,10 have established hospitals and clinics outside of the United States, hoping to capitalize on local and foreign medical tourism.

The top 10 destinations for medical tourism are shown in Table 1.2, 11 They are listed alphabetically, not by frequency of visits.11American medical tourists are most likely to go to South America, Central America, and the Caribbean.4 The most frequent conditions treated are shown in Table 2.11 Most Americans who go abroad for medical care lack health insurance or their health insurance (including Medicare) does not cover certain conditions, including dentistry, cosmetic surgery, in vitro fertility procedures, or weight loss surgery.

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-James E. Dalen, MD, MPH, ScD (Hon), Joseph S. Alpert, MD

This article originally appeared in the January issue of The American Journal of Medicine.

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