news.yahoo.com/s/ap/20061102/ap_on_he_me/outsourcing_health
AP Businesses may move health care overseas By MALCOLM FOSTER and MARGIE MASON, Associated Press Writers Thu Nov 2, 4:47 PM ET NEW DELHI, India - Businesses and insurance companies are starting to eye the potential savings of outsourcing health care from the world's richest country to the developing world.
"It's just one of the many ways in which our world is flattening," said Arnold Milstein, chief physician at New York-based Mercer Health & Benefits, who's researching the feasibility of outsourcing medical care for three Fortune 500 corporations. "Many companies see it as a natural extension of the competition they've faced in other aspects of their business." With an estimated 45 million uninsured Americans, some 500,000 trekked overseas last year for medical treatment, according to the National Coalition on Health Care. Asian hospitals in Thailand, India and Singapore have long been swarmed by medical tourists looking for tummy tucks and face lifts, but many glitzy, marble-floored facilities are now gaining reputations for big-ticket procedures including heart surgery, knee and back operations. Some American hospitals already rely on places like India for X-ray readings and other diagnostics, while also importing foreign doctors and nurses. But the US health care industry has been largely immune to overseas competition -- just one reason behind soaring costs. Premiums for employer-sponsored health coverage have surged 87 percent over the past six years, according to the Kaiser Family Foundation, putting a huge burden on both companies and employees. Family health coverage now runs about $11,500 annually, with workers themselves forking out nearly $3,000. But just as shipping US manufacturing to China and call centers to India initially created loud opposition, some critics are already preparing to fight any possible mass exodus of Americans packing their bags to go under the knife overseas. Carl Garrett would have been the first US employee sent abroad for medical care through an employer-sponsored pilot program, which would have allowed him to share the company's savings. Shortly before Garrett was set to leave, the United Steelworkers, America's largest union, pulled the plug. "We don't want to expose our members to the risks associated with providing health care in the Third World," said Stan Johnson, a union spokesman. "This is perceived to be voluntary, but voluntary programs tend to lead to mandatory programs." Blue Ridge ultimately scrapped its plan for union members, but several other US businesses and insurance companies are starting to explore the option of exporting patients. "I get the impression that they're all waiting for someone else to take the first step," said Jason Yap, director of health care service for the Tourism Board in Singapore, another major medical tourism destination. "They're all interested in doing the homework now so they can move ahead when the time comes." UGP says the plan will save employers more than 50 percent on major medical costs and slash employees' out-of-pocket expenses to zero. Blue Shield of California and Health Net of California also both offer lower-cost policies allowing members to seek medical care in Mexico. In June, David Boucher, an assistant vice president at BlueCross BlueShield of South Carolina, traveled to Bangkok for a close-up look at Bumrungrad. The Thai hospital began heavily recruiting overseas patients after the 1997 Asian financial crisis. It drew 400,000 foreigners last year -- including 55,000 Americans. "We're taking a serious look at this as an alternative" for the health plan's 15 million members. In addition, West Virginia lawmaker Ray Canterbury plans to propose legislation next year that would give government employees the option of traveling abroad for necessary procedures, which could save the state up to $2 million annually. He wants to offer incentives, including extra sick leave and 20 percent of the cash saved by going abroad -- allowing workers to actually make money on the deal. Dodie Gilmore is a rodeo barrel-racing champion who runs a 180-acre ranch in Oklahoma when she's not bouncing across back roads selling farms. Gilmore is a spry 60-year-old who loves the outdoors, but when she could no longer straddle her faithful horse, River, she knew it was time for a new hip. So she asked her boss about traveling to India where hip resurfacing alone would cost just $7,000. He not only gave her his blessing but offered to foot the bill, minus travel and hotels -- making Gilmore one of the very first Americans sent overseas for surgery by an employer. "The doctors were wonderful," Gilmore said days after being discharged, sipping coffee at a New Delhi roadside cafe with her sister, Carol, who was along for whole trip. More and more patients like Gilmore -- who had never held a passport or even tasted Indian food before her trip -- are returning home and spreading the word about an alternative to America's ailing health system. Gilmore's boss, Martin VanMeter, who owns a Coldwell Banker office with about 24 workers, wasn't obligated to pay anything toward the hip surgery. But he sees his employees as family, and if they're too hurt or sick to work, no one benefits. "I've invested so much money in them," he said by telephone. "All she's got to do is make one transaction for us, and we've got our money back." But even with the growing momentum, big questions must be asked by anyone considering treatment abroad. Despite the five-star facades of some hospitals -- fountains, white marble floors, even a Starbucks and McDonald's inside Bumrungrad's lobby -- the comfort of having a major surgery near home with family at the bedside is a far cry from the experience in the developing world, where culture shock alone can be stressful. Pollution, poverty and insane traffic are all part of the experience when visiting hospitals like the Indian-owned Max Healthcare facilities in New Delhi, where it's not uncommon to see people urinating along roadsides. Jet lag, traveler's diarrhea and strange foods also can be coupled with the unpredictable, such as September's bloodless military coup in Thailand, which ultimately had little impact on daily life. Language and cultural barriers also can make communication with doctors and nurses frustrating for some Americans, who are used to being direct with their physicians, often peppering them with tough questions and expecting straightforward answers. Some Asian cultures also rely more on hints and subtleties to communicate, and doctors in some countries are regarded as authority figures who often aren't questioned. Follow-up care back in the US also can be an issue for some patients. "There are a lot of risks," said Rick Wade, a senior vice president at the American Hospital Association. In countries like Thailand and India, medical malpractice claims are rare and multimillion dollar awards are nonexistent. "If there's a mistake, we fix it," said Curtis Schroeder, an American who is group CEO of Bumrungrad hospital, which requires all doctors to carry malpractice insurance. "But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the US" In February, Joshua Goldberg, a 23-year-old American who was traveling in Thailand, died at Bumrungrad after seeking care for a leg injury. His father, James Goldberg, has set up a Web site alleging the hospital administered a deadly drug cocktail to a patient with a history of substance abuse. Thai authorities are investigating the case, as is standard with all unexpected hospital deaths. "What I'm dedicated to doing is to try to alert people to at least do their homework and consider very carefully what they're getting into. It's ultimately up to patients themselves to investigate hospitals and physicians before considering surgery abroad. The Internet is loaded with resources that range from doctor bios to patient blogs, detailing the positives and negatives. As the phenomenon grows, more countries are trying to get in on the action. The Philippines began a campaign this year aimed at attracting Filipinos living abroad and Asians within t...
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