Medical tourism has been heralded as a major trend in the development of cost-saving strategies for secondary and tertiary procedural categories of care.  It is no secret that foreigners have been traveling to the United States to receive treatment and obtain quality care that they cannot get in their own country.  Access to quality specialists and health care institutions with the highest level of accreditation is simply not available in some parts of the world.  The person who has money and needs health care can get it here, as long as they have a visa and a place that will accept them for treatment.

Lesser known is the case of the person who has the need with limited resources and feels that they have to travel to receive care from a place where the care is less costly.  If we can get goods manufactured more cheaply overseas, maybe we can get medical care there at a lower cost, as well.  In any case, there is an industry that addresses this trend, and supposedly, this is a way to achieve big savings in select areas of care.  There is an association that promotes this idea and one of the better sources to read initially relates to the experiences at Serigraph, a Wisconsin-based firm that has championed employee health care responsibility and which participates in medical tourism solutions through Anthem, as reported by the Milwaukee Journal.

Until now, there has not been much in the current literature to prove, or disprove, some of the claims that the medical tourism industry has made about cost and quality.  Reuters now reports that there has been a study done by The University of Iowa (Carver College of Medicine) that suggests the use of medical "travel" is overstated.  Find the article here.  Brandon Alleman and his colleagues conducted a phone survey of businesses engaged in facilitating overseas medical travel for U.S. residents and, of the 45 companies that completed the survey, there were about 13,500 U.S. patients who traveled for care overseas.  They feel that this is about 70% of the market and this is a number that is well under other estimates.  

This research confirms that businesses launch programs of this nature to save on costly procedures.  The study reports that the rates that the companies pay are generally within the range that Medicare might pay for the same procedure.  It would be interesting to know if local and regional health care interests would contract for the same services locally at an equivalent price.  We think they would, and that the savings on some of these programs are overstated.  What is your experience?  Are we missing something here? 

We recently became aware of a new book on how one employer took a giant leap forward in managing healthcare and costs for its employees.   It was written by John Torinus, Jr., the owner of Serigraph, a graphics parts manufacturer based in Wisconsin.

Mr. Torinus describes a rather firm approach to solving the problems his company faced (and continues to face) with rising healthcare costs.  He put his employees right in the middle of the battle, and together they are making giant steps forward.  It all began in 2004 (only six short years ago), and the project has continued and expanded over this time to become a huge success.  Why?  He overwhelmingly supports these pillars of his approach:

1. Use consumer-driven health plans that put employees in charge of their health care and their health care dollars.
2. Get transparency in pricing - a truly tough assignment as all of us know - but Mr. Torinus has proven it can be done.  His company has information available online and through their H.R. offices for employees that is detailed and which compares pricing and quality for major procedures and providers.  By using this resource, employees cannot only save money, but get better quality, too.  His staff has worked hard to understand pricing for major/high volume services, and they have also designated "Centers of Value." 
3. Use primary care as a central component to help keep employees well and out of the hospital. 
4. Fight for consumer regulations which make more quality and pricing data available to the general public.


The approach has worked.   By 2009, the Serigraph employees and their dependents' data showed that inpatient admissions were 23% below the norm for the U.S., and physician visits were 24% below the same standard.  E.R. visits were down significantly (39%) and the total cost/employee annually was $6,648 compared to $8,659 nationally.

National data sources were not provided, but the principles of the book are sound and achievable by any employer who wants to make the "curve bend" in a different direction.  While the focus of the book is not really about "on-site," it is about employer managed options for health care, and we feel that is the important message.  Serigraph does have on-site staffing, and the physician is paid a flat fee/patient who is then provided global primary care services for the year.  The physician becomes that patient's primary care physician, providing an extremely high level of service including longer visits, management of all other services to the patient, telephone calls, etc.

The book describes a model that incorporates on-site programming, value-based contracting, consumer incentives (and disincentives) and, most important, one that works.