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Medical Travel: To Play or Not to Play

More of your patients will be looking for care overseas.

According to a recent research report, over a million Americans will be getting care overseas and the number is expected to grow by double digits for each of the next 5 years. Suppose a 34 year old  amateur tennis player presents to you with shoulder pain. You take a history, do your exam, explain that the MRI shows damage to her joint, and that you recommend an arthroscopic repair. She asks, politely, "But doctor, what will all of that cost?"

Take a deep breath and assess your options. If you are one of the fore-sighted few who has negotiated a package rate with your hospital, imaging, clinical labs and anesthesiolgists, great. Quote her the price.

If you are like most docs and have no clue what the combined cost of her care will be, tell the truth and explain that you can ask your business manager to discuss your surgical fees, but that will only be part of her total bill.

Your budding Williams sister then explains that she has a very high copay, has not met her deductable, and is thinking of getting care from a doctor in Mexico because she found an Internet site that posted cost comparisons and she requests that you help her with preoperative and postoperative care.

Most doctors I talk to deal with this circumstance in three ways.

The "You've got to kidding "approach, characterized by disdain, disgust, frustration and, with a noticeable increase in vocal pitch, they refuse to help.

The "Well I guess that's how things are these days" approach, where the doc helps the patient transmit records, is available for consultation by the operating surgeon, and offers to see the patient in follow up.

Then there is the "Brave New World" approach, where the doctor takes a proactive stance, embraces global healthcare referrals, understands that medical travel is a two- way street, and encourages visits from foreign patients as well.  A recent article in a transplant journal, in fact, reported a significant increase in business to a border state transplant program from Mexican patients when all of the services were offered in Spanish. What a surprise.

The globalization and commoditization of care  changes a lot of  the rules. They are forcing another round of reassessment of physician liability, professionalism, ethics , and continuity of care. Do yourself a favor and think about how you will deal with the medical tourism trend before it walks into your examining room tomorrow.

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