Every year, millions travel abroad seeking health care they can afford. “Medical tourism” is an estimated $92 billion industry that is growing by 15-25 percent each year, promising cheaper access to dental implants, plastic surgery, fertility assistance and even exotic cancer treatments — and doubles as something like a vacation to countries like Thailand or Mexico. The practice has become common around the world, but it’s particularly cost-effective here; the average American pays more than $12,500 on health care each year, outpacing the citizens of any other wealthy nation by $4,000. Some insurance companies have embraced the practice, too, but the savings come along with new risks and potential complications. Is medical tourism a boon for the marketplace, or a symptom of something rotten?
Free-market triumph
Access to doctors and clinics abroad empowers Americans to make the best choices for their own health by introducing competition to a stagnant system, dramatically expanding a growing range of options. Consumers can save up to 80 percent of what they’d pay at home, according to Patients Beyond Borders, a North Carolina company that promotes the practice. For many, these savings constitute a lifeline.
“Our market has always been what I call the ‘working poor’ and they just keep getting poorer,” Josef Woodman, the company’s CEO, told The New York Times in 2021. “The pandemic has gutted low-income and middle-class people around the world, and for many of them the reality is that they have to travel to access affordable health care.” The differences in cost are most salient for elective procedures, like plastic surgery, fertility treatment and dental work, which are not usually covered by insurance.
Institutions and corporations can also benefit from even a quick jaunt into a neighboring country. In Utah, the public trust that insures state employees offers a “pharmacy tourism program,” flying clients to San Diego and shuttling them across the border to buy low-cost prescription drugs in Tijuana, Mexico. Or if they prefer, they can choose to travel to Vancouver, Canada. In 2021, researchers at the University of Chicago argued that even medical tourism to other markets within the United States could be the most cost-effective way to fill the gap left by vanishing rural hospitals. Less glamorous, perhaps, but utilitarian.
Some patients travel for personal reasons, like getting access to cutting-edge treatments or privacy for elective procedures like cosmetic surgery. “Many can return home from their ‘vacation’ without anyone knowing they had a procedure at all,” writes one registered nurse for the physician-reviewed health website Verywell Health. Others may travel for treatments that aren’t approved or allowed in the U.S., like stem cell therapy or other experimental procedures.
Despite the inevitable hand-wringing over quality of care, the independent nonprofit The Joint Commission has recognized over 1,000 medical facilities worldwide that meet its standards. The same organization has accredited American hospitals since 1951 and is the largest health care accreditor in the nation, so its approval carries weight.
Systemic failure
Medical tourism is an indictment of our nation’s health care system, masked in pleasant terminology. “I prefer the term ‘outward medical travel,’” writes MSNBC health columnist Dr. Esther Choo, “and would argue that (this industry) should remind us of how inaccessible health care is here and the lengths to which people will go to get the care they want or need.” Patients may not realize what they’re risking, whether at their own initiative or nudged by insurance providers. “Quality and safety standards, licensure, credentialing and clinical criteria for receiving procedures are not consistent across countries and hospitals.”
These are not academic concerns, but vital issues with life-threatening consequences. One analysis from the Centers for Disease Control and Prevention found that 93 Americans died between 2009 and 2022 due to complications from botched cosmetic surgeries in the Dominican Republic alone. The federal agency has also found outbreaks of antibiotic-resistant bacteria that were linked to medical tourism in Mexico and warns that the most common complications among medical tourists are infections.
Medical tourists seeking access to treatments that have not been tested and approved by regulatory agencies in the U.S. may not be aware of the risks they are taking with a practice that researchers at Canada’s Simon Fraser University call “circumvention tourism.” They warn of potentially enormous pitfalls, from shattered hopes to money-sucking quackery. “Individuals may be desperate for a cure and vulnerable to engaging in decision-making that’s predicated on hope,” they write, “without a full understanding of the likelihood of success.”
Perhaps the most common problems are the most obvious: Patients are traveling far from home to get treatment from doctors who cannot participate in long-term follow-up, often coming up against linguistic and cultural challenges. Much more prevalent than the risk of getting targeted by opportunistic criminals are these impediments to communicate their needs. “It might be a no-brainer,” observes Henry Ford Health, one of the largest health care companies in Michigan, “but if you don’t speak the local language, it might be difficult to explain any feelings of discomfort or apprehension as they come up.”
This story appears in the April 2024 issue of Deseret Magazine. Learn more about how to subscribe.