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She is senior editor of Managed Healthcare Executive.
In the past year, more employers asked for benefit plans that cover medical care overseas in order to rein in costs.
NATIONAL REPORTS - Fueled by employer clients seeking access to foreign providers as a means of reducing their claim expenditures, domestic insurers have been evaluating programs and benefits whereby its customers can elect to seek certain services overseas.
"There has been a growing demand by U.S. employers to reduce healthcare costs, and many insurance companies and reinsurance companies have been telling us of this growing demand," says Jonathan S. Edelheit, president of the Medical Tourism Assn. "Unlike other consumer-driven benefits, medical tourism is the ultimate consumer-driven benefit in that it guarantees hard cash savings and a significant amount, whereas other consumer-driven benefits offer 'theoretical savings.'"
HEALTH PLAN PROGRAMS
"In the last year, we noticed an increase in employers asking about medical travel as an option," says Jill Becher, WellPoint spokesperson. "It's now a frequent question in RFPs and client conversations."
WellPoint's program will initially cover about 700 group members and their dependents at Serigraph, a Wisconsin-based specialty printing company.
Under the program, WellPoint case managers would collaborate with patients on their travel and medical arrangements with Joint Commission International (JCI)-accredited hospitals in Bangalore and New Delhi, India. Serigraph employees will be able to visit the Apollo Health system in India, "which has a strong reputation for excellence in patient care," Becher says.
BlueCross BlueShield of South Carolina launched its global surgical care option, Companion Global Healthcare Inc., in March 2007. Bumrungrad International Medical Center in Bangkok, Thailand, was the first hospital accepted into Companion Global's network.
"We also recognized that an increasing number of our members had been receiving care outside of the United States for multiple years, so we decided to actually help these members travel abroad for care," says David Boucher, president of Companion Global Healthcare. "We also added a layer of due diligence by surveying several of the prominent JCI-accredited facilities."
The global surgical care option is available to all 1.5 million members of the South Carolina Blue plan. The Companion Global Healthcare staff assist with travel arrangements for interested members and spend extra time and effort providing benefit-structure consulting to employer groups. Companion Global Healthcare also contracts with non-BlueCross employers and TPAs.
While Companion's agreements with its network of international hospitals do not limit what services they provide for reimbursement purposes, Boucher says that they have been recommending that employers consider a measured approach to medical travel by modifying their benefit structure for about a half dozen surgical procedures in year-one of the shift: total knee and hip replacement, spinal fusion, CABG, heart valve replacement, and vaginal hysterectomy.
"We have found that, if structured correctly in the employer's plan, the benefits of medical travel can be shared," Boucher says. "One of our employer agreements historically covered inpatient care at 80% after the member paid a $1,000 deductible. This self-funded employer simply layered a 100% benefit over their existing program that waives copays and the deductible amounts for their associates choosing to travel to a Companion Global Healthcare facility for care, and they will decide on a case-by-case basis whether to cover airfare."
CARE IN SINGAPORE
Aetna has a medical tourism pilot program in place with one plan sponsor, working with a hospital in Singapore. It does not expect to have meaningful data from the pilot until at least 2010, says Wendy Morphew, Aetna spokesperson.
Members participating in the pilot have the option of traveling to Singapore for hip and knee joint replacements. Benefit design reduces out-of-pocket expenses. The plan will pay 100% of the cost of the procedure and associated rehabilitation in Singapore, plus it will offer an allowance to cover travel costs for the member and a companion. Aetna normally pays 80% of the cost of the procedure when a member receives care locally.
Edelheit predicts significant growth in 2009 in medical tourism. But even more interesting is that "domestic medical tourism" is about to take off, where Americans travel to other cities in the United States for savings, he says.
"After examining 'all in' costs including the procedure, travel, etc., some domestic hospitals are finding that they could deliver a compelling and competitive price to compete for business that might otherwise go overseas," Morphew says.