Overseas options: Jonathan Edelheit helps prepare U.S. providers for the surge in obtaining care abroad

Edelheit sees countries such as Thailand, Singapore, Costa Rica and Korea becoming leaders in delivering healthcare services. With costs 50% to 80% less than their U.S. counterparts with comparable quality of care, medical tourism more and more has become a viable option.

Q. What percentage of U.S. medical tourism overseas is being covered by health insurance, versus out of pocket non-covered charges, and how has this trended during the past few years?

A. Probably less than 5% is being covered by insurance, while 98% is being paid 100% by individuals out of their own pockets. This trend will change significantly in 2008 as several insurance companies and third-party administrators [TPAs] are lining up to make this option available. It is our hope that by 2008, 10% to 15% of people traveling overseas will be covered by insurance and by 2010, possibly 25%.

Q. Have any of the major U.S. health plans taken a position on medical tourism, and are any proactively encouraging or accommodating it?

A. There are several major health insurance carriers that are about to launch their plans in this arena. Several are joining the association to work with us at the beginning stages of this industry to resolve any issues they may have before getting into medical tourism. We are getting the hospitals, U.S. insurance carriers, TPAs and reinsurers to work together with the hospitals to build from the ground floor up. This is the reason we believe in 2009 plans will be offering the option to travel overseas within their insurance plans. BCBS of South Carolina is allowing members to go overseas, but they are giving no incentives to their members. Without an incentive an employee would have no reason to go overseas. Several TPAs and reinsurance carriers recently have told us of their plans to implement medical tourism within their self-funded plans and give employees cash incentives to go overseas. In 2008, we see the major players in medical tourism to be self-funded employers and TPAs who tend to move faster in cutting-edge industries than insurance carriers.