One of the salient points of the appeal of medical tourism is the cost of expensive or unattainable procedures in the US relative to costs of those procedures in medical tourism destinations. Medical tourism facilitators and industry marketers routinely stress that procedures performed in hospitals outside the US are considerably lower than what is usually charged at most US-based hospitals. But is cost something that most patients care about when seeking medical care?
Don McCanne, M.D., past president of the Physicians for a National Health Program, sent out the organization’s “Quote-of-the-day” on Tuesday about an article in the February edition of the journal, Health Affairs. The article entitled, Focus Groups Highlight That Many Patients Object To Clinicians’ Focusing On Costs, discusses whether patients weigh costs of care when making decisions on their health, as a way to reign in health care spending.
The authors convened twenty-two groups of insured individuals, to determine their willingness to discuss health care costs with their doctors, and whether the patients consider costs when deciding among similar options. They identified four barriers to taking cost into account: a preference for what they perceive as the best care, regardless of the expense; inexperience with making trade-offs between health and money; a lack of interest in costs borne by insurers and society as a whole; and non-cooperative behavior characteristic of a “commons dilemma,” in which people act in their own self-interest although they recognize that by doing so, they are depleting limited resources.
The authors stated that surmounting these barriers will require more research into patient education, more comprehensive efforts to shift public attitudes about health care costs, and training to prepare clinicians to discuss costs with their patients.
The discussions from the focus-groups revealed the following barriers to patients choosing less expensive care: the salience of unlikely, but highly upsetting possibilities; a desire for zero risk, rather than for reasonable risk reduction; an assumption that price always signals quality; the misperception that health care sustainability can be achieved by eliminating wasteful spending alone, without needing to forgo some marginally beneficial care; and the belief that choosing more expensive care constitutes a kind of victory for patients over the insurance companies.
In their Conclusion, the authors stated that if patients and their doctors do not discuss and consider costs, the alternatives are problematic. The authors contend that physicians might make cost-conscious decisions are warranted without telling patients that cost considerations were part of their decision process. The authors pointed to evidence from other countries that indicated that physicians occasionally do limit the use of medical interventions on the basis of cost. The authors offer another alternative whereby the decision to allocate on the basis of cost would be made at the organizational level.
It is inevitable, the authors point out, that given the projections, long-term about health care costs in the US; physicians will face increasing pressure to deliver cost-effective care to their patients. They caution that public attitudes about health care costs must undergo a significant shift, if cost is to be an explicitly recognized and discussed factor in clinical decisions.
In his Comment, Dr. McCanne, with whom I have discussed the likelihood of the US adopting a single-payer health care system, because of my Social Sciences background and MA in American History, stated that some of the emphasis of the discussion on cost has been directed toward the engagement of the “medical consumer” through the policy of consumer-directed health care. Dr. McCanne states that these policies are designed to make patients “better health care shoppers”.
His prescription, and one that I agree with, but do not see happening in the immediate future, is a single-payer system, but given the American stubbornness to accept anything that smacks of “socialism”, and the rampant recrudescence of laissez-faire, free-market capitalist solutions, which are part of the problem with the ACA, the US for the time being will experience ever greater cost rising in health care, until in the words of Winston Churchill, “Americans can always be counted on to do the right thing…after they have exhausted all other possibilities.”
What then does this mean for medical tourism? Since one of the major reasons patients go abroad for medical care is cost, what does this article tell the medical tourism industry about the issue of cost in determining medical care? If the authors are correct, then the whole argument made by medical tourism is moot, because patients really don’t care about cost, and get angry if they are forced to consider it by their doctors.
Are patients opting for medical tourism somehow different than those in the focus–groups the authors assembled? Could it be that the authors are wrong, and that patients can be influence by cost? As far as personal health care is concerned, medical tourism has proven that there are patients out there willing to choose less expensive care that is higher quality or more readily available overseas. For the implementation of medical tourism into workers’ compensation, where the issue of cost is never discussed because the employer or their insurance carrier pays the bill, the authors suggest that that decision would be made at the organizational level, perhaps by the employer, perhaps by the carriers, or by both.
Even if the US ever adopts a single-payer health system that may not preclude future Americans from going abroad for health care. Other factors, such as shortages of doctors and nurses, or ties to home countries by recent immigrants, or even guest workers, will not mean that medical tourism will not be an option.
However the issue of cost is dealt with in the future, attitudes will need to change, not only about being more cost-conscious, but to be more open-minded that better health care is not just available at home, but overseas as well. Medical tourism in general, and specifically as part of the medical provider network for workers’ compensation in the US, will be able to provide quality health care at lower cost for all.