Sinners and Saints

Health Care Without Geographic Boundaries!

 

By Ernest Garfield

Former Arizona State Senator, Arizona State Treasurer, Arizona Corporation Commissioner

Master of International Management – Thunderbird School of Global Management

Bachelor of International Management – Thunderbird School of Global Management

Bachelor of Business Administration – University of Arizona

 

The gorilla in the room is health care.  One of the great American myths is that we have the best health care system in the world!  In reality, treatment is dictated by insurance companies, we have a shortage of medical workers and our system is not readily available to about one third of our citizens. 

 

Clearly, Congress and every state legislature must make health care a priority.  There are solutions!

 

Insurance companies are beginning to recognize the value of reduced cost of overseas treatment to their insured.  Blue Cross Blue Shield of South Carolina has a subsidiary that provides its members help with arranging travel and care in foreign locations.  According to Getahn Ward of The Tennessean, Aetna, United Healthcare and Blue Cross Blue Shield of Tennessee are exploring or offering a medical tourism product.

 

To reduce our rapidly escalating cost of health insurance, overcome our shortage of health care personnel and improve health care service, insurance companies licensed in our state should provide coverage for medical treatment anywhere in the world. 

 

Participating in globalized access to health care is the only immediate solution that will allow a patient to receive the best and least expensive care, alleviate the shortage of U.S. medical workers and guarantee that employers save money for employee benefits.

 

Universal health care proposed by Congress and our President Elect Barack Obama are noble, but will clog our system badly.   Increased needs of aging baby boomers will create further strains!  Delays in treatment and inferior care will become standard unless we prepare our medical infrastructure in advance. 

 

Health care has globalized.  The international competitive marketplace is rising to the occasion and introducing features and benefits to consumers and employers.  Comparable or superior medical outcome at lower costs than with our American system can be more readily available for middle to lower income citizens.

 

The World Health Organization ranks hospitals around the world.  The WHO report is a reflection of their assessment of health systems of 191 member states.  The performance assessment is based on a number of country-specific variables such as socio-economic, political and technological.  While WHO’s method of evaluation may raise questions, the U.S. nonetheless came in as number 37.  See Chart II to learn whose medical services are considered superior to ours.  In line with this, Americans trail 30 nations in life expectancy and the U.S. is 29^th in infant mortality.  These two dismal facts cannot be denied.

 

One of the major problems confronting our health care systems is that of the uninsured.  There are around 45 million uninsured in the U.S.  While many are uninsured as a matter of choice, for most it is a matter of circumstance.  Many of the uninsured are foreign nationals who are here legally.  When they are admitted to a hospital, the hospital usually has to write off the care to bad debt and shift the cost to the insured paying for covered care.  The availability to an individual of low cost government guaranteed loans with strict underwriting standards, funded by financial institutions – not government funds, would allow and encourage immigrants to return to their country of origin for medical treatment.

 

Reuters reported that one out of six New Yorkers lacks health insurance, even though almost two thirds of these individuals are employed.  Many employers are dropping coverage or shifting costs to employees.  Few uninsured seek medical treatment until they are overwhelmed with a serious illness.  Dr. Thomas R. Frieden, New York City Health Commissioner, stated, “All of this adds up to people landing in emergency rooms with costly, devastating health problems that could have been prevented or treated.” 

 

According to Dr. Michael Horowitz of Medical Insights International, “Some 750,000 Americans sought offshore medical care in 2007, a number that is projected to rise to as many as 6 million in 2010.”  By comparison, according to Deloitte Center for Health, 417,000 foreign residents traveled to the U.S. for treatment in 2007.  That number is expected to increase by fewer than 40,000 patients by 2010.  Cost is not the only reason for change in the direction of the flow of care seekers.  Often it is quality of care.

 

In addition, Dr. Horowitz says, “It has been estimated that the global medical travel industry currently generates annual revenues up to $60 billion, with 20% annual growth.  McKinsey & Company and the Confederation of India estimate $100 billion annual revenue by 2012.  Often, this includes partnerships with large U.S. based medical institutions.  As examples, Duke Global Health Institute has medical services and educational partnerships in China, Singapore, Tanzania and Uganda; while Johns Hopkins and St. Jude’s operate facilities in Singapore.

 

This medical globalization trend will continue to increase as our population ages and the cost of health care continues to rise in America.  Dr. Horowitz correctly points out that medical, economic, political and social forces are shaping the emergence of medical tourism.  In any event, globalized medical care is huge business and will continue to grow with or without our approval or our voluntary participation.  All Americans need to hop a ride on this train!

 

We need to understand why the public looks for medical treatment outside of the U.S.  Most often it is the availability of quality care at a lower cost elsewhere.  Price advantage is, of course, a major selling point.  The cost differential across the board is huge: only a tenth and sometimes even a sixteenth of the cost in the U.S.  Open-heart surgery could cost up to $150,000 in the US; in India’s best hospitals it could cost between $3,000 and $10,000.  See Chart I.

 

However, at times the reason is as simple as an immigrant living here who wants to be near family in time of need or is comfortable returning to his or her country of origin for treatment.  Many immigrants do not see any difference between traveling out side of U.S. borders for medical care than do our own citizens that travel across state borders to receive better care or care from doctors “back home”.  Immigrants of all nations understand the medical care available in their country of origin and often prefer it.  We have approximately 8 million Green card holders in the U.S.

 

Many of our neighbors from the South would happily return to their country of origin for medical treatment if we facilitate travel between our country and theirs; and if we support insurance companies, as some are now doing, to pay for treatment outside of our borders.  Many Canadians living in the U.S. return to their country of origin for medical treatment.  Numerous self insured domestic corporations pay for care of employees in foreign locations; and most certainly, multi-national corporations generally have local employees, Americans or otherwise, treated in countries where their factories and businesses are located.  Dr. Horowitz’s figures do not include the multitude of Americans treated in other countries by virtue of location of employment.  It is estimated that there are 6.6 million Americans that live abroad.  They don’t run back to the U.S. for most treatments.

 

Hispanic Americans now account for 15% of our country’s total population.  It is notable that there are nearly fifty thousand Hispanic physicians and surgeons in the U.S.  This constitutes a base of bilingual medical professionals who can readily communicate with Latin American counterparts to coordinate care.  Many Hispanics are among the uninsured and underinsured.

 

Dallas based Christus Health, a not-for-profit Catholic system, established six hospitals in Mexico to serve Mexican residents who live in communities along the Mexico-U.S. border.  A move by all Americans to facilitate and promote cross border medical treatment would show concern for their well-being and simultaneously reduce our health care cost.

 

Many foreign hospitals have been told that American health insurance carriers plan to approve global medical care.  Our state should become the leader.  Large masses of Americans will go outside of the U.S. for health care when that happens. 

 

Dr. Robert M. Wachter, Associate Chairman of the Department of Medicine at the University of California at San Francisco, said in the February 2006 New England Journal of Medicine, “Four things seem certain: the outsourcing of health care will grow; it will challenge traditional arrangements between patients and both physicians and institutions; it will require rapid and thoughtful development of new ethical, legal and quality standards; and it will be controversial.”

 

One solution to the healthcare problem is to return to the underlying American principle of free choice.   Where Do We Start? 

1.      Require insurance companies licensed in our state to expand to global health care coverage.

2.      Develop an appropriate liability level for medical malpractice for health care outside of the U.S.

3.      Encourage and assist insurance companies to extend liability insurance coverage to patients who experience a medical malpractice overseas similar to the $1 million coverage provided by Barbados based AOS Assurance Company.

4.      Pass State and Federal legislation to allow Health Savings Accounts, Flexible Spending Accounts, Health Reimbursement Arrangements and other self-insured funds to be used on a global basis.

5.      Resolve the Hispanic issue by working with the Mexican Government, insurance companies and medical entities to encourage patients return to their country of origin for medical treatment should they want to do so.

6.      Pass State and Federal legislation to encourage banks to extend loans with a government guarantee, subject to strict underwriting rules and creditworthiness, to all seeking medical care outside of the U.S.

Chart I

Comparable Costs

Procedure	United States*	India*	Malaysia*
Heart Bypass	$130,000	$11,750	$18,500
Heart Valve Replacement	$160,000	$11,000	$12,500
Angioplasty	$57,000	$11,000	$13,000
Hip Replacement	$43,000	$10,000	$12,000
Hysterectomy	$20,000	$5,000	$6,000
Knee Replacement	$40,000	$9,500	$13,000
Spinal Fusion	$62,000	$7,500	$9,000

                                                                                                                                    * Approximate costs

 

 

Chart II

WHO Rankings

1	France	65	Uruguay	129	Peru
2	Italy	66	Hungary	130	Russia
3	San Marino	67	Trinidad and Tobago	131	Honduras
4	Andorra	68	Saint Lucia	132	Burkina Faso
5	Malta	69	Belize	133	Sao Tome and Principe
6	Singapore	70	Turkey	134	Sudan
7	Spain	71	Nicaragua	135	Ghana
8	Oman	72	Belarus	136	Tuvalu
9	Austria	73	Lithuania	137	Ivory Coast
10	Japan	74	Saint Vincent and the Grenadines	138	Haiti
11	Norway	75	Argentina	139	Gabon
12	Portugal	76	Sri Lanka	140	Kenya
13	Monaco	77	Estonia	141	Marshall Islands
14	Greece	78	Guatemala	142	Kiribati
15	Iceland	79	Ukraine	143	Burundi
16	Luxembourg	80	Solomon Islands	144	China
17	Netherlands	81	Algeria	145	Mongolia
18	United Kingdom	82	Palau	146	Gambia
19	Ireland	83	Jordan	147	Maldives
20	Switzerland	84	Mauritius	148	Papua New Guinea
21	Belgium	85	Grenada	149	Uganda
22	Colombia	86	Antigua and Barbuda	150	Nepal
23	Sweden	87	Libya	151	Kyrgystan
24	Cyprus	88	Bangladesh	152	Togo
25	Germany	89	Macedonia	153	Turkmenistan
26	Saudi Arabia	90	Bosnia-Herzegovina	154	Tajikistan
27	United Arab Emirates	91	Lebanon	155	Zimbabwe
28	Israel	92	Indonesia	156	Tanzania
29	Morocco	93	Iran	157	Djibouti
30	Canada	94	Bahamas	158	Eritrea
31	Finland	95	Panama	159	Madagascar
32	Australia	96	Fiji	160	Vietnam
33	Chile	97	Benin	161	Guinea
34	Denmark	98	Nauru	162	Mauritania
35	Dominica	99	Romania	163	Mali
36	Costa Rica	100	Saint Kitts and Nevis	164	Cameroon
37	United States of America	101	Moldova