Can Medical Tourism Reduce Real and Perceived Malpractice Risk for US Corporations?

I have spoken to scores of physicians, corporations both Fortune size and small, insurance carriers, TPAs, benefits consultants, Governors and legislators on the topic of medical tourism. The underlying theme is that global healthcare is inevitable, desirable, and that new business models need to be created to enable US patients to take full advantage of the emerging opportunities.

What is interesting, is that the very first question is typically "this is really great, I hadn't even imagined this was an option...so how do I sue?"

It is truly amazing how completely intertwined that healthcare and malpractice have become in our collective psyche. But is it also paralyzing us in our ability to make rational decisions regarding healthcare in other countries? Are we making the assumptions that healthcare in another country is just like ours, only less expensive?

Lets examine some of these deep seated fears that have become all part of the US hospital experience, and contrast them to our patient's experiences in India:

1. Lack of communication
   
2. Medical outcomes
   
3. Perverse financial incentives
4. Lottery-sized awards for pain and suffering when there was no medical malpractice

Lack of Communication

Maybe its just me, but I haven't met anyone that really looks forward to a visit to the hospital. We all know that this is a time of great stress for the individual, including the health condition in question and the unknown financial impact of the visit. There are all manner of risk management procedures to address a problem after it arises in a hospital, but typically little effort is invested in addressing problems in real time.

Contrast the typical introduction to the US hospital with a global health option:

• The prospective patient is immediately in contact with an RN Case manager who begins to understand their medical need, and starts to identify options within our Hospital Partner Network
• Every question the patient asks is answered, typically involving a collaboration between the RN Case Managers, our Medical Director and attending Physician in India
• This experience may also be the first time a patient has traveled internationally, or the realization of a life long dream. In any case, there is the aspect of adventure, with all the attendant travel issues that must be addressed in concert with the medical issues.
• Patients are issued a pre-programmed cell phone, that allows instant contact with the RN Case Manager, and family back home. If there is situation where there is question or unmet need that is not addressed, we are typically able to contact our colleagues at the Indian hospital and address the issue with far greater speed than in the US.

So what might have started out as a small issue...cold food, delayed pain meds, cancelled doctor visit, IV running out, beeping monitors...begin to multiply and are amplified as the hospital stay progresses.

Medical Outcomes

While there are all manner of standard patient forms that a US patient signs to prove he has read the various complications, we all know that not all of the fine print sinks in. The patient is counting on the doctor to do his best job. The only bargaining chip that many patients feel they have is the shield of lawsuit threat. So the the doctor makes nearly every medical decision for the patient haunted by the specter of litigation, and the patient has a malpractice attorney loaded in the cell phone.

A patient that has a good medical result, a good experience and feels they received good value for the money can seem to be quite the exception in the US.

• The hospitals that are typically involved with international medicine are not really comparable to the typical local hospital that most patients find themselves exposed. The hospitals in our network are chosen for their international reputation for consistently high medical outcomes.
  
• Each US patients represents yet another opportunity to showcase India's medical prowess, and they know that the details of each experience will not only be shared with countless friends upon the patient's return back to the US, but may also appear in countless newspapers across the globe.
• Indian cardiovascular surgeons at our super specialty hospitals typically will have operated on as many cases as a US surgeon has upon retirement, by the time they are 40. This seems to be driven by several factors. Not only is their a vast difference in population of the two countries, but in contrast to the US where cities may have several competing heart centers for a limited number of cases, there is a concentration of heart centers that attract the best surgeons.
• So instead of a heart center doing hundreds of cases a year...India centers do thousands.
  

If you take a look at medical outcomes data, the argument can be made that patient may be exposed to a higher risk of complications at the US hospital.

Perverse Financial Incentives

Because of the US healthcare reimbursement system, the hospital has a financial incentive upon the patient admission to get the DRG up on the scoreboard, spend as little as possible in addressing the medical condition that the DRG encompasses, then discharging the patient as quickly as possible. All in hopes of receiving payment at some point in the future. Patients seem to be discharged mid-procedure, many times with wires, hoses and beeping devices still attached, requiring the family to help coordinate home health visits...and on it goes.

Leemore S. Dafny has a great paper (sidebar) Games Hospitals Play: Entry Deterrence in Hospital Procedures Market. And what is surprising conclusion?

"These findings suggest that competitive motivations play a role in treatment decisions."

Ok, not a surprise...and there are countless other citations showing the links between financial incentives and hospital/medical decisions directly affecting the patient.

The discussion of whether this is good or bad thing certainly deserves its own post.

• The hospital in India has already been paid before a patient even arrives. That's right...payment up front. But the healthcare team has much different goal in mind than their US counterparts. The procedure must be done, with an excellent result, and then recovered to a point whereby the patient can enjoy the plane trip back to the US.

  Can you imagine what our US healthcare system would look like if every third party reimbursement system was replaced with cash over night, and every discharged patient had to recuperate in the hospital or resort until they were able to fly to India?

• Of course, there are only a certain number of procedures that lend themselves to this model...which interestingly mirror some the most expensive and profitable procedures here in the US. So when we hear the consultants divine the future impact of the medical tourism market, makes sure to listen carefully if they are distinguishing between number of procedures or financial impact to the individual and corporation.
  

Lottery sized awards

One need go no further than to review the career of former US Senator John Edwards to get idea of how far we have let the system get out of hand. And while the likelihood of a patient or family collecting from the medical lottery is quite remote, a US patient does seem to feel a sense of unease that they do not have their only protective shield when they travel overseas.

• While the fact remains that a patient would need to bring litigation against an Indian hospital or physician in an Indian court...

  We are at this time, unable to identify a malpractice claim against an Indian hospital or Indian physician by a US patient.
  

• Of course, if US patients were followed by news camera crews from the BBC or ABC from patient arrival at the airport to discharge, there might be more similar outcomes.

We need to keep in perspective, that for every $1 million that a lawer puts in his pocket, 70 children could have had heart surgery in India. Its up to America to decide if the system that trades 2,800 pediatric heart surgeries for a trial lawyer's largess is fair.

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In summary then, while there are some topics that need to be researched in the normal course of due diligence, very strong arguments can not only be made for the US patient enjoying a reduced malpractice risk in India, but that corporations could more fully discharge their fiduciary duties by assuring their employess are aware a less risky global healthcare option.