Navigating medical tourism among your patient population
Key Takeaways
“I am getting dental implants in Mexico,” my friend (and patient) said to me one day. I had so many questions. Most of all: Why?
She told me her dental insurance barely covered root canals, and dental implants would cost her about $50,000 in the US. She was referred to an oral surgeon in Mexico by multiple friends who had traveled south of the border for affordable dental care.
Another effect of rising healthcare costs
My gut reaction was to convince her to change her mind, but I knew she couldn’t afford the procedure in the US.
I started to look into this “medical tourism” business, as I knew it was gaining popularity given our increasingly expensive healthcare system. I figure it would only be a matter of time before my other patients would start asking me about procedures overseas.
Fortunately, my friend’s dental surgeries abroad were successful, and although her recovery was painful, she now has a beautiful set of teeth—and she didn't have to drain her savings. She told me she had a wonderful experience, and that her surgeon’s office was literally set up for medical tourism: Accommodations, meals, and travel were all included in the price.
A sign of desperation?
"The healthcare system in the United States is broken for both doctors and patients."
— Kristen Fuller, MD
From a patient’s perspective, it is expensive or even unaffordable; patient’s experience long wait times and must navigate a complex system of insurance companies and specialists.
Doctors know this all too well, so it shouldn’t be surprising that millions of Americans have traveled abroad to receive medical care—even during difficult times. “During the pandemic, Americans continued to go abroad for care. In 2020, an estimated 290,000 Americans went abroad for dental and medical procedures. The previous year, some 780,000 sought outbound services,” according to a Forbes article.[]
For years, dental procedures, reconstructive cosmetic surgery, and other cosmetic treatments dominated the medical tourism markets. However, core medical care, such as joint replacements, are becoming medical procedures performed abroad; in-vitro fertilization and gender reassignment surgeries are also high on the list.
It’s not as if Americans are simply “choosing” to go abroad. If these procedures were affordable and available promptly in their home country, they would stick close to home to avoid the many risks that come with medical tourism.
The pros and cons of overseas care
Medical tourists can save anywhere from 25% to 90% in medical bills, depending on the location and type of procedure.[] The most common countries include Mexico, Thailand, Colombia, Costa Rica, Turkey, South Korea, and Malaysia.
Some of the downsides associated with medical tourism include language barriers, unplanned illness (such as food poisoning), quality of care (staff, surgeons, and facility), postoperative complications, and long flights home after surgery.
However, there are attractive benefits that appeal to many Americans, including the low cost of care, the benefit of traveling to and exploring a new country, the luxury and privacy often offered in state-of-the-art medical facilities, and the plethora of talented surgeons.
When your patient wants a referral
In general, we as physicians understand the unaffordable cost of medical care in this country. Still, we also recognize the potential dangers of going under the knife overseas. What if something goes wrong? What if there is a postoperative complication?
"Medical malpractice laws are much different abroad, and patients most often forfeit their rights to sue if something goes sideways."
— Kristen Fuller, MD
We want our patients to make the best informed decisions, but as physicians, we also have a duty to protect ourselves. In an op-ed in the AMA Journal of Ethics, an attorney explains the importance of distancing yourself from your patients if they engage in medical tourism.[]
This means you do not make referrals for procedures abroad, give recommendations or advice, or be involved in postoperative care. Does this disrupt your continuity of care?
Yes, because you must view this procedure as an isolated event that is not in your chart, despite knowing continuity of care is essential for the patient's overall outcome. Hence, medical tourism is complex to navigate: We want to help our patients, and we want what's best for them, but we don’t want to be liable for procedures we are not involved in or do not recommend.
One of the most common challenges physicians find when their patients choose to go abroad is that they will seek advice beforehand and plan to see their US-based PCP for post-op care; however, this should be separate from the deal.
If the patient chooses to engage in medical tourism, they should make sure that the physician overseas is reputable, licensed, experienced, and will be responsible for all the pre-op and post-op care, even if it means the patient will have to schedule future travel for a post-op visit.
How much risk will you take for your patient?
It is important to educate yourself about medical tourism and the liabilities around this area of medicine if you involve yourself in your patient's plan to travel for medical care.
"It is a double-edged sword—the more you work with a patient who plans to go abroad, the more liability you attach to yourself."
— Kristen Fuller, MD
On the other hand, continuing to involve yourself in the patient’s care means there is a higher likelihood they will have a better outcome given the benefits of continuity of care.
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.