Patients With Passports
Four years ago, Maggi Ann Grace’s partner, a building contractor, learned that he had a defective heart valve. The uninsured 50-something American did not have $200,000 for heart surgery, but the state medical system, with its strange logic, would let him deteriorate before it did anything for him. Grace’s son, a medical student, told them of quality healthcare facilities in India.
Soon, the proactive North Carolina couple were at the Escorts Heart Institute in New Delhi. A team of doctors performed pre-op tests and then surgery-initially to repair the mitral valve, and then, when that didn’t work, replaced it. The fee for the successful surgery as well as the postoperative care and stay was less than $10,000. The hospital staff won the couple’s hearts with the quality of care they provided over an entire month.
Grace, author of State of the Heart: A Medical Tourist’s True Story of Lifesaving Surgery in India spoke of her experience at the Harvard Medical School’s Division of Medical Ethics last Wednesday. She was on a four-member panel to discuss medical tourism, the emerging trend of flying to developing countries for health care. While such travel is not a new phenomenon, its scope is new. Last year, some 150,000 Americans went abroad to receive medical care at a fraction of the cost they would have paid at home.
Global health care advocates say that services in at least 15 countries are equal or better to those offered in the United States. Josef Woodman, author of Patients Beyond Borders: Everybody’s Guide to Affordable, World-Class Medical Tourism, said that these countries are not just in Asia, but in South America as well. Health travel organizations now link U.S. patients with out-of-country providers; the practice is a major revenue-earner for some developing countries.
“Call me ill-informed, call me a snob, but I did not really think that the quality of medical care in developing countries could be equal to what’s offered here in the United States,” said David Boucher, Assistant Vice President of Blue Cross Blue Shield South Carolina. He seemed to echo the sentiments of some in the audience, but fortunately Boucher had the opportunity to revise his opinion. After he traveled to verify the global healthcare researchers’ assertions, he became managing director of Companion Global Healthcare, a company that helps patients get treatment overseas.
But while medical tourism brings down health care costs for middle-class patients, who have the means to consider such an option, it does little for those at the very bottom of the system. More importantly, by skimming off the middle layer, medical tourism could take away some of the pressure that must be brought to bear on a morally bankrupt health care system, which an audience member said, is not above leaving its sick uncared for.
Indeed, medical tourism is rife with ethical questions. Harvard Law School Assistant Professor Glenn Cohen brought up some of these issues. This trend, for instance, could affect the quality of care offered to the poor in developing countries because the best physicians may end up catering exclusively to well-heeled foreign clientele. In certain countries, the medical “brain drain” could be exacerbated as U.S-trained physicians from the richer developing nations like India and Malaysia choose to go back home.
The panel raised a number of questions: Is it ethically appropriate for American insurance companies to provide international health care options and incentives to their customers? What are health care providers’ and insurers’ obligations to patients when they return to the United States and need follow-up care? How do American patients reconcile with the “so, sue me,” attitude of hospitals abroad when things do go wrong?
For me, a foreign national from the Third World, another question was foremost. How do we ensure that America doesn’t end up exporting its mucked-up medical system to these nations that now offer quality healthcare at affordable prices to a sizeable part of their population? In an era of globalization, we have to answer these questions collectively. Refreshingly, we are addressing the vital issue before the juggernaut of healthcare economics relegates all ethical considerations to the wayside.
Story by Vijaysree Venkatraman.