Analyzing patient choices for routine procedures in the United States vs overseas before and after the affordable care act: a case study
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Low prices and good medical care have caused an increasing number of Americans to travel abroad for affordable health care (medical tourism). This study analyzes the viability of medical tourism as an alternative to United States (U.S.) hospitals for routine surgical procedures by considering the total charges paid by U.S. insurance companies and by patients (out of pocket) to hospitals. A mathematical model based on rational choice theory is developed to approximate the most-favorable decisions for both patients and payers, and this is illustrated through an example involving the decision to undergo coronary artery bypass graft (CABG) surgery in India or the U.S. Before the Affordable Care Act (ACA), medical tourism positively offset the total treatment charges associated with CABG procedures, some fully insured and underinsured patients would often opt for overseas treatment. After the enactment of the ACA, more fully insured patients and more people from a much smaller set of underinsured patients may opt for overseas CABG treatment. This paper finds that the ACA pushes individual decisions closer to the system optimal situation, and that if the U.S. health-care industry is unable to eliminate waste and inefficiency and thus curb rising costs, it will continue to lose surgical revenue to foreign health providers.
Keywordsmedical tourism rational choice affordable care act offshoring
- Barua B, Rovere M and Skinner BJ (2010) Waiting your turn: wait times for health care in Canada 2010 report. [WWW document] http://ssrn.com/abstract=1783079 (accessed 6 April 2015).
- Birch J (2014) Uninsured patients cost emergency rooms millions, WNCT 9. [WWW document] http://www.wnct.com/story/25042024/uninsured-patients-costs-emergency-rooms-millions (accessed 6 April 2015).
- Bloomberg Rankings and Nikhil Hutheesing (2012) The real cost of medical tourism, Bloomberg News, [WWW document] http://www.bloomberg.com/consumer-spending/2012-10-23/the-real-cost-of-medical-tourism.html#slide2 (accessed 6 April 2015).
- CDC (2014) Medical tourism – getting medical care in another country. [WWW document] http://www.cdc.gov/Features/MedicalTourism/ (accessed 9 December 2014).
- Congressional Budget Office (2012) Estimates for the insurance coverage provisions of the affordable care act updated for the recent supreme court decision. [WWW document] http://cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf (accessed 6 April 2015).
- DeNavas-Walt C, Proctor BD and Smith JC (2012) Income, poverty, and health insurance coverage in the United States: 2011, US Census Bureau. [WWW document] http://www.census.gov/prod/2012pubs/p60-243.pdf (accessed 28 June 2014).
- Forgione DA and Smith PC (2007) Medical tourism and its impact on the US health care system. Journal of Health Care Finance 34 (1), 27–35.Google Scholar
- Fried BJ and Harris DM (2007) Managing healthcare services in the global marketplace. Front Health Serv Manage 24 (2), 3–18.Google Scholar
- Govindarajan V and Ramamurti R (2013) Indian hospitals could show U.S. hospitals how to save money without cutting quality. The Washington Post. [WWW document] http://www.washingtonpost.com/opinions/indian-hospitals-could-show-us-hospitals-how-to-save-money-without-cutting-quality/2013/11/01/d02c8e58-3c28-11e3-b7ba-503fb5822c3e_story.html (accessed 4 January 2015).
- Groom Law Group (2010) Effective date chart: key provisions of the patient protection and affordable care act. [WWW document] http://www.groom.com/resources-478.html (accessed 6 April 2015).
- Horowitz MD, Rosensweig JA and Jones CA (2007) Medical tourism: globalization of the healthcare marketplace. MedGenMed 9 (4), 33.Google Scholar
- Jaspen B (2014) Doctor wait times rise as obamacare rolls out. Forbes. [WWW document] http://www.forbes.com/sites/brucejapsen/2014/01/29/doctor-wait-times-rise-as-obamacare-rolls-out/ (accessed 6 April 2015).
- Medical Tourism Corporation (2012) Heart bypass surgery abroad. [WWW document] http://www.medicaltourismco.com/cardiology/heart-bypass-surgery-abroad.php (accessed 6 April 2015).
- Riczo S and Riczo S (2009) Globalizing health care through medical tourism. USA Today Magazine, 138(2772), 26–28.Google Scholar
- Schroth L and Khawaja R (2007) Globalization of healthcare. Front Health Serv Manage 24 (2), 19–30.Google Scholar
- Stephens MB (2009) Cardiac rehabilitation. American Family Physician 80 (9), 955–959.Google Scholar
- Travel India Company (2014) Price comparisons between India, US and UK. [WWW document] http://www.indian-medical-tourism.com/medical-tourism-india-price-benefits.html (accessed 28 June 2014).
- Underwood HR and Makadon HJ (2010) Medical tourism: game-changing innovation or passing fad? Healthcare Financial Management 64 (9), 112–114 116, 118.Google Scholar