Glenn Cohen is an Assistant Professor at Harvard Law School. His ” is the most in depth exploration of the medical tourism industry and the legal issues it raises for would-be patients and would-be providers.
In this paper Cohen explores medical tourism that involves patients seeking out treatment in other countries that is legal both there and in their own country of residence. This is one of three types of medical tourism that Cohen categorizes, the other two involving treatment is illegal in the patient’s home country but legal in the destination country, and treatment that is illegal everywhere (like organ harvesting).
Cohen the puts the medical tourism question within the context of American institutions, and explores the implications of problems that might arise for patient’s getting treatment abroad as they relate to those patient’s employers and government institutions at home.
The hope that medical tourism might improve the lot of U.S. patients is obvious from the title adopted by the Senate Committee on Aging for its recent hearing on medical tourism “The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?”17 Nevertheless, for both uninsured and insured patients, medical tourism presents serious legal and ethical issues. To see some of those issues consider the following pair of case studies setting out two archetypal instances of medical tourism I will explore in this paper:
I. Carl is one of the estimated 47 million Americans without health insurance.18 After experiencing the symptoms of angina, he reluctantly sees a cardiologist in his home town of Milwaukee whom he pays out-ofpocket. A battery of tests reveals significant atherosclerotic narrowing in several arteries, and the cardiologist recommends bypass surgery. In Milwaukee, bypass surgery purchased out-of-pocket costs somewhere between $48,350 and $73,300 depending on the hospital.19 Carl can get the same surgery for $10,000 at Bumrungrad Hospital in Bangkok, Thailand, and decides to do so. Unfortunately, he suffers an ischemic stroke (the cutting off of blood supply to the brain) during the procedure. As a result he suffers partial paralysis in his right arm, moderate speech problems, pain, and depression. Believing the stroke to be the result of medical error, he wants to sue for medical malpractice against the hospital and his doctors in U.S. Court.Are there barriers in the U.S. legal system that will prevent him fromsuccessfully bringing suit?
If so, knowing about these difficulties, should (andcould) the U.S. have prevented him from getting treated abroad? Should the U.S.state or federal governments, or a government-supported organization, be requiredto evaluate foreign hospitals before U.S. patients travel abroad for care?II. In an attempt to reduce healthcare costs, White Hill Paper Products, Inc.,a self-insuring American company based in Canton, North Carolina, offers its employees a $10,000 bonus, extra sick-leave time, and the cost of airfare, if its employees agree to have non-emergency surgeries done in the New Delhi, India, hospital approved by the company’s Preferred Provider Organization (PPO). Should the company be permitted to adopt this policy? If, impressed by the cost savings, the company considers changing the policy for the following year from incentive payments to travel abroad for surgery to penalties for failing to do so (in the form of co-pays attaching only to surgeries provided domestically), can they do so under existing law? Should they be able to? What steps could state governments take to prevent this practice? What if the company instead decides not to cover non-emergency surgeries altogether unless they are done in India? If Bob, one of White Hill’s employees, takes the company up on their offer, gets a hip replacement in Delhi, and is the victim of medical error causing significant complications, should he be able to sue the company? Would any of this change if it was not a self-insured firm taking these steps, but an insurance company that provides plans offered by an employer to its employees?
His key point is that the question of how to deal with medical tourism in terms of incentives and insurance schemes will increasingly become an issue in the US as the cost of healthcare goes up. While states like Texas and South Carolina have already taken steps to deal with some of the concerns, Cohen believes that the academic penmanship looking at medical tourism is “embryonic” and that the questions it raises are complex enough to warrant much more additional study. This point is an important one for patients considering medical tourism to consider. At the moment, the issues at legal recourse if a problem with care occurs abroad are slim and there is no precedent to fall back upon when trying to bring suit. So, be careful out there, and absolutely
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What sort of a medical tourism scene exists in China? Have you blogged about this before, D?
varying legal system is one piece of information, quality of service would be a second. Bumrungrad is a good example – largely staffed by medical professionals w training and certification in the US, relatively state of the art, it could well have lower probability of accidental occurance than many facilities in the US. So if you were to give patients information before they make the choice, both the legal options as well as some relative information on quality would also seem important.