Some Insurance Companies Ask Their Customers to Cross the Border for Care image

New Republic, July 7, 2014
Adam Teicholz and I. Glenn Cohen (Faculty Director) and

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Faculty Director I. Glenn Cohen has co-authored a new piece in New Republic on the practice adopted by some insurance companies of sending clients across the border for less expensive care. From the article: 

Before dawn on a Wednesday in January, Cesar Flores, a 40-year-old employed by a large retail chain, woke up at his home in Chula Vista, California. He got in his car and crossed the border into Tijuana. From there, he headed for a local hospital, where he got lab tests—part of routine follow-up to a kidney stone procedure. He had his blood drawn and left the hospital at 7:30. He arrived home before 10. 

Uninsured Americans have long known that seeking medical care abroad is often more cost-effective than seeking it at home. Even after you factor in travel expense and time off work, you still often come out ahead. A hip replacement that would cost $75,000 for an uninsured patient in the U.S. is $9,000 in India. A heart bypass in the U.S. runs about $210,000; in Thailand it’s $12,000. According to Patients Beyond Borders, a company that facilitates medical tourism, those savings drove about 900,000 Americans to leave the country for medical procedures last year—a number they estimate is growing by 15 percent per year.

But Flores’s situation isn’t medical tourism as we know it. Flores has insurance through his wife’s employer. But his insurer, a small, three-year-old startup H.M.O. called MediExcel, requires Flores to obtain certain medical treatment at a hospital across the border. In part due to cost-pressures generated by the Affordable Care Act, other sorts of plans that require travel have the potential to expand. With this prospect looming, it’s important to ask: What’s the impact on patients? Are these insurance plans regulated? And, perhaps most importantly, are they ethical?

Read the full article online.

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