Setting the standards for medical tourism

The AMA has created guidelines to help protect patients when they go overseas for care and in follow-up treatments back home.

Posted Aug. 4, 2008.

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A small but growing number of patients are being treated outside the United States based on the belief that they can receive quality care at a cheaper price than at home, a phenomenon commonly referred to as medical tourism.

While medical tourism constitutes a negligible percentage of the health care Americans receive, it is drawing interest from at least a few health plans and state legislatures. They want to make it easier to give patients the option to board a plane to India, Singapore, Thailand or any other destination pitching itself to American patients -- or their employers and insurers.

The American Medical Association House of Delegates recently took an interest in medical tourism as well. At its Annual Meeting in June, it approved a set of guidelines designed to help ensure that globe-trotting patients have all the information they need to decide for themselves when to go overseas, and that they are protected when they go. The guidelines, outlined in a report by the AMA Council on Medical Service, also consider the role of physicians back home involved in their traveling patients' follow-up care.

Right now, it is too early to conclude whether the risks of medical tourism outweigh the advantages. Meanwhile, long-standing AMA policy on pluralism in health care supports the ability of patients to choose their treatments and physicians.

The operative word is "choose." The guidelines state that medical care outside the United States must be voluntary, and that any financial incentives should not inappropriately limit the diagnostic and therapeutic alternatives, or restrict treatment or referral options. In the end, the decision to travel for care is those patients' -- not anybody else's.

Patients should have assurances before they go that they are not taking on undue risks. The guidelines also state that patients should be referred only to institutions accredited by recognized international accrediting bodies.

Patients also should be informed of their rights and legal recourse agreeing to travel. And they should have access to physician licensing and outcomes data, as well as facility accreditation and outcomes data, for wherever they are considering seeking treatment.

The guidelines state that patients also need to be informed of the medical risks of combining surgical procedures with long flights as well as vacation activities -- the latter often thrown in as part of the package to attract patients overseas for care.

Medical tourism also is about the care that takes place back in the United States before and after what happens abroad.

The guidelines state that before travel, local follow-up care should be coordinated, and financing should be arranged, to ensure continuity of care after a patient returns. Coverage for travel outside the U.S. should include the cost of that necessary follow-up care. The guidelines also say that transfer of documents back and forth should comply with guidelines of the Health Insurance Portability and Accountability Act.

(On a related note, delegates also reaffirmed policy that calls for private payers to recognize CPT codes and modifiers to describe the segment of pre-operative, surgical or post-operative care performed during the global period of a procedure, when more than one physician delivers a specific segment of care. That sometimes proves difficult to get insurers to recognize even when the patient never leaves his or her hometown.)

To ensure that the AMA guidelines are followed, the Association is developing model legislation state lawmakers can use to govern medical tourism.

The cost of care and the issue of the uninsured need to be addressed at home so patients don't feel like they have to look elsewhere for affordable, quality medicine. But while patients are seeking care elsewhere, they need to be fully informed about the risks of opting for medical tourism. Traveling overseas may be their choice. What they certainly don't need is anybody else forcing the decision on them.

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