Medical tourism is no longer just the province of the uninsured and desperate. As health care costs soar in the United States, it is also the insured and their insurers who are scouring the globe for quality at a bargain. This is further evidence that one of our main tenets is true: reforming our delivery system to increase the value of our health care dollar is just as important as covering all Americans.

Medical tourism, or as some prefer to call it "Global Health Care," could become a $150 billion market, according to Wouter Hoeberechts, CEO of WorldMed Assist, a company that assists Americans in accessing overseas care. He was among the experts who took part in a panel on the topic at the recent Association of Health Care Journalists conference just outside Washington.

Going overseas for health care makes sense, he argued, if the care is not urgent, if it doesn't require a lengthy foreign stay or prolonged follow-up care, and if it's relatively expensive, say $15,000 or more. Hoeberechts sees patient demand for orthopedic and spinal surgery, weight loss surgery, cosmetic and dental procedures, some cardiology and even transplants. Heart bypass surgery, for instance, can cost $149,000 in the U.S. (although insurers usually negotiate steep discounts) compared to $10,000 in India including airfare and lodging.

Businesses, including but not limited to companies that offer Health Savings Accounts and High Deductible Health Plans, are eyeing foreign hospitals, and at least one major U.S. insurer, a division of BlueCross BlueShield of South Carolina is not only helping clients find quality foreign care, it is making sure a network of doctors is available for follow-up back home. "It's not about cheap, cheap," BlueCross executive David Boucher said. "It's about safe, safe."

No one is quite sure how many Americans have gone overseas for such procedures; estimates range from 150,000 to as high as 400,000. But whatever the numbers, the trend looks like it's here to stay. That doesn't mean that people (including celebrities and dignitaries) don't come to the United States for treatment; of course some do. But it does say a lot about the dwindling faith tens of thousands of Americans have in their ability to get top quality health care here at home, at a price they can afford. This dwindling faith corresponds to one our of general arguments for comprehensive reform: if we don’t increase value per dollar spent within our delivery system, not only will middle class Americans lose access to insurance and care, but American physician specialists will be subject to increased global competition as well.

Julius Karash, who also took part in the journalism conference panel on the topic, did a nice piece on this in the Kansas City Star a few months ago, including web sites where patients can get information, and a discussion of some of the risks or obstacles.(Sunday dec 9 2007)