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THE UNITED STATES REMAINS ON THE FOREFRONT OF MEDICAL TECHNOLOGY AND TREATMENTS, YET MANY AMERICANS TRAVEL ABROAD FOR CARE, MEANING REVENUE LOSSES FOR U.S. PROVIDERS. THE REASONS AMERICANS BECOME MEDICAL TOURISTS ARE AS COMPLEX AS THE CONDITIONS FOR WHICH THEY SEEK SOLUTIONS. BON VOYAGE? AN ESTIMATED 1. 2 MIL- LION Americans will seek overseas medi- c a l c a re i n 2 014, according to Patients Beyond Borders, an organization that provides consum- ers information about medical services around the world. The Deloitte Center for Health Solutions has projected that Americans seeking care abroad could result in U.S. providers losing revenue of well over $200 billion by 2017. Costs remain a significant factor behind medical tourism. "Some patients seek treatments that a re lega l and available in the U.S., such as hip replacements and cardiac bypass," explains I. Glenn Cohen, JD, Har vard Law School Professor, and Co-director, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics. "Americans in this category typically travel abroad because they are uninsured and the cost is much less abroad; they are underinsured or their insurance does not cover the cost of the procedure — such as cosmetic sur- gery — and the cost is much less abroad; or their insurer has given them a n incentive to go abroad — waiver of co- pay or deductible, or in some instances an actual check and remuneration." Cohen notes U.S. citizens may also seek better-quality services or services that are illegal stateside but legal in other countries, such as assisted suicide in Sw itzerla nd or certa in stem-cell therapies in China. "Medical tourism is a growing, com- plex and heterogeneous business," he says. "There are lots of opportunities but also lots of snake oil salesmen. The ethi- cal and legal issues [it] raises — from malpractice to insurance regulation to extraterritorial criminalization — are diverse and hard." Regulatory Obstacles U.S. physicians play an important role in pushing new treatments forward more rapidly, which could help keep patients stateside, says Gregory Moore, attorney and global healthcare consul- tant, and Chair, healthcare practice group, at Clark Hill PLC. "Government reg ulators have too much control over how medicine is practiced in the U.S.," Moore says. "Physicians and other providers need to change their government relations focus … toward permitting cutting- edge medicine to be approved more quickly. Until that is done, the U.S. will continue to lose its place in the world health community." Medical Tourism Closer to Home While many patients look for treat- ment options abroad, ex per ts note that medical tourism is also as easy a s crossing state lines — a nd phy- sic ia n s shou ld a nt ic ip ate p at ient s researching alternatives. "Medical tourism doesn't necessarily mean traveling half way around the world," Moore says. "It means traveling to a different city or state in search of high-quality, low-cost medicine. With deductibles skyrocketing and with the popularity of higher-deductible health plans, patients are being forced to shop for health care in the same manner as any other consumer good or service." ■ THE COMPLEXITIES — A ND COSTS — OF MEDICAL TOURISM By Rachel Stewart +++++++++++++++++++++++++++++ +++ + +++ + +++++++++++++++++++++++++++++ ❮ BUSINESS OF MEDICINE M D N E W S . CO M ■ MD NEWS Greater Boston | 5