Sun, Sand, and Sonograms

April 23, 2014

For families in the U.S. struggling to pay for health care, integrating local and international care networks may be a way to gain access to affordable, comprehensive coverage. But questions remain as to whether or not transnational health care services are a viable form of global social protection.

A woman working in San Diego uses her employer-based private insurance to cover wellness visits in her home city of Tijuana. A man from North Carolina flies to India for heart valve surgery – and the total cost of treatment and travel is less than the deductible for a similar operation in the United States. A cash-strapped employer in Pennsylvania offers comprehensive health insurance to workers with the caveat that elective surgical procedures will be carried out in the Caribbean. Over the last decade, as health care costs have increased, so have stories extolling the virtues of transnational health care services (heretofore referred to as ‘THCs’), commonly referred to as “medical tourism.” Proponents of THCs note that patients in the U.S. willing to travel abroad for health care not only pay a fraction of the price they would at home, but receive comparable – if not superior – care, and may even be seen by U.S.-trained physicians. These cost savings can be passed onto patients directly, or through transnational insurance plans with lower premiums and deductibles. THCs may be particularly beneficial for groups that are disproportionately un- or under-insured: 1) the young, 2) immigrants and ethnic minorities, and 3) people in their mid-to-late 50s who have lost employer coverage, but are too young to qualify for Medicare.

Despite increased efforts in some states to link existing domestic insurance plans such as Blue Cross Blue Shield to foreign providers or to develop standalone transnational insurance plans, our knowledge of how, when and why THCs can facilitate access to health care is relatively limited. First, much of what we do know on patient attitudes towards THCs and the economic viability of becoming a THC provider is based on industry reports, not independently collected data. Second, the limited case studies and surveys that we do have predate the enactment of the Affordable Care Act (ACA, commonly referred to as ‘Obamacare’) and the development of health care subsidies and exchanges that have shifted the financial and regulatory calculus for patients and providers. Therefore it is unclear that past practice is a guide to current and future behavior: while some insurers see the ACA mandate as an opportunity to offer relatively low-cost transnational insurance plans, domestic subsidies and exchanges may make these unnecessary.

This project will explore the extent to which THCs can act as an alternative pathway to insurance coverage. Taking a mixed methods approach, there are three key questions that will be addressed:

  1. What kinds of THCs exist, and who offers them?
  2. Who is open to taking advantage of these kinds of plans, i.e. willing to travel abroad for some procedures in exchange for lower premiums at home?
  3. What kinds of policies exist and/or are needed to facilitate the development of THCs?

The answers to these questions may have serious implications for both health care policy and individual outcomes.

Erica Dobbs is a recent graduate of the Department of Political Science at the Massachusetts Institute of Technology.