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updated 6/30/2008 8:41:38 AM ET 2008-06-30T12:41:38
COMMENTARY

Road trip! What college student doesn't get a thrill from that cry?

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But road trips may soon have more to do with gimpy-kneed geezers than frat boys and bikini-clad coeds —  if American health insurance companies have their way. Some major insurers are encouraging patients in need of hip replacements, dental surgery, cardiac care and some elective procedures to leave the United States to get them. Companies such as Aetna and Cigna are considering shipping people to places like India, Thailand, Mexico, Israel, New Zealand, Costa Rica and Turkey for medical services.

Medical tourism has been touted for some time as a way to combine high-quality medical care at a lower cost with a vacation in an exotic locale. It is cheaper for employers and insurance companies to offer some expensive medical services overseas. It may even be cheaper for the patient in terms of co-pays and deductibles that would apply in American hospitals and clinics.

It may sound great, but the reality is more risky.

Quality of care is the biggest concern. There is no doubt that doctors in many nations can provide close to the same quality of care as you would find in America. The problem for patients on a medical road trip is assuring access to those qualified physicians. Furthermore, not every specialty is staffed by the kind of doctors you would expect to find in a high-quality U.S. facility. 

Challenges of follow-up care, complications
Hospitals overseas can seek and receive accreditation from reputable American and British hospital organizations. Yet that is not the same as guaranteeing that the specific doctors and nurses involved in doing your surgery have the right training and experience. Nor does it ensure that the kind of peer review that dominates American hospital care is going to be in place in foreign hospitals where doctors may not be held accountable for errors.

What happens if you need follow-up care? Are you going to want to jet back to Singapore or Los Cabos if something goes wrong? Who is going to care for you in the U.S. if there are complications from your outsourced operation? What if the Mexican dental clinic closes — who will manage a failed case? 

Sure, the cost is cheaper in foreign lands and you get to take in some exotic scenery. But do you really want to recover from your knee replacement or bypass in a place far away from family, friends and familiar surroundings?

In many countries, doctors are not big fans of informed consent, which could mean you might not be consulted about all the risks of a procedure or medication. In others, you may find yourself having to locate and pay for your own nursing and follow-up care, since these are not part of the hospital treatment package. If you think the locals goofed up your care, you will quickly find out that the sort of legal recourse you have in terms of a malpractice lawsuit is nothing like what exists in the U.S.

Taking resources from the needy
Finally, you need to keep in mind that every foreign doctor, dentist or nurse that is fixing your leg or suctioning out your fat is one less doctor or nurse available to the local population for their care. Sure, treating the American traveling elite in tourist hospitals means higher payments, but that practice can only exist by taking away scarce health care resources for those who are often very needy and very poor.

As alluring as it sounds to some, I am not sure the best way to squeeze in a vacation is to piggy-back it on top of your colon resection. Until those touting medical tourism can really safeguard that the quality, follow-up and liability for error are on a par with a first-rate American hospital, it might be smart to leave road trips to the kids.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.

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