We will all admit, here at HealthLink Advocates (HLA), that we are medical news junkies. Any health or medical headline coming our way, we read, discuss and earnestly hope that conditions in the medical field regarding treatment and costs are improving. A month or so ago, we read an account in a well-regarded New York paper about a relatively new concept in medical treatment – traveling out of the United States for a surgical procedure, also known as “Medical Tourism”.
Initially, of course we thought the article was speaking to the trend of those looking for inexpensive plastic surgery or expensive dental work to travel elsewhere, often to Mexico. This article, however was not talking about an elective procedure that is often not a necessity, but often a want. This surgery was for a knee replacement!
As the medical insurance advocate at HealthLink, I was dumbfounded. The HLA nurse advocates were equally shocked. To us, this was just going too far. Even more shocking, was the idea that this was not just a fly-by-night idea, but totally orchestrated and endorsed by a well-known furniture company, the patient’s employer.
This patient was a fifty-six year old woman who had struggled for two years with a knee in need of replacement. As if having a painful knee is not enough, the patient worked on her feet for most of the day, assembling furniture tool kits. One cannot imagine the pain she was in. Looking at surgery to replace the knee, she was presented with a unusual option….a totally free surgery, a totally paid for free mini-get-away (including flights and hotel room), no deductibles or co-pays, and a $5,000 dollar check in the end. All paid for by her employer, which also arranged and paid for pre-admission testing (in the US), obtaining passports, hotel (10 days) and meals for the patient and her family member.
In this scenario, it is not only the patient who is getting what might be thought of as perks….The physician (an Orthopedist) was flown to Mexico by the employer and paid $2,700 – reportedly three times more than the $900.00 he would have been reimbursed for the same surgery in the US. by Medicare. He stayed for less than twenty-four hours.
The facility that organizes and markets these trips, known as North American Specialty Hospital (NASH) flies in physicians on their days off from all over the U.S. to complete the surgeries. These physicians, by the way are well qualified. The article mentions that those participating in the surgery were Mayo and Brigham and Women’s Hospital (Boston) trained. As far as any language difficulties that may have been presented, the surgical assistant was bilingual.
NASH, it seems markets to self-insured employers in the US to have their employees travel to Mexico for surgery.
For those of you not familiar with the term “self-insured or self-funded”, here is an explanation as written in a CIGNA “white paper”:
Traditional self-funding is defined as when an employer pays for their own medical claims directly, while a third-party administrator administers the health plan by processing the claims, issuing ID cards, handling customer questions and performing other tasks. Companies with fewer than 250 employees can self-fund but will typically purchase stop-loss insurance. Stop-loss insurance limits the amount of claims expenses (or “stops the losses”) the employer’s self-funded health plan is responsible for per covered individual per plan year. If claims are lower than predicted, the employer can save money directly compared to paying the set monthly premium of a fully insured plan, while the stop-loss insurance policy puts a ceiling on the maximum amount the employer would pay in claims.
Of course, after reading the excerpt from the white paper, it is obvious why so many smaller companies are turning to this option. It all boils down to the cost of health care, which is, as we all know with certainty, is out of control. Smaller companies take a big risk in self-funding. It is a numbers game every month….who needs surgery, who is having a baby, who has had an accident, etc. Every small medical event can grow and bring them over the top to a loss…what a gamble!
Here is a breakdown of the finances in this particular case:
Flights to Cancun: Free for both physician and patient (paid for by employer)
Knee Replacement Surgery: Average $30,000 in US. NASH price - $12,000
Medical Device: Made by Johnson & Jhnson - $3,500 at NASH, $8,000 in the US
Nightly Hospital Stay: $300 at NASH, $2,000 (average) in the US
Finances for Patient: No cost for the patient – instead they walked away with a $5,000 check
Reading through the article, it is not surprising to learn that the patient’s employer, based in Wisconsin, has saved more than $3.2 million in health care costs in the past four years. This patient was the tenth employee to fly to Mexico for a medical treatment. In addition, the article cites that 140 employees or dependents have been treated in Costa Rica. Would you do it, or send your loved one down for care?
As healthcare advocates, we are concerned for the employee who may not be aware of what can go wrong when out of the country undergoing surgery. Is the hospital equipped for all types of emergencies? Who pays if more care is needed in the event of a complication? Who assesses the competency of the rest of the surgical team such as the anesthesiologist and the surgical assistant. Do we know the qualifications and competency of the nurse’s providing postoperative care? What is the plan if a serious adverse event occurs and the surgeon has flown back to the United States? It all sounds good until its not......
All this week, the CBS morning show has highlighted the crazy costs of our health care system. The inequities and lack of transparency in billing is breathtaking.
We stay out of politics here in the office. In this case, however it does not seem to matter what policies you support. Will our medical system ever be fixed?
If you are interested in reading the article in its entirety, click the link:
https://www.nytimes.com/2019/08/09/business/medical-tourism-mexico.html