As advisers continue to look for ways to become more of an asset to their clients, medical tourism is a field that continues to evolve and grow, often saving employers and employees tens of thousands of dollars in the process.

It's "win-win-win," says Steve Lash, president and chief executive officer of San Diego-based Satori World Medical. "It's more and more becoming accepted. We are getting companies contacting us, wanting us to go into their health plans. Two years ago, part of it was that it wasn't known, the quality wasn't accepted. Now it's cost [savings] but not at the expense of quality."

Yet, Lash acknowledges that "it's not for everybody, some people will not be interested."


Working with advisers

Medical tourism companies work with advisers to add their packages into existing or new benefits contracts. It's a value-added benefit and with the cost savings for employers potentially thousands, it's also a way for advisers to stick out in a crowded field, says Lash.

"[Advisers] have done a lot of work with clients to put programs in like smoking cessation and wellness and other programs to help reduce cost," Lash, who founded Satori, adds. "All those programs cost money and their clients are saying, 'You have to bring me something new, something different.' We are that - not only are we new and we are different, but because we don't charge anything, there is no downside for them to put us in."

After an adviser invites a medical tourism company to meet with their client, the company - which facilities the trips and arranges all the care and travel - makes a presentation. If all parties agree, it is embedded into an employee's health plan, Lash says.


Next steps

"Once we are in, we go ahead and put our program in [and] create our employee communication," he explains. "We have to make employees aware. When the employee needs hip surgery, [they] can choose from any of our 30 centers, or go domestically."

For Geoff Moss, vice president of Calabasas, Calif.-based medical travel provider Planet Hospital, the reasons why an adviser should bring this to their clients are clear. "It's potentially saving a business thousands of dollars," he says.

Moss adds that advisers often contact him looking to offer "creative plans for their clients." His company, like most medical tourism providers, doesn't charge any monthly or annual fees, rather everything is on a case-by-case basis - as are commissions.


Real world savings

Lee Davis, an employee with the Imperial County Office of Education in El Centro, Calif., found the cost savings to be significant. Using a program through her employer, she took her daughter to Canada for gastric bypass surgery and contrasts it with her husband's knee surgery in San Diego that took place the previous year.

For her husband's surgery, Davis had to pay $1,000 upfront, spend hours doing research to confirm what was covered with her insurance, and then after the procedure received countless other bills from doctors she does not remember meeting.

"They can never give you a quote. You can't prepare for it, even if you have really good insurance," she says.

In contrast, she went to Canada for her daughter's procedure - booked through Satori - and everything was covered upfront. She estimates it saved her $50,000, which is "absolutely amazing because we have kids in college. It was a huge, huge benefit," she says.

By going to Canada, all of the research was done for her, and she only paid a $15 copay out of pocket for a pre-trip medical exam.

As another example, Moss points to his client Snow Summit Ski Resort in Big Bear Lake, Calif. As a ski resort, Snow Summit has several hundred seasonal employees who often need orthopedic procedures.

The company says to employees, "Do you want to go to UCLA Medical Center or abroad?" If the employee chooses to go abroad, copays and deductibles are waived. "But at no time is the business not willing to provide domestic medical care," Moss says.

Yet, by having some employees go abroad, they are saving the ski resort thousands of dollars in medical costs, as the international procedures are fully covered by the employer.


Quality at a lower cost

When traveling abroad most procedures are covered for the employee at nearly 100%, including travel with a companion, hotel, airfare and all medical expenses related to the procedure.

The medical tourism companies stress that the overseas facilities standards are at - or higher than - those in the United States.

"We get quality indicators from all our hospitals," Lash says. "A lot of people understand that the U.S. is not the front of all clinical excellence. ... People realize there is quality health care outside the United States."

Davis adds that, as a parent, she was concerned about the quality of care her daughter would receive, so she did her own independent research and the doctor was tops in his field. "People seem to forget we in the U.S. are not the only place where we have top-notch doctors," she says.


An adviser's liability?

Advisers may express concerns about liability issues for helping to send their client's employees overseas.

However, Scott Edelstein, a partner in the Washington, D.C., law office of Squire Sanders, says that there is limited or minimal liability for advisers, and there have been no such cases in the courts as of yet.

Kevin Ryan, a member of the Chicago law office of Epstein Becker Green, adds that those going abroad often do even more research than having a procedure down the street, and like most medical procedures, sign consent forms. This limits most liability - including for advisers. "People who go abroad understand what the risks are," he says. "I'm not sure that the patient who goes down the street thinks that."

He adds that especially for foreign providers it is in their best interest to provide the best possible care. "Most providers live or die on medical tourism, [often] by what's posted on the Internet," he says. "Bad outcomes are going to result in bad publicity, and that's the last thing they want."


Why not

Many companies, and their advisers, have yet to offer medical tourism procedures - often because patients don't want to travel abroad. According to the Deloitte 2011 Survey of Health Care Consumers in the United States, 25% of surveyed Americans say that would consider traveling abroad for a necessary hospital procedure. And among those who would travel, it was higher for the younger generation, with 31% of Gen Y saying they would travel, 30% of Gen X, 21% of baby boomers and 17% of seniors.

When it comes to actually leaving the country for medical treatment, only 1% of consumers say in the survey that they have traveled outside the U.S. to consult with a doctor, undergo a medical test or procedure, or receive treatment in a 12-month timeframe.


'An interesting phenomenon'

"That's an interesting phenomenon," says Terry White, president of Denver-based BridgeHealth. "We buy our TVs made in Japan and our cars made in Germany, but we have this idea that health care in the U.S. is way better than anywhere else.

"It says something about the level of spend that we do in this country," he adds. "We think we must be getting more if we spend more, even though all the population statistics would beg to differ."

In the Deloitte survey, consumers say they are most concerned about quality of medical care and treatment when going abroad. "I don't think every employer has the exposure to the high-quality opportunities that might be out there," Ryan adds.


Growth potential

According to a KPMG issues briefing, there are more than 3 million patients currently traveling for medical procedures worldwide; the industry is growing at a rate of 20-30% annually and its global market size is expected to reach $100 billion this year.

And those in the industry agree that the field will continue to grow.

"I think more and more people are evaluating their options and are looking at international, high-quality providers as an alternative for some of the highest cost surgeries," Epstein Becker Green's Ryan says. "Particularly if they have huge out-of-pocket expenses ... I see this as a growth opportunity."

Additionally, in light of health care reform, Edelstein believes that there will be access issues as more and more Americans potentially become covered by health care insurance for the first time.

"Right now, we already have a shortage of health care providers," he says. "If we add 50 million Americans, the demand on limited health care providers will be even greater, resulting in long waits to get care. Individuals will say, 'I don't want to wait. I will go outside the U.S. to get the procedure done in the next week or two.'"

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