Insurer Offers Option for Surgery in India

[Guest guest]

By RONI CARYN RABIN

NYT

Published: November

21, 2008

The health insurer Wellpoint is testing a new program that gives

covered patients the option of going to India for elective surgery, with no

out-of-pocket medical costs and free travel for both the patient and a

companion.

The program is being tested at Serigraph, a printing company in

Wisconsin whose managers have been looking for ways to curb rising health care

costs, said Dr. Razia Hashmi, chief medical officer for national accounts for

Anthem Blue Cross and Blue Shield, which is affiliated with Wellpoint.

“This is a first for us,” Dr. Hashmi said. “We

will be monitoring every aspect of this very closely, to make sure everyone is

satisfied and there are good clinical outcomes.”

By the year 2010, more than 6 million Americans annually will be

seeking medical treatment abroad, according to the Deloitte Center for Health

Solutions, a consultancy. The potential savings are significant. Knee surgery

that costs $70,000 to $80,000 in the United States can be performed in India

for $8,000 to $10,000, including follow-up care and rehabilitation, Dr. Hashmi

said. Similar savings could be achieved for such common procedures as hip replacements

and spine surgery.

If other insurers follow Wellpoint, Dr. Hashmi said, the trend

ultimately may pressure on United States hospitals to be more competitive in their

pricing.

Critics say that’s unlikely.

“There have been some reports of hospitals that have been

willing to match the prices, but I don’t know how they’re doing

that,” said Berliner, a professor of health policy and management

at State University of New York Downstate Medical

Center in Brooklyn. “The reality is there’s just no way that most

hospitals can respond to this. It’s just like any service that’s

outsourced — the price is so cheap abroad that there isn’t much an

American company can do about it.”

At the same time, he said, the program could potentially siphon

off the healthiest, most profitable patients from a local hospital.

Dr. Hashmi predicted that the program would appeal primarily to

people who have traveled abroad. Many employees of Serigraph, which has offices

in India, are familiar with the country.

“The quality is comparable” to care provided in the

United States, Dr. Hashmi said. All the physicians speak English, and patients

can share their medical records and consult with a surgeon in India before

making the trip, she said.

The pilot program arranges for patients to be picked up at the

airport and provides special meals to prevent food-borne illnesses. The program

complies with the American Medical Association guidelines on

medical tourism and uses hospitals accredited by the Joint Commission

International.

Dr. Hashmi said it had actually been easier to evaluate the

quality of medical care abroad than in the United States. “There is a lot

more willingness to share data about complication rates, the total number of

procedures and the outcomes,” Dr. Hashmi said. “We’re able to

get detail per hospital and per physician.”

In addition to saving out-of-pocket costs for surgery for

patients, the program could potentially help keep insurance premiums

affordable, Dr. Hashmi said.

But Dr. Berliner predicted that medical tourism would be of

limited appeal to Americans with private health insurance.

“Everyone is just waiting for the one horrible case to

happen over there,” he said, “and then everyone will stop thinking

this is such a great idea.”

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