Medical Tourism
The Smug French
Us Brits believe our health system performs worse than other European ones – only the Italians and Czechs are more damning about their systems. At the other end of spectrum, the French believe their health system is the best in Europe (see figure 1). Given our apparent dissatisfaction what will happen in practice with the proposed EU reforms?
Figure 1: Responses to “how do other European health systems perform compared with your own?” Results shown are for number of responses stating ‘better’ minus answers of ‘same’/’worse’. Source: Stockholm Network, Impatient for Change, 2004
EU reform
The new proposal makes it possible for people to access non-hospital treatment in another EU country without needing the permission of their domestic doctor or medical authority.
Under this change, patients would only have to pay the difference between the cost of the treatment in their home country and the cost of the same treatment where they received it. Hailed as a ‘bonanza’ for patient choice in Brussels, it nevertheless looks as if the UK Government will still be allowed to insist that patients must obtain permission from the NHS in advance for all hospital treatment and for many out-patient procedures, such as scans and minor surgery.
The NHS’ role is to commission efficient and effective treatment for its patients. It shouldn’t matter where the service is provided if a patient is willing to travel for it. So is the DoH being overly protective in this instance? Rather than judge the DoH’s reaction, we think it useful to explore the potential benefits and impact of the EU’s proposed reform.
The US story
With its commissioning hat on, there is an argument to say that if the DoH can source services faster for the patient and cheaper for the tax payer, the optimal solution is to shop around. Here lies the driver behind the growth in health tourism in the US. US payors (healthcare insurers) see a very real advantage in a 80-90% cost reduction in procedure cost (see figure 2). They will even pass on some of the benefit to the patient if the patient can be persuaded to visit Singapore or India for their treatment.
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Cost of a heart bypass operation (why insurers are partnering with overseas hospitals) |
|
| U.S. | $130,000 |
| Singapore | $18,500 |
| Thailand | $11,000 |
| India | $10,000 |
Figure 2. Source: Business Week, 13th March 2008
Fairly comparable
Back to the EU reform, how does England compare with the other Europeans? We were surprised to see, pretty well. The cost of a primary total hip replacement is shown in figure 3. There’s not much difference in cost, unless patients are willing to travel to new EU member states for treatment.
Figure 3: Mean cost, minimum and maximum cost of primary total hip replacement, evidence from previous studies, 2005 T Stargardt, Health Economics 17:S9-S20 (2008)
So perhaps the tax payer cost argument is not enough to dissuade “commissioner-NHS” from protecting “provider-NHS” from European competition, but what of the service benefits to patients?
Spoilt for Choice
The introduction of patient choice is testament to the government’s belief in competition and all the good performance and service benefits that should come from that. Unregulated access to cross-border provision represents choice in the extreme and it’s a harsh scenario for a national system which is perceived to be inferior to its neighbour.
The most obvious service differentiator is waiting time, an area which may not even need the EU draft to have teeth - Yvonne Watts’ European Court ruling established that a patient is entitled to be remunerated for treatment abroad without prior approval. This is provided the procedure cannot be performed within the time considered advisable by the treating clinician.
Another, more interesting, differentiator is quality which may come at a premium. This raises the question of co-payment. Should you discriminate between a patient who wants to travel to receive faster, possibly better treatment and one who wants to remain in the UK but wants to self-fund a dose of extra treatment or better drugs?
Catalyst or can of worms?
Depending on where you sit then, you might see medical tourism as catalyst for co-payment models, a stick to drive quality, hot air about relative treatment costs, or a reassuring measure of last resort for patients to turn to when their native service is found wanting. We think “provider-NHS” should find this situation a bit uncomfortable but not truly frightening. As patients we think “commissioner-NHS” has little to lose.
