By now, most medical professionals know the hard truth about healthcare delivery in this country: both cost and quality can vary greatly for the same medical procedure from region to region and often times from hospital to hospital in the same market.
It is these same variations between the availability of care in one country versus a patient's home country that has led to the burgeoning international medical tourism industry.
Countries such as Costa Rica, Singapore, India, Turkey and others all have expanding medical sub-industries devoted to providing everything from cosmetic surgery and dentistry to more complex cardiac and joint replacement therapies. Often, people seeking treatment for specific conditions in these countries can save as much as 75 percent on some treatments, even when adding in the cost of the travel.
According to the Medical Travel Association, a global trade organization, nearly 400,000 Americans and 2 million residents of other countries seek out and get some form of medical treatment outside their native country each year. Websites like Patients Beyond Borders and magazines such as Medical Health Tourism help consumers research and find their best treatment options.
One common theme that attracts patients to medical tourism is one that the American medical community is yet to fully embrace: people traveling for treatment know what they'll get and how much it will cost them before making a decision about their healthcare.
But the tide may be starting to turn in the U.S. if programs like Walmart's recently announced Centers of Excellence program are any indication. Using its massive buying power of more than 1.1 million covered employees, Walmart has contracted with six top class medical facilities around the country to provide for a menu of spinal fusion and heart procedures with the sweet offer of picking up 100 percent of the tab of the care, without co-payments or deductibles. It will also pick up 100 percent of travel, lodging and food costs for the person receiving the treatment and a companion.
In selecting the providers for the program, Walmart took into account a number of different factors aimed at improving the cost and quality of the care delivered, according to Walmart spokesman Randy Hargrove.
"We selected multiple medical facilities to participate in this program because of the number of individuals enrolled in our plans," Hargrove noted. "Geography was a factor; an established, accredited program for spine or cardiac care; systems and accountability in place to ensure that evidence-based care is provided; physicians that are incentivized based on the outcomes, not the volumes on patients seen; and experience with medical travel."
For those who have long wanted significant competition and market forces to be brought to bear in the market, this program from Walmart may be the most significant yet.
Sabrina Corlette, of the Center on Health insurance Reform at Georgetown University's Health Policy Institute, hopes these efforts will expand. "Employers have been screaming bloody murder about price increases for some time, and with good reason," she said.
Her hopes are that employers will start forming coalitions, as they have in Oregon and Tennessee, whose goals are to bring market might to the table when it comes to the level of care, cost and quality they expect for the healthcare dollars they spend.
"My dream is that as this is happening at the employer side, that the states should also be at the table, since they also have a good amount of purchasing clout. What would happen if they all lined up and said they all want things such as not paying for readmissions and wanting a medical home and care coordination?" Corlette asked. "Right now you just have a few payers asking for this, but it is not critical mass."
Walmart is not the only employer to take this route. Late last year Pepsi announced it was providing a similar program in conjunction with Johns Hopkins to allow covered employees to travel there for certain joint and cardiac treatments.
But when the largest private employer begins negotiating for healthcare in this way, with the intention to expand the program in the coming years to other treatments, it is not to be taken lightly.
As Brian Klepper, managing principal of consulting company Healthcare Performance Inc. noted in a recent blog post: "Health systems and specialty groups in the U.S. have operated completely outside conventional market forces for decades, a fact that largely explains U.S. healthcare's egregious cost, highly variable quality and rock-bottom value relative to healthcare in other industrialized nations. As the market becomes more cost-weary and price-sensitive, purchasers will follow the leads set by Walmart, Lowes and Pepsico. They'll align with organizations that can measurably demonstrate better care at lower cost."