Amidst the brouhaha over health care legislation, Harvard Business Review has produced a report "Megatrends in Global Health Care."  One interesting statistic is that medical tourism – that's when someone leaves the USA to have a procedure like surgery performed in a foreign country – has risen from 750,000 in 2007 (more than you would have guessed, I bet) to about 1.2million.  Yep, people are going outside the USA for health care.

While everybody in the USA is asking "what do you want" for health care, there is a marketplace.  To recognize this you have to overcome myopia and think bigger than the U.S.  Anyone can have health procedures performed in Germany, France, Canada, Japan, Thailand, Mexico, Brazil, India – etc.  Of course you have to pay for it.  But in medical tourism instances, it is cheaper to have the care provided offshore, often with extensive after-event recovery assistance, rather than in the USA.  Even if you have insurance (which may have declined to cover the procedure because it is so expensive domestically).

While everyone is arguing about healthcare, some violently, it will be the marketplace that will determine what health care we get and how much it will cost.  People want good service at a good price, and they don't like "middle men" such as insurers or regulators, making the trade-offs for them.  They want options, and they want to know likely expectations, and they want to know the actual cost as well as the therapy cost, medicine cost and impact on work, income and life.  Then they want to make an informed decision.

The beauty of medical tourism is it provides a marketplace mechanism for those things to happen.  America has great health care, but it is wildly expensive.  Multiples of the cost in other countries. If you are uninsured, either you don't' get complete health care or you want someone to jump in and bail you out (like a government agency).  If you are insured, quite simply your healthcare is subsidized, and it is dictated to you by the terms of the insurance company – not really much different than a government program just a "privatized" bureaucratic group making the decision.  You aren't the payor, someone else is, so as much as you want to be the "customer" you really aren't.  In America the golden rule of health care applies "he who pays the gold gets to make the rules" and that would be your payor (which is either your insurance company – with guidelines from your employer – or medicare with government guidelines). 

But with medical tourism, you are the customer.  Nobody between you and the doctor, facility or other provider.  You get to hear options, and make decisions.  Gee, what an interesting approach.  This is now competition for the extremely expensive American health care industry.  If you don't like your drugs, go buy them in Mexico or Canada – why let a bureaucrat scare you into paying 5x or 15x more?  If you want a procedure, go get it Paris or Peking.  If you need extended therapy, do it at a spa in Thailand.  And all of this done at a price that is a fraction of doing it in the USA.  Smart providers will soon have to start paying attention, and find ways to compete!

A lot of people want to affix blame for the cost of American health care.  As long as there's no marketplace, then I guess blame fixing is what people like to do.  But if we instead focus on the competition we can see how rapidly things will change.  When a hospital is losing customers to Hyderabad, or a facility in Florence, how long will it keep tinkering with an approach that costs too much and is losing customers?  Real change  happens when people realize that they can fail if they don't change their old Success Formula.

The best thing about medical tourism is it creates a very real option, and very real competition.  If you aren't thinking about it, you should.  You would be surprised what you can have done, and at what quality, and the cost.  While you don't want to run to Damascus to see your doctor for a sinus infection, when it's time for a knee replacement Nice might just be the place to go.  Give it some thought, because your behavior will speak a lot louder than your words when it comes to creating real change in American health care provision and cost.