As the battle rages on over how to address the health care crisis in the US, growing numbers of people have decided to seek more affordable options abroad. Americans are traveling to destinations across the globe – from Buenos Aires to Singapore, from Istanbul to Seoul – to receive care for a range of afflictions or to undergo elective procedures. And they are not alone. Would-be patients from throughout Europe are also crossing borders in search of lower medical costs. At the same time, many from around the world are looking to the US and other countries for more advanced care than they could receive at home.The medical tourism industry is a $20 billion market and is expected to reach $100 billion by 2012. Estimates of the number of people who travel abroad for health care vary widely. Some have suggested 1.3 million in 2008. A report by management consulting firm McKinsey and Co., released in May of that year, offered a slightly more conservative number, noting that 60,000 to 85,000 patients annually undergo inpatient procedures on foreign soil. (To some extent, the discrepancy may result from varying definitions of “medical traveler.” For example, the McKinsey figures do not include those who received outpatient care, emergency treatments, or acupuncture and massage. Nor does the data include expatriates who sought care in their adopted homes.)With health care costs on the rise, many Americans are seeking less expensive alternatives abroad. Countries such as Brazil and Argentina, for example, offer a wide range of dental and cosmetic procedures at a fraction of the US cost – and, not incidentally, tropical locales in which to recuperate.The majority of those who seek care abroad, the report notes, are looking for advanced technology (40 percent), better care (32 percent) and faster medical services (15 percent). Only 9 percent of medical travelers – the bulk of them US citizens – are pursuing lower costs. The report identified this latter market as having the highest potential for growth. Likely, this is even more the case today, with unemployment skyrocketing and those who still have jobs often unable to afford ballooning health care costs.Most medical travelers from the US are having procedures done in one of four areas: dental, cosmetic, orthopedic or cardiovascular. For dental and cosmetic work – including laser teeth whitening and photorejuvenation with intense pulsed light – they are flocking to Mexico, Brazil and Argentina. Patients are attracted by the lower costs (Mexico offers dental and cosmetic surgery at 25 to 35 percent savings; Brazil offers cosmetic surgery at 40 to 50 percent savings) and the relative proximity of these countries.Not to be underestimated, of course, is the additional allure of combining medical travel with vacations in exotic locales – recuperating on the white sands of Rio, for example.The growth in medical tourism has had a positive impact on sales and revenue in the medical device industry. “When you think about it, many countries that have substantial medical tourism efforts market themselves as having similar standards and the same-quality equipment [as in the US, for example]. So it goes without saying that they would have GE, Medtronic and other multinational name-brand devices,” said David G. Vequist IV. He is director of the Center for Medical Tourism Research, located in the H-E-B School of Business and Administration at the University of the Incarnate Word in San Antonio.In an article in the October 2008 on-line issue of Medical Tourism Magazine, Vequist reported a small, measurable impact on US medical equipment sales from the growth of international medical tourism. Using US export data, he showed that countries with a robust medical tourism presence purchased 10.1 percent more medical equipment than countries with almost no medical tourism – or at least with no discernible presence – during the years 2003 to 2007. The former group includes Mexico, South Korea and Singapore, whereas the latter group includes Canada, Japan, the Netherlands, Germany, the UK, Ireland, Belgium and Switzerland.Of course, growth in countries such as Mexico is largely the result of demand from within a developing economy; however, medical tourism could still account for 1 to 3 percent growth of related equipment sales. According to a very rough estimate, this percentage could mean $73 million per year in US sales to developing countries, Vequist said.Manufacturers of medical lasers should also benefit from the medical tourism boom. When asked about laser-based dental care in Latin America, for example, Vequist and Eduardo Galan, a student in the MBA program at H-E-B, pointed to a 2009 report from the Center for International Trade Development. Titled Best Export Markets for U.S. Medical Equipment and Supplies, it suggests that dermatological and laser treatment equipment sales in countries such as Colombia will be boosted by medical tourism and expanding demand for plastic surgery.And the medical tourism market continues to grow, especially as employers and insurance companies begin to recognize the cost benefits of seeking care abroad. In January 2007, the Scarborough, Maine-based grocery store chain Hannaford Bros. Co. introduced a program in which it covers 100 percent of the costs, and up to $10,000 of the travel expenses, for employees who have hip or knee replacements performed at an approved hospital in Singapore. Peter Hayes, the company’s director of associate health and wellness, noted that the program could save 70 percent of the medical costs associated with these procedures.Similarly, BasicPlus Health Insurance of Roswell, Ga., has partnered with Companion Global Healthcare Inc. to offer members with fixed benefit maximums the option of seeking care abroad at approved accredited hospitals. To make this option less daunting, the companies provide assistance in scheduling appointments and making travel arrangements.Coverage a questionThese programs are relatively limited in scope; elective procedures that use lasers – teeth whitening and any number of cosmetic procedures – are not likely to be covered. Still, the companies extending benefits to include some medical services provided abroad could produce a sort of halo effect, casting a positive light and possibly legitimizing medical tourism as a whole.On the other side of the medical tourism coin are patients seeking the best possible care – currently the largest portion of medical travelers. Most of these are coming to the US, oftentimes because physicians from their native countries have trained or are currently practicing in the US, or because friends or family have sought treatment in the US. Of course, reputation also plays a role: The US is still widely perceived as providing the most advanced care in the world.Accordingly, these patients commonly travel to the US to receive cutting-edge cardiovascular, neurological or oncology treatments, with little regard for proximity or cost. Because such treatments are often expensive and typically are paid for in full by the patients’ governments or insurance – or by the patients themselves – US hospitals are marketing themselves more heavily to this particular clientele.Attracting medical travelers helps generate revenue that hospitals can reinvest, for example, in upgraded facilities or new equipment.