John Maa, M.D.

By John Maa, M.D., Assistant Adjunct Professor of Surgery, Division of General Surgery, and director, Surgical Hospitalist Program, TheUniversity of California, San Francisco (UCSF) Traveling overseas for low-cost medical procedures was touted on Capitol Hill as an alternative to the high prices of medical care for uninsured Americans as early as 2006. By 2012, Deloitte LLP reported that as many as 1.6 million Americans might travel abroad for medical care. Consistent with the premise of Thomas Friedman’s The World is Flat, it was speculated that globalization and competition, achieved through the ability to compare prices for surgical procedures internationally, would create a special opportunity to drive down skyrocketing prices for medical care in the US. Fast-forward to early 2013: preliminary observations from Thailand and India suggest that a mass influx of Americans for healthcare has not yet materialized. A key intent of the Affordable Care Act (ACA) was to significantly reduce the ranks of uninsured and underinsured Americans, but it is unclear whether the legislation has sidelined medical travel.  The death of an American who received care in Bangkok in 2006 triggered lingering concerns about the safety and quality of care abroad, and highlighted the difficulties of legal recourse against an international hospital in the case of adverse outcomes. But large numbers of medical travelers continue to travel from Europe, Asia and the Middle East to Thailand for medical care.  Furthermore, boutique services offering procedures, such as 24/7 colonoscopy and endoscopy, for medical tourists have proliferated and been successful. The re-election of President Barack Obama ensures the preservation of his signature healthcare and insurance reform legislation.  Some suggest that the focus on medical travel expansion will therefore shift away from the care of uninsured Americans towards insurance companies seeking to offer low-cost alternatives to employers and employees. The special opportunity to utilize financial forces to drive healthcare costs down in the US remains untapped. What’s more, there is much that the nation can learn from the healthcare delivery systems in other countries.  Consider the following from The Nation: Thailand spends just over four percent of its gross domestic product (GDP) on healthcare, and achieved universal access to healthcare in 2002, along with remarkable reductions in infant mortality and HIV infection rates. In the World Health Organization ranking of healthcare systems of 2000, the US was 37th, while Thailand was 47th. As US healthcare expenditures approach 20 percent, with the Congressional Budget Office projecting that 30 million Americans will still remain uninsured despite the ACA, one might reasonably conclude that the Thailand system represents a better return on investment for their healthcare dollars. Perhaps the greatest benefit would result from sending elected US officials, health policy experts and policymakers abroad to observe real-world solutions that are succeeding in other nations, and integrating these valuable lessons into the US healthcare system. About John Maa, M.D. John Maa, M.D., assistant adjunct professor of Surgery, Division of General Surgery, and director, Surgical Hospitalist Program, at the University of California, San Francisco (UCSF), is dedicated to improving the quality and access of emergency surgical care. He earned his medical degree at Harvard Medical School, and served as a captain in the medical corps of the US Army for nine years. In 2009, Dr. Maa was named one of the country’s leading advocates for healthcare reform by HealthLeaders.