Americans Abroad: Long Term Care and Medical Tourism

November 19, 2008

The Dallas Daily News published a story recently featuring the emergent Long Term Care industry in Mexico.  (link here). What is remarkable about this story is that the newspaper was not discussing new developments in Assisted Living and Skilled Nursing Care in Mexico, designed for Mexicans, but rather new facilities built for the purpose of serving Americans who want to spend their senior years south of the border.  

The listed the pros (strong dollar agaisnt the peso, inclusive culture of long term care in the country, warm weather, little regulation) as well as the cons (little regulation, untested providers, far from family and friends).  The experts from the article seemed to think that servicing the long term care needs of Americans will not just be a niche marketing technique, but rather an entire industry.  As far as I’m concerned, the jury is still out, but the business model is intriguing.  Generally speaking, it is an application of so-called ‘medical tourism.’

I’ve written about this phenomenon with greater precision elsewhere (link here), but the broad strokes are, simply, using the economic inducements of cheaper medical care and exotic, vacation-like locales, to draw wealthy, western patients to poorer, underdeveloped nations for specific, acute medical care.  Most of these ventures have focused on providing surgery to the medical tourist patient, but I see no reason why the long term care industry cannot profit from the same underpinning economic advantages as the mega hospitals in Bangkok that offer hip replacement surgeries for a tenth of the cost as hospitals in the U.S.  

Such foreign provided care is not without problems (resident safety, payor sources, etc.), and the issues are much different for American citizens who intend to move to Mexico to remain rather than stay for a week of surgery.  However, these Mexican facilities may provide some much need dynamic competition to our home-grown long term care facilities.  This is a development I intend to watch very carefully.

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2 Responses to “Americans Abroad: Long Term Care and Medical Tourism”

  1. Sunny Says:

    I tend to disagree about medical tourism being a good thing. I believe American-trained doctors working in American-regulated hospitals is best for all involved; I’m not saying other countries don’t have good healthcare, but I do believe that the countries which offer medical tourism are known for substandard training, hygeine, and patient advovcay. That last issue – advocacy – to me becomes a major issue in eldercare like assisted living facilities. Who will be regulating the conditions in which these elderly, possibly cognitively-impaired individuals live? They won’t be close enough for relatives to go visit; they won’t be monitored by state and federal regulations of the US. I think we need to focus on improving the healthcare system in our country, and longterm care facilities shouldn’t be tempted by the profits to be made in countries without our regulations and protections.

  2. nursinghomeadministrator Says:

    You are absolutely correct to point out that one of the (many) things that gets sacrificed when patients go from highly regulated care to under regulated care is patient advocacy. Whether it is surgery in Delhi or Assisted Living in Cancun, the only incentive for hospital administration to act as patient advocates is professional/moral, not legal financial. And, as you also correctly point out, patient families will bee “out of the loop” because medical tourism always takes place away from the patient’s home — by definition.

    Let me make two things very clear: 1) I do not buy the argument that goes something like this: ‘medical malpractice litigation makes health care too expensive for people to afford US hospitals (and nursing homes); 2) Neither do I think it wise to conceptualize hospitals and long-term care facilities along the same lines as other service-industry businesses. Regulation makes health care better. But, the fact remains that health care, specifically long term care at the Assisted Living level, is increasingly pricing people out. Medical Tourism, I think, may be part of the solution, but not necessarily in the way you might think.

    Having an out-of-country option for the delivery of care helps those that cannot afford care in the U.S. by being better than nothing. But, this is very short term, and in the end, not really much of a help at all because a health care delivery system must be sustainable, and dependable over time to be of any real use. Instead, Medical Tourism in Long Term Care can be a good thing because it provides another facet of pressure on the US health care system to work more efficiently. Market forces cannot do it alone, but competition from foreign competitors for US patients, targeted lawsuits identifying problems by consumers and increased/improved regulation by state and local governments, when working in aggregate, just might. I welcome, therefore, additional pressure that will help to make our care delivery systems better for patients — even if it comes in the form of direct foreign competition.


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