A Qualitative Study of Current Status and Emerging Trends of Medical Care Outsourcing

Objective: To explore health insurer perceptions and strategic plans regarding medical care outsourcing. Globally, international medical care is estimated at $1 billion.

Study design: Key informant interviews, (20 health insurance executives, convenience and snowball sampling, structured question guide). Qualitative analysis using Nvivo, and semi-quantitative analysis.

Results: The sample (2 CEOs, 7 VPs, 7 directors of strategy/allied functions, 1 Chief Operating Officer, 3 medical directors) represented companies/plans covering 57.2% of the US private health insurance market. Majority (14) distinguished medical tourism (consumer-sought medical care abroad) from medical outsourcing (payer/provider utilization of international talent for financial savings). Of 20, 19 considered it a likely and feasible alternative for American patients, a trend that would be driven by cost conscious employers and consumers. 17 were closely watching market trends (supply and demand), 1 offered international dental benefits (and 4 in process), 2 were adding it as ancillary benefits (mostly cosmetic procedures). All participants had engaged in market research on global outsourcing – 10 following historic consumer trends and 5 had conducted focus groups. Almost all were in a formative phase in strategic planning of medical tourism benefits. The most cost-rewarding and feasible for international offerings were elective hip and knee replacements (12 participants), non-emergent cardiac procedures (3), heart/organ transplants (3), cancer treatments (4), experimental treatments not approved domestically (e.g. hip resurfacing), and cosmetic elective procedures (6). Majority (14) thought consumer driven health plans would be the most likely to use tourism/outsourcing arrangements, followed by PPO (5), limited benefit plans (4), every type of plan (4). 16 thought medical outsourcing would significantly lower healthcare costs. Regarding the most viable international care locations, Thailand (14), India (13) and Mexico (11) led the pack. Key criteria in choosing the international care location were quality of care (10), local use of English language among citizenry (8), geographic proximity (14), accreditation (10), western-trained physicians (12), and cost savings (8). Of 6 insurers in process of developing international care options, 2 each were exploring Thailand and Mexico, 1 each, India and Singapore. Product offerings planned for incorporating international benefits were: value added benefit to existing plans (2), consumer driven health plans (2), and limited benefit plans (1).

Conclusion: Currently, international medical care continues to be consumer-initiated, autonomous choice. From US health insurers' perspective, international medical care is a contemplated option to meet the unaffordable segments of health care costs, but not yet a significant component of health plans.