Chapter 1 Page 5 | U.S. Health Care and Spiraling Costs

There is no denying that a public rush to embrace medical tourism could have significant impact for the more expensive or overburdened healthcare systems of the West, particularly for the United States. The healthcare system in the United States has been considered to be in crisis for much of my adult life due to rapidly increasing costs. Health-care spending in the United States reached 15 percent of Gross Domestic Product(GDP) in 2003, even with 42 million or so individuals uninsured.

The United States has, by far, the most expensive health care in the world, by almost any measurement. It may  in some ways also have the best quality of medical care in the world, though that is a contentious statement. What is most important right now for the future of medical tourism in the United States is that most Americans believe they have access to the finest doctors, the most advanced medical technology, and the top facilities in the world. They believe this at a gut level; it is something they have been told all their lives.  They hold this conviction only slightly less absolute and dear, perhaps, than they do the notion that the United States is the best and/or greatest country in the world.

We Americans, deep down, have difficulty believing that individual doctors, dentists, surgeons, and medical facilities abroad can be every bit as good as the ones at home.  It is mostly because we have been instilled with a belief in the superiority of the U.S. medical system, mostly by people who are part of that system. It is close enough to the truth that it is a difficult notion, psychologically, to abandon. It is a part of the American mindset.

At some level above that gut feeling, however, we are profoundly concerned about the quality and cost of medical care in the United States, which leaves open the door to the possibility of medical tourism. We may believe we have the best, but we also think it is not nearly good enough,  and that it costs way too much. According to a poll released in November of 2004, (3) 55 percent of Americans were dissatisfied with the quality of health care compared to 44 percent 4 years earlier;  just 17 percent said the quality of U.S. care was improving.  Another survey, this one released in June 2005, (4) found that 45 percent of Americans were “very worried” about having to pay more for health care and insurance.

In fact,  more respondents were “very worried” about rising health-care costs than having an income that wasn’t keeping up with rising prices (40 percent);  not being able to pay rent or the mortgage (24 percent);  losing money in the stock market (19 percent);  being the victim of a terrorist attack (18 percent);  or losing a job (17 percent).

Despite these numbers,  I am glad not to have to challenge the notion that U.S. medical care is generally the best in the world.  After a year of researching medical care around the world, I have greater esteem for the U.S. medical community than I did previously, and I count myself among the minority that thinks that quality in the United States is generally getting better.  I think we have terrific doctors and surgeons, the finest medical technology, bar none, and more of the finest medical facilities than any other country. You might disagree.  But that is really an argument for politicians, doctors, and health-care policy analysts.

Whether the quality of health care in the United States is getting better, or worse, or is treading water,  is an interesting question, certainly.  But does a patient care about the overall quality of the $1.7 trillion American medical system when making a personal decision about what doctor to go to or what surgeon to choose?  The answer would seem to be immaterial to someone who is making the personal, one-on-one choice as to what doctor to see or what surgeon should operate.  It would seem to be the case, anyway, unless and until one is considering choosing a doctor or surgeon outside of the United States.  For most people, a powerful caution kicks in.

It certainly did for me.

(3) Harvard School of Public Health Survey conducted with the U.S. Agency for Healthcare Research and Quality in Rockville, Maryland, and the Kaiser Family Foundation, based in Menlo Park, California. November 2004.

(4) Kaiser Family Foundation, Kaiser Health Poll Report, June 2005.

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