Expert says wealthy patients come for better care, support services, amenities.

In Maine, most people probably think of medical tourism as a thing Americans do to save money.

A trip to Canada for cheap medication. Some time in Costa Rica for discount dental work. A flight to Barbados for low-cost fertility treatments.

But while the U.S. Centers for Disease Control estimates that 750,000 Americans travel abroad for medical care every year, experts believe about 1 million people come to the United States.

They’re not looking for cheap. They’re looking for the best.

“Most of the patients coming into the United States, No. 1, are affluent and can afford to pay the price of our very, very high-priced health care because most of those patients are self-pay,” said Josef Woodman, founder of Patients Beyond Borders, a website and book series that advises patients about medical tourism.

“They’re (paying) out of pocket,” he said. “And they’re traveling for complex procedures, either for them or for their loved one, including their kids.” 

Although patients come to the U.S. from all over the world, they most often come from regions where medical care isn’t great or the wait for care is long — China, India, Russia, the Middle East and Africa, in particular.

Travelers often seek cancer treatment, cardiology care, neurosurgery, orthopedic surgery or help for their children.

“Pediatrics is huge,” Woodman said. “Almost any academic pediatric hospital in the country does a good bit of international business. If you go to, for example, Texas Children’s (Hospital’s website), they have an international page.”

Patients like traveling to the U.S. because they can get immediate, high-quality, cutting-edge care that isn’t available at home. 

Hospitals like caring for medical tourists because they’re lucrative. Very lucrative.

“Nobody’s looking to the United States to save a buck,” Woodman said.

Partners HealthCare is a nonprofit health care group that includes Massachusetts General Hospital, Brigham and Women’s Hospital and other medical centers in and around Boston. It sees an estimated 6,000 international patients per year — less than half a percent of all of its patients — but the hospital group maintains international patient centers within its two largest hospitals and has created a special division to serve foreign patients and attract more.

“That’s a small population, but it tends to have disproportionate financial potential for hospitals,” said Ed McCarthy, Partners’ vice president for international business. “These patients, for the most part, tend to pay a higher percentage of the charges than local patients. Local patients are usually insured and their insurance companies negotiate discounts and special rates with hospitals.”

Although some foreign patients have health insurance, most don’t. They — or, sometimes, their governments — pay cash with little-to-no haggling on price. Even when hospitals offer 25 or 35 percent discounts, serving foreign patients is still extremely profitable. A single patient can pay tens of thousands of dollars, depending on the treatment. 

With that in mind, large hospitals are increasingly creating international patient departments, forming relationships with “concierge medical tourism” groups to get referrals, and branding themselves — and advertising — as the best places for foreigners to get health care.    

In Rochester, Minn., the Mayo Clinic has become one of the best at wooing medical tourists, both from within the U.S. and from other countries. It’s gotten so good that The Boston Globe recently ran a feature about it.

About 40 percent of the 400,000 patients seen at Mayo’s main Minnesota campus each year live at least 500 miles away, and 8,500 live in other countries, according to the story. That means about 2 percent of their patient population comes from outside the U.S., compared to less than half a percent at Partners.

Woodman said successful hospitals have the basics down when it comes to foreign patients: interpreters, familiar foods, cultural sensitivity. They also have a stellar medical reputation, are easy to get to and, often, have cultural or medical relationships with the sending country. (South Florida, with its Hispanic culture, draws a lot of patients from Spanish-speaking countries, for example.) 

But there’s “tourism” in medical tourism, too. Location matters to patients. Hotels matter. Restaurants, shopping and activities all matter.

“If you’re a patient from somewhere else and you have a choice between going there or New York or London or Los Angeles or Boston or Dubai, you’re competing not just on medical care, you’re competing on the entire pluses and minuses of that city,” Woodman said. “Let’s put it this way: If you can convince a lot of people to come to Rochester, Minn., especially in the wintertime, you’re doing something right.”

The Mayo Clinic and the state of Minnesota seem to agree. In 2013, Minnesota passed a “destination medical center” law that gave a half-billion dollars in state tax breaks to a $6 billion expansion project designed to make the Mayo Clinic and Rochester a complete global medical destination.

Woodman sees medical tourism growing 15 to 20 percent per year worldwide in the coming years as people in developing countries get richer and more cutting-edge treatments become available. 

Long term — in 30 or so years, as more countries develop good medical care — he predicts medical tourism will decline. Mostly. 

“There’s always going to be travel for star doctors, for access to certain types of treatments, for experimental treatments. And for value,” he said.

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