Homesick for Healthcare

As a naturalized U.S. citizen of nearly four years, I don't often worry about whether I'm assimilating well -- I usually feel right at home. Aside from wanting to visit family and friends, there is only one reason why I sometimes wish to go back to my home country: for health care.

Don't get me wrong. I am convinced that health care in the U.S. is exceptional -- but it is also exceptionally expensive. Like many of my immigrant friends, I have realized that, even after factoring in airfare and other expenses, obtaining medical care in my home country can be thousands of dollars cheaper.

This realization is not unique to immigrants. Faced with rising health-care costs and elevated deductibles, Americans are doing more research and finding that procedures such as knee replacement, for instance, which costs more than $40,000 in this country, can be done for less than $9,000 in India. In many cases, these proactive patients are able to negotiate deals with their insurance companies that save money for both the insurer and the insured.

According to the consulting firm Deloitte LLP, 750,000 U.S. citizens traveled abroad for medical care in 2007. This year, the firm estimates that the number will be close to 1.2 million; and next year, 1.6 million.

For immigrants, lower costs aren't the only appeal. Elmer Huerta, an oncologist from Peru popular with Latinos in the Washington, D.C. area, calls it "cultural empathy." Aside from hurdling language barriers, Huerta explains, Latino immigrants value a more personalized kind of care: doctors who are more accessible, more willing to talk with patients and their relatives, and more inclined to provide guidance rather than simply presenting a laundry list of options.

In the current debate over reform of the U.S. health care system, the immigration issue is being used to distort facts and instill irrational fear, largely with the hope of derailing the effort. One common misconception is that illegal immigrants will end up receiving free health care.

The reality is that neither the White House nor Congress is considering including undocumented immigrants in the new plan. Bills from both the House of Representatives and the Senate explicitly deny any subsidies to people living here illegally. If anything, immigrant advocates' main concern is that even legal immigrants won't be eligible for federal assistance for health insurance premiums if they have been living in the U.S. for fewer than five years.

Not surprisingly, some strongly oppose the idea of promoting health care solutions abroad. The alternative to a lack of care "should not be that you travel 1,000 miles," says Jennifer Ng'andu, deputy director of the Health Policy Project at the National Council of la Raza, a Latino civil rights and advocacy organization. "It should be right here at home."
Yet the fact remains that, for years, foreign-born people in this country have found going abroad to be an attractive alternative.

"We have individuals who already have established a pattern of travel for care because it meets their cultural and communication needs," says Ana Andrade, vice president for Latino programs at Health Net of California. In 2000, the company launched Salud con Health Net, which offers California residents the option to receive care in Mexico. "By expanding the scope of services," she says, "we are meeting a need that exists and that increases the care and improves the health status of those individuals."

At Health Net, the average cost of insuring a family of four whose treatment takes place primarily in the U.S. is $990 per month. If they're treated by physicians in Mexico, the average cost is $606 per month. If additional family members live in Mexico, they may also be covered under the same policy.

Since 1972, Western Growers has offered similar benefits to thousands of farmers in California and Arizona. Organized as a nonprofit cooperative, the association currently includes 200 physicians and 12 hospitals in its Mexican provider network.

These programs are geographically limited. But according to Paul Keckley, executive director of the Deloitte Center for Health Solutions and author of the report "Medical Tourism, Consumers in Search of Value," more and more U.S. insurance companies are beginning to offer plans with foreign treatment options beyond Mexico.

Initially, companies were reluctant to do so, wary of creating tension with local doctors and hospitals, Keckley said in an interview. But the supply of such health care plans has steadily increased in response to demand from employers and individuals.

If the ultimate goal is for most people in this country to have access to good and affordable health care, a plan that offers a foreign treatment option makes a lot of sense -- and may, in fact, sell itself.