Intended for healthcare professionals


American Medical Association provides guidance on medical tourism

BMJ 2008; 337 doi: (Published 30 June 2008) Cite this as: BMJ 2008;337:a575
  1. Jessica Wapner
  1. 1New York

    The American Medical Association (AMA) has drawn up guidelines on medical tourism for patients, employers, insurers, and medical travel coordinators. The guidelines call for better public awareness about the need to coordinate care before and after operations. They also advocate that financial incentives to obtain care outside the US do not inappropriately limit the alternatives available to patients or restrict referral options and that patients are referred only to internationally accredited medical institutions.

    The association plans to introduce model legislation based on these principles for evaluation by state law makers.

    An estimated 150 000 US residents obtained health care abroad in 2006, attracted by lower prices, which are important to people without insurance or who have inadequate insurance. Hip replacement surgery in the United States costs $18 000-$26 000 (£9000-£13 000; €11 500-€17 000), whereas in India it costs $9000.

    Some people also travel abroad for care that is not legal in the US, such as stem cell therapy.

    But because medical and healthcare practices vary widely among countries, patients seeking treatment abroad are exposed to several risks. People undergoing surgery in another country may not be guaranteed insurance coverage for care after their operation when they return.

    Standards of care may vary, and long flights after surgery carry a risk of complications, such as pulmonary embolism. Combining a medical visit with a holiday, which many medical tourism companies offer, could also be detrimental.

    The guidelines note that insurance coverage for medical tourists should include follow-up care in the US and that follow-up arrangements should be settled in advance of procedures abroad.

    Recently some health plans have begun integrating foreign care into their benefit packages. In 2007 Blue Cross and Blue Shield, of South Carolina, created a subsidiary company to help beneficiaries plan trips to Bumrungrad International Hospital, in Thailand, for discounted care. United Group Programs, an insurer based in Florida, has recently started promoting surgery in Thailand as an option for some of its clients. A California based insurer covers care in Tijuana or Mexicali, in Mexico, with far lower premiums than for its other plans.


    Cite this as: BMJ 2008;337:a575


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