Trusted by over 1.2 Million Global Healthcare Seekers
Destination Spotlight

The Americans Are Coming! Medical Tourism Patients Revolutionizing European Healthcare Markets

Renée-Marie Stephano
Global Healthcare Accreditation
Destination Spotlight

Nestled in the heart of California’s redwood region along the Pacific coast some 300 miles north of San Francisco, Blue Lake Casino and Hotel is the kind of place where people come to get away from it all.

Bruce Ryan couldn’t wait to get away, either.

But, the 59-year-old construction manager at Blue Lake Rancheria — the Native American operative which oversees the casino and hotel — had a different course of action in mind. He had about all he could take of the superlative sense of adventure that living and working among the tallest trees in the world offered. The pain and inflammation in his shoulder was crying for attention that he could no longer dismiss from the Mendocino National Forest. He needed out.

When Ryan was approached by a human resources manager at Blue Lake Rancheria about having his rotator cuff repaired, he wasn’t worried about where the surgery might be, but rather how soon could he leave.

What Ryan would learn was that surgery did not involve a six-hour automobile trip down the mountain to Stanford University Hospital, in Palo Alto, Calif. — the closest facility capable of performing the procedure and one of the finest institutions the States has to offer — but his instead would mean an excursion halfway across the globe.

Perhaps, it’s not exactly a shot heard ‘round the world. Perhaps, most Europeans are even unaware. But, the Americans are coming. Europeans have heard that phrase before, those with enough long-term memory to recall when Americans landed on the beaches of Normandy where they would begin liberation efforts to free a continent from the grasp of Nazi Germany.

But these modern-day Americans – like Ryan – although similarly well-intentioned, have their own best interests at heart. Desperate for solutions to rising healthcare costs at home, adventurous Americans are coming to Europe, where they can couple their enthusiasm for travel to the land of their ancestors with an opportunity for medical attention.

Affordable Care

Leery of traveling to a less-developed country, where places like Thailand, India and Cost Rica have become synonymous with medical tourism, some Americans – and their employers — are finding affordable treatments and procedures in nearer places – Poland, Turkey, Hungary, Germany, Italy, to name a few – and at levels on par with comparable services offered in the United States, but without the wait and at a fraction of the expense.

Governments and hospitals in Europe have only recently begun promoting their services on an international level. And, despite what many European providers predicted, U.S. employers are eager to hear what they have to say: Americans are not driven on price points alone.

Working Americans and health insurance have been linked since the start of World War II, when the federal government capped wages, forcing employers to establish other means to entice and keep employees. U.S. employers began to offer health benefits and, eventually, their employees demanded them.

Business owners have been happy to oblige because the federal tax code in the United States exempts employer sponsored health plans from taxation. American employees, on the other hand, save money by buying health insurance through an employer, rather than in the individual market, where they would have to use after-tax dollars.

Fast forward to present day and passage of the Affordable Care Act – affectionately dubbed Obamacare — which doubles down on the link between employment and health insurance by mandating that large employers offer benefits or pay a penalty. Critics of Obamacare, which requires that all insurance plans cover “essential health benefits” and caps just how much employees can contribute to their own coverage, fear, as a result, that 43 million American workers will lose access to employer-based health insurance.

Hard pressed for answers and unwilling to discard benefits packages used to attract and retain top-notch talent, U.S. employers are not only asking questions of themselves, but to employees within earshot who might be contemplating serious, but routine elective surgeries like hip or knee replacement, cataract removal, a heart bypass: Would you consider a procedure performed at a local hospital or – for that matter – at one in Asia, Europe or South America?

Employees, who have already witnessed healthcare costs shift their way, don’t need much prodding. Consider that a U.S. employee’s share of premiums increased nearly 7 percent, to $2,974 this year on average. What’s more, out-of-pocket costs also increased. The total employee cost share climbed from 34.4 percent in 2011 to 37 percent in 2014. What’s it mean? In the end, U.S. employees now pay more than $100 more each month for health insurance compared to just three years ago.

Softening Painful Realities

If those figures sound painful, European hospitals are positioning themselves to ease the blows by offering comparable procedures and treatments at rates lower than those available in the United States. Go figure?

In 2011, 82,854 foreign patients were treated in Germany on an inpatient basis and about 123,000 on an outpatient basis. For German hospitals and doctors, medical tourism pays off in annual revenues to the tune of roughly €1 billion.

More hospitals are looking to soften tough economic times and fill beds by extending their market shares overseas.

Istanbul Memorial, like other facilities in Europe, has made great strides in maintaining what is good about its existing healthcare systems while focusing on areas that need improvement.

The hospital, a member of the Medical Tourism Association®, is among a number that have achieved Joint Commission International accreditation, the so called “Good Housekeeping” seal for more than 500 public and private healthcare organizations spanning some 80 countries.

Wellness Vacations

But, it’s not like medical tourism is foreign endeavor for European nations to contemplate and pursue. Central and eastern European countries have long been known for natural spa and wellness resorts, which date back to the 18th century, when elites from the old world were lured to the region’s healing mineral baths.

Now, fast-forward to present day, when “wellness” and “vacation” have since become spoken in the same breath among American travelers, particularly Baby Boomers, who are feeding fitness vacation frenzies at luxury spas and resort hotels throughout Europe.

Leery of traveling to a less-developed country, where places like Thailand, India and Costa Rica have become synonymous with medical tourism, some Americans – and their employers — are finding affordable treatments and procedures in nearer places – Poland, Turkey, Hungary, Germany, Italy, to name a few – and at levels on par with comparable services offered in the United States, but without the wait and at a fraction of the expense.

Americans are not the only healthcare-conscious shoppers in Europe. The cross-border directive of the European Union is designed to improve patient access to medical care across the continent.

In fact, medical tourism has been a financial windfall for the United Kingdom’s National Health Service, contradicting many assumptions behind the government’s plans to clamp down on foreigners abusing the system.

According to researchers at the London School of Hygiene and Tropical Medicine and York University, 18 hospitals – those deemed most likely to be making money from overseas patients – earned £42m in 2010. Their report found that medical tourists spent an estimated £219m on hotels, restaurants, shopping and transport in the Great Britain.

On the other hand, the researchers also learned that more people leave the United Kingdom seeking medical treatment abroad than arrive for care: about 63,000 people from the United Kingdom travelled to hospitals and clinics abroad in 2010, but considerably fewer, about 52,000 people, visited the commonwealth.

At the same time the cross-border legislation fuels the free movement of Europeans for healthcare within the continent, the directive also packs the potential to develop a number of sites equipped with the proper resources – geography, climate, transportation and hospitality infrastructure and, of course, quality medical services — into attractive health travel destinations not only for Americans, but for travelers from the Middle East, Australia and even parts of Asia.

Of course, the proximity of the East Coast makes travel to destinations across the pond easier for some Americans. The West Coast and points in between are not far off the beaten path.

Some say Americans are drawn to Europe because of a common bond that dates prior to the Revolutionary War. Hospitals in countries where English is spoken as a second language have an obvious leg-up on nations that don’t with Americans who might be out of their comfort zone to travel for medical care overseas in the first place.

Common Bond

Some say Americans are drawn to Europe because of a common bond that dates prior to the Revolutionary War. Hospitals in countries where English is spoken as a second language have an obvious leg-up on nations that don’t with Americans who might be out of their comfort zone to travel for medical care overseas in the first place.

Blue Lake Rancheria has not nearly the number of employees as some U.S. employers who have taken advantage of both domestic and international medical tourism, but the hotel and casino operated by the Native American tribe can identify with a similar corporate culture that optimizes wellness, coordinated care, and cost-reducing coverage options.

The casino’s bundled benefit plan includes medical, dental, vision, pharmaceutical and wellness coverage. A few years ago, Blue Lake added a medical tourism component to its plan for some 370 employees and their dependents.

Not one employee at the hotel and casino, except for the few who wandered down the coast and across the border into Mexico for dental procedures, had been willing to take a chance on a procedure overseas and bite on the medical tourism benefit option. All bets were off, until Bruce Ryan agreed to roll the dice. The odds, if he did not know at the time, were stacked in his favor.

Jack Norton, the human resources manager who introduced medical tourism to Blue Lake coverage plans, knew of Clinique de l’Union — the 531-bed surgical and obstetric facility in Toulouse, France, where Ryan’s surgery would be performed – through his partnerships over the years with the Medical Tourism Association®.

Considered among the leading private hospital in Europe, the hospital provided the advantages – to both patient and employer — associated with health travel that caught Norton’s eye.

Last year, after attending the World Medical Tourism & Global Healthcare Congress, in Las Vegas, Norton decided to travel to France and get a firsthand look at Clinique de l’Union operations. When he got back to work, he schooled Ryan in the possibilities.

Ryan did his homework. He was comfortable with the quality of services. Plus, the chance to revisit a country he had once traveled played a pivotal role in his decision. It didn’t hurt that his sister-in-law, who would accompany him and his wife, was fluent in French.

Once Ryan was convinced, Norton sought the assistance of France SURGERY, a local medical tourism company in Toulouse, which helped arrange medical and travel logistics with the hospital and hospitality entities.

“When people think of medical tourism, most think of Latin America because it is inexpensive,” said Carine Hilaire, an operations manager at France Surgery. “But, that’s changing. France is very affordable and the level of healthcare services is very high. People just don’t realize it — yet.”

Winning Ticket

Ryan is back home on the job now at Blue Lake Rancheria following a 21-day trip to France that included successful rotator cuff surgery, post-op recovery, aftercare, sight-seeing excursions with his wife, Joyce, to the Pyrenees mountain range in southwest Europe – and 50 percent off the $32,000 cost his employer would have had to pay for the procedure in the United States.

“It amazes me that the United States could be so medieval in its healthcare,” said Ryan. “Surgery, both quality and experience, were exceptional. Cost of course was unbelievable compared to what I would have had in terms of co-payments in the United States.”

Norton says the trifecta – elevated quality and outcomes, price value, and travel experience in France – was a tremendous payoff and opportunity that proved to be a winning ticket for both employer and employee.

Providing health-insurance benefits to workers like Bruce Ryan remains integral to employee retention at home for American companies, but rising costs have made this incentive a challenge. For many U.S. employers, the healthcare landscape has never been more difficult to navigate.

But, in an ironic twist, more than a few American medical tourism patients are charting a new course in accessing quality and affordable treatments. Who would have thought European surgeons could hold a candle to their counterparts in the States? For much the same reasons their forbearers departed the old world, many Americans now see the light burning and are following to Europe with a similar thought in mind — opportunity.

About the Author

Renée-Marie Stephano is the President and Co-founder of the Medical Tourism Association® and editor-in-chief of Medical Tourism Magazine® and the Health and Wellness Destination Guide series of books. Ms. Stephano has authored several books from “Developing International Patient Centers, Best Practices in Facilitation,” to “Medical Tourism for Insurers and Employers,” and the most recent, “Engaging Wellness.”

Ms. Stephano is a former attorney and specializes in working with governments and hospitals to develop sustainable medical tourism/international patient programs and strategies including the development of healthcare clusters, and international patient departments on long-term plans. Ms. Stephano works with ministers of health, tourism and economic development in developing public-private partnerships to support medical tourism and, at the same time, to provide a benefit and return to the local community. She organizes one of the only summits that brings together ministers of health, tourism and economic development every year.

She has helped assess the feasibility and opportunities of international programs for both the United States and international hospitals, cities and countries to foster international expansion, clinical development and affiliations and partnerships. She also consults governments in the development of sustainable medical tourism zones and free healthcare zones.

Ms. Stephano is a keynote speaker at international conferences and has spoken at hundreds of events and has been featured and mentioned in media publications around the world.

Ms. Stephano serves on the Board of Directors for the International Healthcare Research Center, a 501c3, nonprofit medical tourism research center, the Corporate Health & Wellness Association, and two Washington, D.C.-based groups focused on lobbying the U.S. Congress for the benefits of Medicare reimbursement overseas and the support of U.S. hospitals in their overseas initiatives. Ms. Stephano donates her time as president of the Medical Tourism Association® and editor-in-chief of the Medical Tourism Magazine®.

Learn about how you can become a Certified Medical Tourism Professional→
Disclaimer: The content provided in Medical Tourism Magazine ( is for informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. We do not endorse or recommend any specific healthcare providers, facilities, treatments, or procedures mentioned in our articles. The views and opinions expressed by authors, contributors, or advertisers within the magazine are their own and do not necessarily reflect the views of our company. While we strive to provide accurate and up-to-date information, We make no representations or warranties of any kind, express or implied, regarding the completeness, accuracy, reliability, suitability, or availability of the information contained in Medical Tourism Magazine ( or the linked websites. Any reliance you place on such information is strictly at your own risk. We strongly advise readers to conduct their own research and consult with healthcare professionals before making any decisions related to medical tourism, healthcare providers, or medical procedures.
Free Webinar: Building Trust, Driving Growth: A Success Story in Medical Travel Through Exceptional Patient Experiences