Plan Design ~ Is Your Medical Tourism Plan Ready for the U.S. Market?

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As the medical tourism industry gets into high growth gear and U.S. patients become more aware of the options of traveling abroad for lower cost, quality healthcare, there remain a number of unanswered questions. We know that the consumer market is thriving.  Individuals are making the choice, either through necessity or through awareness of the medical tourism option, to travel abroad to save money or obtain treatment unavailable in the U.S. For them, the personalized service is available.

Interested parties, such as their doctors, their churches, or their good friends, help chaperone them to facilitators, who take care of all the logistics.  While this consumer market may account for a number of traveling patients, there remains the largely untapped market of 135 million non-farm employees.  These employees comprise the business market.  This brings us to the unanswered questions referred to earlier.

Asking the Right Questions

One of these unanswered questions is “Do You Know Who Your Market Maker Is for the Business Market?” I can’t begin to tell you how many people I’ve talked to who think that the decision maker for creating a medical tourism market is the patient.  If I were to survey a hundred people today, about medical tourism, they would all answer my questions as if the patient were the decision maker in the medical tourism formula.


While this may be true for the consumer market, it is only half true for the business market.  How can something be half true, you might ask? Well, that’s because there are two gatekeepers for the business market.  The second gatekeeper is the potential patient.

The first gatekeeper is the Plan Owner.  This is the organization that owns the plan.  Ownership is defined as the responsibility to pay the healthcare costs and to honor the plan contract with the participants.  In the business market, the Plan Owners are employers and government agencies for self-funded plans, and insurance companies for fully-funded plans.  Another way of identifying who the Plan Owner is would be to consider who provides access to the participants in the plan.  


Employers provide access to employees.  Government agencies provide access to the government agency employees.  Insurance companies provide access to the participants with whom they have a healthcare insurance contract; commonly referred to as insureds or plan participants.  This leads us to the second unanswered question.

The second unanswered question is “What Information Does the Plan Owner Require In Order to Consider Medical Tourism for Its Plan Participants?”  This is not an easy question to answer.  The answer is very, very complex.  In order to simplify the answer, one should study numerous healthcare plans.


These plans have provided information to Plan Owners, in an acceptable format, hence their status as a plan.  So, we can learn a lot by studying these plans and considering the information in them as necessary for our medical tourism plan. These plans are already written in a manner that the Plan Owners understand today so it makes sense to emulate the information for a medical tourism plan.

Hence, our third unanswered question.

The third unanswered question in the medical tourism plan world, as it relates to the business market is “What Information Is Contained in Existing Healthcare Plans?”  When you examine current domestic healthcare plans, and current global healthcare plans, the information they contain is voluminous.  You must understand that the information in these plans eventually comprises the contract between Plan Owner and plan participant.  


It is the most important document for communicating the plan features and the participants’ rights.  All the information that a plan participant would need is contained in the plan documents.  This information includes basic information and more detailed information.  


The basic information is items like pricing information, payment information, contact information, list of in-network providers and the length of the healthcare contract.  The detailed information includes items such as coverage information, copayments, deductibles, out of pocket costs and types of covered services.

These services include hospital, clinic, doctor visits, emergency, prescription drugs, dental and vision information  Needless to say, the key concept in the plan documents are first, comprehensive information must be included (all the information i.e.) and second, the information must be written so that the reader can understand it.

Perhaps the most important unanswered question is “What Information is Important to The Plan Owner?”  Plans should be organized so that they contain the following information:

  • Background
  • Plan Description and Reach
  • Plan Objectives
  • Healthcare Network
  • Healthcare Procedures
  • Plan Design
  • Legal Issues
  • Pricing

Remember, these form the basis for discussion with the Plan Owner; the list is not exhaustive, but it is a good beginning.  Some additional items to include would be:

  • Value Chain of Treatment
  • Gaps and Additional Revenue Opportunities
  • Appendix

While the question of what information is important to the Plan Owner is perhaps the most important unanswered question, an equally important question that is unanswered is “How Should Medical Tourism Plan Information Be Communicated to the Plan Owner?”  Pre-requisite questions that should be answered are “Do You Know the Plan Owners’ Decision Making Process?”, and “Do You Know the Plan Owners’ Profile?”


  In other words, who exactly are these plan owners and how do they go about making the decision of what healthcare plans to offer their employees and insureds?  I’m sure we’ve all got our answers to those questions.  I always thought that the answer to the first pre-requisite question was that the Plan Owners are company and insurance company human resource executives.  I still think that this is the correct answer; technically.


  I use the word “technically” because the answer is correct and one would answer the question correctly in an exam, if the question were posed.  However, the potential patient also factors heavily into the answer because the Plan Owner is designing the plan based on the participant population.  To understand the impact that the end-user patient has on the employer’s decision, we need to take a look at the history of healthcare in the U.S.

Employee Interest Leads to Success

Employer-provided and Employer-sponsored healthcare began in the 19th Century.  It was a way for employers to care for the employees that worked so hard for them, often in high health-risk occupations.

It’s also important to note that healthcare insurance began in 1929 as a profit motive by hospitals and clinics in order to guarantee revenue from a quickly declining profession.  Soon, groups of nonprofit hospitals in several cities organized multiple hospital insurance plans. These plans gave subscribers a choice of medical care providers and therefore attracted more patients, strengthening the income to the participating hospitals.


This multiple hospital plan served as a model for Blue Cross, established in 1932 in Sacramento, California. These hospital plans changed the concept of insurance and forever changed the American health care system. Unlike other forms of insurance, the primary purpose of these plans was not to protect consumers from large, unforeseen expenses, but rather to keep hospitals in business by guaranteeing them a regular income. While these plans benefited consumers by giving them a predictable method of paying for their medical care, they contained serious flaws that would become increasingly apparent as our health care system developed.


  (Source: Health care in the twentieth century: a history of government interference and protection; Business Economics, April, 1993 by Terree P. Wasley).  Ironically, our healthcare system today is a combination of exactly those two concepts; caring for the employees and making a profit.


  I still believe that in today’s healthcare environment, Medical Tourism must carefully combine those two concepts into a win/win solution for participants on the one hand, and employers and insurance companies on the other.

A Medical Tourism Plan Ready for the Market

The two keys to an effective Medical Tourism Plan are communication and marketing.  Communication is the key to successfully winning over the Plan Owner, using the components mentioned above, and organizing the plan details in a comprehensive and practical format.  Remember that Plan Owners don’t want to read, they want to implement valuable plans for their participants.  Value in this case is the return they get on their investment.  


Marketing is the key to successfully winning over the participants themselves.  It is the ingredient that catches their attention by highlighting attractive features, makes them consider the invitation by making it worth their while to do so, and engages them to participate by ensuring a successful outcome.  These are bold coming from the author of an article.  But, how exactly do you achieve this, you might ask?

You have to engage a consultant who has devoted countless hours over the last two years to develop a marketable plan.  Such a consultant would have utilized the feedback and expertise of numerous industry experts.  Such a consultant would have invited feedback from Plan Owners and participants, and implemented their feedback into the plan design, communication and marketing.  


While the role of consultants is mostly over glorified and underutilized, such a product could well be the difference between your medical tourism hospital, clinic or destination being ready for the U.S. market or not.

About the Author

With over 17 years experience in Insurance, Marketing and Employee Benefits Management, Alex Piper possesses extensive knowledge of the U.S. Healthcare Market and the influence that Insurance Carriers, U.S. Employers, Hospitals, Physicians, Physician Groups, Healthcare Professional Organizations and Government will have on the next generation of global healthcare. He is the President of OneWorld Global Healthcare Solutions, a consulting company committed to creating a worldwide healthcare solution. He can be reached at: alex@oneworldglobalhealthcaresolutions.com / www.OneWorldGlobalHealthcareSolutions.com