A small number of US employers with self-insured health options for their employees and families are using medical tourism to Mexico in a new way. IMTJ looks at the model used by North American Specialty Hospital (NASH) and assesses the potential for more US employers to take up this option.
Many US employees and employers remain sceptical about overseas care and safety, while several health plan administrators who are part of the big US health insurer/healthcare groups will not use overseas hospitals as they can get good deals in the USA from their own extensive medical networks. It is also only viable for employers with a short flight time to Mexico.
North American Specialty Hospital (NASH) of Denver, Colorado offers cross-border healthcare with pre-operative and post-operative services throughout the USA, plus surgery at Galenia Hospital in Cancun. Next door, and attached by a common corridor, is a new Four Points by Sheraton, a five-storey hotel with 112-rooms, each one of which is handicap-accessible to maximise patient recovery. Four Points Cancun Centro also has a fitness centre, a roof-top swimming pool, a full-service restaurant, a sports bar, and 24-hour room service. At the 55-bed hospital NASH leases the entire third floor, with most patients staying for a week. NASH arranges the surgery, sometimes with local surgeons but mostly flying in surgeons from the USA.
Cancun is connected by daily, non-stop, and year-round air service from airports located throughout the USA. In three years, NASH has helped over 20 Americans use this service, and concentrates on the employer market rather than individual patients.
NASH concentrates on orthopaedics, including total hip and total knee replacement, but is looking to expand into additional medical specialties, including oncology, cardiology, and spine. It arranges travel, uses electronic transfer of patient records, teleheath links, post-operative physical therapy on site, and offers a concierge service in Cancun for patients and companions.
Most employers using the service cover all costs 100% from their self-pay insurance, while treatment in the USA may require a co-pay or other restrictions.
One employer using the service is Ashley Furniture Industries, based in Wisconsin and with 17,000 employees. The cost to IndusHealth, Ashley’s medical travel plan administrator, is less than half of what a knee or hip replacement in the USA would be. Ashley even pays employees US$5,000 to travel, and has sent 10 people to Cancun via NASH. Since 2016, Ashley Furniture has also separately sent 140 employees and dependents for treatment at a hospital in Costa Rica.
The government health insurance agency and the dominant source of coverage in the USA, the Centres for Medicare and Medicaid Services (CMS), expressly prohibits payment of foreign medical providers for elective procedures.
Few large employers have included international medical travel in benefits plans, but some smaller employers have. Many who started to try it have stopped however, as either the arranging agency went out of business, the promised costs savings or quality never happened, or employees refused to travel overseas.
More small companies are moving to self-funding as a way to reduce their share of the health care cost burden. Because small companies are not able to assume the same levels of risk as larger ones, the likelihood that they may add an international medical travel benefit to their health insurance plans is still small. This is where the NASH model works, by taking away risk