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Why Won’t Medicare Pay for Medical Tourism?

In a working paper published by the Mercatus Institute at George Mason University, Marc D. Joffe notes that Aetna, Blue Shield and HealthNet offer health insurance in California that gives beneficiaries access to Mexican providers.

The U.S. insurers rent a provider network from a Mexican insurer. The cost of health care in Mexico is 60 percent to 80 percent lower than in the United States. Therefore, cash-paying Americans travel to Mexico for many medical procedures.

Joffe cites estimates of around half a million Americans annually visiting Mexico for medical care (although the number traveling only to fill prescriptions is not reported).

Joffe notes that 25,000 Americans living in Mexico in 2011 were receiving Social Security deposits. Unlike half a million other Americans who travel to Mexico for treatment, these retirees and their spouses return to the United States for treatment. The reason is that Medicare does not pay for their treatment out of country. Joffe doesn’t estimate how much money Medicare would save if it paid for their treatment in Mexico, but a back-of-the-envelope estimate is not hard to figure out. Let’s just focus on inpatient hospital spending, which totaled $120 billion in 2012 (according the Medicare Payment Advisory Commission). This amounted to $3,263 per beneficiary. However, only 28.9 percent of beneficiaries required inpatient hospitalization in 2012. So, the cost per admitted patient was $11,291.

If Medicare could cut that cost by 60 percent, it would save $4,516 per patient. Scaling that to the American retirees in Mexico, it could amount to as much as $33 million.

Those savings amount to peanuts within the Medicare budget, and would only happen if every retiree took advantage of the option. But it’s a start. And increasing numbers of Americans are planning to retire abroad, not only to Mexico, but Costa Rica and other low-cost countries.

It’s a growing opportunity for Medicare savings. And the federal government wouldn’t even have to establish provider networks: It could just ask Aetna, Blue Shield or HealthNet to share theirs.

Source: John Goodman's Health Policy Blog

John R GrahamJohn R. Graham is a Senior Fellow at the Independent Institute as well as NCPA. As an expert on individual choice and limited government control over medicine, Graham speaks frequently on health reform on radio and television, and at meetings in the United States, Canada, and Europe.

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