In the New Republic, Adam Teicholz and Glenn Cohen discuss insurers whose provider networks run across the border:
Before dawn on a Wednesday in January, Cesar Flores, a 40-year-old employed by a large retail chain, woke up at his home in Chula Vista, California. He got in his car and crossed the border into Tijuana. From there, he headed for a local hospital, where he got lab tests — part of routine follow-up to a kidney stone procedure. He had his blood drawn and left the hospital at 7:30. He arrived home before 10.
But Flores’s situation isn’t medical tourism as we know it. Flores has insurance through his wife’s employer. But his insurer, a small, three-year-old startup H.M.O. called MediExcel, requires Flores to obtain certain medical treatment at a hospital across the border. In part due to cost-pressures generated by the Affordable Care Act, other sorts of plans that require travel have the potential to expand.
Teicholz and Cohen note that this is different than “medical tourism”, where patients pay directly, and that insurers paying for cross-border care like this appears to be in a regulatory gray area. It also re-introduces us to a couple of issues we have addressed in this blog. First: Why doesn’t Medicare pay for cross-border care? Second: What will happen when insurers require cross-border “reference pricing” on U.S. providers, forcing them to meet or beat Mexican hospitals’ charges?
These changes would have a far greater effect than all the proposals for Accountable Care Organizations and High-Performing Systems and Value-Based Care that fill the health-policy journals and conferences.