More Chinese patients are checking into travel abroad for healthcare needs, helped by a rising demand for better quality medical care and sophisticated treatments, according to a recent article by Caixin. Below, I look at the driving forces behind the increase in so-called medical tourism, some differences between the U.S. and Chinese health care systems, the doctor-patient relationship in the U.S., and the U.S. visa requirements for healthcare visits.
Feel free to add your input or questions in the below “Comments” section.
Driving Forces Behind Medical Tourism
Take Mou, for example:
Five years ago, 57-year-old Mou was facing the end of his life when he was diagnosed with colorectal cancer. Doctors in China told him he wouldn’t survive more than two years. Mou decided to go to the United States for treatment. He is now entering his sixth “survival year.”
Earlier this year, Mou’s daughter was diagnosed with breast cancer. She also decided to go to the U.S. not only to increase her chances of being cured, but to take advantage of health care that is centered around the well-being of the patient.
Healthcare travel accounts for 14 percent of the world’s overall tourism industry, according to a Stanford Research Institute study cited by Caixin.
Both Gilbert H. Mudge, the president and CEO of U.S. Public Health Services (PHS), and Melissa Goodwin, in charge of Global Referral Relations at the Mayo Clinic, confirmed with Caixin that in recent years the number of Chinese patients looking for overseas healthcare has grown exponentially.
The majority of cases for medical tourism in China involve cancer patients, followed by those seeking cardiac or neurological treatments. That’s according to Cai Qiang, the founder and chairman of Saint Lucia Consulting, a Beijing healthcare consultation company that recently received an investment from Sequoia Capital China. (In May, the Mayo Clinic signed an agreement with Saint Lucia Consulting to receive Chinese patients through the company.)
A key driving force for healthcare travel is survival rates. In developed countries, the average cancer recovery rate has reached 65 percent, while in China it stands at around 25 percent.
Differences Between the U.S. and China Healthcare Systems
International patients are drawn by the high standard of care at premier American hospitals like Cleveland Clinic, Harvard, UCLA Medical Center, Johns Hopkins, and Mayo Clinic.
perhaps the greatest difference between the U.S. and China healthcare systems lies in the diagnosis and treatment plan. According to Melissa Goodwin, in the Mayo Clinic a patient-centered team of experts is formed. For example, a lung cancer patient’s treatment team is composed of internal and pulmonary physicians, lung cancer doctors, an oncologist, radiotherapy doctors, as well as social workers. “Each person has his field of expertise and opinions. Finally in synthesizing all views, the diagnostic result and treatment are defined. This result has to be endorsed by everyone.”
In contrast, the various departments involved in cancer treatment at a typical Chinese hospital are relatively independent. Mou still recalls going back and forth between different departments and struggling to make his own decisions after waiting in long lines for the privilege to speak to a doctor for less than 10 minutes. Other factors pushing affluent Chinese patients overseas include a lack of developed infrastructure for the most advanced medical instruments, as well as cost-effective anti-cancer drugs.
To take advantage of U.S. diagnosis and treatment planning, Cai says
Some patients choose to go abroad for a medical examination, diagnosis and then they obtain a treatment plan before coming home for implementation in Chinese hospitals…. This is the most economical and optimal choice.
Cai compares international healthcare options for Chinese.
Considering medical standards, facilities and treatments, the U.S. is considered the best choice. But it is also the most costly…. In contrast, Britain is more cost-effective, the quality is good while the cost is half of that of the U.S. Meanwhile, in Asia, Japan also offers good medical care. The problem is that it’s very hard to get a healthcare visa for that country.
U.S. hospitals that draw international visitors often have international patient programs that can help to refer you to an appropriate doctor and set up the appointment. They are sensitive to international patients’ needs, such as:
- Arranging for interpreters or staff who speak Mandarin or Cantonese
- Providing Chinese food and food for special dietary needs
- Arranging for a local hotel and local transportation
- Providing payment and insurance advice
- Helping with your travel plans
The Doctor-Patient Relationship in the U.S.
The relationship between a doctor and patient may be a bit different in the U.S. than in China, but the gaps can be bridged.
In the U.S., informed consent is a critical part of the doctor-patient relationship. Informed consent is more than merely your agreement to a particular treatment or procedure. Informed consent is your agreement to that proposed course of treatment based on receiving clear, understandable information about the treatment’s potential benefits and risks, information about other treatment options, and the risks of receiving no treatment.
And personal health information is considered privileged in the U.S., so it is not shared without the patient’s consent, except for narrow exceptions. For example, family members and your employer won’t be given your health information without your consent. See U.S. Department of Health and Human Services, Your Health Information Privacy Rights.
In contrast, under Chinese law, health information may be given by the patient or the patient’s family, and health information may be withheld by doctors to avoid adverse effects on the patient. See Law on Medical Practitioners, art. 26, enacted by the NPC on June 26, 1998 (“Doctors should truthfully explain patients’ conditions to the patients and their family members, but attention must be paid to avoid an adverse effect on the patients.”)
It can be said that Chinese law is more focused on the whole family, while U.S. law is more individualistic. See Wei-Ti Chen, et al., Chinese HIV Positive Patients and Their Healthcare Providers, 30 Advances in Nursing Sci. 329, 330 (2007). In any case, if you want to include your family in discussions and decision-making, a U.S. doctor should be happy to do that.
The Chinese medical system may also emphasize the patient’s trust in the doctor’s good judgment more that the concept of the patient’s informed consent. See Wei-Ti Chen, supra. Because of that trust, patients in China sometimes ask few questions of their doctors. In the U.S., since informed consent is required, doctors are used to being asked questions typically won’t interpret questions as lack of trust by the patient.
U.S. Visas to Visit for Medical Treatment
The U.S. State Department and Customs and Border Patrol (CBP) have policies on applying for B1/B2 visitor’s visas and entering the U.S. to obtain medical treatment. In our firm’s experience representing clients in these cases, the key requirements are:
- Medical Diagnosis: You will need a detailed and clearly written diagnosis from a physician (usually in your home country) explaining the nature of your medical condition and why you prefer to or need to go to the U.S. for treatment.
- Treatment Plan: The applicant must present a detailed plan by a U.S. physician for treatment at a U.S. medical facility, explaining the planned course of treatment, its length, and the cost of treatment. Many U.S. hospitals offer review of medical records by mail for a fee, so a physician can review your medical status and draft a treatment plan before you enter the United States.
- Ability to Pay: The applicant must prove financial resources to pay for the costs estimated by that facility for the treatment. You’ll need to present evidence such as bank statements, tax returns, or insurance policies showing that you are able to pay for the treatment, transportation, and U.S. living expenses. If somebody else will pay for the treatment, they should also provide a statement explaining they will be financially responsible. It may be wise for that person to also complete a USCIS Form I-134, Affidavit of Support. See 9 FAM 40.41 N11.6 (consular officer may accept a sponsorship affidavit on behalf of a visa applicant seeking U.S. medical treatment). Because of U.S. law mandating that all individuals with emergency medical conditions must be treated regardless of their ability to pay, consular officers are judicious (cautious) to avoid approving visa applications for persons who may require emergency treatment in the U.S. and may be unable to pay. See DOS Cable #199998, Nonimmigrant Visas for Medical Treatment (Nov. 19, 2001), citing Emergency Medical Treatment and Active Labor Act (EMTALA). Some U.S. hospitals require or have the option of pre-payment, after which proving to a consular officer your ability to pay should be easier.
- Nonimmigrant Intent: The applicant must prove to the consular officer’s satisfaction that he or she intends to return to a permanent home abroad after a temporary stay in the U.S. This turns on the extent of the applicant’s business, family, financial, and other ties to China. See Proving Nonimmigrant Intent for a U.S. Visa.
A visa applicant is required by law to reply truthfully to a consular or CBP officer’s questions regarding the purpose of their trip. 8 C.F.R. 214.1(f); 22 C.F.R. 41.103(b)(2). Misrepresentation (for example, “I’m going to the U.S. for vacation travel”), if discovered, makes a person permanently ineligible for future visas (except in narrow circumstances). See INA 212(a)(6)(C)(i) (making permanently inadmissible to the U.S. “any alien who, by fraud or willfully misrepresenting a material fact, seeks to procure … a visa … or admission into the United States”). Misrepresentation by a medical tourist may also constitute federal crimes such as perjury, immigration fraud, and making a false statement to the U.S. Government.
Note that a B1/B2 visa is also appropriate to accompany a close family member receiving U.S. medical treatment. See 67 Fed. Reg. 18065 (Apr. 12, 2002) (proposed rule specifying that B-2 visa is appropriate for “alien parent to stay with his or her minor child receiving medical treatment or … to attend to an acutely ill immediate relative member who is receiving medical treatment.”)
Also note that there is no general rule making people with medical conditions ineligible for admission to the U.S. However, the following specific classes of persons are ineligible (with certain exceptions):
- Persons with the following communicable diseases: chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious syphilis, active tuberculosis. (HIV and AIDS are no longer on this list).
- Persons who because of a physical or mental disorder pose a threat to themselves or others.
- Drug abusers or addicts.
By 2008, nearly 100,000 patients from around the world come to the U.S. each year for medical care. See Jean Der Gurahian, Breaking Barriers, Modern Healthcare, July 7, 2008.
“The demand for overseas medical services will be immense in the future,” Caixin was told by Zhou Kui, a partner at Sequoia Capital China.
For more on traveling to the U.S. to give birth, see Shady Chinese Agencies Promoting U.S. Birth Tourism–Part 3: Policy Responses.
Also see, Chongqing Girl with Cancer Battles Visa Issues to Get U.S. Medical Treatment.
I have nonimmigrant US visa for 10 years and have visited US twice as tourist. Now I require to visit US for medical treatment . Do I need a separate fresh visa or I can travel on already secured visitor visa. I have appointment for MSK cancer centre for March.
I am unmarried and have lost my parents. Can my brother’s daughter accompany me to look after me. I am financially sound to bear mine and her expenditure.
If you have a valid B1/B2 visa, you don’t need to apply for a new one. Remember, though, that a visa is only an authorization to apply at the port of entry for admission to the U.S. The U.S. Customs and Border Protection (CBP) officer at the port makes the final decision as to whether you should be admitted.
As to whether your niece can visit the U.S. for purposes of accompanying you temporarily while you receive medical treatment, that can be a valid temporary purpose for a B1/B2 visit. Still, she needs to meet all requirements for the visa.
My sister is living in Bangladesh, and I am working in US with h1b status. She is suffering from schezoaffective disorder which is one type of psychiatric illness or schezophrenia. She can be referred by her doctor in Bangladesh for advanced medical treatment which she will need. I talked to several hospitals over in US and some responded well. As she is terribly sick, she can’t manage to converse properly or do stuffs herself. She has home and family in Bangladesh, but no job. In this situation, can she interview at the US embassy with my mother accompanying her? Also, can she get the visa? If she would get the visa, can she use her visitor medical insurance for treatment over here? If not, I am willing to bear the full cost of her treatment. Thank you for your suggestions!
The U.S. Embassy will entertain requests for special accommodations required by applicants with disabilities, including allowing an applicant to be accompanied by a relative. As to whether her insurance would cover treatment in the U.S., check the policy and speak with the insurance company. As to whether your sister would qualify for the visa, that determination will be made by the consular officer based on the totality of the facts. You may want to schedule a consultation with our firm or another qualified immigration attorney to discuss options and strategies.
I have a relative in China, Chinese citizen, who is looking into coming to the US for cancer diagnosis and possible treatment. She also would probably stay with us for a while after treatment, and probably do some traveling with us during treatment, if possible. Does she need a medical visa because that’s the reason giving birth to the idea of coming now, or can she get a regular visitor’s visa since she will also take advantage of being here to see relatives and get treatment while she’s here?
Tim: The B1/B2 (visitor for business or pleasure) visa is used for both tourism and visits for medical treatment. The bottom line is that when an a person applies for a visa they should truthfully describe the purpose of their visit. Upon learning that a foreign national seeks to come to the U.S. for medical treatment, the consular officer will request evidence complying with the rules set forth in this article.
Hello sir, my father-in-law is suffering from Parkinson’s disease. We have tried in India but there is no proper treatment for it, and now we want to take him to USA for his treatment. Can I accompany with him
Mir Abul: Accompanying a close family member receiving U.S. medical treatment is a proper purpose for a B1/B2 visa. Of course, you need to meet each requirement for the visa.
Hi Gary I want to ask if I could apply for medical visa to go to US to treat an orthopedic disease. Could I apply for medical visa just because I want to receive better surgery instead of the fact that the according treatment is unavailable in my own country. Thank you very much!
You need not prove that the treatment is unobtainable in your home country. Other reasons for preferring to obtain treatment in the United States are also legitimate. For example, your trusted doctor may be located there, or you may want to be near close family members who can take care of you during the treatment.
My younger brother is suffering from schizophrenia. Me& My parents are green card holders living in the us. My brother lives in our home country all by himself. He couldn’t come with us bcz at that time he was above 21. But my dad applied for him as soon as he got GC. The datas shows that he could get the immigrant visa by the end of next year. But his condition getting worse day by day .We really want to bring him here for his better treatment & we could also be around him. Fyi my mom is also a schizophrenic patient & she seeing a psychiatrist for past few years. We want him to see my brother too. Is there any way we can bring him here?
Jasmine: In this case, since your brother is in the queue for permanent residence, getting a B visa to come to the U.S temporarily for medical care would require paying special attention to the requirement of proving nonimmigrant intent, which is described above.
I [28M from New Zealand] have applied for a B2 Tourist Visa to enter the US to be with my wife [25F from New Zealand with dual citizenship in the US] who has been living in Phoenix for a year studying, and I have visited on an ESTA once at the beginning of this year.
I do not intend to immigrate at this time as she is studying in Healthcare to be able to return to New Zealand where she was living and working for 3 years prior to her return to the US last year for study. She was simply intending to live there for a year and I visit her for 3 months at a time. I am employed full time and beginning July I will begin studying, online but based in New Zealand so I will be free to travel. We both wish to return to New Zealand to live and I have no intentions to attempt a permanent move to the US in the next 12 months.
My first question is; my only ties to New Zealand would be the full-time employment I have now which I can return to and can also have my employer prove this, as well as my entire family being here, and the intention that my Wife and I have to return, but I own no property here and own no businesses.
Additionally – she is due to give birth in Phoenix, in September, to our first child. We have chosen to have our child there as she would like to be with her family who are also all from New Zealand but have Naturalized over 21 years of residing in the US, and she would like to minimize time taken away from her studying and attending school.
My second question is regarding my late application for a B2 visa and the wait times for an interview which is the same week as her due date – being 8 weeks or so later that the date I plan to be back in Phoenix. Because of this, I requested Emrgency Consular Processing and chose Medical Treatment as my reason for requesting this [accompanying my wife during her 3rd trimester and post-partum].
Have I done the right thing given my situation and do I have the correct requirements for this? I was instructed by the US Consulate in Auckland, New Zealand to apply this way and was told that I will qualify for Emergency Consular Processing under Medical Treatment and to provide proof of this, which I did during the application. Also, I have read other pages on your site and understand for me the main points would be to ensure I can prove strong ties to my home country so the officer who interviews me is convinced I will be returning to New Zealand. Any advice on how I can prove this more? Would a letter from my Wife stating her intent to return home after finishing study be considered proof of this intent?
I would like to also share a BIG thank you for your thorough answers, this is the best place online to find any case-by-case specifics and I would appreciate any help or reassurance you could give me at this time.
Ryan: As to your second question, it may be worth doing a full analysis of whether it’s preferable to enter on ESTA or apply for the B1/B2 visa. And as to your first question, you are right to stress proving that your wife intends to be in the U.S. only temporarily. If you would like to schedule a consultation with our firm, we can help you get a full understanding of what to expect at your visa interview, do mock interviews, and strategize how to present your situation to the consular officer.
Hi Gary pleasure to meet you.
First i would like to commend you for your good work. Secondly am writing on behalf of my wife who has been diagnosed with aplastic anemia. Hence i already applied for B2 visa, her doctor in our home country already provided a document for the embassy, now the issue we are facing is getting a document from a physician in the U.S. we d’ont know how to go about this, all the hospitals i have contacted insist on meeting her in person first for a proper check up. Can she still show up for the interview ?
Lois: If you Google “international patient department,” you will find that some hospitals regularly treat international patients and tend to be familiar with the visa application requirements they face. They may be hesitant to explain a course of treatment without having conducted examinations and tests at their own facilities. But the international patient department may be willing to provide a letter for the Consulate describing the likely course of treatment (and approximate related costs) if the foreign doctor provides sufficient records regarding examinations and tests done abroad. (Sometimes, the U.S. doctor can use telemedicine appointments to gather needed information.) Some communications and cooperation between the foreign and U.S. doctors can be helpful for the U.S. visa application.