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.
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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.