Read Case #68, Competition Across the Border, (Cases in Health Care Management). Why do you think medical tourism has become increasingly an issue for patients across the United States? What are the drivers and concerns? Are there issues relating to quality of care particularly follow-up care?especially when there are complications, in medical tourism? What ethical issues do you see affecting this issue? Why?

CASE 68 Competition Across the Border Nancy H. Shanks Dr. Driller was the one of the owners and the managing partner of a comprehen sive dental practice in southern California. Located south of San Diego and not far from the border of Mexico, the practice had provided dental, orthodontic, and dental surgery services to the community for many years, had grown to be a successful operation, and had recruited several new dentists to help meet increase ing demand. While the practice had experienced years of steady growth, the last couple of years had not been as lucrative as anticipated. This made little sense to Dr. Driller, as the population had continued to grow and there was little com- petition in town. To better assess the situation, Dr. Driller discussed it with the practice admin- istrator, Mona. He asked her to prepare some additional financial and utilization reports that would allow them to evaluate trends, compare several years of data, and get a better idea about what was going on. Mona compiled utilization data by type of procedure/ service rendered, payment sources, and gender and other demographics, as well as revenues generated from this utilization. When they looked at these reports, Mona and Dr. Driller found that the demand for emergency types of procedures had continued, but the numbers for routine and elective care were on the decline. That is, the numbers of regular checkups and cleanings, as well as procedures such as whitening, dental implants, reconstructions, and other types of cosmetic treatments had decreased. The demographic breakdowns showed that most of these decreases were related to Patients who were uninsured and therefore paying out-of-pocket. Dr. Driller seemed quite puzzled, but Mona had several ideas. 245CASE 246 CASE 68 COMPETITION ACROSS THE BORDER "I think we are being impacted by the new dental clinics that have opened in ADDITIONA Mexico. Think about it, Dr. Driller. If you had insurance coverage, you would Bauer, J. C. (2009). A come here and not worry too much about what you would have to pay. If you Financial Manag didn't have coverage, however, you would look for the low-cost provider where Buchbinder, S. B., & (2nd ed.). Burli you would pay less for care." Forgione, D. A., & S "I thought health care was local. Has that changed?" care system. Jou 'You're right, it used to be that way, but times have changed with the world Horowitz, M. D., & economy. The becoming increasingly global. Medical and dental tourism is becoming increas Keckley, P. H., & U ingly common and is becoming the new reality for many providers, even in our Washington, D little corner of the world." Keckley, P. H., & "How do you know so much about this?" Washington, I Medina, J. (2012). 1 "The border towns are only 30 miles away, which makes them readily acces- from http:// sible to the people in town. I have neighbors who are going across the border for -with-medical all types of care. There are many new high-tech clinics there. Haven't you seen Nakra, P. (2011). those ads on television? They're in English and Spanish and advertise costs for 23-24. procedures that are way lower than what we charge." Stanley, M. (201 tourism look "Oh my golly, Mona, we've had our heads in the sand and haven't been pay- Underwood, H. R ing enough attention to who our competition is. Although our competitors tion or passi aren't right next door, we need to change our strategy." ohus es vasoul es wing of bouninos bed nonelugng ad on lin( Discussion Questions 1. Why do you think that medical tourism has become increasingly an issue notfor patients in the United States? What are the drivers of it? And, are there concerns about it? 2. Are there issues relating to quality of care, particularly follow-up care when there are complications, in medical tourism? Explain the rationale for your response. art 3. What are the liability issues patients should be concerned about? 4. What would you recommend that the clinic do to try to retain patients? Mona. Identify specific strategies that you might recommend to Dr. Driller and 5. Medical tourism is a two-way street. Are there ways that Dr. Driller's practice can attract patients from Mexico to obtain care from his practice? How might they go about this