Americans spend $2.7 trillion a year on doctors, prescription drugs, and insurance plans—and the price is only going up. Desperate for cheap health care, more and more of us are traveling overseas to save money. But there's not exactly a Fodor's guide to the $100 billion industry of medical tourism. So a couple of engineers are building software to help you plan and execute your own overseas medical excursion.
It's called Emissary. The fledgling "medical destination" startup was founded by ex-Zynga and Google engineers Jonathan Howard, Tom Wu, and Woody Hooten. They're low profile—as of this writing, about 25 people follow them on Twitter. But the ambition of their company is outsized; the new service will help travelers vet doctors and facilities, book travel and accommodations, and even get patients situated in-country. Think Lonely Planet meets Airbnb for medical tourism—navigating what could otherwise be a confusing, and potentially dangerous journey. The company is preparing to release a private beta soon.
Emissary vets surgeons by examining public and private outcome reports, complication and infection rates, and the number of procedures a surgeon performs annually. Hospital and medical facilities are similarly scrutinized to meet international accreditations like JCI to form a baseline of care.
"We make sure they use the same FDA-approved medical devices you’d get in the U.S.," Howard says. "And we don’t make these up ourselves. This comes from our advisory board of U.S. surgeons who help us interview their respective counterparts abroad."
Prospective patients can research physicians and locations and book entire trips from the site, and use the service in-country via a mobile app.
Emissary’s cofounders personally meet every doctor and medical professional they work with. Once doctors are cleared, Howard says the focus then moves to "concierge-level care," which includes hotel and transportation partners, and Emissary staff physically meeting patients right off the plane. Full-time nurses and special recovery suites for surgical patients are a part of the package.
"Even the drivers we work with specialize in surgical patients," Howard says. "We make sure that they have sophisticated bilingual concierge care on the ground, from the time you get off the plane, to the time the doctor clears you to go back."
Right now Emissary is launching after months of medical testing services in Costa Rica which included everything from Lasik procedures to dental inlays, orthopedics, dermatology, and physicals.
The idea for the company came after Howard contracted chicken pox while traveling in Israel. He says the care he experienced, and the relatively low price, opened his eyes to the potential for a new way to experience health care. Upon returning stateside in 2011, Howard underwent oral surgery in San Francisco; shuttled from specialist to specialist, and paying thousands after experiencing "assembly-line" treatment, he was convinced there was a better way.
"When a friend told me his mother had gotten arthritis treatment in India, paid for the whole family to stay with her for a month, and still saved tens of thousands of dollars, it all clicked," Howard said. "When I looked at the space, it was like the Wild West. A lot of the competitors are willing to send you anywhere, so introducing a patient-centric competitor that leverages the latest in mobile technology made a lot of sense."
Destination health care, as the founders call it, is a nascent field with tons of upside—but matched by a great degree of risk for both patients and Emissary. So far a limited patient pool has shared glowing reviews. But it only takes one slip-up to cause a PR nightmare, a tightrope Emissary’s founders are well aware of.
To help minimize hazards, Howard says surgeons won’t accept risky international patients. "By the time you buy your plane ticket, you’ve already got all the test results the surgeon’s requested, and probably Skyped with them as well. That said, surgery is surgery, and even general anesthesia carries its risks."
Patients can buy complication insurance from insurance providers and hospitals also have malpractice insurance policies, and an arbitration process available to patients, Howard explains. Because Emissary acts as a marketplace between practitioners and patients, the company cannot legally offer opinions about specific medical options.
"We can only provide information or defer to the doctor themselves," Howard explains. "And we make sure to go through these details with a patient who engages with us to make sure they fully understand. But we defer to the doctors and other care providers in all things, so any medical disputes would be between the patients and the appropriate care provider."
Income for primary care physicians rose 10% from 1995 to 2012. Specialists like dermatologists, gastroenterologists, and oncologists saw their wages grow at least 50% in that period, even with inflation.
Surgery has fast become a one-way ticket to debt for many, even those with insurance. That’s because since procedures, such as topical biopsies and treatments, have skyrocketed, some insurance providers are limiting coverage. And with with huge payouts to specialists, anesthesiologists, and sometimes physical therapists or recovery centers, timely pay-offs begin to resemble Mafia collectors rather than modern medicine.
Surgery and recovery options outside of the U.S. are much cheaper. Hip replacement in Costa Rica is around $15,000 versus north of $100,000 in the states. And Emissary offers packages which includes hospitalization in private rooms, private transportation (one round trip to the airport and three round trips to the hospital), plus hospital fees, pre-op exams, a post-op appointment, and eight physical therapy sessions. Howard says about half of medical travelers have procedures paid for by their insurance.
"We’re not in the business of convincing people to go outside of the U.S.," Howard says. "We’re trying to make sure all the people who do choose medical travel do so safely, comfortably, and with as much transparency as possible."
While this service could be a boon for those seeking surgery, that specific functionality may also alienate others.
"It looks interesting, but it's not really applicable to chronic pain patients," warns Roei Eisenberg, a 26-year-old Israeli national who spent the last decade in Los Angeles before moving back overseas. Eisenberg was diagnosed with lymphocytic colitis and fibromyalgia at 16, and has been dealing with medical bureaucracy for most of his adult life.
"The larger idea is interesting, like the idea of pot medical tourism to Uruguay, but Emissary is more of a service to save you the cost of expensive surgery in the U.S.," he says. "People who need close monitoring for weeks or months can't fly somewhere. I can't just leave my job and go to Costa Rica while doctors take me through a hurdle of tests."
Eisenberg is right. It isn’t easy for most people to just up and leave their country and work, even if the service is cheaper. Plus with out of pocket prices lowering because of Obamacare, overall fees could drop even further.
"The question is what percent of individuals, who have insurance, are still going to go down to Costa Rica or Panama to have surgeries," says Dr. Warren Roston, a Beverly Hills pulmonary disease specialist with more than 30 years of experience.
Roston says the long-term success of services like Emissary depends on how much insurance companies cover, and how much patients will have to pay out of pocket. "If the numbers are anywhere close, I don’t think people will run down there."
Howard says Medicare does create demand, because of coverage caps. And since elective procedures aren’t often covered, he says, there will always be need.
"Many employer health care plans are already including the option to choose international treatment in exchange for lower or no co-payment," Howard says. "The financials and quality make just as much sense to insurers as consumers."
While Howard acknowledges it’s tough to have to vet every medical professional Emissary works with, he’s convinced his company is getting a head start in a hot sector.
"We don’t actually need to scale that quickly. If we had five new patients a day, we’d be a close to $100 million company," Howard predicts. "The biggest challenge there is to invest heavily in working with high-quality partners who share your vision and your values. Because partnering with a new network is probably the least scalable part of the business, you need trust there."
An estimated 8 million people travel overseas for medical care every year. If Emissary can navigate the challenges of insurance companies, customer acquisition, and provide affordable, quality service, the company could be a major player.