Why Medical Tourism Is a Really Dangerous Idea: The CRE Edition

I’m usually a big fan of economist Dean Baker. Since the mid-1990s, he has been debunking much of the Social Security and Medicare misinformation pumped out by conservative faith-tanks; he was also one of the few and first people to realize that the housing market was going to implode. So it pains me to note that Baker has come up with a really, really bad idea to ‘improve’ healthcare (actually, it improves healthcare budgets, which isn’t the same thing as medical care, but I’m getting ahead of myself). What’s the bad idea? Medical tourism (boldface mine):

As every policy analyst knows, the problem of Medicare costs stems almost entirely from the fact that our healthcare system is incredibly inefficient. We pay more than twice as much per person for our healthcare as people in other wealthy countries – even though we have almost nothing to show for it in the way of better health outcomes.

This enormous gap in costs suggests an easy opportunity for massive gains from trade. If people in the United States could get their healthcare from other countries, there would be huge savings.

While it may impractical for most of the population to go to another country for most of their healthcare needs, this is not true for Medicare beneficiaries, the vast majority of whom are retired. Many retirees have friends and/or family in other countries. If they opted to move to another country to get their healthcare, there could be enormous savings that they could share with the government.

Anyone who has followed the spread of multidrug resistant bacteria just had her stomach flip-flop. In the U.S., many of the recent antibiotic resistance genes that confer resistance to most (e.g., CTX-M-15) or all (e.g., KPC, NDM-1) penicillin derivatives–and which are also resistant to all other classes of drugs) were initially traced back to patients from other countries*. With the most recent and nearly untreatable carbapenem-resistant organisms (CREs), this isn’t anecdote, the CDC recently published a paper describing how two separate patients from Bangladesh carried a resistance gene (OXA-81) to Singapore (similar transmission patterns have been described for cases associated with India, where this gene was first observed, in Oman, the Netherlands, and New Zealand).

From the clinical perspective, these infections are terrifying:

Not only will CREs increase mortality rates, but if carbapenem-resistance establishes itself in the larger E. coli [commensal, non-diseased] population, a significant fraction of commonplace urinary tract infections will become untreatable. The amount of misery this would cause would be significant–UTIs [urinary tract infections] would be the new STD. And keep in mind, that there are already roughly 36,000 E. coli associated deaths per year in the U.S., which blows U.S. HIV/AIDS deaths out of the water.

At best, I figure we probably have five years, give or take, to get this under control before it spirals out of control (and in the past, I’ve been uncharacteristically optimistic about CREs).

Leaving aside the increased mortality in severe cases (though we shouldn’t), the prospect of one to two percent of otherwise treatable urinary tract infections becoming untreatable should give everyone pause–this would be a devastating step backwards for women’s health. In terms of cost, these infections increase the cost of treatment by 50 – 300 percent relative to sensitive infections–this cost is only the cost due to resistance.

Right now, we need to do everything we can do delay the spread of CREs and other multi-drug resistant bacteria. The last thing we need to is send patients abroad to acquire new strains. And of course, some countries might not want our patients who are carrying these bacteria either. Once these organisms get established, no press conference or reimbursement scheme will remove them: like Honey Badger, they just don’t give a shit.

Not everything in the so-called healthcare debate should be reduced to economics–there are biological realities that supersede dollars-and-cents. Or nonsense.

*It’s worth noting that MRSA was a ‘Western’ disease that was spread to the East. Things travel in both directions.

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4 Responses to Why Medical Tourism Is a Really Dangerous Idea: The CRE Edition

  1. starskeptic says:

    *conservative faith-tanks*

    Love it!

  2. lee2jh says:

    This is really interesting. The pending rise of health care costs are scary but the American people shouldn’t opt to leave their own country for medical care and needs.

  3. albanaeon says:

    Ha. The concerns of rising health care costs are enough to get easily excitable people ready to tank the economy. But our machines of death, their budget is sacrosanct.

    This country sometimes…

  4. Ryan G says:

    It wouldn’t have to be Bangladesh. There are some things where a Canadian hospital’s fee for out-of-country uninsured visitors is a minuscule fraction of the US fee. Maybe even cheaper than the insured copay.

    That said, CRE does scare the shit out of me.

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