Why Medical Tourism Can Make More Sense Than US Care

Medscape

21-07-2025

This transcript has been edited for clarity.
Who out there has seen the movie Super Size Me , where the late, great Morgan Spurlock eats only McDonald's for 30 days? If you haven't seen it, you should. It's wild.
Anyway, Spurlock uses this type of experience-based filmmaking to also teach us about value-based healthcare in his show Inside Man , when he goes to Thailand to get worked up for knee pain.
Spurlock, like so many Americans, especially those with musculoskeletal injuries, thought he needed an elective procedure. He called all these clinics around New York City, but he wasn't finding much transparency in prices. What he did learn was that the costs were all over the place and there were long wait times. Instead, he plays medical tourism and goes to Thailand to get his care.
The Price of Clarity: What $4300 Gets You Abroad
For $400 and in only 1 day, he got two expert consultations, an MRI, and found out that he did not need surgery. Spurlock went even further and got more lab work, a cardiac stress test, a capsule colonoscopy, and more consultations. The entire thing, including airfare and accommodations, cost him $4300.
What can you get in American healthcare with $4300? It wouldn't include a trip to Thailand. [ Sigh ] Medical tourism.
Now, granted, Spurlock was overseas, but this is the definition of value-based care. He had transparent, seamless, coordinated care with the focus on outcomes and not just volume.
Over here, it's a completely different story.
Meet Mya Neehurtz: A Very American Healthcare Story
I came across an email titled "The Surgeon's Record," by editor-in-chief Dr Ben Schwartz, that goes through a hypothetical case showing just how fragmented and complex musculoskeletal care can be. In the post, which can be viewed on his Dem Dry Bones Substack, there's a fictional character named Mya Neehurtz (a great name) who has knee pain, similar to Morgan Spurlock and millions of Americans.
The hypothetical journey goes like this. Mya sees her PCP for knee pain, who orders an ultrasound and an x-ray, and obviously, she faces two facility fees because the imaging center is not where her doctor is. Some of the results show bone arthritis and a potential bone mass.
The PCP is like, This isn't my area of expertise. Let's order an MRI and get your referral to an orthopedic surgeon . Well, all the surgeons are busy. She can't get in for months unless she goes out of network, so she pays out of pocket. The surgeon is like, Wait, I can't access these images because the systems don't communicate. Also, why did your doctor order all these tests? This is all while the surgeon is really backlogged, so he reorders some images and tries Mya out on noninvasive treatments. Her knee pain continues, and finally, after months, she gets a knee replacement.
Examples like this happen all the time in American healthcare with chronic and acute illnesses. In Mya's case, in this example, there's a lack of shared decision-making, there's poor access to subspecialists, and evidence-based guidelines may or may not be followed. Even the technology isn't properly communicating, and I know you could probably relate with this. I see these barriers that happen with patient care all the time.
What Is Value-Based Care, Really?
Value-based care isn't just a buzzword. According to many experts, including those at the Commonwealth Fund, value-based care is all about getting patients the right care at the right time, while minimizing all these unnecessary and fragmented steps.
Value-based care ties provider payments with the quality of care performed, with additional focuses on cost efficiency and equity. Improving health outcomes while reducing waste — what a win. Who wouldn't want that?
Now, the Centers for Medicare & Medicaid Services (CMS) has several value-based programs in place, including the End-Stage Renal Disease Quality Incentive Program, Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program.
And these programs have three goals in mind:
Better care for individuals
Better health for populations
Lowering cost
Lower cost — what a concept. According to a 2019 JAMA article, up to $935 billion is wasted annually on unnecessary services. If you look at this example from Dr Schwartz and then you amplify it across all states and include many more conditions, you can see how this adds up to a large amount of money and time wasted.
So, What's Holding Us Back?
I agree with Dr Ben Schwartz when he says that we have the capability to have these integrated medical clinics right here. They don't have to just be medical tourism fairytales of places like Thailand. We can have all-inclusive surgery centers that have state-of-the-art, digital health support, and that have everything you need under one roof, including subspecialists you may refer to — imaging, PT, OT, lab work, and more.
For now, this seems like the diamond-in-the-rough exception and not the rule.
Yes, we need more advocacy and lobbying. As suggested by Dr Maria Ansari in an article posted on the AMA website , we need more data looking at health disparities and actionable items, and then we could potentially follow a payment playbook that involves identifying the right patient population, good benchmarks, and then having transparent feedback.
The reality is that we have all the parts to the solution; we just need to put the puzzle together. Now, I'm obviously simplifying a very complex system that is rooted in bureaucracy, but who am I? I'm just a burned-out physician. I'm not a health policy researcher.
I want to hear from all of you. How far are we, really, from having a more efficient, value-based healthcare system?
What are the barriers? Are there any initiatives that you have come across that work? Comment below.