This paper examines Blue Cross & Blue Shield's consideration of medical tourism as a corporate downsizing strategy on the demand side of healthcare. Drawing on a 2008 BusinessWeek report, the paper traces how the insurer explored incentivizing policyholders to seek medical procedures abroad in lower-cost countries such as Thailand, Turkey, and Ireland. The analysis situates this development within broader trends of corporate globalization and cost reduction, while raising critical questions about whether profit motives are overriding patient health and comfort. The absence of physician input in the policy discussion is noted as a telling indicator of the decision's managerial — rather than medical — origins.
Downsizing is not merely letting workers go. Downsizing means streamlining organizational processes and reducing the input costs of an enterprise. In today's environment of corporate downsizing, sending jobs overseas to be filled by cheaper workers in developing nations has enabled corporations to cut costs significantly. This form of downsizing maximizes a corporation's ability to use globalization to a cost and strategic advantage by reducing the input costs of labor, land, and the overhead costs of running a facility in the United States. Making use of low-wage Chinese laborers in manufacturing facilities and English-speaking Indian citizens at call centers in offshore locations has become routine. But what about downsizing on the demand side of things? This may sound impossible — but not for health insurance companies.
Blue Cross & Blue Shield noticed the phenomenon of medical tourism — individuals going abroad for cheaper medical care — and decided that it was missing out on a potential profit opportunity. In the future, Blue Cross may begin pressuring its policyholders to travel abroad to nations where medical costs are less expensive. "Getting covered employees to leave the U.S. won't be that hard … An insurance company could waive all deductibles and co-pays, offer to cover travel costs for the patient and family members, even throw in a cash incentive, and still save tens of thousands of dollars," enthused one of its vice-presidents (Einhorn 2008). "Americans haven't come to grips with having their heart surgery in Thailand," admitted the American CEO of one of the Blue Cross affiliate hospitals abroad, "but that will change" (Einhorn 2008).
"Profit over patient care; no physician input in policy"
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