As more Americans seek medical services abroad, primary care physicians have raised concerns about continuity, communication, and safety. They wonder how best to serve their own patients who venture into this rapidly expanding sector within international healthcare.
“Medical tourism is no longer a fringe trend — it’s a strategic solution for patients facing affordability, access, or treatment limitations in the U.S.,” says Jonathan Edelheit, JD, chief executive officer of the Medical Tourism Association in West Palm Beach, Florida. “From life-saving surgeries to fertility treatments, Americans are looking abroad for high-quality, cost-effective options.”
Americans travel abroad for medical care for a variety of reasons. Some patients may have high deductibles, limited coverage, or no insurance at all, making care in the United States difficult to afford. For others, some treatments or procedures may not be readily available locally, or the wait times may be excessive. In some cases, patients are seeking a specialist with specific expertise, or they may desire alternative options that haven’t received approval in the United States.
THE GROWING POPULARITY OF MEDICAL TOURISM
Once perceived as risky, medical tourism is now increasingly viewed as responsible, particularly when it’s done with proper research, trusted providers, and medical continuity.
“For physicians, this isn’t a threat — it’s an opportunity to help patients navigate care globally while ensuring outcomes and patient safety remain a top priority,” Edelheit says, adding that “the medical tourism movement isn’t about abandoning domestic care — it’s about empowering patients to make informed decisions.”
One of the major concerns, however, is a lack of coordination. “When patients arrange medical travel independently, without involving their primary care provider, physicians may be left out of the loop,” says Renée-Marie Stephano, JD, chief executive officer of Global Healthcare Accreditation (GHA) in Palm Beach Gardens, Florida, which certifies the quality of medical services patients receive abroad. “That makes it difficult to review the treatment plan, ensure it aligns with the patient’s medical history, and properly manage follow-up care once the patient returns home.”
Open communication is a cornerstone of best practices. The primary care physician “can help assess fitness for travel, flag underlying conditions, and coordinate the sharing of test results with the international care team,” Stephano says. However, “this level of coordination doesn’t always happen,” especially for self-paying patients who organize their own care abroad.
“Some patients may not inform their primary care physician until after the fact, or they may choose to have all testing done at the destination hospital to keep costs streamlined or avoid involving multiple providers,” she says. “Still, it’s something we encourage and strive for as part of responsible medical travel. Even a basic level of communication between the patient, their primary care doctor, and the treating facility abroad can go a long way toward improving outcomes and avoiding unnecessary risks.”
ENSURING QUALITY CARE
To assuage concerns about quality, experts recommend that primary care physicians check whether facilities abroad meet international standards and whether healthcare providers in other countries are fully credentialed by inquiring about accreditation by recognized organizations, such as the GHA or Joint Commission International (JCI). This validation plays a fundamental role in cultivating trust and safeguarding against clinical uncertainty, they say.
“JCI accreditation focuses on the consistent delivery of safe, high-quality care,” says Andrew Rosen, vice president at JCI in Oakbrook Terrace, Illinois. “Patients who choose JCI-accredited organizations benefit from reduced variability and minimized patient safety risks, improved clinical and operational processes, and care from experienced staff trained in international standards and best practices.”
If you’re a primary care provider whose patient expresses interest in medical tourism, “the first thing to do is not judge; listen to the patient’s reasoning for their plan,” says Rebecca Andrews, MS, MD, MACP, a professor of medicine and director of primary care at UConn Health in Farmington, Connecticut.
“Hopefully, the individual is in a fact-finding stage when you have time to provide information. Safety is the first concern. Is the patient healthy enough to sustain the procedure? Will they have an aftercare plan and travel home will be at a safe time period,” she says.
It’s also important for a primary care physician to review the entire gamut of costs — from the procedure to any medication, travel, and other expenses incurred abroad.
“There will always be concerns, but if your patient is set on this path, we can mitigate some risks,” says Andrews, who is also chair of the Board of Regents at the American College of Physicians. “If traveling to Brazil, say for a ‘tummy tuck,’ I would ask my patient how long they would be cared for after the procedure, what plan were they given for any infection after the surgery, and especially review the risks of blood clots if they fly home too soon. A blood clot can be life-threatening if not identified and treated quickly, and an infection might mean the benefits of the procedure are lost with follow-up surgeries and scarring.”
Complications also may arise after a patient returns home, and a surgeon unfamiliar with what was done may encounter more challenges correcting the problem. In the end, this may result in higher costs, and there may not be any recourse if something goes awry. Patients undergoing procedures abroad are unlikely to have the same protections as they would in the United States, where the healthcare system permits legal action for gross negligence, Andrews says.
Monitoring patients after they return from medical services abroad is an important role primary care providers can play, even if they weren’t consulted during the initial decision to travel, Stephano says. “At a minimum,” she adds, “they can assess wound healing, review medications, order any needed follow-up labs or imaging, and help manage ongoing symptoms or complications.”
Juan L. Giraldo, MD, a reproductive endocrinologist and co-founder of Inser Fertility Group with five clinics in Colombia, says about half of the group’s patients come from abroad, including many from the United States. In 2024, the group treated 568 U.S. patients, up from 463 in 2023.
In his practice, one cycle of egg freezing costs $3,700, including medications and five years of storage, compared to about $10,000 to $12,000 in the United States, without counting annual storage fees. And one cycle with an egg donor costs $8,100 in his practice, compared to about $25,000 in the United States.
“We work closely with local physicians in the U.S. who assist with the initial diagnostic work-up, pre-treatment preparation for IVF, post-treatment monitoring after embryo transfer, and even prenatal care,” Giraldo says. “We have longstanding relationships with many of them, and they are familiar with the quality of care we provide.” He adds that “many U.S. physicians understand that their patients often pursue fertility treatment abroad because of the high cost of care in the U.S.”
Chadwick C. Prodromos, MD, an orthopedic surgeon in suburban Chicago, Illinois, and Naples, Florida, has been performing stem cell treatments for four years in Antigua and one year in Athens, Greece, on patients with arthritis, autism, long COVID, and autoimmune diseases other than multiple sclerosis (MS) at a cost of $20,000–$25,000. He also offers exosome treatments for $12,500 to patients with amyotrophic lateral sclerosis, Parkinson’s disease, MS, and stroke. Exosomes are tiny vesicles within stem cells that penetrate more easily by bypassing the blood-brain barrier.
U.S. insurers currently do not cover either procedure because the Food and Drug Administration has cited a lack of adequate studies, Prodromos notes. “We are providing data from our studies that we hope will allow coverage relatively soon,” he says.
Matthew Smith, who works in software technical sales in the Boston area, recalls having “an awkward conversation” with his primary care physician about pursuing a laparoscopic sleeve gastrectomy for weight loss in San Jose, Costa Rica. The physician couldn’t provide guidance on another country’s medical standards but was “open-minded” and offered to monitor him upon his return.
Smith, 41, says he had no choice but to pursue treatment abroad after his health insurer denied the minimally invasive procedure initially and on appeal. It would have cost $30,000 to $40,000 out of pocket in the United States, compared to the $13,200 he paid in Costa Rica, including an overnight hospital stay. He also spent $2,500 on a two-bedroom apartment for nine nights for himself and his mother, who accompanied him, in addition to airfare.
Diet, nutrition classes, and exercise had failed to consistently help him shed excess pounds. After undergoing the procedure in March 2024, Smith says he is “absolutely satisfied” with the outcome, having lost 165 pounds in 16 months. “My only regret is not having the procedure earlier,” he says. “It has been such a positive and life-changing experience.”
To verify whether a healthcare organization is accredited by Joint Commission International (JCI), visit the JCI website (https://www.jointcommission.org/en ) and search for JCI-Accredited Organizations.
MEDICAL TOURISM — WHO, WHAT, AND WHERE
Jonathan Edelheit, chief executive officer of the Medical Tourism Association in West Palm Beach, Florida, says the roughly $100 billion medical tourism industry is growing at an annual rate of 15%.
Medical tourism has surged because of a convergence of factors:
Skyrocketing healthcare costs in the United States have even made insured patients seek alternatives abroad.
Patients with high deductibles — often $5,000 or more — find it more economical to go abroad, even with travel costs.
Patients with no insurance coverage for specific procedures, such as IVF, dental reconstruction, cosmetic or reconstructive surgeries, bariatric surgery, and experimental or integrative therapies, prompt outbound medical travel.
As a result of the globalization of healthcare, many international hospitals now meet or exceed U.S. standards, with JCI accreditation and U.S.-trained physicians.
Employers and self-funded health plans are also starting to offer incentivized outbound care for cost containment.
Roughly 1.4 to 2 million Americans travel abroad for medical care annually. Patients can save 30-80% on procedures depending on the destination and treatment. According to research from the Medical Tourism Association and other industry reports, the most popular procedures and destinations are:
Mexico — dentistry, bariatric surgery, orthopedics, plastic surgery
Costa Rica — dental, orthopedic, cosmetic
Thailand — orthopedic, fertility (IVF), cancer care
India — cardiology, oncology, transplant, orthopedic
Turkey — hair transplant, plastic surgery, IVF
Colombia — plastic surgery, dentistry, IVF
ADVICE FROM THE CDC
AAPL reached out to the Centers for Disease Control and Prevention regarding information about medical tourism. Julie Thwing, MD, travel medicine team lead at the CDC’s Travelers’ Health Branch, responded to the following questions from medical reporter Susan Kreimer.
How big an industry is medical tourism? For which procedures? Which countries?
There is not currently a surveillance system for tracking medical tourism, and it is difficult to track for various reasons. What we do know is that millions of U.S. residents travel to other countries for medical care each year.
The most common procedures that people undergo on medical tourism trips include dental care, cosmetic surgery, fertility treatments, organ and tissue transplantation, and cancer treatment.
Medical tourists from the United States most commonly travel to Mexico and Canada, and to several other countries in Central America, South America, and the Caribbean.
Do patients often ask primary care physicians if they should travel abroad for medical care?
Because of the lack of surveillance, we cannot say how often patients talk to their primary healthcare providers about travel related to medical tourism.
CDC suggests people seek expert advice at home before travel for the purpose of receiving medical care. Ideally, they should consult their healthcare provider (or primary care doctor) and a travel medicine specialist for advice tailored to their specific needs four to six weeks before any travel.
How should the primary care physician advise in such a situation, perform necessary tests, and/or follow up?
If patients mention or ask about travel related to medical tourism, it is important to have an honest and candid discussion about the specific risks they may face related to the patient’s current health status and the planned procedures.
It’s especially important for a patient’s primary care doctor to be in the loop because of the potential need for long-term follow-up care when they get back, especially if complications develop.
You can find a travel medicine specialist through the International Society of Travel Medicine (ISTM.org).
Is there anything you would like to add?
If a patient is traveling outside of the United States for medical care, let them know to do their research. This includes checking the qualifications of the clinician who will be doing the medical treatment or procedure and the credentials of the facility where this will be done.
Advise them to obtain international health insurance in the event they need medical treatment outside the U.S. and consider additional medical evacuation insurance in case they need to be medically evacuated to the U.S.
Follow-up care for medical complications can be expensive and might not be covered by your health insurance. Travelers considering procedures outside the United States should understand the potential financial costs associated with follow-up care or emergency care in the event of complications; review their health insurance policies to determine what, if anything, is covered; and plan for the possibility of paying for additional care out of pocket.
If they visit you for a pre-travel consultation, discuss their current health status and make sure they have a copy of their medical records.
Advise patients to take their medical records with them from the U.S. and be sure to get copies of the medical records from the international facility where they received care. These should include the clinic name, clinician who performed the procedure, and procedure(s) performed.
Patients should be prepared and arrange for follow-up care immediately following the procedure and when they return to the U.S.
If patients feel unwell or experience complications upon their return, they should seek care immediately and be honest about recent travel as well as any procedures they had done.
CDC Resources
For clinicians: The CDC Yellow Book: Medical Tourism. https://www.cdc.gov/yellow-book/hcp/health-care -abroad/medical-tourism.html
For travelers: Medical Tourism: Travel to Another Country for Medical Care. CDC Travelers’ Health. https://wwwnc.cdc.gov/travel/page/medical-tourism