Colorectal cancer screening is important for prevention and early detection, and contributes to better prognosis and longer survival. While screening rates have generally increased in the United States, they have remained disproportionately low in some minority and immigrant populations. Recent evidence suggests that in some cases, these rates may be low because of medical tourism, where individuals return to their home country to receive preventive care. To assess the impact of medical tourism on colorectal cancer screening, Dr. Linda Ko and colleagues in the Public Health Sciences Division, Dr. John Inadomi at the University of Washington, and their community partners including Dr. Eun-Jeong Lee from the National Asian Pacific Center on Aging, surveyed Korean Americans for their screening history. As recently reported in BMC Cancer, the authors found that participants who engaged in medical tourism were significantly more likely to be up-to-date for their colorectal cancer screening.
Korean Americans comprise the fourth largest Asian group in Washington state, the majority of whom live in the Seattle metropolitan area. Colorectal cancer is the most commonly diagnosed cancer among Korean Americans, which may be partly due to low screening rates. Said lead author Dr. Ko, “the anecdotal evidence from people around us suggested medical tourism might be a factor, and we said, let’s measure it to see the extent of people’s engagement in medical tourism.”
To evaluate the prevalence of medical tourism in this group, the authors conducted a cross-sectional, observational survey of 193 Korean Americans in 2013. Participants answered questions regarding whether they were up-to-date on their colorectal cancer screening, which meant either a stool test within the last year or a colonoscopy within ten years. Participants also reported on their history of medical tourism, socio-demographic characteristics, health factors, acculturation, knowledge of colorectal cancer screening tests, and worries about the costs of health care.
All of the study participants reported being born outside of the U.S., but had lived in the U.S. for an average of 23 years. The average age of immigration was 39 years old, and most reported that they did not speak English well (72%). One third of the participants reported traveling outside of the U.S. for medical care, mostly to South Korea, an average of 2.5 times over the previous 5 years. Only 57% of the participants were up-to-date on their colorectal cancer screening, with nearly all reporting colonoscopy as their screening test. Said Ko, “what surprised us was the high percentage of Korean Americans who engaged in medical tourism; about half of those who have gotten screened for colorectal cancer have done so outside of the U.S.” In fact, medical tourism was the only significant predictor of colorectal cancer screening, with participants who engaged in medical tourism having nearly 9-fold greater odds of being up-to-date compared to those who did not travel for healthcare.
One potential explanation for the high level of medical tourism is the relative costs of healthcare services in the U.S. versus other countries. For example, the cost of a colonoscopy in South Korea is only 2.3% of the cost in the U.S. – or approximately $130-200. Half of the participants reported being worried about medical costs for general care (51%) or serious illness (62%), and patients without insurance were more likely to engage in medical tourism (41%) than those who had insurance (29%). Said Ko, “we were able to document that the rising healthcare cost in the U.S. is driving people to get healthcare outside of the U.S., and this can ultimately impact how people receive coordinated cancer care.” Also contributing has been a rise in South Korean hospitals partnering with Korean travel agencies in the U.S. to promote medical tourism as part of vacation packages.
Understanding medical tourism will become increasingly important as the global medical landscape continues to change, and the authors plan to evaluate this trend further. Said Ko, “we are curious to see whether medical tourism is also practiced among other immigrant populations. Again, we have anecdotal evidence that immigrant population other than Korean Americans engage in medical tourism, but would be interesting to measure that as well. In addition, we are curious to see how engaging in medical tourism affects continuity of cancer care in the U.S., especially when the screening results are positive and how having received cancer screening outside of the U.S. affects communication with the U.S. oncologist. Lastly, it would be important to work with healthcare providers in the US to raise awareness that many Korean American patients may be engaging in medical tourism and following cancer screening guidelines that may be different from the US. Communication with these patients will be critical to avoid mistrust with the US medical system.”
Also contributing to this project was Dr. Victoria Taylor from the Fred Hutch and Dr. Joo-Ha Hwang from the University of Washington.
Funding for this study was provided by the Centers for Disease Control and Prevention, Fred Hutch, and the National Institutes of Health (NCI).
Ko LK, Taylor VM, Yoon J, Copeland WK, Hwang JH, Lee EJ, Inadomi J. 2016. The impact of medical tourism on colorectal screening among Korean Americans: A community-based cross-sectional study. BMC Cancer. 16(1):931.
Image provided by Dr. Linda Ko