The ability of patients to seek high-quality medical care at drastically lower costs in other countries could pose a challenge to Michigan hospitals, which are trumpeting their own quality and value propositions to wider audiences as health care delivery goes global.

Hospitals, insurers and others who work with the health care industry agree that international medical tourism, well established in other parts of the world, is knocking at the United States' door.

Foreign-based medical tourism hospitals see an opportunity to advertise savings as high as 90 percent on certain elective procedures to a U.S. market swamped by high costs and some 47 million uninsured residents. And businesses seeking relief from the escalating costs of providing employee benefits are persuading insurers like Aetna and Blue Cross Blue Shield of South Carolina to incorporate medical tourism options into their health plans.

Some see a ripe market in Michigan, where rising unemployment is pushing more people off insurance coverage and employers are trimming benefits for employees and retirees.

PlanetHospital, a medical tourism brokerage based in Southern California, is working with health care attorneys at Detroit-based Clark Hill in the hopes of drumming up business in Michigan. The 7-year-old company also wants to open a $1.1 million call center in the Detroit area by early next year and is exploring tax incentive packages with the state.

"Competition has never really existed for health care," CEO Rudy Rupak said. "Just like telecom and cable, they're their own little islands."

The company sees a market in the United Auto Workers, which is now managing retiree health benefits from union-run trust funds and will have to carefully watch costs. Rupak also said he was meeting with General Motors Co. prior to its bankruptcy filing about offering medical tourism options for early retirees.

GM spokeswoman Geri Lama said the company doesn't comment on internal discussions and wouldn't say whether it's considering medical tourism for its benefit plans. The automaker doesn't offer such options for any of its hourly, salaried or retired workers, she said.

Alex Piper, a Troy-based medical tourism consultant who frequently speaks on the topic, said one client - a major corporation based in southwest Michigan - plans to implement medical tourism benefit options next year. He declined to name the company, citing confidentiality agreements.

Piper said accredited medical tourism hospitals in countries like Jordan, Colombia and South Korea are eager to tap the U.S. market.

"They have the U.S. right in the crosshairs as willing to market their health care to them," said Piper, the president of OneWorld Global Healthcare Solutions. "You're going to see more and more of it."

A 2008 report from consulting firm Deloitte said more than 750,000 Americans went abroad in 2007 in search of less expensive care, with the numbers expected to rise to 6 million by 2010. That translated into $2.1 billion spent on care by Americans and $15.9 billion in revenue lost to providers in the U.S.

In Michigan, hospital systems such as Spectrum Health, the University of Michigan Health System and the Detroit Medical Center already are positioning themselves as medical tourism destinations for certain specialty programs. Oakland County also is touting its considerable health care infrastructure as a medical tourism destination with its Medical Main Street initiative.

Brian Peters, executive vice president of the Michigan Health & Hospital Association, said more than one member hospital reported treating patients from all 50 states and half a dozen foreign countries in 2008. Detroit-based Henry Ford Health System says its robotic prostate surgery program alone has hosted patients from more than two dozen countries.

"At this point in time, the feedback that we get from our members is more of an optimistic view" about medical tourism "as opposed to concern about losing revenue," Peters said. "I think they're looking at this as an opportunity to draw new patients to the state."

Some are skeptical that traveling overseas for medical care will take hold in Michigan.

At Grand Valley Health Plan, a small HMO based in Grand Rapids, underwriters are already commonly designing plans that include medical tourism options for specialty services within the U.S. or Canada, CEO Ron Palmer said.

Such options, which could include cancer treatments or heart surgery, promise savings as high as 50 percent. Some even guarantee the surgery and promise to pay costs related to errors or infections, Palmer said.

"I think that we're going to see referrals expanded in terms of their geographical scope," Palmer said. "But let's not make the assumption that that necessarily means overseas."

Medical tourism has been touted as a hot trend, notes Dr. Mary Beth Bolton, chief health officer for Detroit-based Health Alliance Plan of Michigan.

"HAP will continue to gauge interest, but we have not seen a demand for this service among members and employers," Bolton wrote in an e-mail response. "Making the decision to cover elective procedures abroad would require a benefit change and a conscious decision by an employer to drive that change."

Michigan hospitals are in a good position to hold their own in the competition for out-of-state and international patients, said Peters of the MHA. The state has more hospitals in the Thomson Reuters list of top 100 hospitals than any other, and reports have shown that Michigan hospitals rank below the national average in terms of average costs, he said.

The challenge for Michigan hospitals could be to effectively communicate that message to consumers and purchasers looking for relief from the high costs for care.

"With anything that provides a catalyst for reform, there's quite a bit of controversy around it," said Greg Moore, the head of Clark Hill's health care practice who is working with PlanetHospital. "Obviously, folks here in Michigan don't want to see business go overseas. But providers in the United States are realizing that health care business has to become more competitive on a global basis.

"Really there are two sides to medical tourism. It's not just exporting business based on cost, it's importing business based on quality."

-Sven Gustafson writes about health care and other topics for Michigan Business Review. contact him at (734) 302-1732 or sveng@mbusinessreview.com.

Photos: Alex Piper, Brian Peters, Ron Palmer, Greg Moore