Under-Regulated Health Care Phenomena in a Flat World: Medical Tourism and Outsourcing

Abstract

This Article examines two intersecting phenomena: medical tourism and the outsourcing of health care goods and services. "Medical Tourism" (Part I) involves the resident of one state or country physically experiencing health care in another place. "Out- sourcing" (Part II) involves care that appears domestic but has been disaggregated to allow some components to be performed non-do- mestically. Frequently the patient (or in the case of final benefi- ciaries of a clinical trial, a domestic user of a subsequently approved drug) does not know that care has been outsourced. These two phenomena currently operate outside, and may be disruptive of, contemporary Western health care regulation. While health care, particularly in the U.S., is our most highly regulated industry, medical tourism and outsourcing appear to operate outside our traditional regulatory matrix. Having examined the ex- tent to which this is an accurate intuition, this Article questions (in Part III) the extent to which we do or will enjoy increased trading of health services and addresses some of the issues that must be considered in approaching any regulatory questions posed by medi- cal tourism and outsourcing.