Americans traveling abroad to Costa Rica in search of cheaper, non-emergency medical care have been either wealthy or uninsured. But, recently, the profile of tourists travelling for medical reasons is changing. Now, medical tourists are more likely to be covered by private insurers, which want to keep medical costs from spinning out of control. Four of the larger U.S. health insurers, with an estimated enrollment of 100 million people, have incorporated pilot programs, which offer overseas travel. The smaller insurers and a few brokers have also incorporated travel options.

Medical tourism is having a slow go of it, partially because some patients and some employers are concerned about the quality of care they will be receiving and any if there will be any legal responsibility if something goes wrong. Also, people who carry traditional insurance plans (low deductibles), have little incentive to travel abroad to Costa Rica. But, there is a growing number of insured, ones with a high-deductible plan, are beginning to make these medical trips. The insurance industry’s promotion of medical tourism seems to have had an interesting side-effect in the United States: price breaks in provider care due to foreign competition. With the slumping economy, domestic competition has led to the slow go of medical tourism.

Last year, the Deloitte Center for Health Solutions estimated around 6 million U.S. citizens will make a medical tourism trip to Costa Rica in 2010. But, in 2010 that figure has been reduced to 1.6 million, which is still more than double the 750,000 who traveled abroad in 2007. The center expects that medical tourism can only grow as more health insurers offer the ‘high-deductible’ plan.

Quality and liability are legitimate worries. The average consumer has no way to compare hospitals around the world concerning the quality of their services, which varies widely. But, insurers are now getting involved with raising the standards by scrutinizing and inspecting all of the hospitals before listing them on their overseas network. As for employers who are considering adding medical tourism to their insurance plans, many medical tourism companies, especially in Costa Rica, have begun to offer insurance that protects employers that send their employees abroad from liability.