LOSING PATIENTS
The pandemic is disrupting medical tourism to Houston, including Sara Rozin’s business.
The patients who use Sara Rozin’s medical concierge company are not Houstonians, but she treats them like family and friends all the same.
Rozin, who runs Houston Health Concierge, has seen thousands of out-of-state and international travelers in nine years. Some come to the Texas Medical Center to seek a second opinion; others believe the specialists employed in one of Houston’s biggest industries will provide better care than they can find in their home countries.
Houston’s Texas Medical Center draws more than 24,000 international travelers seeking medical care each year, but the COVID-19 pandemic forced many to stay home, fearful of contracting the virus abroad when they were already immunocompromised, and walled off by federal travel restrictions. Medical experts worry about the patients whose health is only worsening as they wait to return to Texas’ hospitals and clinics.
“It’s hard to build the trust, the silk road. But it’s very easy to destroy,” Rozin said.
Prior to the pandemic, medical travelers brought upwards of $1 billion in revenue to the city, according to the Center for Medical Tourism
Research at the University of Incarnate Word.
Outpatient procedures such as gastric sleeve surgery, along with physical rehabilitation services, are the most popular treatments sought out at the Texas Medical Center. Many patients also visit for cancer and pediatric care.
With Texas Medical Center institutions limiting elective procedures and family visits during COVID-19, the sudden absence of international patients forced Houston to lose at least $294 million in 2020 as international patients stayed home, according to the Center for Medical Tourism Research.
“We know it’s at least hundreds of millions of dollars, but potentially, it could be billions of dollars that were lost in Houston during the pandemic,” said David Vequist, director of the Center for Medical Tourism Research.
The lucky ones
Families who have visited for critical care during the pandemic must weigh the dangers of traveling as COVID-19 cases abound.
Cases surged after the winter holidays, but that wasn’t the biggest concern for Daniel Mariscal Romero and Mariana Ocejo. The parents of four had just discovered a large, hard bump on the stomach of their only daughter, 7-year-old Fernanda. Doctors told them it was a mass in her left kidney. Her diagnosis: Wilm’s tumor, a childhood cancer in the kidneys.
“We wanted the best (hospitals),” said Mariscal Romero, who lives in Mexico City. “Here in Texas, they met all the requirements with the kids: the experience; the surgeons; the child support.”
There was no doubt in Mariscal Romero and Ocejo’s minds that they would seek treatment in the U.S. Houston is a two-hour flight from Mexico City. They have family in The Woodlands and had visited in the
past. So in January, they packed up all four kids and their dog, Coco, and moved to Texas for Fernanda’s surgery and chemotherapy.
COVID has been hard on Mexico; at its peak in January, 22,000 cases were reported in one day. So even as Texas reported alarming highs — nearly 28,000 new cases at its peak in January — they felt it was safer to homeschool their kids in the U.S., see doctors and nurses who already had access to COVID-19 vaccines and limit their suddenly immunocompromised child’s exposure to a virus that could seriously sicken her.
Patient care specialists have been diligent about preventing COVID-19 cases from transmitting to others in the hospital. Early in the pandemic, several Texas Medical Center institutions clamped down on visitor policies. MD Anderson Cancer Center, the strictest of the hospitals, barred visitors entirely unless they were the adult caregiver of a patient. Texas Children’s Hospital limited their visitor policy to just one parent in the room.
Joann Lee, who oversees Texas Children’s Hospital’s international destination patient services, said her division primarily attracts patients who are seeking care that is unavailable or lackluster in their home countries.
“Even in the pandemic, there was more of a case to be made that some of those very high acuity cases still did need to come,” Lee said.
Fernanda was one of those patients. In Mexico City, there was no guarantee there would be enough medication to treat her illness, Ocejo said. If she needed a blood transfusion, there was an expectation they would find a donor to replace the blood she used.
“We’re so thankful and lucky to be here within this horrible situation, where we’re not having to worry where our kid is going to get her medicine,” her mother said.
Making do in the meantime
Not every patient is as lucky as Fernanda. It was nearly impossible for Rozin, the health concierge, to bring any of her patients to Houston. One of her clients was an 11-year-old boy sick with leukemia, died in 2020 before he could travel to the U.S. for treatment.
Rozin, a Soviet refugee who spent time in Israel before moving to the U.S., saw her own children and grandchildren in him. Her breath still hitches when she remembers how his hometown raised more than $100,000 to send him to Houston for treatment.
“The world lost the boy,” Rozin said. “We were devastated.”
At Dan’s House of Hope, a Houston non-profit that houses young adults and their caregivers as they seek cancer care at the Texas Medical Center, only one family has been allowed to stay in the home at a time.
Dawn and Roger Kenneavy, the couple who co-founded the organization, try to provide financial aid for a few nights of housing or point patients to potential stays if they can’t house them when they need help.
“Not only do they have a cancer diagnosis, they’re immunocompromised and could get the delta variant, and now they have the additional burden of trying to find someplace to stay,” Dawn Kenneavy said.
COVID-19 has also caused patients with less urgent medical issues to delay care, partially because many have lost health insurance due to layoffs. Others postponed appointments due to a fear of medical settings.
An estimated 41 percent of people in the U.S. put off seeking preventive care last year, worried about COVID-19, according to the Centers for Disease Control and Prevention.
“What this has done is created a lot of pent-up demand,” Vequist said. “It’s bad for public health, it’s bad for people’s health.”
Patient care specialists worry those patients will become sicker, resulting in costlier treatments or death from what begins as preventable illnesses.
Businesses’ saving grace
People travel from countries such as Canada, Mexico, Russia, the United Arab Emirates and Vietnam for care in Houston. The average visitor spends about $3,400 on food, hotel stays and other incidentals when coming for care, Vequist said.
In the interim, businesses have also had to find new ways to stay afloat.
Houston Health Concierge pivoted to online second opinion consultations during COVID-19. It was not a profitable service, Rozin said, but it pays the bills.
For hospitals, which make much of their revenue off elective procedures and run a hefty part of their businesses based off international visitors, the earliest months of the pandemic were the hardest. But in recent months, visitors like Fernanda’s family have trickled back.
Patients are usually backed by international insurance or embassies, sustaining a consistent cash flow. Those numbers will soon return to normal as vaccines become available in other countries.
The arrival of the delta variant in the U.S. impeded plans for some to expand again. The Kenneavys wanted to invite multiple families to stay at Dan’s House of Hope again, but decided against it due to the resurgence of the virus. But they’re hopeful this time the surge won’t last as long so patients can return.
“I expect it to come back with a roar,” Vequist said.