Birth Tourism - Should Physicians be Disciplined?

SEPTEMBER 14, 2016
Future Proof, MD

BY DRRANDOMFACTOR, VIA WIKIMEDIA COMMONS [CC BY-SA 3.0]
 
If you've never heard of "Birth Tourism", you would be like me a month ago. But my interest was piqued when my niece who lives in China contacted me and asked for a review of the doctors and hospitals she was considering for the purpose of birth tourism. After doing some research, I kindly declined to comment. But I could not stop thinking about it and the doctors involved.

WHAT IS BIRTH TOURISM?
Birth tourism refers to the act of traveling to another country (usually a more affluent one) for the purpose of giving birth to an “anchor baby." US and Canada are popular destinations given their jus soli policy toward citizenship - you are considered an American citizen if you are born on American soil no matter where your parents are from. This has led to a large number of foreign women flocking to America to give birth. Once the American-born child reach the age of 21, he/she can then petition for the parents to become lawful residents and eventually citizens of America. This is not a uniquely Chinese problem. But as incomes rise in mainland China, more and more Chinese women are arriving in the US for the goal of giving birth to an American citizen. California in particular is a hotbed for "maternity hotels". 

HOW I GOT INTERESTED
About a month ago, I received a message from my niece who lives in China on the popular instant messaging app WeChat. Honestly I was surprised because this was someone I haven't spoken to in over 10 years. This is what she sent me:
 

CHART SCREENSHOT COURTESY OF THE AUTHOR (CROPPED FOR SIZE)


 
For those of you who don't read Chinese, let me explain. The above image is a screenshot from an online forum posting advertising birth tourism packages (all prices in US dollars):
  • First Column - Hospital, all of which are in California. Hospitals in red fonts are those without NICUs.
  • Second Column - Prices for natural vs. caesarean births during 24, 48 or 72 hour hospital stays. Cedar Sinai (Row 2) and UCLA Reagan Medical Center (Row 3) demand the highest prices.
  • Third Column - Whether there is a Chinese speaking physician and what that particular physician's fees are (natural vs. caesarean births). As you can see, they are much higher than the typical insurance reimbursement.
  • Watermark - Also the poster's Weibo (China's Twitter) handle. It literally translate into "Dr. Give-birth-in-America Liu" (No relation to yours truly).

WHY DOES IT MATTER ANYWAY? 
Birth tourism has been featured in multiple investigative reports - including the Huffington PostWall Street JournalUSA Today and this in-depth piece from Rolling Stone Magazine. The negative impacts of birth tourism are easy to summarize:

1. It is an abuse of immigration and visa law - essentially turning a temporary stay into permanent residency. The women are often coached to lie to immigration officials about their true intent of visiting America. Often, the baby is taken back to China within weeks of birth and won't return until college age. I would argue an “anchor baby” born to an illegal immigrant who grows up in America is much more American than a baby born to a birth tourist.

2. It is an abuse of the social safety net. While many of the expectant Chinese mothers are wealthy and can afford to pay the much higher rates for healthcare shown above, there are cases where the taxpayers are stuck with the bill:

"In one case, new parents last year paid just $4,080 of a $28,845 hospital bill, even though their bank account showed charges at Louis Vuitton, Rolex and Wynn Las Vegas hotel-casino."

FUTURE PROOF TAKE:
Let me be clear - I don't have the solution for birth tourism. That issue stems from complex socioeconomic realities and has no simple solution. Even if we take away birthright citizenship as many has advocated including The Donald, I'm sure the wealthy Chinese will simply find another way. However, I do want to shine a spotlight on column 3 - the physicians who take advantage of the current system.

On one hand, you can argue that these physicians are simply providing a necessary service - if they didn't do it, someone else will. On the other hand you can make the same argument for drug dealers and prostitutes, yet neither is widely accepted by society at large. Also, by partnering with birth tourism agencies, these physicians are facilitating this abusive process for personal financial gain. In cases where the birth tourist sticks the American taxpayers with the hospital bill, they are also facilitating healthcare fraud. So my question for you is this: "Should we discipline physicians who knowingly participate in birth tourism for financial gain? If so, how should we do it?"

Thoughts and comments? Reach me at http://futureproofmd.com/
 


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