The Widening Care Gap
Alex N@anapheys
+2.4%
since Sep 30
The idea
I believe US healthcare costs keep rising until more procedures become worth a trip abroad, while the ones that stay home get paid in cash instead of insurance. Since the overseas hospitals themselves aren't investable, I own both sides of the trade: the device and implant makers who supply surgeries wherever they happen, plus the US cash-pay telehealth, surgery centers, and price-transparency names benefiting as patients shop for care directly.
What it owns
- Hospitals that attract international patients buy robots and implants from these companies, so they capture revenue wherever the operation happens. · Intuitive SurgicalIts da Vinci robots are installed in hospitals worldwide that serve international patients, so procedure fees grow regardless of which country does the surgery., StrykerIts hips, knees and surgical tools are bought by overseas hospitals serving international patients and by US surgery centers doing procedures for cash., Boston ScientificIt has the fastest emerging-market growth among major device makers, exactly where medical tourism hospitals are buying equipment., MedtronicIt sells devices in essentially every country a medical tourist could land in, so it earns from procedures regardless of location., Zimmer BiometHip and knee replacements are among the most-traveled-for procedures because of the US price gap, and it supplies implants on both sides of the border.27%
- The same cost gap that pushes patients abroad also drives those who stay toward cheaper cash-priced care at home, where insurance codes don't apply. · Hims & Hers HealthIt lets patients pay flat cash prices for care with no insurance codes involved, capturing the domestic version of the cost-gap pressure., Tenet HealthcareIt operates ambulatory surgery centers that perform the same procedures hospitals do for a fraction of the cost, embodying the domestic version of the price gap., Surgery PartnersIt operates outpatient surgery centers, the cheaper venue that wins when patients and payers start shopping on price., GoodRx HoldingsIt exists because the cash price of a drug is often lower than the insurance price, embodying the take in miniature.24%
- Dental work is the single biggest medical tourism category, and these companies supply the aligners, chairs and materials to clinics worldwide. · Align TechnologyIt sells aligners and scanners to dental clinics in Mexico, Turkey and Thailand as much as in the US, riding international cash-pay volume., Henry ScheinIt distributes chairs, drills and consumables to dental clinics globally, so more dental tourism means more supply flowing through its warehouses., Dentsply SironaIt makes imaging and milling equipment that lets clinics in cheaper markets complete complex work in days, enabling the core pitch of dental tourism.15%
- Cosmetic surgery, aesthetics and fertility are the procedures people most often travel for, and these firms supply the equipment behind them. · Establishment LabsIt makes breast implants from Costa Rica, one of the medical tourism capitals, and sells mostly outside the US where aesthetic surgery costs less., InModeIt sells aesthetic devices to clinics worldwide, riding the demand from patients chasing the cheapest quality care abroad or domestically for cash., ProgynyFertility is expensive and one of the biggest reasons Americans travel abroad for care, and it grows as employers respond by covering fertility directly.13%
- Cash-pay medicine needs accounts to hold funds and cheaper coverage options, and these companies facilitate that movement of money. · HealthEquityIt holds the HSA accounts people use to pay for care in pre-tax dollars, which grows as insurance premiums become more painful., Oscar HealthIt sells cheaper individual coverage to people priced out of traditional insurance, serving the same cost pressure driving the take.11%
- Cash10%