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One misstep last summer was all it took for Debi Thorkelson to wrench her knee so badly she couldn't even bend her leg. After an MRI showed that she'd torn a major ligament, the doctor said she needed surgery. "I had no insurance, and the operation was more than $41,000, not including the hospital stay," says Thorkelson, 45, of Naples, Florida. "I just didn't have the money."
Then her husband remembered a show he'd seen about Americans getting medical treatment in Panama, at rock-bottom prices. He found a travel agency that matched patients with physicians abroad. The agency recommended a U.S.-trained doctor working at the Clinica Biblica Hospital in San Jose, Costa Rica. The total cost? Just under $4,000 for surgery, plane tickets, and nine days in a brand-new rehab center.
Thorkelson is one of half a million Americans who traveled overseas last year to countries like Brazil, Costa Rica, Singapore, Thailand, and India for treatments including hip and knee replacement, heart and gynecological surgery, even cancer and experimental procedures such as stem-cell therapy, according to Josef Woodman, author of Patients Beyond Borders, the first comprehensive guide to medical travel. Many experts believe that outsourcing healthcare is the wave of the future; others are convinced the risks involved -- long-distance travel, unknown doctors, little recourse if things go wrong -- make it a poor, and sometimes dangerous, alternative. "Medical tourism is extremely safe as long as patients do their homework and know what they're getting into before they go," says Woodman.
The number of patients traveling for care is growing rapidly, and this is only the beginning, according to Karen Timmons, president and CEO of the Joint Commission International (JCI), an offshoot of the organization responsible for evaluating and endorsing U.S. hospitals. "With medical costs continuing to rise and the number of uninsured growing, the globalization of healthcare is about to explode," she says.
Rudy Rupak, president and founder of California-based Planet Hospital, one of several companies that arrange medical trips abroad, says business is booming. "Last year, we worked with 10 to 12 clients a month. Now it's 3 to 5 a day." Some U.S. corporations and insurance companies even cover treatment overseas. BlueCross BlueShield of South Carolina recently began offering healthcare in Thailand, Singapore, Turkey, Ireland, and Costa Rica, and dental care in Costa Rica as well, to its 1.5 million members.
"Soon insurance companies will start giving financial incentives to encourage patients who want to seek care abroad," says Sander Domaszewicz, of Mercer, a human-resources consulting firm. "For instance, if an employee needs a non-life-threatening procedure like a hip replacement, she might be told, 'You have options. There are four or five facilities in other countries that can do this at a sixth of the U.S. price. If you choose one, we'll waive your co-payment or share of the cost.' "
For most patients and businesses, the huge savings are the obvious appeal. Almost 62 million Americans have no insurance or are underinsured, and more than 100 million don't have dental coverage. Illness and medical bills are a major cause of personal bankruptcy, according to a 2005 Harvard University study.
Treatment in foreign hospitals is a bargain: A root canal may be $280 instead of $750; a hysterectomy $3,000 to $6,000 instead of $20,000; a heart-valve replacement $9,000 to $12,000 instead of $160,000.
Michelle Schuetz, 41, opted to seek treatment in another country after spending eight years -- and $9,000 -- trying to have a baby. "The next step was in vitro fertilization [IVF], but the cost was staggering -- at least $20,000 for a single try," says Schuetz. In 2005, a friend suggested that Schuetz look overseas. After doing some research, she found the Barbados Fertility Centre, which specializes in IVF. The cost of the procedure, plus plane tickets and a hotel room, was $13,000, almost half what it would have been in the U.S., and the clinic's success rates were impressive. In addition, the facility offered a health-and-wellness package that included acupuncture and a couples massage. After two visits to Barbados (the first IVF attempt failed), Schuetz and her husband, Michael, had a baby boy. "The experience was great; I felt so relaxed the entire time. We were well cared for," says Schuetz.
The quality of care is a big selling point for many -- often it is just as good as (or better than) in the U.S. This is due in part to an increasing number of foreign doctors choosing to get trained at American medical schools. Bumrungrad International Hospital in Bangkok, which treats more than 400,000 medical travelers each year, including a reported 64,000 Americans, has more than 200 doctors who are board-certified in the U.S. In addition, several overseas hospitals have partnered with U.S. medical schools to improve the level of care they provide -- National University Hospital in Singapore has teamed with Johns Hopkins Medical School, and Harvard University has opened a medical institute in Dubai. "It's becoming more and more common for hospitals with a large number of foreign patients to have doctors who trained overseas," says Dan Snyder, group COO of ParkwayHealth, a private healthcare provider in Asia.
What's more, foreign hospitals are now being accredited by the Joint Commission International. Those that apply for and receive JCI accreditation must meet hundreds of safety standards and be able to verify the credentials and licenses of the doctors and nurses who work there, says Timmons. "Currently we have more than 160 accredited hospitals around the world, and we're seeing a tremendous increase in the number of medical centers interested in initiating the process."
To top it off, it's gotten easier for Americans to seek treatment abroad because of the increasing number of medical-travel agencies. These companies, whose fees are often paid by the hospitals, do the legwork for patients, like researching the reputations and specialties of different clinics and doctors. They also arrange for travel, a place to recover and the transfer of medical records.
Patients say the rave reviews they hear about English-speaking staffs, high nurse-to-patient ratios, plenty of face time with their doctor, and luxurious facilities are persuasive. "My doctor was fluent in four languages," says Thorkelson. "He answered every question I asked. When I returned home, my physician in Florida looked at my knee and said it was a beautiful surgery."
Medical tourism is not a vacation, though, and it isn't for everyone. "When you have surgery, you're at a very weak point in life," says Anmol S. Mahal, MD, immediate past president of the California Medical Association. "While you may be able to find cheaper care abroad, I believe the best place for a patient to get treatment is close to home, with a doctor he or she trusts."
The mileage involved means that traveling for healthcare is best for "routine procedures, such as orthopedic surgery or a one-time cancer treatment -- things that have major cost savings and high success rates," says Patrick Marsek, of the Chicago-based medical-travel agency MedRetreat. Would-be patients need to be fit enough to withstand very long flights both before and after treatment, says Marsek, so "it may not be safe to send someone abroad for a quadruple bypass."
Making sure the right aftercare is available, especially if problems arise, is also crucial, says Taizoon Baxamusa, MD, a clinical assistant professor at the University of Illinois at Chicago. Not every doctor is willing to treat complications from surgery done elsewhere, because "repair work is more complicated, less predictable, and has a greater chance of a negative outcome than the initial procedure," Dr. Baxamusa explains. Also, treatment for complications can be expensive, which is a problem if you're uninsured.
One of the biggest drawbacks to care abroad is that there's little you can do if something goes really wrong. Malpractice suits are generally hard to file and even harder to win in other countries. Awards, if any, are usually much lower than they are in the U.S. A few companies, such as Companion Global Healthcare, are starting to put together insurance policies that patients can buy to provide malpractice coverage for care performed outside the U.S., but "right now, your rights as a patient just aren't clear," says Renee-Marie Stephano, JD, general counsel and COO for the Medical Tourism Association (MTA), an international nonprofit organization that is providing some standardization on medical travel. "Even in America, malpractice laws vary state by state. Bring in foreign doctors and procedures done in different countries and it becomes impossibly complicated. Where should a suit be filed? Who is liable when a medical-travel agency is used? There just isn't any case law on these issues."
Organizations are working to make the process safer. The MTA is creating guidelines on how medical-travel agencies should operate. (Currently, these groups are not accredited. For tips on finding a reputable one, go to www.fitnessmagazine.com/medicaltravel.)
By the end of the year, the MTA plans to launch a Web site where would-be patients can compare foreign hospitals and surgeons by procedures, safety records and success rates (MedicalTravelAuthority.com).
For now, the best way to ensure a safe and successful trip is with research. Here's what you need to do before you go:1. Read up.
Two good places to start: the book Patients Beyond Borders by Josef Woodman and the Web site medicalnomad.com, which is run by a team of medical and IT professionals. The book and the site have basic information about planning a trip and contact numbers for medical-travel agencies, hospitals and clinics. (Double-check that any hospital you're considering is JCI-accredited by logging on to jointcommissioninternational.org.)
Ask to speak to a patient-services coordinator (most hospitals have one). A few important questions to go over with her: Do doctors and support personnel speak English? How many surgeries like yours has the doctor you're considering performed, and what is his or her success rate? How up-to-date is the equipment? Where were support staff, such as ICU nurses and anesthesiologists, trained?3. Get references.
Once you've narrowed down your list to a handful of doctors, it's time to request references. "Ask for the names of past American patients and call them," says Dr. Mahal. You will want to find out what they thought of the physician and the hospital and whether they were pleased with the overall experience. Also, be sure to ask whether they experienced any complications.4. Make plans for aftercare before you go.
Let your U.S. doctors (both your GP and any specialists you see) know that you're going abroad for treatment. Ask if they're willing to provide follow-up care and, if not, whether they'll phone colleagues on your behalf before you leave. "Physicians are much more likely to accept a referral when it comes from another physician," says Dr. Baxamusa.
Originally published in FITNESS magazine, October 2008.