Surgery abroad: With med­i­cal tourism, cost is deep­est cut

The Washington Times Weekly - - National - By Joyce Howard Price

Grow­ing num­bers of Amer­i­cans are trav­el­ing abroad to un­dergo med­i­cal and den­tal pro­ce­dures that are much less ex­pen­sive than they are in this coun­try — and some­times not avail­able in the United States at all.

Th­ese so-called “med­i­cal tourists”haveava­ca­tion­i­nanex­otic place where they can soak up the sun, visit a few golden tem­ples or other land­marks and end up with a new hip or knee, a healthy heart — or a ro­bot-con­trolled joint re­place­ment, a pro­ce­dure that has not yet been ap­proved in this coun­try.

Inad­di­tion,“theyre­turn­with­alot more money left in their pock­ets — some­times 70 [per­cent] to 80 per­cent­morethani­fthey’dbeen­treated in the United States,” said Diana M. Ernst, a pub­lic-pol­icy fel­low in Health Care Stud­ies for the Pa­cific Re­search In­sti­tute (PRI).

No or­ga­ni­za­tion tracks the num­berofAmer­i­can­swho­trav­e­labroad for surgery, ac­cord­ing to Con­sumer Re­ports. But Plan­etHospi­tal, which ar­ranges med­i­cal trips to eight for­eign coun­tries, said it re­ceives more than 4,000 in­quiries a month.

“In a re­cent month, we ar­ranged 81 surg­eries, and 47 pa­tients were from the United States,” said Rudy Ru­pak,founderand­pres­i­dentofthe Cal­abasas, Calif.-based com­pany.

Uwe Rein­hardt, a health econ­o­mist at Prince­ton Univer­sity, said he has not heard “one hor­ror story” in­volv­ing a med­i­cal tourist.

“If there had been, you could be sure the med­i­cal es­tab­lish­ment would have am­pli­fied it,” Mr. Rein­hardt said.

But Con­sumer Re­ports warns that peo­ple “should know the risks” in­volved in hav­ing surgery in a for­eign coun­try, such as “un­cer­tain reg­u­la­tion, lack of back­ground in­for­ma­tion on sur­geons, lack of fol­low-up care and dif­fi­culty su­ing” a for­eign physi­cian or hospi­tal.

How­ever, it does ac­knowl­edge that go­ing abroad might be the only way­toaf­ford­surgery­or­den­tal­work forthose­with­outhealth­in­sur­anceor forthose­whose­poli­cies­donot­cover the pro­ce­dures they need.

“The health care sit­u­a­tion in the United States to­day is caus­ing peo­ple to go bank­rupt and is forc­ing com­pa­nies to de­cide if they will have to lay off peo­ple in or­der to pro­vide health care ben­e­fits,” said Tom Kesling, pres­i­dent of Raleigh, N.C.-based IndUShealth, which sends Amer­i­cans to In­dia for var­i­ous med­i­cal pro­ce­dures.

The Amer­i­can Med­i­cal As­so­ci­a­tion has not yet taken a po­si­tion on med­i­cal tourism, al­though it is ex­pected to do so in the fu­ture, a spokes­woman said.

“But we don’t think med­i­cal tourism is a pol­icy for unin­sured Amer­i­cans,” she said. ‘One player among oth­ers’

MedRe­treat, a Ver­non Hills, Ill.basedmed­i­cal-tourism­firmwith­of­ficesinFul­ton,Md.,said­i­tar­ranged surg­eries in for­eign coun­tries for more than 200 Amer­i­cans last year and more than 350 this year.

MedRe­treat spokesman Pa­trick Marsek said he has not heard any diresto­riesaboutAmer­i­canstak­ing part in med­i­cal-tourism pro­grams.

But he cited a case that oc­curred last Fe­bru­ary, when Joshua Gold­berg, 23, a Cal­i­for­nia man who went to Thai­land to be or­dained as a Bud­dhist monk, died at Bum­run­grad Hospi­tal in Bangkok af­ter be­ing bit­ten by a snake.

Re­ports in­di­cated Mr. Gold­berg was “si­mul­ta­ne­ously ad­min­is­tered [. . . ] six con­traindi­cated and lethal med­i­ca­tions,” de­spite warn­ings to doc­tors from his fa­ther about his al­ler­gies to cer­tain drugs.

“Bum­run­grad Hospi­tal is sup­posed to be the world’s leader in at­tract­ing for­eign pa­tients,” Mr. Marsek said. It is the only hospi­tal in Thai­land ac­cred­ited by the U.S.-based Joint Com­mis­sion on In­ter­na­tional Ac­cred­i­ta­tion.

But Mr. Rein­hardt cited a re­port in 1999 by the In­sti­tute of Medicine that­found­nearly100,000peo­pledie ac­ci­den­tally in U.S. hos­pi­tals each year.

“With a track record like that, the med­i­cal in­dus­try in this coun­try can­not­siti­na­glasshouse­andthrow stones,” he said.

In fact, Mr. Rein­hardt said: “A lot of re­search shows we are just one player among oth­ers. A lot of surgery is just plumb­ing that re­quires skill. Given cir­cum­stances to­day, it’s much harder to run a hospi­tal in Los An­ge­les than in In­dia. And while things could go wrong in a hospi­tal in In­dia or an­other Asian coun­try, they would prob­a­bly turn out just as well there as here.” A cheap fix

MedRe­treat said the low cost of med­i­cal treat­ment in the seven for­eign coun­tries with which it has ar­range­ments — Ar­gentina, Brazil, In­dia, Malaysia, South Africa, Thai­land and Turkey — al­lows a U.S. pa­tient­tofly­there,en­joy­ava­ca­tion,get treated, “re­cover in a four- or fives­tar­resort”andthen­fly­home,“hav­ing spent less than the pro­ce­dure alone in the United States.”

For ex­am­ple, Mr. Marsek said: “InMalaysiaorThai­land,anAmer­i­can can get a com­plete face-lift and neck-lift for un­der $3,000. But the price will be $6,000 to $12,000 or even higher in the United States.”

How­ever, he ac­knowl­edged it is not fi­nan­cially wise to go abroad for a pro­ce­dure that would cost $6,000 in the United States. Even if the same pro­ce­dure costs only $1,500 in a for­eign coun­try, “you’ll prob­a­bly only break even,” when you add in the costs of air­fare and ho­tel ac­com­mo­da­tions, he said.

MedRe­treat’s price for a trip to Thai­land for a hip re­place­ment is $12,000, in­clud­ing $8,000 or $9,000 for the pro­ce­dure, he said. Also in­cluded is round-trip air­fare for two; a one-week stay in the hospi­tal; and a two-week stay in a five-star ho­tel. In the United States, the price of the hip re­place­ment alone is at least $40,000, Mr. Marsek said.

Mr. Ru­pak — whose firm sends pa­tients to Ar­gentina, Bel­gium, Costa Rica, El Sal­vador, In­dia, Panama, Sin­ga­pore and Thai­land — said a pa­tient would spend $36,000 for coro­nary ar­te­rial-by­pass graft­ing and $55,000 for a heart-valve re­place­ment in the United States. But in some for­eign coun­tries, the same op­er­a­tions are avail­able for as lit­tle as $11,000 and $13,000 re­spec­tively, in­clud­ing air­fare and ho­tel.

A per­son who un­der­goes can­cer surgery in In­dia or Thai­land could ex­pect to pay $14,000, in­clud­ing air­fare and ho­tel, he said. In this coun­try, the surgery alone would cost about $65,000.

Ex­plain­ing why the cost of med­i­cal treat­ment is so much lower in other coun­tries, Ms. Ernst said, “The Amer­i­can dol­lar is more valu­able in many un­de­vel­oped, for­eign coun­tries,wherethe­p­ayscaleis­low and the num­ber of pa­tients high.”

One of the main rea­sons Amer­i­can sur­geons and hos­pi­tals are start­ing to lose out to com­peti­tors in for­eign coun­tries is that “med­i­cal mal­prac­tice is not nearly so ruth­less” over­seas as it is in the United States, she said in her re­port in PRI’s news­let­ter, Health Pol­icy Pre­scrip­tions.

In­such­for­eign­des­ti­na­tions,“doc­tors can pay as lit­tle as $4,000 a year for mal­prac­tice in­sur­ance. Amer­i­can doc­tors can pay 25 times that amount ev­ery year,” Ms. Ernst said.

In ad­di­tion, for­eign hos­pi­tals in­volved in med­i­cal tourism do not have­towor­ryabout­the“bad­debts” that plague so many fa­cil­i­ties in the United States, Mr. Marsek said.

“Hos­pi­tals in­volved in med­i­cal tourism don’t take you un­less you pay. When you go over­seas for med­i­cal­tourism,youp­re­sen­ty­our­credit card, and that’s that,” he said. Ex­plor­ing op­tions

Jeanne Ben­nett, 49, of Raleigh, N.C., re­ceived na­tional at­ten­tion for a trip she made to Chen­nai, In­dia, where she un­der­went hip resur­fac­ing to elim­i­nate arthri­tis pain.

Hip resur­fac­ing is a long-last­ing

ther­apy that is less in­va­sive than hip re­place­ment and is usu­ally rec­om­mended for younger pa­tients, such as Mrs. Ben­nett, who have en­dured years of de­bil­i­tat­ing pain.

While com­monly per­formed in Euro­pe­andAsia,hipresur­fac­in­gre­mained an ex­per­i­men­tal ther­apy in the United States un­til the Food and Drug Ad­min­is­tra­tion ap­proved it May 10.

Mrs. Ben­nett said she first learned of the pro­ce­dure and its low-cost avail­abil­ity in In­dia from a re­port last spring on “60 Min­utes.”

In June 2005, she and her hus­band,John,cashed­in­fre­quent-flyer miles and flew to In­dia, where Dr. Vi­jay C. Bose resur­faced Mrs. Ben­nett’s arthritic right hip for $5,600, in­clud­ing all hospi­tal fees.

“My ex­pe­ri­ence could not have been any bet­ter,” she said. “I had lived with chronic pain for 10 years, andIwalked­with­a­severe­limp.My leg would lock up at night, and I couldn’t sleep. But to­day I sleep with­out prob­lems. I can walk again, andthere’snopain.Iplayten­nis,and there is no pain.”

When Mrs. Ben­nett first learned abouthipresur­fac­ing,thetech­nique was­be­ingteste­datDukeUniver­sity Med­i­cal Cen­ter and sev­eral other U.S.hos­pi­tals.But­be­cau­sei­thad­not yet­beenap­proved­bytheFDA,Mrs. Ben­nett would have had to pay $40,000 to have the pro­ce­dure done atDuke—and­her­health­in­sur­ance would not cover it.

Mrs. Ben­nett said she had con­fi­den­ceinDr.Bose­be­cause­he­helped de­velop the spe­cial pros­the­sis that’s now in her right hip.

“In fact, I sent two other peo­ple over there af­ter I got back home,” she said.

Mrs. Ben­nett had her hip resur­face­dat­fa­cil­i­tiesop­er­at­ed­byApollo Hospi­tal En­ter­prises, the largest com­pany in In­dia serv­ing med­i­cal tourists. Like other com­pa­nies ag­gres­sively seek­ing those will­ing to travel for health care, Apollo Hos­pi­tals usu­ally pro­vides West­ern pa­tients with a pack­age that in­cludes round-trip flights, ho­tels, med­i­cal treat­ment and even a post­op­er­a­tive vacation.

The Apollo Hospi­tal in Chen­nai and two other Apollo hos­pi­tals are among five fa­cil­i­ties in In­dia ac­cred­ited by the Joint Com­mis­sion.

“To sweeten the at­trac­tion, many [for­eign] hos­pi­tals pro­mote their ser­vices like a re­sort, of­fer­ing private, air-con­di­tioned rooms with on­site spas, pools and In­ter­net ac­cess,” Con­sumer Re­ports said.

The phe­nom­e­non of med­i­cal tourism is a role re­ver­sal for those ac­cus­tomed to hav­ing for­eign­ers travel to the United States for high-qual­ity health care, if they can af­ford it.

“But if you don’t have in­sur­ance, and you are in pain like I was, you’ll do what­ever you have to,” Mrs. Ben­nett said. Over­com­ing road­blocks

While­someAmer­i­cansare­head­ing to Asia for low-cost med­i­cal ser­vices, oth­ers are bound for Poland for den­tal work.

Den­tal Travel Poland (DTP) said it or­ga­nizes “money-sav­ing den­tal trips” to War­saw, the na­tion’s cap­i­tal, where for­eign pa­tients visit “top den­tal clin­ics” and re­ceive “a wide range of high­qual­ity ser­vices at one-third of the prices” charged in Eng­land and the United States.

The deal also in­cludes ac­com­mo­da­tions at some of War­saw’s “best” ho­tels plus sight­see­ing and trans­porta­tion in the city. DTP pro­videsad­viceon­flightar­range­ments, but air­fare is not in­cluded in its treat­ment pack­ages.

In an e-mail mes­sage, DTP said its prices are “very com­pet­i­tive, es­pe­cially for ma­jor work.” For ex­am­ple, its fee for a den­tal im­plant is $980. The price in the United States is about $3,400.

Given­thataround-tripflight­from Wash­ing­ton to War­saw can be as low as $350 at cer­tain times of the year, go­ing to Poland for ma­jor den­tal ser­vices can still be cost ef­fec­tive, es­pe­cially if mul­ti­ple re­pairs are made, said Marek Purowski, a spokesman for the Pol­ish Em­bassy in Wash­ing­ton.

“The prices for den­tal care in the United States are un­be­liev­able, ridicu­lous,” he said.

In Latin Amer­ica and South Korea, the big draws are plas­tic surgery and den­tal work.

“South Korea is the world’s cap­i­tal for plas­tic surgery,” Mr. Rein­hardt said. “They do it round the clock. Get­ting plas­tic surgery in SouthKore­ais­likeget­tingy­ourhair done in the United States.”

A State De­part­ment of­fi­cial said med­i­cal tourism is also a “big in­dus­try” in Ti­juana, Mex­ico. The of­fi­cial, who spoke on the con­di­tion of anonymity, said Amer­i­cans usu­ally seek den­tal work or cos­metic surgery.

Those same ser­vices are also in de­mand in Costa Rica, Mr. Ru­pak said. “And be­lieve it or not, El Sal­vado­ral­so­hasamaz­ing[med­i­cal]fa­cil­i­ties, par­tic­u­larly for hys­terec­tomies, tubal lig­a­tions or re­verse tubal lig­a­tions,” he said.

How­ever, there are still some road­blocks to a groundswell of U.S. sup­port for med­i­cal tourism. For ex­am­ple, a North Carolina pa­per­prod­ucts com­pany in­ter­ested in send­ing an em­ployee to In­dia for shoul­der and gall­blad­der surgery and giv­ing him the $10,000 it ex­pected to save ran into dif­fi­cul­ties with a union that rep­re­sented some of its em­ploy­ees.

“LargeAmer­i­canin­sur­ance­com­pa­nieshavenot­ful­lyjumped­aboard themed­i­cal-tourism­band­wagon,so the num­ber of med­i­cal tourists re­mains pal­try com­pared to the mil­lions of surg­eries per­formed in the U.S. ev­ery year,” Ms. Ernst said.

But Mr. Rein­hardt said med­i­cal tourism will only grow in the com­ing years.

“And if it is used a lot, this has the po­ten­tial of do­ing to the U.S. health care sys­tem what the Ja­panese auto in­dus­try did to Amer­i­can car­mak­ers,” he said.

Re­searchers Amy Baskerville and John Sopko con­trib­uted to this ar­ti­cle.

Agence France-Presse / Getty Images

Thai Dr. Pinyo Hun­sa­jaru­pan per­formed a fer­til­ity treat­ment at the Je­tanin In­sti­tute in Bangkok on Aug. 4. For years, for­eign­ers have come to Thai­land for med­i­cal care. Some clin­ics are carv­ing out a niche with fer­til­ity treat­ments too ex­pen­sive or too con­tro­ver­sial else­where.

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