Tourist Rx: Traveling overseas for inexpensive, quality care: For surgeons in India, dentists in the Philippines, medical tourism is taking off -- and U.S. medical insurers are taking notice

(The Miami Herald)

By Jacob Goldstein, The Miami HeraldMcClatchy-Tribune Business News

http://www.hotel-online.com/News/2007_Jan_07/k.MIL.1168280803.html

Jan. 7--Medicine is going global.

Vacation time isn't just for fun. Increasingly, people who have never left the United States before are traveling thousands of miles for complex medical procedures.

The reason is, simply, money. Treatments that would drive many people into bankruptcy at home often cost only a few thousand dollars in the developing world.

Added bonus: Medical tourists get to see another part of the world. But the risks can be significant. Imagine everything that can go wrong after surgery -- then imagine it going wrong in a strange city, 10,000 miles from home, in a country whose legal system may make it difficult or impossible to sue.

Still, the financial rewards are big enough, and the quality of care high enough, that growing numbers of Americans with limited or no insurance are outsourcing their medical care.

Take the case of Tim Devinney, a North Carolina Realtor who needed surgery to close a hole in his abdominal wall. Devinney, who is in his 40s, did not have insurance, and a doctor told him the surgery would cost about $30,000.

He put it off, but his intestine kept squeezing through the abdominal wall -- an incredibly painful experience that sent him to the emergency room several times.

Then he read a newspaper story about a North Carolina company that helped people -- mostly middle class and uninsured -- find medical treatment overseas. A few months later, he was on a plane to Delhi, India.

When Devinney landed, a driver was there to meet him. But his medical liaison, who was stuck in Delhi's notorious traffic, was not. The driver didn't speak much English.

"The driver just dropped me off at the emergency room and these people did not know who I was," he says. 'The doctor was ready to start an examination and I was like, 'No, you're not.' "

His liaison found him a few minutes later, and shepherded him through the admissions process. The hospital was a bit shabby -- no air conditioning in the hallways, interiors that felt older than those in U.S. hospitals. Some nurses wore gloves when they touched him; others didn't.

But, he says, "where they were way ahead was in patient care. . . . The night before I had the procedure, I had six doctors in my room for an hour, talking with me about the procedure, answering questions. That's unheard of here."

The cost of the entire 10-day trip -- including airfare, the hotel stay and all of his medical bills -- was less than $5,000, one sixth what the procedure would have cost in the United States.

THE NEW PATIENT

In many ways, Devinney is typical of the new wave of medical tourists. In the past, those who traveled abroad for care often had family overseas, and typically went for minor or elective procedures, such as dental work or cosmetic surgery.

To be sure, many still make such trips.

Abella Bayanos of Miami took her son home to the Philippines this summer after she learned that he needed dental work that would have cost $7,000 here. The whole trip, including the dental work in Baguio City and two round-trip tickets bought at the last minute, cost just over $3,000.

"For me, I think if there's any kind of problem again I'd rather go back to the Philippines," Bayanos says. "It's a lot cheaper."

More and more, though, medical tourists are going to unfamiliar countries for complex treatments such as orthopedic surgery and cardiac procedures. For the most part, these are working people who are under-insured or uninsured -- though this may soon change.

Several large corporations are considering adding overseas medical treatment to the range of options for employees with health insurance, says Dr. Arnold Milstein, of Mercer Human Resource Consulting, who has been retained by five Fortune 500 companies (he won't say which) to figure out whether outsourcing healthcare is a viable option in some cases. One option under consideration to make the trip more palatable: Covering all of the employee's out-of-pocket expenses, along with a round-trip ticket for a spouse or other caregiver.

Price discounts vary widely, but Milstein says savings of 60 percent are realistic, after factoring in roundtrip airfare for the patient and a companion, the cost of the procedure itself, and food and lodging during the recovery process. Anecdotal reports show even greater discounts.

TOUGH STANDARDS

Of course, price is the easy part. More difficult is finding a hospital with highly trained staff, and the equipment and training to handle the wide range of problems that can arise during or after any medical procedure.

One useful indicator is accreditation by Joint Commission International, the international wing of the Joint Commision on Accreditation of Healthcare Organizations, or JCAHO, the most important source of hospital accreditation in the United States Joint Commission International was launched in 1998 and has now accredited roughly 100 hospitals in 25 countries, said Anne Rooney, JCI's vice president of consulting. She said the international accreditation standards are based on U.S. standards, with modifications that suit local customs and regulations.

Bumrungrad Hospital in Bangkok, Thailand, one of the best known of the JCI-certified hospitals, now claims more than 400,000 international patients (inpatient and outpatient) per year.

'You go to Bumrungrad's website and you say 'I'd like to see a rheumatologist, or a gynecologist, or an orthopod,' " says Claudia Auger, who retired from Miami to Bali and has been to the Bangkok hospital several times. "There's a link to all those doctors. Then you can click on their name and up comes a photo of them and a full bio."

Auger, who chose a doctor who trained at the Mayo Clinic, likes the customer-service side of Bumrungrad.

"You are not held to wait," she says. "You are walked to your next appointment. When you go to pay for your whole procedure, they hand you any drugs that have been prescribed."

MIDDLEMEN

In the United States, several small companies have sprung up to act as middle-men, helping U.S. consumers find doctors abroad.

Stephanie Sulger, a nurse in New York, launched Medical Tours International five years ago, and now works with a team of doctors and nurses screening both overseas hospitals and U.S. patients.

She tries to warn off those who are too sick to make a long journey, or those with unsafe medical plans.

"People are getting too much cosmetic surgery at one time," she says. "They'll go overseas and get a complete body lift. The American Society of Plastic Surgeons has clearly said you shouldn't be getting this much plastic surgery at one time, even here."

Despite the recent boom in medical tourism, the number of South Florida patients coming in for help for problems after an overseas cosmetic procedure goes wrong seems to be declining, according to Dr. Onelio Garcia, a Hialeah plastic surgeon who chairs the board of trustees of the Florida Society of Plastic Surgeons.

"There was a time around the turn of the century where this was a weekly event where some nightmare was showing up in an emergency room in this town," he says. "We see it less now than we used to . . . I think people are more aware of the risks."

The problem hasn't disappeared, though. And often, Garcia says, issues arise not because of incompetence on the part of the overseas doctor but because the patient does not have access to follow-up care and so does not address post-operative complications as soon as they arise.

But even with risks such as these, the global economics of health care mean medical tourism will continue to grow, says Milicia Bookman, an economist at St. Joseph's University in Philadelphia who lives in Miami and is writing a book on the subject.

"Medical tourism has the possibility of being the great health care equalizer in this country," she says. "You've got highly trained, western trained physicians using state of the art technology. What more do you want?"

ROAD TO RECOVERY

For Devinney, the North Carolina Realtor, the answer might have been home sweet home.

His surgery last year went well, and a few days later he moved into a nearby hotel. But he was alone, and the recovery proved emotionally difficult at times.

"Being in a strange country where you don't know anyone -- even though they're all very nice -- it's not the same. There's that loneliness."

Despite that, he'd do it again, he says. "I would recommend it to someone else. But I would say don't expect it to be exactly what you would get here. In some ways it is going to be better, [in others] it's going to be not as good."