Sunday, December 3, 2006

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” have a vacation in an exotic 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.

In addition, “they return with a lot more money left in their pockets — sometimes 70 [percent] to 80 percent more than if they’d been treated 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 number of Americans who travel abroad 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, founder and president of the 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 way to afford surgery or dental work for those without health insurance or for those whose policies do not cover 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.-based medical-tourism firm with offices in Fulton, Md., said it arranged 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 dire stories about Americans taking 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 that found nearly 100,000 people die accidentally in U.S. hospitals each year.

“With a track record like that, the medical industry in this country cannot sit in a glass house and throw 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. patient to fly there, enjoy a vacation, get treated, “recover in a four- or five-star resort” and then fly home, “having spent less than the procedure alone in the United States.”

For example, Mr. Marsek said: “In Malaysia or Thailand, an American 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, where the pay scale is low 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.

In such foreign destinations, “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 have to worry about the “bad debts” 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 medical tourism, you present your credit 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 Europe and Asia, hip resurfacing remained 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, cashed in frequent-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, and I walked with a severe limp. My leg would lock up at night, and I couldn’t sleep. But today I sleep without problems. I can walk again, and there’s no pain. I play tennis, and there is no pain.”

When Mrs. Bennett first learned about hip resurfacing, the technique was being tested at Duke University Medical Center and several other U.S. hospitals. But because it had not yet been approved by the FDA, Mrs. Bennett would have had to pay $40,000 to have the procedure done at Duke — and her health insurance would not cover it.

Mrs. Bennett said she had confidence in Dr. Bose because he helped 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 resurfaced at facilities operated by Apollo 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 on-site 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

While some Americans are heading 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 high-quality 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 provides advice on flight arrangements, 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.

Given that a round-trip flight from 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 South Korea is like getting your hair 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 Salvador also has amazing [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 paper-products 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.

“Large American insurance companies have not fully jumped aboard the medical-tourism bandwagon, 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.

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