Health Care Bargains Abroad

Bruce Pearson owns a nursery, raising orchids and other lush flora in Boynton Beach, Fla. But it was painful sciatica that made his back as delicate as a hothouse flower. While leading an eco-tour in Thailand a few years ago, Pearson experienced back pain so severe that it put him in a local hospital. The treatment he received converted him into an enthusiastic medical tourist. In six months, Pearson was back in Bangkok, at renowned Bumrungrad International Hospital, for a laminectomy—spinal surgery to relieve the pressure on a nerve.

The cost, including a five-day stay in a private room, was $4,700, compared with quotes of $70,000 and higher that Pearson had received in the U.S. Even with insurance, Pearson would have paid nearly $20,000 out-of-pocket here. In Bangkok, his biggest problem, he says, was “choosing between the tuna in red wine sauce and the lobster salad.” Since the 2005 surgery, Pearson, now 65, has been back to Bumrungrad for follow-up back care and three comprehensive physicals—at a cost of about $400 each—that he believes were more thorough than he’d get here. Travelers on Pearson’s eco-tours to Thailand now often seek medical attention, too.

If you’re willing to hop on a plane, you can find significant savings abroad. India is a top destination for orthopedic procedures and heart surgeries. Singapore and South Korea are well known for cancer diagnosis and treatment, Malaysia for painstaking executive health screenings. Israel is emerging as a popular destination for in vitro fertilization, and Latin America, already the cosmetic-surgery capital of the world, is becoming renowned for its dentistry. The cost differential between U.S. and foreign medical procedures can be staggering. Compare a coronary valve replacement and bypass surgery in Taiwan, at $18,000, with the U.S. equivalent at $85,000.

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This year, more than a half-million U.S. residents will get medical care abroad, according to Patients Beyond Borders, a consumer advisory service. That number is likely to grow at a 25% to 35% annual rate. But that’s far fewer jet-setters than experts had predicted just a few years ago, when a 2008 report from the Deloitte Center for Health Solutions foresaw six million medical tourists by 2010.

In an abysmal economy, many have indefinitely postponed the elective dental and cosmetic procedures not covered by insurance that are medical tourism’s staples. Employers that might have included a medical-travel option in their benefit plans are waiting to see how health reform plays out, says Deloitte’s Paul Keckley.

Serious savings

Some procedures lend themselves to international travel; others are best left to local docs. The five most-popular overseas procedures, according to Patients Beyond Borders, are cosmetic surgery, dentistry, orthopedics, in vitro fertilization and other reproductive services, and weight-loss surgery. Some experimental drugs and procedures, such as stem-cell therapies, are, for the most part, available only overseas—and should be undertaken only with extreme caution.

Complex procedures that require lengthy recuperation (think bone-marrow transplants) are problematic. Cancer is a gray area, with travel dictated less often by potential cost savings and more often by the desire to undergo treatment close to friends and family. Even with lower-stakes procedures, costs can add up. It makes more sense to travel for four dental implants than for two because you have to make a second trip to get crowns on the implants. A good rule of thumb, according to experts, is that cost savings should be at least $5,000 to $6,000 to make a trip worthwhile.

Medical care overseas is cheaper in many places because the cost of living is lower than in the U.S.—which figures into everything from surgeons’ fees to the costs of building a hospital and hiring the semiskilled labor to staff it. Efficiencies are often greater overseas as well. In Singapore, you’ll find few general hospitals, for instance; most medical procedures are performed in specialized centers.

Many hospitals abroad are world-class facilities that roll out the red carpet for medical tourists. Bumrungrad is one of the biggest, boasting more than 400,000 international patient visits per year. Many of its 900 doctors completed fellowships or residencies in the U.S.; some 200 are U.S. board-certified, and nearly all speak English. The hospital’s International Medical Coordination Office will schedule procedures, attend to family logistics and coordinate follow-up care. Bumrungrad will even send someone to pick you up at the airport.

More than 20% of the patients at Hospital Clinica Biblica, in Costa Rica, are from other countries. Ben Schreiner, 65, from Camden, S.C., went there in 2008 to have a hernia repaired. “Doctors, staff were all first-rate,” says Schreiner. “I recuperated there for five days, in a small hotel. The hospital furnished an English-speaking nurse who visited daily.”

Facilities don’t have to be huge to be attractive. The Barbados Fertility Centre is the smallest hospital to receive accreditations by the Joint Commission International, the global arm of the Joint Commission, the major hospital accrediting body in the U.S.

The appeal of medical travel is obvious for the uninsured and under-insured. Travel is also appealing to workers with high-deductible health plans. Not only might they save a bundle abroad, but they can use tax-free dollars from a health savings account to pay for care (and some of the travel), provided the procedures meet Internal Revenue Service criteria for qualified medical expenses. (See what the IRS permits.) Or you can always deduct the cost of qualified procedures that exceed 7.5% of your adjusted gross income. It’s rare that U.S. insurance is accepted by overseas care providers.

Some of the best deals go to workers at a small but growing number of employers—typically those funding their own health care expenses—that include medical travel as a benefit and are dangling incentives to get people to sign on. Patrick Follett’s wife, Tina, 51, had a hysterectomy last year at Hospital Punta Pacifica—which is affiliated with Johns Hopkins Medicine International—in Panama City, Panama. “I didn’t pay a dime,” says Pat, who works for Snow Summit Mountain Resort, in Big Bear Lake, Cal. The company paid for travel and lodging, the surgery, the hospital stay, and attendant medical care—and even gave the couple spending money.

How to find care

If you’re considering medical travel, your first stop should be the book Patients Beyond Borders, by Josef Woodman, a comprehensive guide to medical travel with information about the best international hospitals and clinics. A newly revised edition is due out in February (about $16 on Amazon.com). The organization also publishes several country-specific and hospital- specific guides, and it offers one-on-one advice in free 15-minute consultations or more in-depth advice for $250.

Some medical tourists prefer to arrange a trip with the help of facilitators, or brokers. Many work with networks of hospitals, doctors and clinics with which they’ve negotiated discounted rates. But be careful. The industry is unregulated, and anyone can hang out a shingle. Look for a long track record and satisfied customers; an affiliation with major insurers or employers; or safeguards against bias in recommendations.

Brokers should thoroughly inspect the facilities they recommend. Companion Global Healthcare is a subsidiary of Blue Cross Blue Shield of South Carolina. “We physically visit every hospital in our network. Our on-site survey takes five to nine hours, and sometimes a couple of days for large hospitals,” says CEO David Boucher. Companion does not accept referral fees from hospitals. Patients pay a $700 case-management fee, in addition to the cost of travel and medical care. Planet Hospital typically recommends three or four hospitals for you to choose from, and although the company is paid by the hospitals in its network, staffers have no incentive to recommend one over another. Most patients pay for concierge service that costs $100 per day for the first three days and $75 a day thereafter.

Be aware that in some countries, doctors may use products that are of lower quality than ones required in the U.S., such as certain types of silicone implants and cosmetic injections. Infection is a leading cause of complications—as it is in U.S. hospitals. Whether you travel for care on your own or with help, insist on a few things. JCI accreditation is a must. (More than 400 public and private health care organizations in 39 countries are accredited or certified by JCI.) Look for English-speaking patient representatives. And ask your doctor the same questions you’d ask a doctor anywhere: Where were you trained? How many of these procedures have you done? Who makes the implants you’ll use? Ask if you can contact the doctor before, during and after care. Before you go, arrange for the transfer of medical records and for after-care in the U.S.

Insurers, facilitators, and clinics and hospitals may try to reduce or eliminate their liability in case of malpractice, so read the paperwork carefully. Foreign medical arbitration systems often drag out the process, and if you do get compensation, don’t be surprised if it’s much smaller than what you’d expect in the U.S.