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Medical tourism: A faraway health fix

When Stan Long's doctor told him he needed

prostate

surgery, the unpleasant procedure bothered him less than the part of the price tag he'd be on the hook for: $15,000 for the hospital stay his Medicare plan didn't cover.

So Long, who lives in

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Washington
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state, followed the lead of a friend who had been going to

Mexico

for inexpensive dental work, and headed south for a better deal.

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With the help of medical tourism facilitator Planet Hospital, last summer Long flew to San Diego, where he was picked up by a limousine that drove him two hours to a hospital in Mexicali. After the four-hour TURP (transurethral resection of the prostate) procedure to remove a section of his prostrate blocking urine flow, Long spent the night, and the next day the limousine driver, who doubled as an interpreter, drove him back.

The total cost, including airfare, was less than $4,500, Long said.

"My service was excellent, the hospital room was excellent, the nurses were outstanding," said Long, 73, who decided to return to Mexico this summer for the same procedure when the problem resurfaced (a common occurrence). "It's the only way to go."

For procedures ranging from knee replacements to

breast implants

,

heart transplants

to dental crowns, medical tourism is expected to draw 550,000 Americans this year to hospitals across the globe for high-quality medical care at drastically lower costs than they find in the U.S, said medical tourism consumer advocate Josef Woodman, author of the book "Patients Beyond Borders" (patientsbeyondborders.com). (Woodman is not paid by any hospitals or medical tourism operators.)

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The once-cottage industry is becoming increasingly mainstream, growing steadily at about 30 percent to 35 percent a year, Woodman said, and hospitals from Korea to Colombia are rising to meet the demand. More than 400 hospitals in 39 countries currently have accreditation from Joint Commission International, the international arm of the body that accredits U.S. hospitals. In 2004, only 46 hospitals had accreditation.

The industry caters mostly to the uninsured and underinsured, whose plans don't cover certain elective procedures or have deductibles that are prohibitively high.

A few years ago, it was forecast that 1.6 million Americans annually would go abroad for procedures by 2012. That dramatic boom in medical tourism has not materialized, perhaps because people are waiting out the recession or waiting for

health care reform

before getting surgery, Woodman said.

In the meantime, other trends have emerged. A rise in quality surgical care in Latin America and Mexico --JCI accredited several hospitals in Mexico in the last three years -- has given Americans the option to take short trips for cardiac, orthopedic and other highly invasive surgeries that used to be the purview of majestic medical centers in

Thailand

or

India

, Woodman said.

A small but growing number of insurance companies have pilot programs to cover procedures abroad.

And patients are willing. In a 2009 Gallup poll, 29 percent of Americans said they would travel abroad to treat a major medical problem, 40 percent if they could assume the quality was the same and price was cheaper.

But some legal and health professionals have raised concerns.

The American College of Surgeons in 2009 issued a statement warning of the risks of seeking medical care abroad, including the variability in the training of health professionals, difficulties of being treated far from friends and family, and communication barriers.

Of graver concern is "transplant tourism," an off-shoot of medical tourism that involves going abroad for organs to avoid long waiting lists in the U.S. In addition to the ethical concerns of exploiting poor communities and illegal organ trades, recipients risk poor organ matching, unhealthy donors and higher risk of post-transplant infection.

Patients also have little recourse if something goes wrong, as they usually sign contracts leaving themselves to bear most of the legal risks, said Nathan Cortez, assistant professor of law at Southern Methodist University Dedman School of Law.

There haven't been any high-profile lawsuits filed by patients hurt in medical tourism, but Cortez said that's likely because the industry settles complaints quietly. There's no good data on how many patients have experienced problems or in which countries, he said.

In leiu of legal perameters, groups have tried to establish codes of conduct.

American Medical Association

guidelines advise in part that follow-up care in the U.S. be coordinated ahead of time and that only accredited institutions be used.

The Medical Tourism Association, an industry trade group, has a certification program for medical tourism facilitators, who help patients coordinate their trips.

It's not always worth the trip. Woodman says if your total quote for treatment in the U.S. (including consultations, procedure, and hospital stay) is less than $6,000, you're likely better off having your treatment at home.

Costs here and there

Americans can save an average of 50 percent to 80 percent on certain medical procedures if they travel abroad, according to MedRetreat, a medical tourism facilitator. Prices vary by country and hospital, but to give an idea of the cost differences, here are average prices on some procedures, according to MedRetreat.

Hip replacement

U.S.: $40,000-$65,000

Abroad: $7,000-$13,000

Spinal fusion

U.S.: $80,000-$100,000

Abroad: $6,000-$10,000

Heart bypass

U.S.: $90,000-$120,000

Abroad: $10,000-$18,000

Hysterectomy

U.S.: $18,000-$25,000

Abroad: $4,000-$7,000

Tummy tuck

U.S.: $6,000-$12,000

Abroad: $3,800-$5,200

Dental crowns

U.S.: $800-$1,200

Abroad: $200-$600

MAP

Though many international hospitals can perform any medical procedure imaginable, some are known for specialties and procedures. Josef Woodman, author of "Patients Beyond Borders," which releases its third edition in September, offered some guidance.

(Countries listed for their transplants have hospitals known for excellence in the procedures themselves, not for having a ready supply of organs.)

Antigua

Addiction

and recovery:

Home to

Crossroads

Centre, a 12-step program for alcohol and drug addiction, founded by

Eric Clapton

.

Brazil

Luxury

cosmetic surgery

, liver transplants:

Most per capita plastic surgeons of any country. Not as cheap as other destinations but a nice vacation.

Barbados

Fertility/IVF:

One IVF cycle can cost less than $6,000, compared with more than $20,000 in the U.S. Tropical resort setting emphasizes stress relief.

Costa Rica

Restorative and reconstructive dentistry, cosmetic surgery:

One of the top medical travel destinations for Americans; second only to Mexico for Americans and gets 30,000 medical tourists annually, 85 percent of whom are American.

Hungary

Restorative dentistry:

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Boasts more dentists per capita than any other country

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Israel

Fertility/IVF, urology, pediatric

oncology

:

Where much of the surgical technology used in hospitals worldwide is invented

India

Orthopedics, cardiology, heart transplants, Birmingham hip resurfacing procedure, CCSVI (

multiple sclerosis

treatment):

Best value, excellent physicians

Malaysia

Health screenings, kidney transplants:

A top-to-bottom screening, including

MRI

, CT scans, dental, hearing and tumor markings, costs less than $1,500, versus well more than $6,000 in the U.S.

Mexico

Bariatrics (weight-loss surgery), biodental, orthopedic and cardiology, CCSVI:

A good destination for Americans seeking weight-loss surgery, because the risk of deep-vein

thrombosis

means they shouldn't travel long distances

Singapore

Stem-cell and regenerative therapies,

cancer

diagnosis and treatment, pediatrics:

More expensive than Thailand or Malaysia but 40 percent to 50 percent cheaper than in the U.S.

South Africa

Luxury cosmetic surgery:

It's not the price that attracts so much as the privacy, first-rate surgeons and chance to couple surgery with an exotic safari.

South Korea

Spine surgery, robotics-assisted prostatectomies, proton-driven therapies for zapping

tumors

:

Home to the world's largest JCI-accredited hospital and known for high-tech equipment

Taiwan

Lung

transplants:

Draws mostly a Chinese-American audience because of culture differences

Thailand

Everything:

Bumrungrad International Hospital, a million-square-foot complex in downtown Bangkok representing every specialty, sets the standard for world health care.

Turkey

Oncology, IVF:

With 42 JCI-accredited facilities, it has more than any other country. Prices are comparable to the lowest in Asia.

aelejalderuiz@tribune.com

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