TWO years ago, Edson Martinez of North Hollywood needed a couple of wisdom teeth extracted. To save money, he found a dentist in Tijuana who charged $50 for the procedure.
But the extraction cost him much more, said Martinez, 28. "He [the dentist] used pliers. He said they were dental pliers."
Still in pain three weeks later, Martinez went to a Los Angeles oral surgeon who told him the Tijuana dentist had extracted only part of each tooth. Martinez had to spend $1,000 to complete the work. He said he would never again have dental work done outside the U.S.
But June Flowers, a 46-year-old school lunchroom cashier from Huron, S.D., had a different experience with medical care outside the U.S. In June, she flew with her sister to Bangkok, Thailand, for a microscopic discectomy, a procedure to treat a painful herniated disc in her lower back.
Her surgery was expected to cost $30,000 in the U.S. In Thailand, the procedure was $3,500. A big difference, especially to Flowers, who has no health insurance. Including her sister's airline ticket, she said she spent $6,400.
"They treated me like royalty," she said. "Everyone spoke good English." And there was time for sightseeing and shopping after she recovered from the surgery.
Medical tourism, as it's called, isn't new. U.S. citizens have been crossing borders for medical and dental procedures for years. But now, some facilities outside the U.S. are aggressively marketing their services, courting American travelers with the promise of cheaper medical care and a nice vacation.
India, South America, the Middle East, Africa, Southeast Asia and Europe are among destinations listed at MedicalTourism.com, http://www.medicaltourism.com , a website that provides information on countries that promote such journeys.
The Louisiana-based site, launched in 2005, gets 70,000 hits a month, says Dr. Andrew Gomes, chief executive and founder. Organizations outside the U.S. that offer medical and surgical services at a cost advantage over U.S. facilities are included. He says the site's organizers are working on setting standards for which organizations should be listed.
The idea of going outside the U.S. for medical care is tempting, especially if you have no health insurance or if you are longing for cosmetic surgery and can't justify spending the money.
Do you fantasize about a face-lift but can't swallow the cost? The savings overseas are staggering. A U.S. surgeon's fee for a full face-lift averaged $4,822 in 2004, not including hospital costs, according to the American Society of Plastic Surgeons.
At Bumrungrad Hospital in Bangkok, the surgeon's fee for a full face-lift is about $1,200, and includes a neck lift and upper and lower eyelid lifts. With hospital and other fees, the total bill is about $4,000.
No U.S. government agency keeps statistics on how many Americans travel outside the country for medical care. But doctors and other observers in the U.S. as well as those overseas who court American business say it is a growing trend.
The website of Bumrungrad Hospital, for example, reports that a third of its more than 900,000 patients a year travel from other countries, including the U.S. In 2005, Bumrungrad treated nearly 58,000 U.S. patients, said Ruben Toral, a hospital spokesman.
Organizations such as the American Medical Assn. and the American Dental Assn. have not adopted policies on medical tourism. Others, such as the American Society of Plastic Surgeons, have issued statements of caution.
Although there are skilled physicians practicing all over the world, the briefing said, it might be difficult to assess the training and credentials of doctors overseas. The society also notes that vacation activities soon after surgery can boost the risk of complications, as can travel.
"Some of the work we've seen that people have had done at bargain-basement prices is so substandard it can't be fixed," said Dr. Brent Moelleken, a Beverly Hills plastic and reconstructive surgeon.
Combining a beach vacation with cosmetic surgery, particularly, is a bad idea, Moelleken said. "People need to stay out of the sun after [cosmetic] surgery. Incisions heal poorly if they get sun, and especially for laser or facial surgery, people develop very bad scars if they go in the sun."
The same is the case after dental surgery. If you're on antibiotics for infection control, you should not be in the sun, said Matthew Messina, a dentist in Cleveland and a spokesman for the dental association.
Few experts dispute that those who choose wisely can get good, even superior care outside the States or that a bad result or complications can certainly occur in the U.S., even with the most qualified surgeon or doctor.
But there are some extra hurdles when you seek care overseas. One is figuring out whether the training the doctor received is on par with that in the U.S. Another is the language barrier in some destinations.
Lacking personal touch ALSO missing, said Messina, is a patient-doctor relationship. "The best dental care exists when the dentist and the patient have developed a relationship," he said. If you get dental care elsewhere during a trip, Messina said, "There is no opportunity to develop a relationship, even if you could get over the cultural and language barriers."
Then there is the quality of the materials to consider, Messina said. "A patient who has something done in L.A., then comes to Cleveland, I have a pretty good idea that the materials were FDA approved and how things were done. One of the things about having dentistry done outside U.S. borders is there is less assurance of the quality of the materials."
What about complications? "If something goes wrong here, I have recourse: the court system," Messina said. "If you have something done in other countries, you can't sue them in U.S. court."
But advocates say that if you choose wisely, your care will be as good — or even better — than in the U.S. Bumrungrad Hospital, for instance, is accredited by the U.S.-based Joint Commission International, which is affiliated with the Joint Commission on Accreditation of Healthcare Organizations, which accredits U.S. hospitals.
During the first five years of the international accreditation program, launched in 1997, the commission accredited 55 hospitals in 14 countries, said Charlene Hill, a spokeswoman for the accreditation commission. (For a listing, see http://www.jointcommissioninternational.org .)
The standards at overseas hospitals are not identical to those in the U.S., Hill said. The practice of obtaining conformed consent for a procedure, for instance, may be different in some countries, depending on local customs and law. Other differences have to do with the structure of the medical staff and other administrative details.
Travelers who decide to seek care abroad can follow several measures to boost the chances it will be adequate. For one, ask about a healthcare provider's education, training and certification.
To find qualified cosmetic surgeons, check the website of the American Society of Plastic Surgeons for international members.
Or ask your doctor or dentist if he or she can recommend a practitioner elsewhere, although a home doctor may be reluctant to do so.
Some U.S. citizens who have traveled abroad for care said they would do it again in an instant. Larry Grove, 50, is one. The father of 15, who runs his own drywall business in Wanamingo, Minn., traveled to Thailand in November for hernia repair and removal of nonmalignant testicular cysts. He doesn't have health insurance. The price here would have been about $16,000, he said. In Thailand, it was $2,500. In all, he spent just under $5,000 for airfare and other expenses and squeezed in some vacation fun.
One of his sons needs extensive dental work, Grove said, and he's thinking of taking him to Thailand. "It will be about a fifth of the U.S. cost," he said.
Healthy Traveler appears every other week. Kathleen Doheny can be reached at kathleen firstname.lastname@example.org.