The Road to Recovery? What You Should Know About Medical Tourism

Gary Hulmes, the manager of a Florida furniture store, had chronic pain in his back. He needed spinal surgery, but he didn’t have health insurance and was looking at medical costs that probably would have run somewhere between $36,000 and $50,000. What could he do? In the spring of 2006 he got in touch with a travel company that arranged for him to go to India for three weeks to have the surgery done there instead of at home. He stayed at a New Delhi hospital for five days, had a successful operation, and did a little sightseeing on the side. The cost: $9,000 (plus $295 to the company that helped him plan the trip).

A few months before Hulmes’s journey, an Oregon woman named Betty Meisel also traveled abroad to get medical care. She wanted some plastic surgery but didn’t care to pay the $20,000 it would have cost her in the United States. She went to Thailand instead. When she returned home and had the bandages removed, she said that her eyes “looked like a cross between a bloodhound and a Shar-Pei. . . . I didn’t want anyone to see me.”

The success story of Gary Hulmes, reported in The New York Times, and the unfortunate experience of Betty Meisel, described in The Washington Post, represent the two sides of a growing phenomenon called “medical tourism.” Medical tourism is the practice of traveling abroad to receive medical care. For many years the United States has been a recipient of medical tourism, with people traveling here for advanced procedures not available in their home countries. Now there is a corresponding flow in the other direction, as Americans go abroad for procedures that would be much more expensive or are not available in the United States. For these people, medical tourism usually involves significant and costly surgery. In some cases, the people who go abroad are very ill and seek treatment as a last resort. But people also travel for less serious procedures, such as Botox injections or even dental work.

The savings from medical tourism can be sizeable. Some procedures can cost up to 80% less overseas than they would in the United States. Though reliable numbers are hard to come by, it has been estimated that a heart bypass operation that costs $130,000 in the United States can run to about $10,000 at a hospital in India. A hip replacement operation that costs $43,000 in the United States might cost $12,000 in Singapore. And a gallbladder removal can cost 50% less in a foreign hospital, even when figuring in the cost of a recuperative period spent in a luxury hotel. One person who went to India for hip and knee replacement spent $23,000 for the surgery. The other travel expenses, including airfare, added some $5,000 to the tab. But compared with the $125,000 or more he might have had to spend in the United States, it was a bargain.

A growing trend

It’s not surprising that savings like those described above draw people to distant lands. The American Medical Association (AMA) acknowledges that the rising cost of health care in the United States “puts needed health care out of reach for many, particularly those without health-care coverage.” It’s difficult to calculate the number of US citizens who travel abroad for medical care. The AMA estimates that about 150,000 Americans received health care overseas in 2006, and that number has certainly grown since then. Bumrungrad International Hospital in Bangkok, Thailand, one of the major world centers for medical tourism, says that it treated 55,000 Americans in 2005, a 30% increase from the year before. About 83% of the procedures were noncosmetic.

Many hospitals like Bumrungrad that cater to medical tourists are new and staffed with English-speaking physicians and nurses trained in the United States. And many of them attempt to create a luxurious, spa-like atmosphere, combining the benefits of medical travel with those of a traditional vacation. Bumrungrad, which likes to explain that its name translates as “care for the people,” encourages its patients to enjoy the nearby beaches and take in the sights of Thailand. Another Thai facility, Phuket International Hospital, is even more direct, advertising “bright sun, blue sea, cosmetic surgery.” Wockhardt Hospital in India promotes its air-conditioned private rooms with computers and high-speed Internet, color televisions with DVD players, sofa beds for companions, and room service. And facilities combining medical care with spa pampering are becoming a specialty in Singapore, which is avidly reaching out to international customers.

But medical tourism is not confined to only a few places. Many hospitals throughout the world are realizing the benefits of establishing similar services for foreign patients. Medical facilities are being or have been developed in, among other places, Costa Rica, Brazil, Mexico, Malaysia, Hungary, Argentina, South Korea, Turkey, the Philippines, South Africa, and Dubai. They are often aided by governments that deliberately promote medical tourism. Singapore alone hopes to attract one million medical tourists by 2012.

Catching on stateside

Both American corporations and American insurance companies have begun taking note of the savings to be had overseas. Recently HR Magazine, a publication for professionals in the field of human resources, predicted that more and more companies will offer medical tourism as one of their benefits. Some have already started. And some state legislatures are reportedly considering offering medical travel to state workers. Since the cost of some procedures can be so much lower overseas, some companies, as a way of encouraging medical tourism, may not only pay for airfare and other expenses but also give employees a percentage of the money saved.

To facilitate the connection between Americans needing medical care and distant hospitals, a small industry of medical travel companies has sprung up. These companies typically locate hospitals and doctors, arrange flights and hotels, and schedule operations for people wishing to have their medical care abroad. The best ones have nurses and physicians on their staffs who visit foreign hospitals to evaluate the facilities and the credentials of the doctors and make sure the hospitals maintain a high quality of care. Some have been known to screen clients to make sure they are not too sick to travel a great distance. Experts warn, however, that not all of the many medical tourism firms that appear on the Internet are reliable. If you decide to use a medical tourism company rather than make your own arrangements, it’s important to find out how long a company has been in business and whether it has medical personnel on its staff. An organization called the Medical Tourism Association, whose stated aim is to promote high standards and transparency in the medical tourism field, offers a list of medical travel facilitators who are association members here.

Risks

While much of what one hears about medical tourism from foreign countries and travel companies paints a very rosy picture, this general perception should be taken with a big grain of salt. After all, much of the information comes from those who have a vested interest in promoting medical tourism. There are no hard statistics comparing care in the United State to care overseas (and much overseas care can be very good). But common sense says that there are risks associated with medical tourism that go above and beyond the risks of medical care in the United States. The following are some of them:

  • Regulation of safety and quality may not be as thorough overseas as it is in the United States. Also, foreign doctors may not have had to undergo the same level of training as US doctors.
  • While foreign hospitals may be well-equipped to perform a certain type of surgery, they may be less prepared to deal with possible complications of that surgery.
  • People may find it difficult to find necessary follow-up care once they return to the United States.
  • The Centers for Disease Control and Prevention has reported a few cases of people returning to the United States with difficult-to-treat infections.
  • After some types of operations, it is inadvisable to take a long plane trip or engage in the vacation activities such as sunbathing, swimming, drinking alcohol, or exercising that are often offered as part of a package to attract patients overseas.
  • It can be very difficult to sue an overseas hospital for malpractice if the surgery goes wrong.

Have a safe trip

With these risks in mind, how can anyone feel safe going halfway around the world for a medical procedure? To address this issue, the AMA has developed guidelines to make sure the overseas medical treatment people get is safe and effective. The guidelines are for employers, insurance companies, and other groups that facilitate medical tourism, but they give a good sense of what is involved in keeping medical tourism safe and effective.

If you are considering going abroad for a medical procedure, the first step is to make sure that you know exactly what procedure you need. Say, for example, that you want to have weight-loss surgery. There are several different ways it can be done. You should have a thorough discussion with your US doctors ahead of time so you know which of the procedures they recommend and why. That way, you’ll already be armed with solid professional advice if the overseas doctor starts talking about using a different procedure instead.

The next step is to find the right hospital. Make sure that a recognized international body such as the Joint Commission International (JCI) accredits the facility. JCI is a division of Joint Commission Resources (JCR), the not-for-profit affiliate of the largest accreditor of health-care organizations in the United States. The Web site of the JCI contains a complete list of accredited organizations, such as hospitals, arranged alphabetically by country. The JCI sets detailed accreditation standards stipulating that, among other things, facilities use established methods of preventing infections and gathering infection statistics. They also require that accredited facilities have standards of physician certification and a system for tracking patients as they progress through their course of care. The JCI furthermore insists that facilities have translators available. Another accrediting body is the International Society for Quality in Health Care (ISQua). Unlike JCI, ISQua does not accredit individual hospitals or other health-care facilities. Instead, it accredits regional and national accrediting bodies. So if a hospital you are considering tells you it’s accredited and it’s not on JCI’s list, look to see if the organization that gave the hospital its accreditation is itself accredited by ISQua.

You will also want to know as much as you can about the facilities you’re considering, beyond whether they are accredited. This means asking a lot of questions—about mortality rates, any malpractice suits, the English-speaking abilities of the physicians and staff, and the number of surgeries performed and the success rate. You’ll want to know where the doctor who will be treating you went to school, his or her credentials, how long he or she has been practicing, and the number of surgeries he or she has personally done. If you’re using an agency to help plan the trip, agency personnel should be able to help with this information. It’s also a good idea to ask for referrals so you can talk to other Americans who used the same physician. You might not always get all the answers you seek — that’s not easy even in a US hospital — but you’ll never know unless you ask. Hospitals that are serious about attracting and retaining foreign customers should be willing to address most inquiries.

Next, you should figure out how you are going to pay for the procedure. If you have insurance, you should check whether it covers your procedure and whether the coverage extends to medical care outside the United States. In addition, you should make sure that you will be able to get continuing care from your US doctor or elsewhere once you return home (and that the US doctor will get the information he or she needs to ensure that your follow-up care is appropriate). If you have insurance, will it pay for continuing care? Will it pay for any complications that may arise after the surgery? And you should know about what legal recourse, if any, you have in case the procedure is not successful. (Again, a good medical travel company should be able to provide you with this information.) Finally, you should be aware of any danger (such as blood clots) that long flights might pose to you postsurgery, as well as any risks involved in doing common vacation activities.

Two more quick pieces of advice: It can be very helpful to bring along a companion on your trip who can run errands while you are recuperating. Also, it is a good idea to let your bank know that you are traveling abroad in case you have to put a large amount on your credit card. You don’t want to risk its being rejected.

Deciding whether to travel to a foreign country in order to get medical care is a lot like buying almost anything else. You ask yourself, “If I purchase the less expensive item, will I get the same quality that I’d get if I paid more?” Of course, that decision is less critical when you’re buying a refrigerator than when you’re dealing with your health. In any case, it will probably be a decision more people make in the coming years. Does it make sense? There are many success stories, but, according to the AMA, “it is too early to conclude whether the risks of medical tourism outweigh the advantages.”

Joseph Gustaitis is a freelance writer and editor based in Chicago.

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