8 Feb

The growing trend of overseas medical care has its pros and cons. To help you arrive at an informed decision, here’s a shortlist of the arguments why medical tourism is good – or bad – for you.

Are you one of the millions of people who need to undergo a health, medical, wellness or beauty treatment that you can’t afford? Are you tired of waiting for lawmakers to approve a new treatment that can save the life of a loved one? Are the waiting lists too long for you?

Answer yes to any of these and you may be a likely candidate for overseas medical care.

While some happily focus on the fun side of overseas treatment, others issue dire warnings of filthy hospitals, shady treatment practices and procedures gone bad. As with most things in life, the truth lies somewhere in between.

Here’s a shortlist of why people sign up for overseas medical care.


Most people like to get the most for their money. The single biggest reason why people travel to other countries for medical treatment is the opportunity to save money.

Depending on the destination country and the type of treatment, uninsured and underinsured patients, as well as those seeking elective care, can enjoy 15 to 85 percent savings over the cost of treatment in their home countries. As one health traveler puts it, ”I took out my credit card instead of a second mortgage on my home.”

As baby boomers become senior boomers, costs of healthcare and prescriptions are devouring nearly 30 percent of retirement and pre-retirement incomes. With the word getting out about top-quality treatments at deep discounts overseas, informed patients are finding creative alternatives abroad.

For example, a hip replacement in Bangkok, Thailand costs about $18,000, an estimated savings of at least $15,000 compared to the US market price. Savings on dentistry becomes more dramatic when extensive mouth-work is required, involving several teeth or full restorations. Savings of $15,000 or more are common.


Veteran health travelers know that facilities, instrumentation, and customer service in treatment centers abroad often equal or exceed those found In the United States. Governments of countries such as India and Thailand have poured billions of dollars into improving their healthcare systems, which are now aggressively catering to the international health traveler.

VIP waiting lounges, deluxe hospital suites, and staffed recuperation resorts are common amenities, along with free transportation to and from airports, low-cost meal plans for companions, as well as discounted hotels affiliated with the hospital.

Moreover, physicians and staff in treatment centers abroad are often far more accessible than their US or UK counterparts. “My surgeon gave me his cell phone number, and I spoke directly with him at least a dozen times during my stay,” said David Palmer, who traveled to Bangkok for a heart valve replacement


Even the best health Insurance plans exclude a lot. Your plan probably excludes cosmetic surgeries, dental care, vision treatment, reproductive or infertility procedures, certain non-emergency cardiovascular and orthopedic surgeries, weight loss programs, substance abuse rehabilitation, and prosthetics – to name only a few.

Many health plans restrict prescriptions, some of which are quite expensive.  Many exclude postoperative care, congenital disorders and pre-existing conditions. As a result, many who need medical care – even one recommended by their physician – find that their insurance won’t cover it.


Some procedures and prescriptions are simply not allowed in the United States. Either Congress or the Food and Drug Administration have banned a certain treatment – or perhaps it’s still in the testing and clinical trials stage, or the treatment was only recently approved. Treatments such as fertility and stem cell are offered abroad.

One example is an orthopedic procedure known as hip resurfacing, a less expensive alternative to the traditional hip replacement still practiced In the United States. While this procedure has been performed for more than a decade throughout Europe and Asia, but was only recently approved in the United States; availability remains spotty.

Hundreds of forward-thinking Americans, many of them suffering years of chronic pain, have found relief in India, where hip resurfacing techniques, materials, and instrumentation have been perfected, and the procedure is routine.


For decades, thousands of Canadian and British subscribers to universal, “free” healthcare plans have endured wait as long as two years for established procedures. “Some of us die before we get to the operating table,” commented one exasperated patient who journeyed to India for an open-heart procedure.

In the United States, long waits are a growing problem, particularly among war veterans covered under the Veterans Administration Act for whom long queues are becoming far too common.

Some patients figure it’s better to pay out-of-pocket fees to get out of pain –  or to halt a deteriorating condition – than to suffer the anxiety and frustration of waiting for a far-future appointment and other medical uncertainties.


Health insurance companies apply more pressure on hospitals to get patient out of expensive beds quicker. As a result, assembly-line health procedures are becoming the norm. Those who travel overseas for health care find the welcoming flexibility at the best hospitals abroad. There, they are often encouraged to spend extra time in the hospital for post-procedure observation and recuperation.

Furthermore, the patient-to-staff ratios are usually lower abroad; because more staff care for patients and maintain facilities, hospital-borne Infection rates are much lower.

Patient-friendly cultures result in charming nurses and doctors who spend more time at patient’ bed- sides, than overseas patients are used to. “Absolute angels,” says an English lord who recently traveled incognito to Bangkok for hip resurfacing. “Those nurses are absolute angels.”


Although traveling abroad for medical care can be challenging, many patients welcome the chance to blaze a trail. In addition, they find the creature comforts often offered abroad a welcome relief from the sterile, impersonal hospital environments so oft en encountered in U.S. hospitals and clinics.

For others, simply being in a new and interesting culture lends distraction to a worrisome process or a boring recuperation period. Getting away from the myriad obligations at home and professional life can yield healthful effects at a stressful time.

What’s more, travel – particularly international travel – can be a life-changing experience.

You might be humbled by the limousine ride from Indira Gandhi International Airport to a hotel in central New Delhi or struck by the simple, elegant graciousness of professionals and ordinary people in Thailand, or wowed by the sheer beauty of the mountain range outside a dental office window in Mexico.

As one veteran medical traveler put it, “I brought back far more from this trip than a new set of teeth.” So, do the research and the math, and you may find yourself joining the thousands of others who set sail to an exotic land that they never thought they might visit, let alone for a medical procedure.


Although concierge services such as and are helping with lists of potential hospitals, appointment scheduling, arranging airport pickups and drop-offs, as well as with general hand-holding, there are many questions.

There are concerns about safety and postoperative care when the patient returns home. If a patient receives treatment abroad and something goes wrong, who does the patient sue: the insurer or the employer? Where can the case be filed?

The questions are just as relevant to solo travelers. Author Josef Woodman of Patients Without Borders tells of a Vietnam veteran who had a hip replaced, developed complications on his return, and found his doctors in the USA unwilling to help. “There’s a lot more burden on the consumer to have a successful medical journey,” says Woodman.


Doing the sort of advance research that makes this possible can be arduous. You may or may not get information about hospital mortality rates, or about a surgeon’s credentials and how many heart valves he has replaced, for example. If you do get answers, these are not necessarily trustworthy, says Woodman.

American hospitals do not volunteer such information easily either, but they are monitored by federal and state agencies, as well as by professional and trade organizations that collect these data. Such monitoring is largely absent in countries such as in India or Thailand.

So far, however, no reports of patterns of botched operations, rampant infections, or other warning signs have surfaced. Recently, the Singapore National Eye Center suspended laser eye surgery after 1 7 patients developed an inflammation, but this was the first interruption of its kind at the center. A few weeks later, surgery resumed. Overall, medical standards in Singapore – where prices are somewhat less attractive but English is universal – are very high.


One precaution Americans can easily take is to choose a hospital accredited by the Joint Commission International, the global arm of the Joint Commission, which makes sure U.S. hospitals meet specific standards. For instance, the Wockhardt facility in Bangalore completed its JCI accreditation survey. The hospital is clean but there’s nothing fancy such as the soaring atrium and opulence that make Bumrungrad Hospital in Bangkok particularly popular with medical travelers.

Accreditation does not ensure good care, but it does offer important evidence of safety, “a risk-reduction activity,” said an accreditation CEO. Make sure that your physicians have adequate and valid credentials, with patient data examined at least once a year to monitor increases in deaths or complications, or in longer hospital stays.


As a patient moves through the hosp ital, a standard routine must track and avoid treatment mix-ups. A transfer to or from intensive care should, for example, be documented with a written transfer statement and verbal confirmation by a physician, then compiled into an ongoing summary.

Computerized tracking, with supermarket-type bar codes that can be scanned from patient wristbands and stickers on their records, is used at a few top hospitals in Thailand. Accreditation standards require different ways of minimizing infections such as a review of infection statistics and any necessary corrections.

For instance, water used in surgery and laboratories should be regularly filtered and tested. Western patients always get bottled drinking water. There should be disinfectant alcohol gel dispensers near each bed for hand cleaning.


A safe blood supply cannot be assumed. Ask: where do blood banks get the supply? How well are donors screened? How is blood supply safety verified? Although there is no way to verify the answers, patients should ask a hospital representative these questions.

On the other hand, hospitals don’t want mistakes. They don’t want their patients to return home and have problems. They know the power of the testimonial, not to mention the power of the Internet.

With great numbers of patients each day, patients or their companions should also ask a hospital how blood is routed to the right patient. Give marks for hospitals that use bar coding on each patient’s body, or on clothing used for record scanning, before any transfusions.


Joint-replacement patients are a special class in all hospitals because of the consequences of infection: An artificial joint that harbors a deep infection must be replaced. For an American patient’s operation, surgeon Sanjay Pai and his team at the Wockhardt hospital in Bangalore sealed off their skin and breathed filtered air pumped into hoods covering their heads like those at good U.S. hospitals.

Like other Asian hospitals, Wockhardt had to be persuaded to reveal its rates of postsurgical infections, but the statistics are comparable to those of good U.S. hospitals: 1 .1 percent rate of surgical infection for heart-bypass patients and zero for joint replacements.


In Asia, nurses play a much smaller role in care than they do in US hospitals. Emily Slaback, a former CU nurse from Haslet, Texas, whose left hip and knee were replaced at Wockhardt last year, says they are more like nurse’s aides. They are not expected to check patients as often or as closely, so patients have to take responsibility. Calling a doctor’s attention to a bruise, for example, could prevent a bedsore that might become infected as well as prolong your stay.

And, while nurses who care for Americans are trained in English, their command is often incomplete. After his first surgery, Barnum was given a special mattress to prevent bedsores. He asked the nurses for the same mattress after his second surgery but couldn’t make himself understood — or, as he says, perhaps they felt he didn’t need it.


People who in the end decide to head abroad might consider a last bit of wisdom from those who have gone before. Think of it as medical travel,  “and don’t count on much tourism.” Few who arrive with a bad back or heart will be wandering through the tourist sites and sights of Bangkok or New Delhi.

After surgery and one or two weeks of recuperation, few will have the desire to lengthen their stay. On flights where coach will cramp your recuperating body and challenge your sanity, go business class.


There would be no need for uninsured American patients to go abroad at all if the prices they were quoted in the United States were more in line with what insurers and Medicare pay. Those in the UK would stay home and enjoy free medical care if sex change surgeries did not require too much red tape, hospitals were cleaner, and if medical services were quicker. If, if, if.

In North American hospitals, the uninsured and the wealthy pay full price for an elective procedure. People who come in through the emergency room for non-elective surgery get a list-price bill, but few hospitals expect to be fully paid.

You should know by now: the medical service industry in the U.S.A. has a very high profit margin and there is plenty of room for price-cutting. For a routine heart-bypass surgery in Texas, the list price is about $70,000 at one hospital in Abilene and $47,000 at one in Austin.

Commercial health plans pay at least 60 percent below the listed prices. Medicare pays even less — $18,609 to $23,589 on average for an uncomplicated bypass.

Because of the serious amounts of money flying overseas with medical tourism, American hospitals are going global. For instance, North American Surgery, a Canadian company formed to match hospitals in Kansas, Michigan, New York, Oklahoma, and in Washington who are willing to provide some procedures in expensively with American patients. Hip or knee replacement or heart-bypass surgery is $14,000; weight-loss surgery is $10,000 or $1 5,000. The service is free; the hospitals pay the company for their middleman services. Patients pay for travel and lodging only.

Diligence, research, and careful planning can ensure that those who consider traveling abroad for treatment will have a safe and effective treatment, a chance to experience a new culture, as well as a savings of thousands of dollars. However, there are growing options nearer to home.

This article was originally published in 2009 in the Medica Tourism magazine.

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