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Medical Tourism Takes Flight

By Kathleen Doheny
HealthDay Reporter
Friday, July 6, 2007 12:00 AM

FRIDAY, July 6 (HealthDay News) -- Soaring U.S. medical costs are causing many Americans to take to the skies on "medical tourism" junkets, looking for high-quality yet low-priced health care at foreign clinics.

In many cases, patients get exactly what they are looking for, but experts also warn that the booming industry does have some risks.

"My own advice would be to look carefully at the accreditation of the hospital and consider the nature of the procedure. Are you sure it is the procedure you need? And is it done well at the place you are going?" said Dr. Ann Marie Kimball, a professor of epidemiology and health services at the University of Washington School of Public Health, in Seattle.

The surge in medical tourism over the past decade is being driven by rising U.S. health-care costs and growing numbers of uninsured or under-insured Americans, said Josef Woodman, the author of a guidebook on the topic calledPatients Beyond Borders.

Almost 45 million Americans, or slightly more than 15 percent of the population, are currently uninsured, according to U.S. Census Bureau statistics from 2005, the latest available.

Woodman estimated that more than 150,000 Americans traveled abroad for health care in 2006. The number is projected to double in 2007, he said.

"That 150,000 number is conservative," he said. "Some experts say 400,000." Among the top destinations: Southeast Asia and Mexico, with many other countries, such as Costa Rica, expected to be the next popular destinations for medical care.

Medical tourism companies, in collaboration with special "health travel agents," have sprung up across the country, and some insurance plans are participating in these endeavors, as well.

In California, for instance, Salud con Health Net, a program of Health Net of California, provides access to health care for their insured Latino participants for services conducted across the border in Mexico. And BlueCross/BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina now offer medical care at Bumrungrad International Hospital in Bangkok, Thailand, among treatment options. Bumrungrad treats more than 400,000 international patients every year.

The price savings on cross-border medical care can be dramatic. For example, one commercial medical tourism Web site (www.medicaltourism.com) estimates that a heart bypass in the United States costs $130,000, but just $10,000 in India and $11,000 in Thailand. A hip replacement in the United States would cost $43,000 but just $12,000 in Thailand or Singapore. Hysterectomy costs are about $20,000 here but $3,000 in India.

The medical tourism companies that have sprung up can help travelers find the hospital that provides the procedure or care they need. A growing number of overseas hospitals are accredited under the Joint Commission International, the international arm of the Joint Commission on Accreditation of Healthcare Organization (JCAHO), which accredits U.S. hospitals and other facilities.

As the practice has become more common, medical tourism has evolved, Woodman said. While the practice used to be associated with vacations -- get your facelift, sit on the beach -- and sometimes still is, for most procedures, he recommended separating the surgery from the vacation.

"Even after a minor surgery, there can be swelling," Woodman said. "Most doctors will advise you to stay out of the sun after surgery."

"It's not a 'fun in the sun' gimmick," he added. "People are going overseas and getting serious surgeries."

Medical tourism isn't without some concerns, of course. Experts in the United States worry that consumers might end up getting substandard care if they don't choose their hospital and physician carefully.

The American Society of Plastic Surgeons has issued a briefing paper on the subject, cautioning potential patients that "it may be difficult to assess the training and credentials of surgeons outside of the United States." The ASPS also stressed that typical vacation activities -- which are sometimes marketed as part of a surgery trip -- should be avoided to allow for proper healing and reduce the risk of complications.

Even when patients select and book medical care abroad through a health travel agent, they must remain critical, informed health-care consumers, Woodman said.

The main thing a patient needs to do, he said, is check out the accreditation of the hospital and the credentials of the surgeon.

Spread of disease is another potential concern, said Kimball, who is also director of the APEC Asia Pacific Emerging Infectious Disease Network and author ofRisky Trade: Infectious Disease in the Era of Global Trade.

"Medical tourism is obviously a route for pathogen spread," Kimball said, noting that different hospitals in different regions may have different types of flora. "The extent to which it's a problem versus a theoretical concern is as yet not known," she said. "I can't issue a blank 'go' or 'don't go,'" she added.

Kimball's advice: Look carefully at the accreditation of the hospital concerned and do your homework before you board the plane. "Check out the number of surgeries done, the success rates," Woodman added. It's also key to ask the surgeon you talk to if he or she will perform the operation, not an assistant.

Kimball said she urges potential medical tourists to talk it over with their own physician. As the concept and the practice of medical tourism has evolved, she said, a physician is not likely to automatically rule out the idea.

More information

There's more on medical tourism at the American Society of Plastic Surgeons.

SOURCES: Josef Woodman, author,Patients Beyond Borders, (Healthy Travel Media, 2007); Ann Marie Kimball, M.D., professor, epidemiology and health services, University of Washington School of Public Health and Community Medicine; director, APEC Asia Pacific Emerging Infections Network, Seattle, and author,Risky Trade(Ashgate Publishing, 2006); American Society of Plastic Surgeons, briefing paper

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