A ‘medical tourist’ scours the world for safe, affordable care and learns that she doesn’t need a passport to get it. (istockphoto)

I assumed that palm trees or streets teeming with foreign humanity were in my future as I began a quest to find a hip replacement at a price I could afford.

Because my severe osteoarthritis was deemed a preexisting condition, my insurance carrier would not pay for the surgery, so money was definitely an object.

Yet, after exploring so-called medical tourism options in Thailand, India, Hungary and Dubai, I settled on nothing so exotic. With rates that rival overseas alternatives, Oklahoma City beckoned me. It seems it has become a medical tourism hot spot.

Granted, I wasn’t able to lounge on exotic beaches during my recuperation; instead, I toured a cowboy museum and the livestock market at Stockyards City. But the price was right.

Competitive fees at doctor-owned hospitals and the high quality of surgery are responsible for turning Oklahoma City into a health-care hub, said Richard Baker, founder of Timely Medical Alternatives. His firm, based in West Vancouver, B.C., brokers deals between U.S. hospitals and patients from the United States and Canada.

“Oklahoma City is very medically entrepreneurial,” said Baker, who has negotiated discount pricing with three hospitals in Oklahoma.

A number of hospitals around the United States are agreeing to negotiate discounts for routine but serious and expensive procedures being sought by the uninsured. In fact, Timely found me hospitals in four cities that would replace my right hip for less than $20,000: Oklahoma City; Sioux Falls, S.D.; Phoenix; and Auburn, Maine. Timely’s fee, paid by the hospital, is included in the price. As usual, the wise consumer checks hospital ratings and the experience of the surgeon.

Since Baker founded Timely Medical in 2003, he has referred 4,000 patients from 49 states and Canada to U.S. hospitals willing to negotiate prices with him, many of them in Oklahoma.

Baker said his U.S. clients typicially seek affordable surgery while his Canadian patients want to avoid long waits under their country’s government-controlled health-care system.

Baker and his clients are not alone in discovering Oklahoma as a medical tourism destination.

For example, ProCure Proton Therapy Center has partnered with the Integris Cancer Institute of Oklahoma to offer specialized cancer treatment. Today, about 30 percent of ProCure’s patients travel from other states and countries. Some come from as far away as Australia, Israel, Russia and Brazil, said Hadley Ford, ProCure’s chief executive.

While discount pricing is the big draw, high patient satisfaction also stands out, said Ford, who added that patients are impressed with the friendliness of the people they meet while recuperating.

I began my quest for a new hip with an online search using the keywords “uninsured,” “hip replacement” and “Hawaii.” I added “Hawaii” because I had read about a hospital there that performed hip replacement surgery on the uninsured at reduced rates and needed a reminder of the name.

Instead, I landed on the home page of Timely Medical.

It was about time.

Limping along

For the past year, I had been limping along on my bad hip until I developed increasing chronic pain that wouldn’t abate with medication or steroid shots. At age 57, I had had enough of the pain and the decreased mobility.

I started an e-mail exchange with Baker. He said hip replacement surgery in the United States averages $53,500.

He might have been exaggerating a bit. I have since found online estimates that a total hip replacement will cost, on average, $39,299. At any rate, there were four U.S. hospitals in Timely Medical’s network, including Oklahoma City’s McBride Orthopedic Hospital, that would perform the surgery for less than $20,000. That was manageable but still a big hit.

At that point, it seemed worth pursuing overseas alternatives, particularly since I was living in Dubai, as I still do.

I consulted four surgeons there, all of whom would have charged just under $20,000. But they generally specialized in knee replacements; for hip replacement, they recommended techniques that would have cut through muscles, which lengthens the recovery period and, in some cases, raises the risk of having the prosthetic dislocate from the hip socket. (My U.S. doctor went in from the front, which required only a spreading of the muscles to reach the femur and socket.)

Then I explored the Bumrungrad International Hospital in Bangkok, a private hospital which draws people from around the world for a variety of medical procedures. The cost averaged 700,000 baht, or $22,008.

The quote from Fortis Hospital in India ($8,500) was by far the cheapest and one I probably would have considered more seriously had it not been for concerns about the safety of its blood banks if I needed a transfusion. (Turns out, I did.)

I also started exploring options in Hungary but lost patience before pinning down a price.

Like any person undergoing major surgery far from home, I faced an increased risk of blood clots by flying before the recommended six-week no-fly period. The increased risk comes from remaining sedentary— as during a long flight, for example — for too long in the first six weeks after my operation. I had planned to fly back to Dubai five weeks post-op. I discussed the risk with my surgeon in Oklahoma before committing to surgery, and he, after providing in-flight excercises, said a five-week wait should be fine.

Oklahoma was looking better.

Besides a competitive price, McBride gets high grades for orthopedic services from independent ranking services. HealthGrades, for example, gives it five stars; the national average is three.

The next round of decisions put me in a do-it-yourself mode, so I set out to find affordable accommodations in Oklahoma City. For $65 a night, I rented a two-bedroom, two-bath house with WiFi, a koi pond in the back yard and a walk-in shower (an especially attractive feature because I wasn’t sure I would be able to safely lift my operative leg over a bathtub ledge to shower).

If I couldn’t manage by myself, I was prepared to hire a home health care agency — Oklahoma City has 20 such agencies to assist with bathing, toileting, meal preparation and errands.

In the end, I paid McBride $19,600 for my new titanium hip, which was less than Thailand, the same as Dubai and more than India. The price includes treatment for complications, although determining whether a complication was due to the surgery or some other cause might get, well, complicated.

‘People think we’re hicks’

Things certainly began smoothly, starting with a friendly taxi driver who picked me up at the airport.

“People think we’re hicks, but this state is very progressive,” driver Mark Cardwell said. When he heard why I was in Oklahoma City, he said I should explore taking chocolate-covered mushrooms from Siberia to ease the inflammation.

Given that the cartilage between my ball and joint in the hip socket had worn away, leaving bone on bone, I told him I was way past that.

Medical advice from taxi drivers is probably not reliable anywhere in the world, and it turns out my surgeon did a good job. After four days in the hospital, I managed with the help and kindness of strangers, including Cardwell, who took me grocery shopping.

Eleven days post-op, I felt good enough to scoot around on my walker, visit the sights and breathe in the heritage of the West.

After paying the agreed-upon amount, I asked McBride for an itemized bill, or what I would have paid without the negotiated rate: $36,221.73.

I still don’t know what the operation would have cost in the Washington area: Several hospitals told me I would have to consult a surgeon.

“We are not in the practice of participating in ‘pricing wars’ for medical procedures. There are too many variables in play, such as the prospective patient’s medical history, extent of injury etc.,’’ Johns Hopkins spokeman John Lazarou wrote in an e-mail. “A thorough exam is required and each case is different. . . . Quoting a price is not wise and for these reasons, we don’t do this without seeing the patient first.”

Maryland, I’ve since learned, has a unique Health Services Cost Review Commission that, among other things, provides average prices for specific services at hospitals in the state. According to the commission’s Web site, www.
, the University of Maryland Hospital has the highest average price for a hip replacement: $39,112. The lowest: Frederick Memorial, $18,500. Of course, most of those prices reflect discounts negotiated by Medicare, Medicaid and private insurance companies, so are likely lower than what I, as a private payer without a negotiated rate, would have paid.

Looking back on this medical adventure, I must admit that the thought of recuperating on a hot, sunny beach in an exotic country still sounds fascinating.

Maybe with my new hip, I’ll consider getting a facelift, and this time recuperate under the shade of a swaying palm.

Lytel is the manager of a nursery school in Dubai and author of “Act Early Against Autism.”