Rx: Pack Your Bags

In 2008 Joyce Birdwell of Berry Creek, California, was growing desperate. Her menstrual periods were increasingly heavy, and the amount of blood frightened her. A few years earlier she had gone to her health maintenance organization (HMO) about the problem, but the doctor had been dismissive. Now, at 51, with the bleeding dramatically worse, she had moved and was without insurance.

“I was pretty sure I had fibroids of the uterus,” she says. She found a doctor who performed an ultrasound and confirmed that diagnosis. But the recommended surgery—a hysterectomy—cost $30,000, far more than she could afford.

An Internet search led Joyce to an option she had never considered before—traveling outside the United States for medical treatment. “I thought, It’s got to be a scam,” she says of the low-cost providers she found. “But when you get desperate you get more open-minded.”

With help from Denver-based BridgeHealth Medical, a medical travel service provider, she went to Hermosillo, Mexico, for a hysterectomy. At CIMA Hospital, the physician used an up-to-date, noninvasive robotic technique, called da Vinci surgery. “Everyone was supernice to me,” Joyce says. “I could not believe how easily I recovered and how much better I felt.” Her total medical bill was $6,600; travel expenses, including 10 days in a hotel, were another $1,600. In all she spent roughly one-quarter what she would have in the United States.

A Growing Trend

Joyce is among a growing number of Americans seeking medical care in other countries. In medical tourism’s early days, the typical traveler crossed the border into Mexico for inexpensive cosmetic surgery or dental work—procedures not covered by their health insurance. The media ran horror stories of patients returning from other countries disfigured or infected from botched surgical procedures.

But increasingly, patients like Joyce with serious medical needs are traveling for care that is both affordable and high quality. Today, Americans fly to exotic places halfway around the world to receive hip or knee replacements, spinal disc fusion, angioplasty, heart valve replacements, coronary artery bypass graft, and infertility treatment—generally nonemergency procedures with fairly short hospital stays and routine follow-up.

With no agency monitoring medical tourism (or medical travel, as many in the industry prefer to call it), objective information on benefits and risks—or even how many patients travel—is hard to come by. A 2009 report by Deloitte Center for Health Solutions predicted that 878,000 Americans would travel outside the United States for care in 2010 and nearly twice that number by 2012. Others dispute this figure as too high.

“It’s safe to say it’s growing by 15 to 20 percent a year,” says Josef Woodman, author of Patients Beyond Borders. Woodman has surveyed hundreds of international hospitals and estimates that 300,000 to 400,000 Americans travel annually for medical or dental care. Driving this growth, he says, “are baby boomers [who are] aging into expensive, financially challenging treatments and the huge build-out of American-accredited hospitals in Asia and Latin America.” Woodman’s rule of thumb: if a procedure costs more than $6,000 in the United States, you’re likely to find a high-quality option for considerably less money in another country.

Woodman has identified several international hospitals with excellent cancer centers. For example, Anadolu Medical Center in Kocaeli, Turkey, treated 1,928 international patients in 2009, more than half of them for cancer, according to hospital spokesperson Dilek Inzi. None, though, were from the United States.

“Who wants to leave your family, leave a familiar environment, and go to a far-flung land to have a scary procedure done on your body?” says Woodman. “It’s not ideal.” On the other hand, he says, “For someone who’s uninsured, the costs are astronomical in the United States. Even to be able to shave off money on the diagnosis and testing by going overseas might be worth it.”

Savings and Quality of Care

Regardless of the procedure, the potential savings are huge. Eileen Clemenzi, 60, an uninsured hairdresser in Abilene, Texas, thought she could never afford a $45,000 hip replacement. In 2006, after seeing a news story about medical tourism, she went on the Internet and immediately found a company, MedRetreat, which helped her make arrangements to have surgery at Gleneagles Medical Centre in Penang, Malaysia. “Everybody thought I was crazy,” she says. “But I really had no choice. I was on a cane and could hardly walk.”

The total cost, including travel, was $11,000. A friend accompanied her and paid her own airfare.

“The care was unbelievable,” Eileen says. “It was the greatest experience I have ever had, and I would not hesitate to go back.” In addition to high-quality care, she says, she enjoyed the adventure. “For what other reason would I have gone around the world?” she says. Her only quibbles: the nurses were sometimes difficult to understand, the food was “a guessing game,” and “the coffee was awful.”

Some hospitals catering to international clientele boast luxurious facilities and expansive patient services that go beyond what most Americans expect—everything from a driver waiting for you at the airport, to private rooms with accommodation for a travel companion, to ready access to U.S.-trained physicians who take time to answer questions, including by e-mail, before and after surgery.

Helping medical travel go mainstream is the Joint Commission International (JCI), an affiliate of the nonprofit Joint Commission, the primary hospital-accrediting organization in the United States. Since 1999, JCI has given its stamp of approval to more than 250 foreign hospitals. Respected U.S. teaching medical centers such as Harvard and Johns Hopkins have also formed relationships with hospitals abroad.

High-quality care is even luring overseas some U.S. patients who have health insurance. Anne Grant, 64, of Providence, Rhode Island, a writer and retired pastor, has insurance, but in 2007 the treatment she wanted—hip resurfacing (rather than replacement)—had only recently been approved in the United States. Searching globally for an experienced physician, she settled on Dr. Vijay Bose at Apollo Hospital in Chennai, India. “We were just amazed at how smoothly everything went,” says Anne, who blogged about her experience (http://maudandme.blogspot.com).

The worst part, she says, was the travel itself: three flights over 24 hours. Still, “It wasn’t as difficult on the way home as I expected,” she says. “I was able to stand. It was very important to avoid blood clots. But I think that was the most difficult thing. That would most likely give me pause if I needed a procedure again.”

Although she was prepared to pay the $7,029 hospital bill out of pocket, she was pleased that her insurance company, Guardian Life Insurance, agreed to reimburse her $5,300.

Insurance Companies Respond

Bargain prices like these appeal to employers and insurers. In 2007, Blue Cross/Blue Shield of South Carolina established a subsidiary, Companion Global Health Care, Inc., to help self-insured employers offer a medical travel option to employees. The company has relationships with 29 JCI-accredited hospitals in 14 countries.

“We’re in the very early stages of a long-term market,” says David Boucher, CEO of the company, whose clients include 256 employers in 21 states. To date, only 30 employees have traveled for medical care.

To entice more employees to travel, companies waive co-pays and deductibles. Some even pay travel costs for the patient and a companion. “It makes sense,” says Boucher. “If an employer is going to save $40,000 to $60,000 on a hip replacement, why not throw in a travel allotment?”

But that might not be enough. Aetna Insurance has a pilot medical travel project with Hannaford Brothers, a grocery chain in Maine. Through the plan Hannaford’s 9,000 employees can receive knee or hip replacement surgery at no cost if they are willing to travel to a U.S. hospital several hundred miles away, where Aetna negotiated low rates, or to one in Singapore. Since January 2008 no employees have gone to Singapore, although several have chosen the domestic option.

For those with insurance, international medical travel may seem too risky. In testimony to the Senate Special Committee on Aging in 2006, Arnold Milstein, MD, of Mercer Health and Benefits in San Francisco, who advises Fortune 500 companies on medical travel, said, “The emotional benefit of close access to familiar physicians, friends, and family will remain important for major surgeries. In addition, many other countries do not offer consumers meaningful redress for healthcare negligence.”

Indeed, one reason why medical care is cheaper in other countries is that malpractice insurance is not the norm. “If you like to sue, forget it,” says Eileen Clemenzi. “This isn’t for you.”

Another reason why costs are so much lower elsewhere is low wages. Anne Grant’s bill from Apollo Hospital, for example, included a mere $100 charge for a week’s worth of nursing care.

A Welcome Option

Ideally, Americans would be able to have affordable, high-quality healthcare without traveling thousands of miles. But that may be a long time coming, say medical travel proponents.

“I waited way too long,” says Eileen Clemenzi of her hip replacement. “There’s no reason for somebody to be in that kind of pain. I just feel bad that I had to travel to another country to get that care.”