Traveling afar to cut surgery costs

A place in your health plan?

In the past two years, IndUSHealth has shifted its focus to companies, and specifically to those that self-insure or pay their employees' health-care costs rather than contract with an insurance provider. The typical arrangement with IndUSHealth resembles what the state representatives of Colorado and West Virginia are trying to implement, namely providing an incentive -- such as getting back 25% of the money saved or waiving the copays and deductibles -- for patients to travel abroad for less-expensive medical care.

First to get on that train have been several large manufacturing companies with 100,000 or more employees, says Rajesh Rao, the chief executive officer of IndUSHealth. "The level of benefits they're providing to their employees has always been very generous," he says. "And while in other industries they have the luxury to do cost shifting, that's not as easy with unionized, blue-collar workers." Particularly interested are employers with large numbers of retirees covered by their insurance plans. Such employers, he adds, are not only looking to cut costs, but also have a demographic that isn't actively working and presumably wouldn't mind an all-expenses-paid trip to Malaysia, Singapore or South Africa for hip or knee surgery.

That said, medical tourism isn't without risks. Should something go wrong with your surgery you have no legal recourse as you do at home, says Rick Wade, the senior vice president at the American Hospital Association, which represents 85% of all hospitals in the U.S. "In virtually all these cases, you lose your ability to do anything if there's a liability issue," he says. (Incidentally, this is largely why overseas hospitals are that much cheaper. They don't face massive malpractice-insurance costs.)

And the way medical travel agencies get paid is murky. Often, their payment comes from the hospitals they recommend, presenting a potential conflict. This can be a big risk because it's more difficult for a patient to do due diligence on an overseas hospital than on a nearby facility.

Whether you choose to go abroad for medical care or are asked to do so by your insurance provider or employer, here's what you need to know:

Choose the right travel agent

Find a reputable company that will connect you with the best hospitals and doctors for your specific procedure. "Remember, you're not going on vacation," says AHA's Wade.

Make sure the agency employs at least one medical professional, preferably more. These people will talk with you on the phone and recommend hospitals for your treatment, but they are also the ones who have chosen the specific hospitals they work with.

"The biggest concern we have is many nonmedically oriented travel agencies have entered into this arena," says Joint Commission International's Jaimovich. "I'm not sure what kind of background work they do to ensure the level of care in the hospital."

Interview several agencies, ask them how long they've been in the business (keep in mind, this is a relatively new field), how many clients they've had, and ask for references, Woodman suggests. Make sure the agency responds to all your questions promptly and with care. Also, ask how they will be paid for referring you and whether there are financial incentives to send you to one hospital or country over another.

Find the best hospital

To make sure the hospital you're going to meets international health-care standards, it's best to look for JCI-accredited hospitals. But look for any local accreditation they may have, as well. Most important, look at the success rate for your specific procedure at that hospital, Woodman says. Same for your overseas doctor: Look at his or her education, training and experience with your specific surgery. (Most hospitals that participate in medical tourism post that information on their Web sites.)

The good news: Many overseas hospitals have affiliations with some of the best medical centers in the U.S., including Johns Hopkins and the Mayo Clinic. In addition, they often have surgeons and physicians who are U.S.-trained. (If you have a problem with overseas doctors, keep this in mind: Many physicians currently in practice here got their training in another country. Also, some U.S. hospitals currently outsource some medical procedures, such as radiology, overseas.)

Keep your U.S. doctor involved

In an ideal situation, your doctor here should talk with your overseas surgeon before your procedure, and once you're home as well.

"I hope there's communication between your physician here and the ones who'll be taking care of you in the foreign hospital," Wade says. "Whatever medications you're taking, are there comparable medications in the foreign country? Do you have special allergies, dietary concerns?"

Once back home, don't hesitate to contact your overseas surgeon with any concerns or questions you may have, or ask your doctor to do so.

This article was reported and written by Aleksandra Todorova for SmartMoney.

Published April 3, 2007

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