Travel agents aren't the only ones luring Americans abroad with big discounts this year. The overseas surgery industry, once a slightly scary medical niche, has taken off to a remarkable degree, its rise fueled by the continued rise in U.S. health care costs and by an economy that is creating an army of underinsured Americans looking for bargains.
This unusual blend of tourism and medicine doubled last year, with roughly 1.5 million Americans heading abroad for medical care in 2008, according to consultancy Deloitte Center for Health Solutions. They're traveling all over the map -- to destinations from Turkey to Thailand and Costa Rica -- for procedures ranging from perfunctory dental work to six-hour bypass surgeries. To hear the hospitals abroad tell it, no procedure is out of the question now that more of them boast new affiliations with big-name U.S. hospitals and medical schools.
The movement is not without its critics, though. Some consumer advocates are skeptical about whether surgery abroad really meets U.S. safety standards. Finding out isn't easy, since reliable quality ratings, already hard to get in the United States, can be even more elusive elsewhere. For their part, patients sometimes come back with horror stories about language barriers or the culture shock of getting cushy treatment while surrounded by poverty. Even fans of overseas care say Third World medicine, upgraded or not, isn't for the faint of heart.
"Put it this way," says Paul Keckley, executive director of the Deloitte health consultant group, "it's still very much cowboy country out there."
Yet it's hard to argue with the savings, especially in recessionary times. Surgeries and dental makeovers in Asia and Latin America can cost as little as 10% of the equivalent services in the United States. Deals like that have some major U.S. insurers now peddling the overseas option as a way to cut costs on pricey procedures. And many patients say they're surprised to find that, at least for them, overseas hospitals offer the kind of pampering that would be unthinkable here. With straight faces, insurers say your next hip replacement can be a "five-star experience,” with attentive service, personal chefs, massages and haircuts.
Medical tourism isn't a new phenomenon. As early as the 1970s, wealthy Americans and Europeans were known to slip away to Brazil for the occasional nip and tuck. But over the past 10 years, the game has begun to change dramatically:
- Hospitals in Thailand and India have led the way, marketing heavily to international patients, often by piling on plush, hotel-style amenities. Bumrungrad, a pioneering hospital in Bangkok, wraps its patients in a comfortable bubble of butler service, Oriental rugs and marble floors.
- Some countries have even invested in medical facilities catering almost entirely to foreigners. South Korea, for example, is building Health Care Town, a 370-acre beachfront oasis filled with hospitals and luxury apartments for foreign patients and their families.
- And on U.S. shores, an industry of medical travel brokers has popped up to help clients find these outposts and set up travel arrangements.
When insurers send you abroadMost American patients venturing abroad either lack decent insurance or want operations that their insurers and employers won't cover. But recently, some big insurance companies have started to get into medical tourism themselves, creating the potential for a whole new push for overseas surgery.
Aetna, WellPoint and Blue Cross Blue Shield of South Carolina are all experimenting with including foreign facilities in their networks and making them available to their employer clients. The health plans step in to arrange -- and, in many cases, pay for -- travel and lodging for patients and their families. In practice, a patient might face the choice of paying a deductible of tens of thousands of dollars for a surgery in the U.S. or getting the same procedure abroad for nothing.
At Serigraph, a West Bend, Wis., printing company that contracts for overseas health care with WellPoint, where to go is up to the employee. But the incentives to travel are clear, says Linda Buntrock, senior vice president of human resources: "They'd rather see their money in their 401k than in some doctor's pocket."
When Kris Mann needed both knees replaced, going abroad was her only affordable option. The 60-year-old uninsured legal assistant from Whitefish, Mont., went to Wockhardt Hospital in Bangalore, India, last year -- and returned with a curious tale.
Arriving, she says, she met a Harvard medical student who was actually visiting the hospital to study its close-to-zero infection rate for joint replacements. And after the operation, far from being rushed out of the hospital like she would have been at home, she says she remained for 25 days, getting daily physical therapy from physicians. But the country and its care had a rougher side, too. Mann says she got sick from eating ice cream made with unpasteurized milk, and after that, her stomach couldn't tolerate Indian food. (She says doctors and nurses tried hard to compensate, bringing her Domino's pizza, among other things.)
Mann was also jarred by the poverty she saw around her; outside her cool, private suite, she says, patients were bunked four to a room, without air conditioning. Getting treated like royalty in such an environment, Mann says, "is almost embarrassing."
Sometimes, cultural barriers can translate into more serious trouble for the patient. When Jeff Loren, a fireplace installer from Shoreline, Wash., got a spinal fusion in Seoul, South Korea, a hospital nurse slept on a futon in his room for four nights to accommodate his needs around the clock. But Loren says the nurse hardly spoke any English, and one night he couldn't communicate that he was in excruciating pain and needed more medication. "It wasn't a night to remember," he says of his 12-hour ordeal.