Imagine having major surgery at an internationally accredited hospital, performed by a board-certified surgeon, and then recovering with your spouse in a four-star hotel on the beach in Costa Rica. Add daily nurse and physical therapist visits to the mix, and all for less than the cost of the surgery, hospital stay, and rehabilitation in your home city. This is medical tourism – and many Americans have recently discovered it.
According to the website Patients Beyond Borders, an estimated 1.2 million Americans will travel overseas in 2014 for medical and dental services. It’s also estimated that, globally, six million people will travel across international borders for less expensive (though comparable) care to save money or avoid long waits for treatment. According to the Huffington Post, British citizens are headed “to Switzerland for things like face lifts, Botox and liposuction; the Czech Republic for boob jobs, lip fillers, and nose jobs; and Thailand for teeth whitening.” The Economic Times reports that the Indian medical tourism business is growing 30% annually, with 3.2 million visitors projected to spend $2 billion U.S. in 2015.
Major health insurers such as Aetna, UnitedHealth, Humana, and WellPoint are experimenting with cross-border plans, according to the New Republic. Blue Cross Blue Shield of South Carolina has contracted with foreign providers for its high-deductible, low-premium plans. While Medicare does not currently cover healthcare costs overseas, the nonpartisan group Center for Medicare Portability predicts that it’s just a matter of time – retired Americans living overseas who paid Medicare premiums during their working years are currently denied medical care or must pay out-of-pocket. In addition, there would be substantial savings in the Medicare programs since comparable services overseas cost around 60% to 70% of U.S. prices.
The Reasons Behind Medical Tourism Growth
The drivers for increased medical tourism include the following:
- Lower Costs. As medical costs continue shifting to consumers through higher deductibles and co-pays – the Affordable Care Act “Bronze” plan, for example – consumers are seeking lower costs overseas.
- Foreign Hospital Accreditation. Overseas hospitals are increasingly receiving Joint Commission International (JCI) accreditation to assure foreign patients that they offer quality, safe care consistent with the best U.S. standards.
- Board-Certified Physicians. Foreign practitioners are coming to the U.S. to receive certifications from the American Board of Medical Specialties, qualifying them to provide excellent, state-of-the-art services in 24 medical specialties.
- Shortage of American Physicians. According to the Association of American Medical Colleges, the United States lacks sufficient physicians to serve the growing population – especially the aged – and will face a shortage of 130,600 physicians by 2050.
- Luxury and Exotic Locations. Many hospitals have partnered with major hotel chains to provide complete packages of medical services and extraordinary vacations in locales such as Singapore, Thailand, India, Brazil, and Costa Rica for less than the costs of the U.S. surgery alone.
U.S. Premier Hospitals’ Presence Overseas
There are plenty of examples of premier American hospitals with overseas ventures. According to a recent U.S. News & World Report article, they include the following:
- Cleveland Clinic’s new 24-story facility in Abu Dhabi
- University of Pittsburgh Medical Center’s transplant and specialty surgery center in Palermo, Italy; a transplant center in Singapore; and a radiation therapy center in Ireland
- St. Louis-based Ascension Healthcare’s new $70 million facility in the Grand Cayman Islands
Additionally, once the Medica Sur Hospital in Mexico City met strict requirements for quality and safety, the Mayo Clinic added it to its network. And Johns Hopkins Medical now has affiliation with hospitals in Brazil, China, Saudi Arabia, and Singapore.
Popular Destinations and Projected Cost Savings
According to Patients Beyond Borders, a U.S. citizen’s costs in another country should be significantly lower than in the U.S. for the same quality medical care. Popular medical tourist destinations include the following:
- Brazil: 20% to 30% savings
- Costa Rica: 45% to 65% savings
- India: 65% to 90% savings
- Malaysia: 65% to 80% savings
- Mexico: 40% to 65% savings
- Singapore: 25% to 40% savings
- South Korea: 30% to 45% savings
- Taiwan: 40% to 55% savings
- Thailand: 50% to 75% savings
- Turkey: 50% to 65% savings
- United Kingdom: 25% to 60% savings
Savings vary according to specific medical and surgical treatments, and they may not exist across the board. For example, breast implants and reductions cost more in Singapore ($8,000 each) than in the United States ($5,200 and $6,000, respectively), while a hip replacement in Poland ($6,375) is less than half its cost in Costa Rica ($14,500) and 20% of its cost in the United States ($34,000). As a consequence, Renée-Marie Stephano, president of the Medical Tourism Association, recommends that the destination be determined by the procedure, price, expertise and accreditation of the providers, and geographical accessibility.
In addition to the normal risks accompanying any surgical procedure – whether performed in the United States or overseas – potential medical tourists should consider the following:
- Some surgical techniques, treatments, and drugs are not approved within the United States.
- Follow-up can be difficult when the patient returns to the United States, particularly if there are complications.
- Some physicians and hospital administrators have questioned the efficacy of quality assessment, since accreditation decisions are based on adherence to a precise set of procedures, rather than patient outcomes. Critics note that the JCI’s revenues depend upon the number of hospitals it accredits, and there is a very high rate of accreditation and a low rate of revocation. According to Joel Miller, senior vice president of operations at the National Coalition of Healthcare (NCHC), “It’s very difficult to evaluate the medical training of practitioners and the ongoing quality of facilities outside the country.”
- Language barriers can create misunderstandings between patients and caregivers.
- Medical malpractice laws vary from country to country. In the event of medical errors, foreign patients may lack acceptable recourse.
Since there are plenty of sharks in the overseas medical waters, it makes sense to protect yourself and your pocketbook.
1. Use Only Joint Commission International (JCI) Accredited Hospitals
While there are other accrediting authorities, JCI is the best known. Better yet, seek out facilities tied to “name brand” U.S. hospitals, such as Johns Hopkins and the Mayo Clinic.
2. Employ Only U.S. Board-Certified Physicians
Larger overseas hospitals catering to American medical tourists tend to employ physicians who received certification in the U.S. Ideally, the practitioner has performed these procedures many times and is fluent in English, or has English-speaking staff readily available.
3. Obtain Specific Safety and Quality Data
Check with your local physician for specific data on safety and quality applicable to your case. You should always have information about infections associated with catheter use, bloodstream, and surgical site. Ensure that the hospital has an aggressive hand-hygiene program and inquire about its use of pre-surgery antibiotics to prevent infection – worldwide experience suggests that prophylactic antibiotics are effective and cost-efficient.
4. Check American Patient References
Other Americans are likely to expect a similar level of care, treatment, and hospital conditions than foreign patients. Ask your potential providers for names and contact information of other American patients they’ve treated, and contact them directly for a detailed report of their experiences.
5. Engage a Medical Travel Concierge or Facilitator
Take advantage of firms that specialize in medical tourism. They can make introductions, handle appointments, transfers, and arrange travel and accommodations. Do not rely upon such agencies for medical advice though – they exist to make your stay easier, nothing more.
6. Arrange Medical Records Transfers
Prior to treatment, your medical records should be transferred from your American physician to your foreign provider. When your treatment concludes, all records – including X-rays and lab results – should be sent back from your foreign provider to your physician in the U.S. Your medical facilitator may be able to handle these transfers for you. However, be prepared for your American physicians to express a negative opinion about your trip – after all, they’re competing for your business. Nevertheless, you need to be sure that your domestic physician and your foreign provider agree about the treatment you’re about to receive.
7. Bring a Companion
Having a friend or family member with you can provide peace of mind and potentially speed your recovery. It also lends a sense of security.
8. Get Everything in Writing Before You Depart
Know what you’re buying before you go so you can avoid “sticker shock.” Your agreement or contract should include costs, treatments, supplies, in-hospital and post-operative care, and amenities including hotel, flights, food, and transfers (if they’re part of the final package).
9. Use Common Sense
Traveling too soon after surgery can be dangerous, especially on long airline flights with pressurized cabins and restrictions on movement – blood clots can form in the legs and move to the heart or lungs with sometimes fatal consequences. Always travel with your physician’s agreement, which might include instructions on the use of blood thinners or compression stockings. Physicians often recommend waiting a minimum of 10 to 14 days after surgery before air travel, especially if you’ve had chest, abdominal, neurological, or head surgery.
Medical tourism is increasingly common, especially for cosmetic surgeries and dental care. While rarely applicable for trauma – unless you’re overseas when a need for urgent care arises – treatment for chronic conditions can come at the same level of quality as in the United States, and for a lot less money. Plus, you have the opportunity to recuperate in luxury. If you’ve been waiting for a knee replacement or are considering bariatric surgery, check foreign suppliers for those services. At a minimum, you’re going to be in a better position to negotiate with your insurer or healthcare provider as a result.
Have you gone across the border for medical treatment? If not, would you consider becoming a medical tourist?