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Medical Tourism

Patients jet to foreign locales for surgical procedures and return home for follow-up care

Monday November 17, 2008
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The concept is enticing. Hospitals in exotic locales are advertising packages for patients needing surgery that include personal medical attention in luxury rooms, airfare, and the chance to enjoy a vacation after recovery — all for a fraction of the same surgery cost in their home country.

Once primarily focused on cosmetic surgery, the concept of medical tourism now includes life-changing and life-saving procedures such as hip replacements and heart bypass operations. Patients are jetting off to Thailand, India, Mexico, and Costa Rica, and the list of countries that want a piece of the market is constantly expanding.

Insurers in the U.S. are taking notice, and a few are offering coverage for foreign procedures. Advocates point to greatly reduced costs, shorter wait times, highly trained medical staffs, and more personalized care. But there are risks, and patients need to do their research before going this route.

Ask the Questions, Weigh the Risks

Joshua Jacobs, MD, an orthopedic surgeon at Rush University Medical Center in Chicago and former chairman of the American Academy of Orthopaedic Surgeons Council on Research, says questions should go beyond the qualifications of the surgeon. Patients should ask about the availability of technology, subspecialists, and services.

"Even if a physician is well-trained, what about the availability of radiology, physical therapy, and blood banking services?" Jacobs says. "Are the standards and regulations in place for wrong-site surgery and prophylactic antibiotics?"

He says the patient likely will get follow-up care back home with a doctor who was not present at the surgery. Also, drugs prescribed overseas may not be approved by the U.S. Food and Drug Administration, so medical professionals in the U.S. would have to find substitute drugs with similar mechanisms.

"There is value to having follow-up care with the surgeon who does your surgery," Jacobs says. "That can be lost with medical tourism. Can it be measured in outcomes? There's no real scientific data on that."

The other big question is liability. There's always a risk that a procedure could go wrong, which could lead to navigating unfamiliar legal systems. And who determines whether the standard of care was met? Patient privacy rules also are different abroad.

Medical tourism has caught the attention of the American Medical Association, which this year issued nine guidelines for patients, insurers, employers, and companies responsible for coordinating travel. Among them are that patients should be referred only to institutions accredited by recognized international bodies such as the Joint Commission International or the International Society for Quality in Health Care. Also, before travel, local follow-up care should be coordinated to ensure continuity of care when patients return to the U.S.

Patients first need to consult their home physicians on whether a long flight would jeopardize their health. Those at risk for developing deep vein thrombosis, for instance, are not good candidates.

Next, patients should research which hospitals and physicians are internationally accredited. A good start is the JCI, which lists accredited hospitals on its Web site. Patients also should find out where a doctor received training and how many times he or she has performed the procedure.

Doing the research can be a small price to pay for the cost savings. According to a study by the Medical Tourism Association, a non-profit international association created in response to the growing interest in medical tourism, the average price for a hip replacement in the U.S. is $43,000. The cost for the same procedure in India is $5,800-$7,100; $12,000 in Thailand and Costa Rica; and $14,000 in Mexico. A hysterectomy costs $20,000 in the U.S.; $2,300-$6,000 in India; $4,500 in Thailand; and $6,000 in Mexico.

It's not just the cost patients should consider, but the value, says Renee-Marie Stephano, chief operating officer and general counsel for the MTA. "Do you go and get a Botox shot?" she says. "No. Do you go for a minor procedure? Maybe, if you want to incorporate a vacation."

Stephano says some people seek help overseas for the wrong reasons, particularly cosmetic patients who have run out of doctors willing to perform more procedures on them. "Lots of chronic cosmetic patients go overseas and think, 'The doctors won't know my history and they'll be willing to work on me.' " she says. "But if five doctors here have told you it's not a good idea, then that's what the doctors overseas are going to say."

She points to reasons medical tourism is an attractive choice, among them that doctors abroad may have more experience performing procedures only recently approved in the U. S. "The volume of patients coming through is higher than that of most hospitals here," Stephano says.

A Personal Touch

Stephano says patients are drawn to the personal care. "Personal nurse-to-patient ratios in private hospitals that are promoting themselves for medical tourism have an average ratio of 1 to 3," she says. "Generally, in private hospitals (in the U.S.) that number is 1 to 10. You also can get your doctor's cell phone number — that's standard procedure overseas."

Terri Ingram of Edwards, Miss., had just that kind of experience recently. She needed a vertical sleeve gastrectomy to repair a stomach stapling operation. The operation was not covered by her insurer, so she investigated alternatives for an operation that can cost more than $20,000 in the U.S.

Ingram traveled to Clinica Biblica in San Jose, Costa Rica, in June. She said her total costs for surgery, a nine-day stay in a four-star hotel, plus airfare and related expenses were $12,050. She was impressed with the accessibility of the staff and follow-up visits by a home nurse who visited her at her hotel.

"The surgeon gave me his cell phone and his office numbers," Ingram says. "Also, a liaison or interpreter went from one appointment to the next to make sure we got where we needed to be. We never had a moment when we could not communicate with someone."

The number of people buying into medical tourism is unclear because of patient privacy issues and because of a lack of a central agency tracking the reasons people are getting surgery in another country. But all signs indicate huge potential for growth in the industry as U.S. healthcare costs swell and the number of uninsured and underinsured patients balloon.

Quantifying results of offshore medical procedures is more difficult. "It would be really helpful if we had good scientific outcome studies," Jacobs says. "As it is now, we are operating in a vacuum. Medical tourism is happening and people are making this choice, so it's something we should observe and monitor."


Marcia Frellick is a freelance writer. To comment, e-mail editorNTL@gannetthg.com.

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