Current News |
Going Abroad to Find
Affordable Health Care
By WALECIA KONRAD
Published: March 20, 2009
http://www.nytimes.com/2009/03/21/health/21patient.html
WHEN Ben Schreiner, a 62-year-old
retired Bank of America executive, found
out last year he would need surgery for
a double hernia, he started evaluating
possible doctors and hospitals. But he
didn’t look into the medical center in
his hometown, Camden, S.C., or the
bigger hospitals in nearby Columbia.
Instead, his search led him to consider
surgery in such far-flung places as
Ireland, Thailand and Turkey.
Ultimately he decided on San José, Costa
Rica, where just a week or so after the
outpatient procedure and initial
recovery, he and his wife were
sightseeing throughout the country, then
relaxing at a lush resort. He was home
four weeks later, with no complications.
Mr. Schreiner is what’s known in the
health care world as a “medical
tourist.” No longer covered under his
former employer’s insurance and too
young to qualify for Medicare, Mr.
Schreiner has a private health insurance
policy with a steep $10,000 deductible.
Not wanting to spend all of that on the
$14,000 his operation would have cost
stateside, he paid only $3,900 in
hospital and doctor’s bills in Costa
Rica.
“I didn’t have to fork over my entire
deductible,” Mr. Schreiner said. “What’s
more, they bent over backwards there to
take care of me — no waiting, a friendly
staff, everyone spoke English.”
At least 85,000 Americans choose to
travel abroad for medical procedures
each year, according to a recent report
by the consulting firm McKinsey &
Company. Treatment includes dental
implants, hip and knee replacements,
heart valve replacements and bypass
surgery. The cost of surgery performed
overseas can be as little as 20 percent
of the price of the same procedure in
the United States, according to a recent
report by the American Medical
Association.
Medical tourism is expected to expand
quickly in the coming years because of
rising health care costs in the United
States, increasing availability of
international facilities with United
States accreditation, and the fact that
insurers and employers are beginning to
embrace the practice.
Blue Cross Blue Shield of South
Carolina, for example, has started a
subsidiary company, Companion Global
Healthcare, to offer medical tourism
services to individuals and businesses.
Hannaford supermarkets in Maine recently
added an international option for hip
replacements to its health care plan.
At the moment, however, the bulk of
medical tourism candidates are uninsured
and underinsured people paying their own
bills and looking for low-cost
alternatives to American care. Medical
tourism advocates argue that the quality
of care overseas is often equal to or
better than that in the United States.
Many countries have high success rates,
American-trained English-speaking
doctors and the newest facilities, often
built specifically to attract foreign
patients.
But there are no comprehensive data that
adequately compare overseas surgical
outcomes or other quality measures to
those used in the United States, said
Dr. Sharon Kleefield of the Harvard
Medical School and a specialist in
overseas health care quality measures.
“No matter how high your hospital is
rated, there are issues with regard to
quality and safety when you travel for
medical treatment,” she said.
The American Medical Association, also
worried about the risks associated with
overseas medical travel and the
difficulty in getting adequate follow-up
care, issued guidelines on medical
tourism last June. (They’re available on
the Web at tinyurl.com/cpklcw.)
With those cautions in mind, here’s what
you need to know if you are considering
an international medical option:
Determine whether you are a good
candidate. “Traveling for surgery is a
big deal,” said Josef Woodman, author of
“Patients Beyond Borders: Everybody’s
Guide to Affordable World-Class Medical
Tourism.” Recovery time is often
compressed, and a long flight home can
cause complications like a blood clot.
You’ll need to provide a thorough health
history and have a physical stateside
before you go to make sure you can
withstand the trip.
Mr. Woodman points out that not every
condition should be treated overseas:
“Orthopedic and nonemergency heart
procedures have some of the highest
success rates. But with something like
cancer, you need the ongoing
relationship with your oncologist and
health care team.”
Get a reliable middleman. Dozens of
medical tourism facilitators and
planners have sprung up in the past
decade hoping to capitalize on the trend
and simplify the process for consumers.
“Unfortunately, plenty of unreliable
firms have sprung up, too,” said
Jonathan Edelheit, president of the
Medical Tourism Association, a nonprofit
organization made up of hospitals and
facilitators that cater to traveling
patients.
Good firms, said Mr. Edelheit, will
match your medical needs with the best
overseas hospitals and physicians; make
your travel, lodging, visa and local
transportation arrangements; handle
billing; and help arrange follow-up
care. For a list of facilitators vetted
by the association, go to
medicaltourismassociation.com. Once you
narrow your search, ask each potential
firm for references and former patients
you can interview.
Check out quality yourself. Although
medical tourism firms will say they work
only with the highest quality hospitals
and physicians, you’ll still need to
check the records. Don’t be swayed by
the luxurious private hospital rooms,
gourmet food and other amenities
splashed on the Web sites. You want to
be sure you’re going to a hospital
accredited by the Joint Commission, the
organization that reviews both American
and international medical and dental
facilities,
using United State standards. (Find it
at
http://www.jointcommissioninternational.org)
Be sure to read carefully, a commission
spokeswoman, Elizabeth Zhani, warned.
You may find a facility’s name on the
accreditation list, but it may be that
only an affiliated lab or clinic is
accredited, not the entire facility.
“Keep in mind that commission
accreditation is the floor, not the
ceiling,” said Dr. Kleefield. You’ll
want to ask your own questions about the
facility’s blood safety, medication
safety, infection rates and unexpected
morbidity rates for the procedure you’re
undergoing, and discuss the data with
your American doctor.
Just as you would in the United States,
you’ll want to interview the physician
handling your case before you arrive.
Ask if he or she was trained in the
United States and is fluent in English,
how often he or she has done the
procedure you’re having, and what the
long-term outcomes have been. Conducting
this interview beforehand will also help
you establish a rapport with your doctor
before you go under the knife.
Arrange your follow-up care in advance.
“The biggest stumbling block with
medical travel is getting care when you
return,” said David Boucher, chief
executive of Companion Global. Doctors
often balk at treating complications
from overseas surgeries because they are
unfamiliar with the procedures or
prosthetics used or are worried about
liability.
Meet with your general practitioner and
any specialist who may have been
treating you before you go, said Dr. Ted
Epperly, the president of the American
Academy of Family Physicians: “They’ll
be able to provide your medical records,
either electronically or on paper, to
your overseas doctors.”
Give your doctors in the United States
specific details on where you are going
for your procedure and contact
information for your overseas doctors.
And be
sure to ask what medical records and
information you need to bring home to
complete your care.
Finally, before you leave, do your best
to arrange a phone or e-mail conference
between your doctors at home and abroad
so communication will be established
before a problem arises.
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