TICKET TO TREATMENT
A guide for Americans seeking affordable medical treatment abroad
Harry Campbell / For The Times
Medical travel
Improving quality and bargain prices are luring U.S. patients to developing countries for increasingly sophisticated procedures.
By Marla Dickerson 2:34 PM PDT, November 1, 2008
Reporting from Monterrey, Mexico -- When Andy Dijak injured his right knee playing tennis, he wasn't surprised that he needed surgery. "It swelled up like a balloon," said the 50-year-old West Lake resident. ¶ The real shocker was the price tag: $12,000 to $15,000 to repair tattered cartilage. Dijak, a creative director for an entertainment company, has no health insurance, so he started shopping for a deal. ¶ He found it in the northern Mexico city of Monterrey at Christus Muguerza High Specialty Hospital, owned by Dallas-based Christus Health. Here, the staff treated him more like a big shot than a bargain hunter. An English-speaking employee picked him up at the airport. Dijak recuperated in a private hospital room with a flat-screen television and a view of the peaks of the Sierra Madre. His surgeon recorded the operation on video and gave Dijak a DVD copy for his peace of mind. ¶ Total cost, including airfare: $4,500. ¶ "I got better care there than I would have in the United States, unless I were a billionaire," he said. ¶ Americans have long been willing to leave the country for bargain face-lifts and cut-rate dentistry. But now the availability of top-notch medical services at low cost is enticing a growing number of U.S. patients to developing nations for more sophisticated procedures. Most, like Dijak, are obtaining elective surgeries for ailments that aren't life-threatening. Increasingly, they are seeking treatment for more serious conditions, including heart maladies and cancer.Last year, 750,000 Americans traveled abroad for care, according to estimates by the Deloitte Center for Health Solutions, a Washington-based research center that's part of the consulting firm Deloitte & Touche. Other analysts say the numbers are lower. But hardly anyone disputes that medical care, once a highly local business, is going global like never before. By 2010, Deloitte projects, 6 million consumers a year will venture outside the United States for medical treatment.


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The idea of jetting off to India for heart surgery might strike some as a radical way to save money. But proponents say it's a logical outgrowth of the globalization that's reshaping the industry.Already, offshore firms handle Americans' medical records and read their X-rays. Top U.S. hospitals such as Johns Hopkins have established outposts abroad. Rising prosperity in many parts of the developing world is luring foreign-born, U.S.-educated doctors home to practice in modern hospitals catering to increasingly affluent consumers.Nearly 200 institutions outside the U.S. have been certified by the Joint Commission International, an affiliate of the organization that accredits U.S. hospitals. Medical travel companies are springing up to link American patients with foreign providers eager to boost their profits.
Add a rapidly aging U.S. population and a shrinking medical safety net, and the notion of Americans looking elsewhere for treatment no longer seems such a stretch."This is going to be one of those things that starts slow and becomes pretty routine 15 years out," said Arnold Milstein, chief physician for Mercer Human Resource Consulting.The fact that 1 in 6 U.S. residents, nearly 46 million people, lack health insurance is well known. But soaring deductibles and increasing restrictions on coverage are driving even insured consumers to seek alternatives.Mark Sawko's insurer balked at paying to replace a bum knee the 50-year-old Arizonan injured back in high school. So he called a Tempe, Ariz.-based medical travel company called MedToGo. The firm arranged for him to have surgery last year in Puerto Vallarta, Mexico, where he spent $13,500 instead of the $50,000 quoted by a local orthopedic surgeon.The owner of a company that makes industrial parts, Sawko competes every day with foreign manufacturers. He sees the same thing happening in medical care."I think we're going to lose a lot of business to these other countries," said Sawko, who has returned to playing golf without pain. "I'm American, so I'd like to keep things here. But no one was going to make it affordable for me."At present, the vast majority of U.S. medical travelers are cash-paying patients such as Sawko. But analysts say that's changing fast as insurance companies and employers add foreign providers to their networks to slow runaway costs.In Southern California, insurers Aetna, Blue Shield of California, HealthNet and PacifiCare have developed cross-border programs that allow members to seek treatment in Mexico. That means cheaper premiums for employers and smaller co-pays and other out-of-pocket expenses for members."A lot of small employers have been priced out of traditional coverage," said Jim Arriola, president of Sekure Healthcare Inc., a Chula Vista, Calif.-based company whose plans cap services at a fixed dollar amount. "That same $1,000 benefit goes a lot further south of the border than it would in the U.S."Uptime Electronics Inc., a Whittier-based equipment repair company, recently began offering its 20 employees the option of going abroad for care. The company has contracted with Planet Hospital, a Calabasas medical travel coordinator that has relationships with providers in 13 countries.Large self-insured companies are doing the same. Hannaford Supermarkets, a Maine-based grocery chain, has given its 9,000 insured employees the choice of having knee and hip replacements at National University Hospital in Singapore, where such procedures can cost a third of what they do in the United States. Hannaford waives all deductibles and covers travel expenses for the patient and a companion.Other employers are offering workers cash incentives as high as $10,000 on top of free medical care and travel. It's not hard to see why. Heart bypass surgery that can cost more than $100,000 in the U.S. is generally less than $10,000 in India's finest hospitals, whose success rates rival those found in the U.S. and Europe, according to Josef Woodman, author of "Patients Beyond Borders," a popular guide to medical travel.So if healthcare in other countries is so good, why is it so cheap?Experts point to a variety of factors. Doctors' salaries and the cost of living are lower in many countries. Government-funded healthcare in some nations helps contain costs in private-sector hospitals, which don't have to shoulder the unpaid bills of uninsured patients as U.S. hospitals do. In addition, malpractice insurance is cheaper and litigation awards are significantly smaller in most parts of the world.That lighter liability burden is one reason hospitals in New Zealand can perform procedures such as hip and knee replacements for less than half the price some U.S. facilities charge. The Pacific island nation is wooing American patients by promoting its First World living standards and common language.
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