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Your Next Vacation May Include a Knee Replacement

Saving patients up to 85 percent on procedures, medical tourism is one the hottest trends on the planet

By Elyse Weiner | June 7, 2012

Nikoli Bailey moved to Anchorage, Alaska, 17 years ago, attracted by the beauty of the state and its outdoor sports. Her knee had ached for years, but when the pain got so bad that she had to stop hiking, the 56-year-old legal assistant saw an orthopedist, who told her she needed a replacement. Because her small law firm couldn’t offer health insurance, the $70,000 replacement surgery was out of the question.

After doing a little research, Bailey decided to have her surgery in Puerto Vallarta, Mexico, feeling she’d be safer walking there than on the ice and snow of home. She flew to Mexico and got a new knee for $12,300.

As health care costs and premiums escalate, a growing number of Americans are heading to the airport. Going overseas for health care has become such a huge trend that it has a name — medical tourism. Half of all medical tourists are Americans, and in 2011 the global industry racked up $40 billion.

With more than 50 million Americans uninsured or underinsured, medical tourism is attractive not only to individuals who can save tens of thousands of dollars, but also to insurance companies.

In 2012, 1.5 million Americans are expected to leave the country for some kind of medical procedure. Most people go for elective procedures that, even if they are covered by insurance, are prohibitively expensive in the United States, like orthopedic, cosmetic, dental and bariatric (weight-loss) surgery. Others do it because they have no insurance and can’t afford the fees American surgeons and hospitals charge. Some are just looking to save some money on an elective procedure and squeeze in a nice vacation.

The most common orthopedic procedures for Americans abroad are knee and hip replacements, and topping the cosmetic surgery category are breast implants, liposuction and various kinds of face work. Since many Americans lack dental insurance coverage, travel for dental procedures is expanding rapidly. Top foreign surgeons perform everything from heart and cancer surgeries to ophthalmologic procedures and increasingly, every manner of imaging and screening.

While this might seem extreme, or risky, the majority of the people who do it feel the out-of-pocket savings are more than worth it. Given foreign countries' much lower labor and malpractice-insurance costs, the savings abroad can total 85 percent. As for risk, many feel that’s a nonstarter. The nonprofit Joint Commission of the United States, which accredits American health care facilities, has an international division that accredits hospitals around the world, and most Americans choose one of those 500 centers.

Asian countries, especially India, Singapore and Thailand, are leading the way, but Korea, Taiwan and Malaysia are catching up. It’s a lucrative industry, with India set to make as much as $2.3 billion this year. Countries in Latin America and the Middle East are upgrading their surgical training and facilities to capture medical tourist dollars, and Israel has seen a boom in its medical tourism by catering to a Western clientele.

Just compare these national averages: Heart bypass in the United States costs $144,000, in Israel $27,500; hip replacement in the United States $50,000, in India $7,000; colonoscopy in the United States $3,000, in Mexico $800; dental implants in the United States $2,800 per tooth, in Costa Rica $900; Lasik eye surgery in the United States $4,400, in Malaysia $477. 

Medical Travel Facilitators

Sixty-three-year-old Mike Libertus' left hip had deteriorated to the point that he needed a cane to walk. He lost his health insurance when he lost his job in the 2008 recession and couldn’t afford the $65,000 replacement surgery. An acquaintance of his had had surgery in Malaysia, where, she said, she was treated like a queen at very little cost. She recommended her medical travel facilitator, HealthGlobe.

Like the growing crop of reputable third-party facilitators, which act as brokers or agents, HealthGlobe does firsthand inspections of the medical facilities it uses, making sure the care, equipment and training are up to American standards. Facilitators take care of all the arrangements: booking the hotel and airfare, arranging to have patients met at the airport and driven to the hospital and later their hotels for recovery. HealthGlobe even oversaw Libertus’ follow-up physical therapy and transportation — all for its standard $700 fee.

Libertus brought his girlfriend with him to Kuala Lumpur, Malaysia. “It was a fantastic, beautifully kept hospital with great personal care,” he says. “My surgeon had trained in Australia and had performed more than 650 hip replacements.” Libertus’ total out of pocket was $16,000, which included the surgery, post-op physical therapy, airfare — plus a week at the Shangri-La hotel after his hospital stay.

Cardiovascular disease is the No. 1 killer in the United States, causing 1 of 3 deaths. Angioplasties, procedures used to open up clogged arteries, can cost as much as $82,000 in this country. South of the border, in Costa Rica, the price is $13,000, and in India it’s around $3,500.

So when Mimi Shaw, who lives on Hawaii's Big Island, was told she needed an angioplasty, the 77-year-old retired schoolteacher hit the books and learned that for someone her age, common femoral angioplasty through the groin holds a far greater risk of complications than radial angioplasty through the wrist. Yet no doctors in Hawaii performed radial angioplasty. Further research led Shaw to zero in on Bumrungrad Hospital in Bangkok, Thailand.

Prior to her trip, she conversed via email with her English-speaking doctor, who sent her home not only with her records, but also a DVD of the entire procedure, pumping heart and all. “They saved me — physically, financially and spiritually,” Shaw says. Bumrungrad, which is said to look more like a fancy hotel than a hospital, took care of 25,000 traveling Americans last year, mostly for elective joint replacement and plastic surgery. More than half the hospital’s revenue comes from foreign patients.

Even the Insurance Companies Are Getting Onboard

As their costs skyrocket, insurance firms and large corporations are offering the option of going abroad for safe, affordable health care at a fraction of the price, saving themselves and the insured a bundle. This has translated into a boom for Latin America, whose proximity to the United States means patients don’t have to travel as far, reducing post-op risk as well as travel costs.

Case in point: Kathy Marlowe, 64, of Euless, Texas. Her Aetna insurance would have paid for most of the knee replacement surgery she required ($65,000 per knee), but Marlowe still couldn’t afford her 20 percent share of the cost. So when Aetna offered to fly her to Costa Rica, she happily consented.

Companion Global Healthcare, which facilitates foreign care for several American health insurance companies, including Aetna, arranged to have her met at the airport by an English speaker, taken to the hospital and given appropriate attention after the procedures. Because the total cost was less than what Aetna would have paid in the United States, it waived her deductible and co-pay. “The care was probably better than I would have gotten in Texas,” Marlowe says.

When he retired, 62-year-old Ben Schreiner lost his health insurance and had to buy his own. Because he was healthy, he chose a Blue Cross/Blue Shield policy with a $10,000 deductible to save money on his monthly premiums. The next year he was told he needed a hernia operation. At home, the surgery costs $14,000. His insurance company referred him to a broker, who told him in Costa Rica the same procedure would cost just $3,500.

“I was quoted a price and paid it upfront in San Jose,” Schreiner says, “and I never saw a bill after that.” The ultramodern facility even had a concierge nurse on staff whose sole function was to help Americans through the system.

“They gave me a physical exam that was much more thorough than any American care I’ve received,” Schreiner says. After the surgery, he recuperated in a neighborhood hotel, with English-speaking nurses visiting him daily as part of his care. Completely healed a couple of weeks later, Schreiner and his wife enjoyed the fringe benefit of overseas medical travel: a week touring the natural wonders of a beautiful foreign country. Vacation for two, round-trip airfare — and a hernia operation — for less than half of what the surgery alone would have cost him at home.

The boon of medical tourism is having a trickle-down effect on local economies, with entrepreneurial types recognizing the needs of this new tourist segment and stepping up to meet them. In Israel, a popular destination for cardiologic, orthopedic, dental and cosmetic procedures, enterprising residents have made a cottage industry of renting out their homes to visiting patients, making the stay even more comfortable. In Costa Rica, one patient described a scene of “dental clinics on practically every corner, with attendant pharmacies, taxi services and restaurants full of foreigners.” 

Risk to Reward of Medical Tourism

The vast majority of medical tourists describe their care as excellent, and according to an industry survey 85 percent of patients feel they got more personalized care abroad than at home. Yet these treatments are not without risks — from infectious diseases for which Westerners don’t have immunity to inadequately trained doctors — although when patients book through brokers, these occurrences are extremely rate.

Yet they do happen. A 51-year-old New Yorker who works in publishing, Maria Sheffield thought her plastic surgeon was a little pricey, so she flew to the Dominican Republic for breast augmentation and liposuction. “I had heard about a spa where the whole package — hotel and airfare, surgery, meals, medication, relaxing in the spa — cost 70 percent less than just the procedures would in New York,” says Sheffield.

But once she got home, her breasts healed unevenly, and the lipo was lumpy. She had several corrective surgeries and wound up spending more than twice her original American estimate. “When I did have a problem, nobody at the Caribbean spa wanted to deal with it. I couldn’t get them to call me back, let alone fix anything,” she says.

So consumers need to do their homework and work with reputable medical facilitators, warns Jonathan Edelheit of the nonprofit Medical Tourism Association. (The association is a clearinghouse for information, including facilitators, listing 33 on their website, www.medicaltourismassociation.com.) Nikoli Bailey calls the doctor who performed her knee replacement surgery in Puerto Vallarta “an exceptional human being who gave me better care for less money.”

And Mimi Shaw, the former teacher who trekked to Bangkok, points out yet another bonus: “Not only did I get a first-rate angioplasty and three weeks touring Thailand, I got enough frequent flier miles for another trip!”

Elyse Weiner is an Emmy Award-winning journalist and television news producer who runs iJourneys.com, a travel media company.