| | |  Health & Beauty | November 2009 
Health Without Borders: Medical Tourism
 Bill Kettler - Mail Tribune
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November 29, 2009
| | Jim Krois, 61, of Williams, is traveling to Mexico for hip replacement surgery this week. He’s one of hundreds of thousands of “medical tourists” who travel abroad each year for health care they can no longer afford at home. (Jamie Lusch) | |
Like a lot of folks from Southern Oregon, Jim Krois has scheduled a trip to Mexico during our rainy season.
Most travelers head south this time of year to get a break from winter weather. Krois has a different motive. He needs hip-replacement surgery, and he can have it done at a hospital in Puerto Vallarta for a quarter of what it would cost him in the Rogue Valley.
"They told me it would cost $50,000 here," said Krois, who lost his health insurance in 2008 when he was laid off from his job as a photographer with the Grants Pass Daily Courier. "It will cost $12,000 in Mexico."
The 61-year-old man from Williams is one of a growing number of "medical tourists" — people who travel abroad for health care they can no longer afford at home. One study estimated some 750,000 Americans left the country for medical treatment in 2007.
Many medical travelers stick to the simple stuff, such as getting a cavity filled by a dentist in Mexico. Others, like Krois, go abroad for major procedures — an artificial hip, a new knee or even coronary artery bypass surgery.
Their numbers are expected to grow as health care costs rise and more people lose their health insurance. A 2008 study by Deloitte Consulting predicted medical tourists could number 6 million by 2010.
Traveling for health care isn't new. For decades people came to the United States to get sophisticated treatments that weren't available in their native lands. Now, the traffic flows in many directions, as physicians and hospitals in developing countries begin to catch up with the U.S.
Krois isn't the only Rogue Valley resident to go abroad for surgery. Dee Misenheimer of Shady Cove traveled to India in 2007 to have a spinal cyst removed. Misenheimer had no health insurance, and she was told the procedure would cost $80,000 locally.
"I was in severe pain in my back," she recalled, "and the pain was going down my leg to where I could no longer walk. I really needed to have it removed."
With no insurance, the cost seemed prohibitive. Then Misenheimer happened upon an article in an AARP magazine about medical tourism and the companies that have sprung up to promote it. She contacted New Jersey-based Med Journeys and paid the company to arrange transportation to India for her and her husband, her hospital stay and several weeks of post-operative accommodations.
The whole package cost about $20,000, she said.
"They treated me like royalty," Misenheimer recalled. "They offered me anything I wanted. My husband and I shared a room like a suite."
She said the service was unlike anything she'd seen in American hospitals. "When I rang the bell, two nurses came.
"If I had the money, I'd go back and have my hips (replaced)," she said.
In an interview last week, Sonny Krishana, the president of Med Journeys, said his clients include baby boomers with failing joints; active young adults with sports injuries; people seeking cosmetic surgery; and those who have pre-existing conditions that disqualify them from health insurance.
"Predominantly we're catering to the 47 million (Americans) who don't have insurance," he said.
His company has agreements with hospitals and physicians in Brazil, Mexico, Costa Rica, Poland, Thailand, Turkey, Malaysia and Singapore, and he expects to soon add Belgium and Colombia to his clients' options. He books patients into many of the foreign hospitals that are now certified for safety and quality by the Joint Commission International, which accredits hospitals around the world.
Even people with insurance sometimes go abroad for treatments if their policy doesn't cover what they want. Brian Orsborn of Medford traveled to Thailand in 2007 for gastric bypass surgery, which wasn't covered by his insurance plan.
Orsborn, 52, said he chose Thailand because his wife is Thai, and he had family connections there. He said he paid $17,000 for surgery that would have cost about $30,000 here.
"We had $30,000 in our savings account but (surgery) would have wiped it out," he said.
"The care was wonderful," he said. "They pampered me the whole time. I felt like a king."
Judi Howlett of Shady Cove traveled to Mexico for her bariatric surgery last March. Her insurance had a provision for weight reduction surgery, but she wasn't sufficiently overweight to qualify for coverage.
"I had turned 62," she said, "and I had access to my IRA and I asked myself, 'How long am I going to live?' "
She made arrangements to travel to a newly built hospital in Juarez, just across the border from El Paso.
"It was beautiful," she said. "Inside it was very clean."
She used frequent flier miles for the airfare, and paid $9,000 for surgery that she was told would cost twice as much in the United States.
She said the only apparent difference in her treatment was that she didn't get the post-surgical counseling that most U.S. physicians provide for bariatric patients.
"If you're not a self-starter, I can see where you might have problems," she said.
Most medical tourists travel to developing countries, where costs tend to be lower, but that isn't always the case. Keith Manich of Talent went to Germany this fall to have a hernia repaired surgically.
Manich, a massage therapist, had no insurance, so he shopped locally for the best deal. He said the best estimate he could find pegged the procedure somewhere between $5,000 and $6,000.
Out of curiosity, Manich called his son, who's a physician in Germany, and asked him what a hernia repair would cost there. The best estimate was 1,500 to 2,000 euros, about $2,200 to $3,000 at current exchange rates.
Manich said his son told him that was the basic charge for hernia repair under the German system.
"I paid for the surgery," he said. "They were happy to have me and happy to do it."
He said surgeons found a second hernia during the procedure and fixed it, too, for no additional charge.
He described the hospital care as "really first class — as good as I would have gotten here."
"The Germans are a lot cleaner than we are," he said. "I found everybody friendly and helpful."
Although Manich himself spoke very little German, he said language was no barrier because many Germans speak at least some English. He did acknowledge that it was helpful having family members who spoke fluent German while he was recovering.
"I'm not sure what it would be like if I hadn't known anyone," he said.
Some people travel abroad to get treatments that haven't been approved for use in the United States. Thad Hodgdon of Medford went to Switzerland to have an ankle joint replaced in 2006.
Hodgdon, 62, said he was living in North Carolina when he decided to replace an ankle that had been injured decades earlier in sports. His physician told him the best ankle joints were being made in Switzerland, but they had not been approved for use by the U.S. Food and Drug Administration.
Hodgdon said his doctor told him if it were his own ankle, he'd go to Switzerland for the surgery. When Hodgdon compared costs, he discovered he could go to Switzerland, spend a week in the hospital, buy the joint and have the surgery for $5,000 less than the U.S. costs, not including the joint.
Hodgdon said he had health insurance at the time, and his insurance provider initially said the surgery in Switzerland would be covered. By the time he'd made travel arrangements, the insurance company changed its mind, leaving Hodgdon to pick up the tab.
He said the care was "first class."
"It was the best hospital I'd ever been in," he said. "The food was like a five-star restaurant. I even had some wine with a meal."
Analysts who study the global medical industry expect more Americans to travel abroad for health care as other countries continue to invest in state-of-the art technology. Health insurance providers have their own concerns about Americans traveling abroad for treatment.
"Medical tourism often offers cost advantages but generates other significant concerns," Samantha Meese, a spokeswoman for Regence BlueCross BlueShield of Oregon, wrote in an e-mail. She listed issues such as the responsibility for providing continuity of care, including follow-up care and treating complications, along with increased risk in delivering care at a site far away from the patient's home.
Meese also noted that the competencies and capabilities of non-credentialed providers and facilities are uncertain. "Consumer protections available in the United States are not guaranteed in other countries," she wrote.
She noted that nationally recognized organizations such as the Mayo Clinic, Cleveland Clinic and John Hopkins University have opened international sites of service that promise the same high quality care present in their American operations, but it's important for patients to carefully understand their health plan benefit structure, reimbursement responsibility for non-contracted providers, and quality of care in the United States or abroad.
For now, traveling abroad for treatment offers a viable, affordable alternative for people such as Krois, the Williams man who's scheduled for hip-replacement surgery this week. He recalled how fast he went from having a job with health insurance to facing overwhelming medical debts without insurance.
"People who have insurance and everything's going good for them, they don't want to change things," Krois said. "They don't realize something could happen to them next week."
Reach reporter Bill Kettler at bkettler(at)mailtribune.com. |
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