TAKING A MEDICAL VACATION

Ahh, summer vacation. Think sandy beaches, exotic trips, cultural museums, remote resorts, and…. root canals?

Medical tourism, a component of health care tourism, is when people travel to a foreign country for medical attention.  A decade ago, people went from third world to more developed countries for superior care. Today, the concept has morphed into a 70 billion dollar per year industry as individuals travel abroad for medical procedures that cost them a fraction of the price back home.  Last year, over 11 million Americans did just that, treating a host of medical issues in other parts of the world. On the surface, it seems there is good reason for the trend. In addition to a significantly lower price tag for treatment, trips may include a fancy hotel room, some touring, and fine food.  Traveling abroad affords privacy and can also allow for better attention and easier access to renowned experts or experimental drugs and procedures banned in the U.S.

RX Respite

America’s insurance companies are notorious for not covering non-medical procedures such as plastic surgery. Practically all procedures, even those deemed risky or controversial, will get approval by some physician abroad, and for a fraction of the cost.   

Canadians, Brits, and others living in countries with universal health care travel to avoid long waiting lists for treatment. Canadian Christy Evon entered the medical tourism field after experiencing firsthand the frustration of having to wait for an urgently needed appointment for her infant son who was failing to thrive.  Her experience prompted her to launch Health Ventis, a medical facilitation business in the health tourism field that assists Canadians who are on wait lists or seeking treatment options.  “Canada has incredibly long wait lists due to the structure of its health care system,” she explains. “Over one million people are currently on waiting lists for treatment. It takes an average of 21.2 weeks to see a specialist and be treated across the board, although some provinces have longer wait times than that.”

Dr. Ron Baise, a dentist with a thriving practice in London, has had a few patients inquire about treatments abroad. He credits the boom in this trend to the fact that there is so much relevant information online. “Online resources will recommend specific places for specific treatments, as well as break down the costs in a transparent way. These offer a ‘social proof’ that medical tourism is a worthwhile endeavor,” he says. 

Break Waves – Not the Bank

Costa Rica, Mexico, Thailand, India, and Israel attract thousands of tourists a year for reasons beyond their sunny skies and clear blue shores. According to Patients Without Borders, an online resource for medical tourism, what makes these destinations top is their commitment to international accreditation.  Hospitals that are accredited adhere to specific guidelines, processes, and standards set by medical professionals. Another reason why medical tourists favor these countries is that they are socially and politically stable. They are also advanced in health care and maintain reputations for clinical excellence.  

 The savings potential varies by country, physician, and facility, but charges are on average 60 to 85 percent lower than U.S. hospitals, according to the National Center for Policy Analysis. For example, an MRI test costs over $1,000 in the United States, but only $200 or $300 in Brazil. A bone marrow transplant could cost $350,000 to $800,000 in the U.S. while the same procedure in India, including hotel and transportation, could cost less than $55,000. Interestingly, some of the Indian doctors have worked previously in leading U.S. hospitals such as Pennsylvania Hospital, according to Jonathan Steele, RN, who offers consultation services for people considering medical tourism.

Medical tourism saved 53-year old Howard Staab’s life back in 2004 when doctors told him he had to have mitral heart valve replacement surgery to avoid heart failure. Staab was uninsured at the time, and the cost of surgery in the U.S. would have totaled $200,000. He was unable to negotiate the fees with the hospital or find an insurance company willing to cover within the first year of the policy. Although he lives minutes away from a major medical center in North Carolina, Staab ultimately decided to travel to India. “Our own country’s health care system, supposedly the best in the world, failed us,” Staab testified before a U.S Senate Committee hearing in 2006. “We were forced to travel halfway across the globe.” The surgery was a success, and he only had to pay $6,700, which included all hospital and doctor charges, a three-week hospital stay for him and his companion, tests, meals, lodging, and transportation. “The Indian doctors did such a fine job here, and took care of us so well,” says Staab, who also got a nice trip to the Taj Mahal during his stay.  

I Went on Vacation, and all I Got was This Baby

“Maternity tourism” or “birth tourism” is another growing trend in the health tourism field. It is especially popular in East Asian countries where citizens return for a cheaper labor/delivery experience.  Others do it to give their child dual citizenship. Maternity tourism also allows them to take advantage of domestic entitlement programs such as education.

Infertility is one of the most common reasons cited for medical tourism.  Infertility treatments in the U.S. are often not fully covered by insurance and are extremely costly.  But in Mexico, for example, where infertility is the third most profitable source of income, treatments cost 30 to 50 percent less than in the U.S., Canada, and European countries. The National Institute of Statistics and Geography (INEGI) reports that 2.6 million cases of infertility have been treated in Mexico. Each year the number increases by 180,000.

Israel’s IVF may not be the cheapest option for foreigners seeking treatments, but it is one of the most technologically advanced in the world. The best part is, it’s free for all returning citizens. Israel subsidizes eight IVF treatments for up to two children for all women up to age 42 and three rounds of IVF for women up to age 45. The country respects and understands how important it is for Jewish couples to have a family, which is why so many flock there when their IVF journey fails elsewhere. The Frieds* of Staten Island endured three failed IVF treatments during the first decade of marriage. That’s when they found out that because Mrs. Fried is a Sabra and Mr. Fried spent time in Israel as a lone soldier, they were eligible for free IVF treatments in Israel. Today the Frieds are the parents of adorable twin girls.  

Insuring your Vacation

Nearly one in every four Americans is denied a health care request because of financial hardship, according to the National Association of Insurance Commissioners. As a solution, several states in the U.S. including California, Florida, South Carolina, and Wisconsin are considering or have partnered with insurance programs for international medical travel and treatment.  Some insurance companies like Blue Cross Blue Shield are encouraging the practice of foreign medical alternatives as part of standard medical health care insurance programs. According to the essay “Medical Tourism and International Health care Option” by David Conley and Alberto Coustasse, Blue Cross Blue Shield has enabled those covered by their programs (in Florida and Wisconsin) to consider off-shore medical facilities as a low-cost alternative.  In this practice, some personal costs, such as airfares and deductibles, have been waived. Similarly, in California, the insurance company has several programs in place to assist patients of global medical operations and practices. Such plans are geared largely toward Mexican-Americans and account for nearly 20,000 patients. South Carolina’s Blue Cross Blue Shield policyholders have been able to seek treatment at Bumrungrad International Hospital in Thailand, an accredited facility, which treats approximately 400,000 foreigners including about 80,000 Americans.

Risky Business

Before you rush to book your flight to Fiji for some fun, sun, and liposuction, be aware that there are many risks. Language or cultural barriers in a foreign country may hinder communication with medical staff. Solo travel might prolong recovery. “Consider the distance you have to travel.  If it is a flight more than four hours, your risk for a deep vein thrombosis and blood clots increases four-fold, “says Christy, director of Health Vantis.

How do you locate a competent doctor when you cannot refer to personal recommendations from friends, family, or others in the know? Start by researching hospitals.  The most recognized accreditation is Joint Commission International (JCI), which is considered the gold standard in global health care.  Accreditation Canada and Accreditation Association for Ambulatory Health Care (AAAHC) are also acceptable organizations according to Christy who warns that just because foreign hospitals claim they are “accredited, ”it doesn’t necessarily mean they comply with JCI or AAAHC  standards.

The next step would be to look at the hospital infection, re-admission, and mortality rates and compare them to a state, province, or country average. This information should be available on the hospital website. You can also check with the state or province department of health.  If you choose to work with a facilitator, like Health Vantis, for example, make sure they pay the hospital directly and that you are given a detailed, itemized bill.  You should know what the facilitator charges and what the hospital charges and pay each business accordingly, advises Christy.

Upon returning home, it might be hard to find a physician who will want to take on your case if there are complications. “You need to have a good relationship with your regular practitioner, so he or she can monitor the long-term outcome of your treatment, “says Dr. Baise.   But perhaps the most pressing issue is accountability and legal discourse if complications arise. In some jurisdictions, such as most Asian countries, patients sign an agreement waiving their right to sue their doctors for malpractice. In India, where malpractice relief is available, patients might be dismayed to learn that around 95% of cases are ultimately dismissed.

Penny Wise, Pound Foolish

Although Dr. Baise helps advise patients in choosing a competent practitioner, he always makes sure to tell them about the risks. He says he has dealt with complications of many patients who received subpar work abroad.

As they say, “caveat emptor,” let the buyer beware.  This is a lesson many have learned the hard way after engaging in medical tourism to save money only to be left with severe complications.  The medical journal Plastic and Reconstructive Surgery conducted a study on 78 American women who went to the Dominican Republic from 2010 to 2017 for plastic surgery. The study found that doctors exposed many of the women to incurable diseases such as HIV, TB, and typhoid, prompting the U.S. Centers for Disease Control and Prevention and the U.S. State Department to issue alerts warning American to steer clear of that country.

Some have even entered the OR for one procedure and ended up losing an organ in the process. There are horror stories of patients becoming victims of organ theft. Last year, four Jews from the New York area traveled to Mexico to undergo bariatric surgery. According to Yeshiva World News, after returning home and becoming ill, they discovered they were all missing their kidneys.  

Of course, the main advantage to medical tourism is financial, but you must decide if the savings are worth the potential risk to your long-term health. “You need to really believe that the money you save is worth the potential risk to your well-being,” says Dr. Baise. Dr.  Jeffrey Spiegel is a world-renowned facial plastic surgeon who practices in Boston, MA. He sees a steady flow of patients looking to fix botched surgeries committed in Mexico, South America, Eastern Europe, Korea, or Thailand.  There are many competent physicians worldwide, but if a surgeon offers services for a very low price or has immediate availability, there’s likely a reason.  Price is an important consideration for most things, but for your health and well-being may not be the right place to economize, says Dr. Spiegel, whose office has frequent requests from foreign doctors to visit and learn new methods.  

So how did you spend your summer vacation? Lounging around a bungalow colony? Escaping to Florida? Well, if you were a medical tourist, you could have maximized your summer productivity by being a globetrotter and patient wrapped into one, experiencing the sights and sounds of an exotic land while getting that annoying tooth filled.

Should make for an interesting summer photo album or back to school report.    

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