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Medical Travel

By Jesse Jayne Rutherford

If your health insurance denied you coverage for surgery, what would you do? Would you resign yourself to the body and life you have now? Would you borrow the money any way you could and pay your surgeon out of pocket? Or, would you borrow less money and take a large ?overseas discount??

Each year, more and more U.S. patients are choosing the latter. When procedures outside the country can be found for 25-75% less?and many health care providers overseas have pricing as transparent as the price tag on a new pair of shoes?the temptation is understandable. As tourists board planes bound for Mexico, Brazil, India, and Thailand to undergo WLS, tummy tucks, face lifts, and even dental work, American news coverage has portrayed this as a risky venture indeed. 

Is medical travel safe? When and why do people opt for it, and when do they decide to stay home? What developments can patients expect in the next few years?

 

Safety

No on can guarantee the safety of medical treatment?anywhere. Complications arise in American hospitals, and they arise in Costa Rican and Malaysian hospitals. Doctors from India and Brazil can be fraudulent and dishonest. Unfortunately, so can American doctors. 

In a New York Times article from 2004 which portrayed medical travel as a risky, dangerous venture, an epidemiologist from New York said that a seemingly minor procedure done incorrectly could lead to ?months, even years of suffering if done improperly.? Yet one woman who was born in the Dominican Republic and has several friends who have undergone cosmetic surgery there, quipped, ?There are good and bad doctors everywhere.?

Jeff Schult, author of Beauty from Afar: A Medical Tourist?s Guide to Affordable and Quality Cosmetic Care Outside the U.S., did extensive research for his book, and says that prospective medical tourists have to remember ?It is surgery, and there?s no such think as a ?safe? surgery. They shouldn?t take it lightly.? It would be difficult to conduct an international study that compares countries for overall patient safety. That being said, Schult?s book?which was born of his trip to Costa Rica for dental work he couldn?t afford at home?offers tips for researching a surgeon abroad, and the key to doing that research is to be very thorough. (In fact, thorough research could increase the odds that you will be satisfied with your care here at home!) Today, Schult moderates a medical travel blog called The Bridge (bridgehealthinternational.com/blog). In a nutshell, as Schult writes in the conclusion of the second chapter of his book, ?Comparing Quality, Comparing Costs? with ?If the surgeon?s credentials and the quality and standards of the surgical facility can?t be reasonably verified and vouched for, you shouldn?t go. Simple.?

Other Factors

Out-of-pocket costs are the driving factor in most patients? decisions to seek medical care abroad, but in recent months, another interesting factor has developed. A few insurers, like Blue Cross/Blue Shield of South Carolina, are beginning to include hospitals in other countries as part of their network, and the Hannaford supermarket chain in the Northeast is offering some medical travel as part of their benefits package, according to Schult, who adds, ?They almost have to from the point of view of keeping costs down.? Also, BridgeHealth International, a Denver-based company that connects American patients with foreign medical care, says that it is working with small businesses like these as well as large Fortune 500 companies who run their own insurance to increase medical care options abroad. Today, more employees are seeing that they are eligible for medical treatment abroad.

So, if a patient?s surgery is approved by their health insurance, but the hospital she is directed to happens to be in Brazil, that could also influence her to get on a plane.

Another factor in patients? decisions to seek health care on foreign soil is the availability of medical procedures they might not find here at home. An example is hip resurfacing, a new procedure that is being pioneered instead of total hip replacement surgery. The procedure, and the implants used in it, have a very short track record?ten to fifteen years, with the first ever implant performed in 1991?and the different brands of implants used are just now earning FDA approval. While the medical community around the world is using the implants with apparent confidence that hip resurfacing is generally superior to hip replacement when patients are selected according to medical guidelines, and with the belief that this surgery will gradually become more common than hip replacement, it has not yet become commonplace in the US, much less earned a so-called household name. For the last few years, and for a few more to come, hip resurfacing may be a procedure that American patients seek overseas until more implants earn FDA approval and more surgeons become trained in implanting them. 

 

The Future

This doesn?t mean that five years from now, all American surgeons will be out of a job. By nature, medical care is still largely localized: if you need emergency surgery or are too ill to get on a plane, you will probably stick close to home. What is more, travel in itself requires strategy, time, and logistics that are fine for leisure but hardly worth it to see a doctor if a comparable procedure is offered in your hometown?for a comparable rate. In addition, innovative procedures like hip resurfacing will probably migrate to American doctors as soon as the FDA approves them and American doctors have more procedures under their belts. 

?The reality is, the number of procedures and patients to go abroad is highly unlikely to impact any one [U.S.] hospital or physician,? says Victor Lazzaro, Jr., CEO and co-founder of BridgeHealth International. ?Taken across the U.S., it?s a big number, but no one will feel the pain of lost patients.? His colleague, Stephanie Sulger, BridgeHealth?s VP of Consumer Divisions and a former operating room nurse, adds, ?Baby boomers? age is increasing, and there?s a shortage of doctors and nurses and dentists, cardiac and orthopedic surgeons? who won?t be able to meet the rising health care demands.

While it would be difficult to conduct a study that compares patient safety and outcomes internationally, that is just what BridgeHealth International and other fledgling companies like it are pioneering. Though there are no international benchmarks as of now, Lazzaro says they are conducting assessments of almost thirty hospitals in about fifteen countries. A representative from the company goes in person, sometimes more than once, to the facility before it is approved for patient referral, and patients are tracked and followed up with through eighteen months post-procedure to measure quality of life. 

Do not be surprised if you see international hospitals and doctors as options the next time you take a close look at your health care plan. Just remember, as Jeff Schult wrote in his book, thorough research is key to increasing the odds you will find a surgeon who really is qualified to operate on you.