Friday, January 8, 2016

Looking for Medical Bargains? Visit Other Countries.

There’s an increase in medical tourism as people seek treatment abroad for procedures, such as tummy tucks or a new set of teeth, that their health insurance does not adequately cover.


Linda, 65, needed a lot of dental work, but the price quoted by her local dentist would have caused financial hardship. So she did some research and found a clinic in Los Algodones, Mexico that would do the work for one-third the cost: $560 for two crowns and a tooth extraction. When she did a follow-up with her own dentist, he praised the Mexican dentist’s work. On her second visit to the Sani Dental clinic in Los Algodones, the savings were even better: $4,600 for three implants and a redone crown, which would have cost her three times as much at home.
AMA: Coordinate Local Care Before Trip

For medical care outside the United States, the American Medical Association (AMA) advocates the following principles:
  • Only visit institutions certified by recognized international accrediting bodies, such as the Joint Commission International or the International Society for Quality in Health Care.
  • Before travel, coordinate local follow-up care and arrange financing to ensure continuity of care upon your return.
  • Ensure that coverage for overseas medical care includes the costs of necessary follow-up care after returning to the United States.
  • Understand your rights and legal recourse before agreeing to procedures and operations abroad.     
  • Access physician licensing and outcome data, as well as facility accreditation and outcome data, for medical care outside the United States.
  •  Ensure consistency with Health Insurance Portability and Accountability Action (HIPAA) guidelines when transferring medical records to and from foreign facilities.

On top of saving money, she had a good experience, because most of the clinic staff spoke English and strove to make her feel comfortable. Plus, she had an adventure—a fun drive from her Colorado home.

Los Algodones, which is right over the border from Yuma, Arizona, has some 350 dentists working within a few blocks of downtown and attracts Canadians and Americans looking for inexpensive dental work (NPR). It’s part of the growing medical tourism trend, as people seek treatment abroad for procedures, such as tummy tucks or a new set of teeth, that their health insurance does not cover or that have high deductibles.


In 2014, Patients Beyond Borders, a provider of medical travel information, estimated that roughly 1.2 million Americans would travel outside the country for medical care this year. The total medical tourism market is a big one: between $38.5 billion and $55 billion, based on 11 million people crossing borders worldwide for medical and dental procedures.


Most Popular Countries


Because of their proximity, Costa Rica and Mexico are popular with U.S. travelers, especially for dentistry and cosmetic surgery. More than 50,000 Americans cross the border each year just for dental work, according to Patients Beyond Borders. Mexico also specializes in weight-loss treatment and surgery, at an estimated 30 to 60 percent savings, especially in cities near the U.S. border such as Tijuana and Juarez.

Europeans, especially, flock to Thailand, Singapore and Malaysia to save money on expensive, invasive surgeries, such as open-heart surgery or knee replacements. Thailand and Brazil have good reputations for cosmetic surgery, while India is known for organ transplants and fertility, orthopedic, cardiac and oncology treatments. Other popular medical-tourism destinations are Israel, South Korea, Taiwan, Turkey and the United States.


In developing countries, healthcare is cheaper for several reasons. Wages and infrastructure costs are less, and other countries aren’t burdened by the high costs of liability or malpractice insurance found in the United States. In fact, insurance and administrative costs compose much of America’s healthcare budget.


At the same time, international healthcare can be first-rate. To compete for the revenue that medical tourists can bring, many countries’ healthcare institutions offer modern facilities, well-trained medical staff, cutting-edge technology and accreditation by organizations such as Joint Commission International. Many overseas physicians, dentists and surgeons received their medical training and degrees at the top medical schools in the U.S., the U.K., Canada, Switzerland or Germany. In fact, many hospitals, particularly the larger institutions in Southern and Southeast Asia, have lower rates of complications than in the U.S., particularly for complex cardiac and orthopedic surgeries.


Top Reasons for Traveling


According to Patients Beyond Borders, patients travel to different countries for these reasons:
  • Cosmetic surgery
  • Dentistry (general, restorative, cosmetic)
  • Cardiovascular (angioplasty, coronary artery bypass grafting, transplants)
  • Orthopedics (joint, spine, sports medicine)
  • Cancer (often last resort)
  • Reproductive (fertility, in vitro fertilization, women's health)
  • Weight loss (lap-band, gastric bypass)
  • Scans, tests, health screenings and second opinions
Why Go Outside the United States?

There are many reasons patients travel to foreign lands for medical treatment, according to Patients Beyond Borders:


Cost savings. Depending upon the country and type of treatment, uninsured and underinsured patients, as well as those seeking elective care, can realize 15 to 85 percent savings over the cost of treatment in the United States. For example, according to Medical Tourism a gastric bypass that would cost $35,000 in America costs $11,500 in Costa Rica, $10,000 in India, $11,500 in Mexico and $12,200 in Thailand. Similarly, a $40,000 knee replacement would cost $11,000 in Costa Rica, $8,000 in India, $12,000 in Mexico and $8,600 in Thailand. Of course, you also need to add in the cost of the airfare, lodging and other travel-related expenses to offset your savings.


Better patient experience. Government and private stakeholders in countries such as Mexico, Costa Rica, India, Malaysia and Thailand have poured billions of dollars into improving their healthcare systems to lure the international health traveler. Amenities include deluxe hospital suites and recuperation resorts, along with free transportation to and from airports, low-cost meal plans for companions and discounted hotels affiliated with the hospital. One Costa Rican hospital offers free massages, haircuts and pedicures.


Treatments excluded in U.S. Although health insurance policies vary, most plans exclude treatments such as cosmetic surgeries, dental care, vision treatments, reproductive/infertility procedures, some non-emergency cardiovascular and orthopedic surgeries, weight loss programs, substance abuse rehabilitation and prosthetics. More than 70 percent of American health travelers leave the country for elective treatments elsewhere.


Shorter waiting periods. In countries with universal healthcare plans, such as Canada and Great Britain, long wait times for procedures have caused patients to go elsewhere. Even in the United States, some patients determine it is better to pay out of pocket than wait for a distant appointment and have to endure pain from a deteriorating condition.


More patient friendly. As economic pressure causes hospitals to move patients out of costly inpatient beds sooner than later, sufficient time is often not allowed for basic recovery. Abroad, patients are frequently encouraged to spend extra time in the hospital post-procedure. Patient-to-staff ratios are usually lower, as are hospital-borne infection rates. Moreover, physicians and staff in treatment centers are generally far more accessible than their U.S. counterparts.


How to Avoid Risks


The Centers for Disease Control and Prevention (CDC)  points out that there are risks: Medical tourism has been associated with complications, including infections from antibiotic-resistant strains of bacteria not previously seen in the United States. Experts have documented several infectious-disease outbreaks among medical tourists after their return to the United States.


The CDC recommends that patients seeking care elsewhere do research. One reputable resource is Patients Beyond Borders, which gathers information from surveys completed by international hospitals and clinics, various countries’ ministries of health, leading hospital associations and third-party market research sources. Patients Beyond Borders’ website lists hospitals, clinics, procedures and countries so that you can plan your medical-tourism trip. For example, the site recommends 14 places that do dental crowns in Costa Rica and Mexico, including La Casa del Diente, which “comprises six clinics in the Monterrey [Mexico] metropolitan area. Established in 1984, ‘The Home of Teeth’ has 110 certified dentists and dental surgeons.”


The leading hospitals abroad have accreditation from one of several international institutions, including the U.S.-based Joint Commission International (JCI). To receive accreditation from JCI, an international hospital must meet the same set of rigorous standards as hospitals in the United States. More than 600 hospitals and clinical departments around the world have now been awarded JCI accreditation, and that number is growing by about 20 percent per year (Patients Beyond Borders).


In addition, the CDC recommends that you:



  • Be aware of additional risks associated with surgery and travel, either while receiving or recovering from treatment. Flying and surgery both increase the risk of blood clots and pulmonary emboli.
  • Don’t travel for 10 days after chest or abdominal surgery to avoid risks associated with this change in pressure. After facial cosmetic procedures, or after laser treatments, wait 7 to 10 days before flying.
  • Following surgery, avoid vacation activities such as sunbathing, drinking alcohol, swimming, taking long tours and engaging in strenuous activities or exercise.
  • Obtain complete medical records before returning home to ensure that details of your care are available to U.S. providers. At the same time, bring your overseas provider complete records, including your medical history and current conditions and medications, over-the-counter drugs and supplements.
  • Make sure your healthcare provider abroad is certified in their specialties through the same process used by the American Board of Medical Specialties. For instance, the American College of Surgeons, American Society of Plastic Surgeons and International Society of Aesthetic Plastic Surgery all accredit overseas physicians.

For dental work, make sure you get a copy of the American Dental Association’s “Traveler’s Guide to Safe Dental Care,” which has questions to ask your regular healthcare provider before embarking on a medical tourism trip. For additional tips from the American Medical Association, see the sidebar.

Sources


“Sand, Sun and Surgery,” June 25, 2013, Bloomberg Business 


The 10 Best Countries for Medical Tourism,” Oct. 7, 2014, Insider Monkey 


“Top destinations for health tourism,” March 12, 2014, CNBC 


“What Is Medical Tourism?” Medical Tourism Guide 


“A Reason To Smile: Mexican Town Is a Destination for Dental Tourism,” June 10, 201410, NPR 



Looking for Medical Bargains? Visit Other Countries.  is a featured article in the January 2016 Senior Spirit newsletter

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www.csa.us