Some Americans heading overseas for less-expensive medical treatment

MEDICAL MATTERS

October 06, 2006|By JUDY FOREMAN

Eileen Clemenzi, a 56-year-old hairdresser from Vero Beach, Fla., had a great time in Malaysia this summer. She loved the malls, the beaches and the attentive service she got from hotel staff, including a bellboy who sent her a jade Buddha after she got home.

But the best part of her overseas adventure was getting a new hip at Gleneagles Medical Centre in Penang - a surgical procedure that Clemenzi could never have afforded at home with no health insurance and an annual income of $30,000.

"It was a great experience. Oh, my god, the care was great. I could never have gotten a hip any other way," said Clemenzi, who had been in severe pain for two years.

Like Clemenzi, more Americans are embracing medical tourism: flying to India, Thailand, Malaysia, Turkey, Brazil, Singapore and other places for treatment in attractive, sometimes-world-class foreign hospitals, often with a resort vacation after.

No one knows exactly how many Americans are outsourcing their medical care. And no one, apparently, has kept good data on how well those patients have fared.

The trend began among Americans who were native to the countries they chose for their care, and among those who wanted procedures not covered by insurance, such as a facelift. Today, people with inadequate or no insurance are going for more complicated procedures - meanwhile, insurers and employers are beginning to consider the practice as a way to save money.

Robert K. Crone, president of Harvard Medical International, said the big news is that Americans are now confident enough in the quality of care to get hip and knee replacements and cardiac surgery thousands of miles from home.

"And the motivation there is clearly financial," he said.

In Clemenzi's case, the whole shebang - airfare, two weeks in a hotel, plus an $8,000 bill at Gleneagles - cost about $14,000. Hip replacement surgery in the United States would have run more than $35,000, largely because of higher labor costs.

Her trip was organized by MedRetreat, one of several companies that puts American patients in contact with foreign hospitals and doctors.

MedRetreat has worked with about 320 American patients since it opened in 2003.

Consumers pay for their own airfare and hotel. They also pay 20 percent of the medical bill, up front, which goes to MedRetreat, then pay the remaining 80 percent to the hospital and doctors after treatment.

Dr. Naresh Trehan, chief of cardiac surgery at the Escorts Heart Institute in New Delhi, India, said he can offer cardiac surgery of the same quality he offered for 20 years at New York University for about one-fifth of the price.

He said his clinic does 4,500 to 5,000 heart procedures a year, including a few dozen operations on Americans who lack health insurance. It's not much different, he said, than the era when rich Indians came to him for surgery in New York - except now, the motivation is economic instead of technological.

David Frazzini, a senior health care consultant for Mercer Health & Benefits, a consulting firm, said Mercer is "having conversations with a handful of big employers," including "at least a few Fortune 500 companies," about the idea of sending employees overseas for care.

Frazzini added that "there is already very strong evidence of large financial reasons to be looking at outsourcing health care, and a lot of the other pieces are coming together, too, like international quality accreditation for facilities."

But Sen. Gordon H. Smith calls medical tourism a sad commentary on the health care system. "Americans should not have to travel overseas to obtain affordable health care," the Oregon Republican said in a prepared statement released at a hearing he held this summer.

Citing Medicare and Medicaid data, Smith noted that the average charge for heart valve surgery in the United States is $115,221, while at Apollo Hospital in Chennai, India, it's $7,000. "The $108,221 difference is staggering," he said.

Organized labor officials are concerned that workers will be forced to go abroad for medical care, a practice that will eventually cost American jobs.

Not long ago, Stan Johnson, assistant director of United Steelworkers District 9, got wind of the fact that a union member, Carl Garrett, 60, who works as a technician at Blue Ridge Paper Products Inc. in Canton, N.C., was going to India for gall bladder and rotator cuff surgery.

Worse yet, in Johnson's view, Blue Ridge was providing incentives for him to do it.

"I would have had no co-pay," said Garrett, and the company was set to give him 25 percent of the savings it realized from sending him abroad for treatment. He was thrilled, as was his fiancee.

"We had gotten our shots, visas, passports, we were packing, buying things to take. Our friends even threw us a beautiful party," he said.

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