With the cost of health care continuing to soar, more older Americans are exploring medical tourism -- that is, going abroad for medical treatment.
The term "medical tourism" might be a bit of a misnomer -- often a traveler's focus is solely on obtaining health care as opposed to seeing the sights of a foreign city -- but it's often used to describe a trip for medical treatment outside the home country. The Huffington Post has been exploring some growth in medical-related travel , finding that some 600,00 people are expected to travel abroad for this purpose in 2012 versus an estimated 180,000 in 2007, according to Josef Woodman, CEO of Patients Beyond Borders, which provides information on medical tourism for consumers and no-fee consultations for hospitals.
In a 2007 report examining medical tourism, the American Medical Association frowned on the practice of health insurance companies granting incentives and went as far as seeking legislation "to prevent insurance companies from incentivizing subscribers in this country to have to go overseas for medical treatment that could be provided locally.”
"It is imperative that travel for medical care outside the US be voluntary," the report stated. The AMA warned of the risks associated with the practice. In 2009, the American College of Surgeons followed suit, the Chicago Tribune reported.
Yet cost advantages continue to prompt patients and their companies to book tickets.
After disc pain led golf caddy Fred Schuler to rely on a wheelchair for two months in 2011, he traveled to India for a diskectomy.
"I do a job where I'm walking seven to eight miles a day with a 45-pound backpack," Schuler said. "I get stiff; I get sore. But I'm 61 for godsakes."
Now having made a successful transition from relying on a wheelchair to returning to work in February, Schuler called his overseas operation "one of the best experiences I've gone through."
A longitudinal survey done by IndUSHealth, a medical-tourism provider for consumers and businesses, found similar satisfaction levels. In the company's survey of 479 American IndUSHealth clients who traveled abroad for major operations from January 2006 to January 2011, 73 percent reported zero complaints about their medical tourism experience.
The cost difference between a U.S. procedure as compared with one in a foreign country can't be denied. And with more American-trained doctors operating in some of these hospitals, the quality of care can be higher, asserted Rajesh Rao, IndUSHealth's CEO.
In 2011, a spinal fusion operation, which a U.S. doctor recommended that Schuler have, could cost $41,000 in the States, according to a survey done by Patients Beyond Borders, encompassing "hundreds" of hospitals. This procedure cost $9,500 in India and $22,000 in Korea that year. For gastric bypasses (running $25,000 in America), the costs ranged from $6,800 to $14,000 in selected countries abroad.
But anyone considering booking a flight to Bangalore for a medical tourism visit should weigh not only the potential savings (see the chart below for more cost comparisons by Patients Beyond Borders) but also a host of other concerns. (Click the link to zoom in for a better view.)
Comparative Costs of Major Procedures (as of August 2011)
A trip abroad might provide access to procedures not yet available in America. Even though the United States is a leader in medicine, some treatments and medicines are widely used abroad but not available in the States because of research constraints and a lack of Food and Drug Administration approval.
Or another country might have doctors more familiar with new, cutting-edge procedures: "It's about access to better expertise with people who have been doing it a bit longer," said Woodman of Patients Beyond Borders. When it comes to arranging for a new hip replacement technique, hip resurfacing, some might find it makes sense to have the procedure done in India rather than in the States, where the FDA only approved it a few years ago. "I would rather put my hips in the hands of someone who has done 600 to 700 of these things than 30 to 40 of them here in the United States," Woodman said.
Untested, experimental treatments can present drawbacks, said Dr. Douglas Lundy, an orthopedic trauma surgeon at Resurgens Orthpaedics in Atlanta. "The FDA does an amazing job of protecting the citizens of the United States," Lundy said. "It has blocked drugs that [people] started to [use] abroad" but that were later proved to be detrimental.
"There may be situations where there might be unexplained viruses," cautioned Rajesh Rao, CEO of IndUSHealth. While Rao downplayed the potential threat posed by superbugs -- antibiotic-resistant germs -- they can be a real concern for medical travelers.
Even though some might be tempted by the prospect of a cheaper surgery abroad, the old saying "You get what you pay for" can be dead on, Lundy said. "One of the big [concerns] is if you have a complication, if you develop an infection. If you have a knee replacement and it needs to be revised, it will cost you far more money in the long run than if you had done it here."
While Woodman claimed that many hospitals abroad "bend over backwards to make sure they don't have stories of procedures going bad with an international patient," patients who seek legal remedies to inadequate treatment might face difficulties because of bureaucratic hurdles, he said.
A situation in a foreign country that's unfamiliar can also make a recovering patient uncomfortable. A person raised in the States who is thoroughly used to a certain way of doing things won't necessarily find the same setup in another country, Lundy said. In IndUSHealth's survey, for the 27 percent who raised complaints, the top three concerns cited were food options, bed comfort and language barriers.
With these issues in mind, prospective medical tourists should be cautious and educate themselves. "Nobody faults anyone for shopping around," Lundy said. "The only thing you can do is similar to what you do in the [United States] -- research."
View the slideshow below for some questions to consider when weighing a medical trip abroad.
Is This Facility Accredited?
A number of organizations offer accreditation for international hospitals, which then must strive to meet standards for conditions, ranging from architectural design to hygiene. The Joint Commission International sets quality standards for hospitals that participate in its program of review.
What Is The Doctor's Experience?
Has the doctor done this procedure before? Is he or she used to working with patients from overseas? For how many years has this doctor been performing this procedure and how many has he or she done?
Would A U.S. Doctor Be Willing To Help When You Return?
Find a doctor in the United States with whom you can follow up if complications arise, as some physicians don't like being tasked with taking care of someone else's mistakes, says Dr. Douglas Lundy. "Make sure you've identified more follow-up care and be sure that you have a doctor who's engaged and supportive," adds IndUSHealth's Rajesh Rao. "The last thing you want to do is find a doctor who is apprehensive."
How Available Is The Doctor For Questions?
The new doctor "took the time to call me from his home before I even went," says Fred Schuler, who in 2011 had a diskectomy in India. "He actually talked to my doctor in Springfield, Missouri, to tell him what he was going to do." This kind of dynamic is critical, according to IndUSHealth's Rajesh Rao. "Patients should actually talk to their doctors well before they sign up and lock in a deal," Rao says. "It's very important the doctor be sufficiently available and give you good advice and make you feel comfortable."
What Is The Success Rate?
What is the overall success rate for this procedure or operation? What is this doctor's success rate? Make sure you're in the hands of the best possible physician. "If you're going for a heart bypass," says Josef Woodman, CEO of Patients Beyond Borders, "you want to know that particular doctor's done 300 of them instead of 20 and that that procedure has a 98.2 percent success rate," roughly comparable to the rate in the States.
Can The Doctor Abroad Have Access To Medical Records?
Letting a doctor oversees gain access to your health history -- X-rays, prescriptions -- can make for a better transition of care. While it may be awkward to let a doctor in the States know about a planned treatment overseas, "you just have to do it," says Josef Woodman, CEO of Patients Beyond Borders. "You reduce your chances for complications to a minimum."
How Long Is The Recovery?
To stave off complications from surgery and provide continuous care, some countries require that a patient stay at least two weeks, until "the red zone has passed," says Patients Beyond Borders' Josef Woodman. Get an idea of what the recovery and rehabilitative care is expected to look like in your host country -- and back home -- to provide the best possible chance of pulling through unscathed.
What Accommodations Are Available For Companions?
Many hospitals provide luxury-level accommodations not only for the patient but for companions as well. "It's psychological and emotional leaving your family," says Josef Woodman of Patients Beyond Borders. "We recommend a companion join you if that's possible financially, to be an extra pair of eyes and ears, fetch prescriptions and make sure that things are okay."