Medical tourism: A faraway health fix

Christopher Reynolds/Los Angeles Times

When Stan Long's doctor told him he needed prostate surgery, the unpleasant procedure bothered him less than the part of the price tag he'd be on the hook for: $15,000 for the hospital stay his Medicare plan didn't cover.

So Long, who lives in Washington state, followed the lead of a friend who had been going to Mexico for inexpensive dental work, and headed south for a better deal.

With the help of medical tourism facilitator Planet Hospital, last summer Long flew to San Diego, where he was picked up by a limousine that drove him two hours to a hospital in Mexicali. After the four-hour TURP (transurethral resection of the prostate) procedure to remove a section of his prostrate blocking urine flow, Long spent the night, and the next day the limousine driver, who doubled as an interpreter, drove him back.

The total cost, including airfare, was less than $4,500, Long said.

"My service was excellent, the hospital room was excellent, the nurses were outstanding," said Long, 73, who decided to return to Mexico this summer for the same procedure when the problem resurfaced (a common occurrence). "It's the only way to go."

For procedures ranging from knee replacements to breast implants, heart transplants to dental crowns, medical tourism is expected to draw 550,000 Americans this year to hospitals across the globe for high-quality medical care at drastically lower costs than they find in the U.S, said medical tourism consumer advocate Josef Woodman, author of the book "Patients Beyond Borders" (patientsbeyondborders.com). (Woodman is not paid by any hospitals or medical tourism operators.)

The once-cottage industry is becoming increasingly mainstream, growing steadily at about 30 percent to 35 percent a year, Woodman said, and hospitals from Korea to Colombia are rising to meet the demand. More than 400 hospitals in 39 countries currently have accreditation from Joint Commission International, the international arm of the body that accredits U.S. hospitals. In 2004, only 46 hospitals had accreditation.

The industry caters mostly to the uninsured and underinsured, whose plans don't cover certain elective procedures or have deductibles that are prohibitively high.

A few years ago, it was forecast that 1.6 million Americans annually would go abroad for procedures by 2012. That dramatic boom in medical tourism has not materialized, perhaps because people are waiting out the recession or waiting for health care reform before getting surgery, Woodman said.

In the meantime, other trends have emerged. A rise in quality surgical care in Latin America and Mexico --JCI accredited several hospitals in Mexico in the last three years -- has given Americans the option to take short trips for cardiac, orthopedic and other highly invasive surgeries that used to be the purview of majestic medical centers in Thailand or India, Woodman said.

A small but growing number of insurance companies have pilot programs to cover procedures abroad.

And patients are willing. In a 2009 Gallup poll, 29 percent of Americans said they would travel abroad to treat a major medical problem, 40 percent if they could assume the quality was the same and price was cheaper.

But some legal and health professionals have raised concerns.

The American College of Surgeons in 2009 issued a statement warning of the risks of seeking medical care abroad, including the variability in the training of health professionals, difficulties of being treated far from friends and family, and communication barriers.

Of graver concern is "transplant tourism," an off-shoot of medical tourism that involves going abroad for organs to avoid long waiting lists in the U.S. In addition to the ethical concerns of exploiting poor communities and illegal organ trades, recipients risk poor organ matching, unhealthy donors and higher risk of post-transplant infection.

Patients also have little recourse if something goes wrong, as they usually sign contracts leaving themselves to bear most of the legal risks, said Nathan Cortez, assistant professor of law at Southern Methodist University Dedman School of Law.

There haven't been any high-profile lawsuits filed by patients hurt in medical tourism, but Cortez said that's likely because the industry settles complaints quietly. There's no good data on how many patients have experienced problems or in which countries, he said.

In leiu of legal perameters, groups have tried to establish codes of conduct.

American Medical Association guidelines advise in part that follow-up care in the U.S. be coordinated ahead of time and that only accredited institutions be used.