Outsourcing Surgery

A close friend of mine is currently recovering from a total knee replacement. He had his surgery at a hospital here in Georgia, followed by ten days of physical therapy in a well-known orthopedic clinic. The cost for his week-long stay at the regular hospital is $58,000...and he hasn't yet gotten the bill for the orthopedic rehab stay. Chances are that his total bill will top $100,000. In this light, I can certainly see why some people choose to go to other countries for major operations. My friend's concern, when I told him about this practice, was the language barrier in other countries.

Sent by Rachael | 2:38 PM | 3-8-2007

It is understandable for people to want to go abroad for medical services. So many insurance companies in the United States have "policies" against any and all types of restrictions. I personally have dealt with the frustrations of trying to get necessary surgeries covered. Outsourcing, if it's affordable and quality work then by all means do it. I am currently doing my own research to see about outsourcing and saving some money.

Sent by Laurie | 3:14 PM | 3-8-2007

Are patienys likely to look for American trained doctors for outsourse Medical care? Are the doctors independent pratitioners or attached to US hospitals?

Sent by Nasser Malit | 3:15 PM | 3-8-2007

I'm a self-employed American who can't afford worthwhile insurance. When asked about what I do for health insurance, I say I have the Thailand express health plan. With the cheapest insurance that I can afford leaving me with a $5000 deductible, it seems that I might as well stretch my dollar and recover from treatment on a beach for two weeks. I've done the math, and it still comes out cheaper than health care in the United States.

Sent by Gary | 3:16 PM | 3-8-2007

My husband is Brasilian & our two children were born there. We lived there 23 years. We are back to the USA and overwhelmed with costs of all health work here. Ridiculous.!! It is worth it for us to travel to Brasil (beautiful country it is) and tend to health issues there. We have always had top knotch care & professionals here are astounded. I feel we had better get on the ball in the USA or both doctors and insurance companies are going to lose out on patient care!

Sent by Patty from Roeland Park, KS | 3:22 PM | 3-8-2007

What are the responsibilities of the providers of health care to the patient? If something goes wrong with the procedure who takes care of the patient in the United States? What redress does the patient have if there are future problems with treatment given in another country? This does not sound like tens of thousands of dollars are being saved--maybe hundreds and sometimes a couple of thousand.

Sent by Lynne Lacey Binghamton, NY | 3:23 PM | 3-8-2007

My husband and I have been traveling overseas for medical purposes for the past 4 years. We have had our annual physicals and dental work done in Costa Rica, Panama, Delhi, Bangkok, and even Tijuana Mexico. The savings are up to 90% of what we have had quoted here in the US. With the amount saved, we manage to enjoy a fabulous vacation in addition to having our medical needs met.
We are thrilled with our experience in every case. The level of care is top notch. Many of the doctors and dentists have been trained in the US. We can actually have a dialogue with the doctor.
Even if we could afford to have these procedures done here, we would travel overseas anyway because our experience has been so fantastic.

Sent by kathy Kennedy | 3:26 PM | 3-8-2007

I gave birth to my daughter in Tokyo two years ago. Despite the high cost for some things in life there, medical care was affordable and more importantly, personal. The hospitals near where I live have high rates of Cesarian sections, epidurals and other interventions- it sometimes seemed like they were just ready to intervene with drugs at the first chance. But where I gave birth, I was encouraged to give my body a chance, supported by 2-3 midwives throughout labor, had a wonderful OB, five nights of hospital stay with delicious and healthy meals, classes in breastfeeding, bathing, changing diapers, and help watching my baby right after birth so I could get some much needed rest... for about $4,000. After a 70% reinbursement from our health insurance, I have no doubt in my mind I would do it again.

Sent by Emily | 3:27 PM | 3-8-2007

we lived in Thailand for two years, we had medical emergency with our third child, and were very well looked after with excellent care. I've had friends who have had eye lazer surgery perfomred there as well and have been very happy with it. I would go to Thailand for almost any kind of surgery or medical care if I needed to, in a heart beat.

Sent by Tacoma Zach | 3:29 PM | 3-8-2007

It's ironic that your guests mentioned that in order to save money by getting medical care overseas, you may have to give up the option of sueing the bejesus out of your doctor. One of the reasons medical care costs so much in the USA is precisely because our doctors here are so sue-able. We need to figure out how to hold doctors responsible for doing good work without encouraging extortion and driving up costs for everyone.

Sent by David Dudley | 3:32 PM | 3-8-2007

We're already donig this, albeit unbeknownst to the patient. Digital studies (X-Rays, etc.) are sent around the globe for reading from smaller facilities or ones that can't keep a doctor in the hospital.

Regarding followup: if you travel outside your surgeon's practice area, you are doing the same thing as medical tourism.

Sent by tom benzoni | 3:36 PM | 3-8-2007

Wonderful show -- great topic. I'm on a limited budget and though I have Medicare it doesn't cover expensive dental procedures like implants. I've seen the online information for both the Canadian and Costa Rican dental practices but when I've mentioned these to my American dentists they have no information regarding them. How do I go about finding a good dentist in either of these countries?

Sent by Colleen | 3:36 PM | 3-8-2007

i wonder if jeff would share the name of his costa rican dentist? Also, does he know of any other sources of lower-cost quality dental care overseas, and how to best research this - and get names of particular recommended dentists - online?
thanks

Sent by clay | 3:38 PM | 3-8-2007

A couple of years ago, I wrote a letter to my physician in which I mentioned that I would like to be in India towards the end of my not-yet-commenced, planned pregnancy. My physician answered my question by stating, "I wouldn't want to be in India at the end of pregnancy. Since my husband is a citizen of India, I would like for my future children to be born in that country. How would one research prenatal care and the birth experience in India? Does anyone have an experience they would like to share? What recommendations do you have about my desire to have my children in that country? Can the experience be as safe, sanitary, and medically advanced as in the U.S.A.? Or do I have a pipe dream?

Sent by Yvonne in Bonner Springs, Kansas | 3:42 PM | 3-8-2007

I really enjoyed listening to your show on medical tourism.

Hopefully the trend of outsourcing medical treatment will gain momentum and I hope that the current trickle will become a torrent.

I believe that only when enough of our currently well-paid medical professionals begin to experience a wide-spread general loss of income and employment opportunities that they will engage their powerful Washington lobbies to pressure Congress to enact legislation to prevent the outflow of money and jobs that the manufacturing sector has already endured.

Sent by John Mathias | 3:52 PM | 3-8-2007

In Michigan, thanks to the insurance lobby, medical malpractice claims are not at all easy to file or win. Drug companies are almost impossible to sue here. These changes in Michigan law have NOT decreased to cost of medical care. You might as well go to another country for medical care or another state - if you want your full legal rights.

Greg Crockett
Attorney at Law
Member, State Bar of Michigan

Sent by Greg Crockett | 4:03 PM | 3-8-2007

Compare this phenomenon to that of the "exclusive" hospital, with the country club setting for those who can afford it, in brand new facilities. We continue to create a nation divided between the wealthy and the rest of us hard working stiffs who will travel out of country in order to afford even basic medical and dental care. What I wonder is where this will lead, ten or twenty years from now? What will it do to our access to medicine in this country?

Sent by Doug, CO | 4:09 PM | 3-8-2007

This is a fascinating topic, on the air and in this blog. And it speaks volumes not only about our health care "system" but about the economic state of America as a whole. We all know that the gap between the richest and the poorest Americans is bigger than ever. Now it seems that the gap between the rich and the middle class has grown out of control too.

The cost of necessary medical procedures has joined major-market home ownership as something which only the upper and upper-middle classes can easily afford. When the cost of a necessary medical procedure in America is the price of a big-city mortgage and the same procedure in a foreign country (even in America's next-door neighbor, Canada) is the price of a car, something is wrong here, something is terribly wrong.

Who is to blame for this deplorable state of affairs? Doctors who believe they are entitled to uppercrust status? Pharmaceutical companies whose greed surpasses that of big oil? Robber-baron insurance companies? Or is it merely the American-as-apple-pie ideology that money isn't everything, it's the only thing?

Sent by Jonas Schweitzer | 4:17 PM | 3-8-2007

Please, could you write for me the names of those international insurance companies? Here, in USA, the medical services are too high.
Thank you, Marta Clifford

Sent by Marta Clifford | 4:20 PM | 3-8-2007

Hi folks,

Jeff Schult here. In response to a few posts above, I just wanted to say I can be contacted from the web page for "Beauty from Afar" (www.beautyfromafar.com
) or just write to jss at beautyfromafar dot com. I'm happy to answer additional questions regarding my own experience or about the book.

In answer to the question about who my own dentist was (and is) ... my original article about that is linked from the book page as well. I think it's important to add that one can get high quality dental work in a number of medical tourism destinations. "Your mileage may vary," etc.

This blog is already looking like the best consumer discussion of medical tourism I've seen online in quite some time, and I just got home from the NPR studio! I'll check back again later.

Sent by Jeff Schult | 4:27 PM | 3-8-2007

I also wonder if Jeff would share the name of his Costa Rican dentist?

As well, my husband travels quite frequently to Shanghai, and I am always invited to join him. What would be the best way to research dental care in Shanghai and to get the names of reputable dentists who work on highly specialized needs (jawbone implants and implants into the implanted bone?) Or is this where my work in researching them on-line comes in?

I was informed just yesterday that I am in need of a toe join implant. I will be looking for a knee replacement in the future. (I sound like a mess, but actually I'm riduculously active in hiking, and am getting back, now winter is gone, into biking and canoeing/kayaking.) What countries would Jeff suggest for these procedures and/or where can I find a book on this? In the program it didn't sound like his book covered specifics.

Thank you so much! Great shows, always.

Sent by Lisa Ross | 4:49 PM | 3-8-2007

The key word seems to be "offshore" to avoid cost + malpractice insurance costs, so therefore, put a big "hospital" ship just offshore of the U.S. coast. Walmart could run it, since I heard they want to get into healthcare. (They want to put "docs in a box" in their stores. Could go there for ordinary stuff like sore throats. Why not?)

Del from panama city, florida

Sent by del pass | 5:22 PM | 3-8-2007

Hello Potential Medical Tourists:

This is Patrick Marsek from MedRetreat, one of the guests on Neal Conan's "Talk of the Nation" show.

As the topic of medical tourism is a very interesting, and viable alternative to healthcare in the U.S., there are many issues to consider before deciding to travel abroad to receive your procedures.

MedRetreat was developed to help American consumers make an educated decision about whether or not medical tourism is a good option for their specific situation.

You are welcome to visit our website at http://www.medretreat.com for a comprehensive education about how medical tourism can work for you.

Wishing you a safe and healthy day!

Sent by Patrick Marsek | 5:23 PM | 3-8-2007

I have a slightly different take on the above. Being originally from India, I have experienced excellent care in India for literally peanuts. Surely, there is also a high degree of variance in the quality of care (as there is in US). But what I wonder about is what this "medical tourism" will do the local patients. Sure it would be cheaper for people from wealthier nations to get care, but even that cheap price may turn out to be out of the reach of poorer or even middleclass folks in those countries as the more and more providers start to look for these (relatively) lucrative patients from overseas. It already happens in several service sectors where the companies cater exclusively to overseas clients.

Sent by Balaji Murthy | 6:16 PM | 3-8-2007

There's no such thing as a free lunch, they say, and when we engage in medical tourism perhaps we should wonder who's picking up the check. First-world class facilities for medical services abroad siphon resources and medical training and talent away from basic medical services for the local population and toward those who can afford to pay cash for procedures that may be discretionary and in any case could be provided in the U.S., albeit at a far higher cost.

It seems to be regarded as entirely ethical to seek cheap drugs in Canada (let the Canadians pay for the governmental mechanisms that negotiate lower prices) and cheap surgery in Costa Rica (too bad if the Costa Rican national health service finds it hard to keep providers on staff). We are fine with forcing other nations to solve our grotesque health care problems by subsidizing some of our needs.

I'm disappointed that none of your callers and only one of the bloggers suggested that this might be an ethical problem. Come on, folks, let's take some responsibility for legislating and paying for an equitable, adequate health care system here at home.

Sent by Mary Anglim | 8:21 PM | 3-8-2007

Organ Transplant tourism is very dangerous and ethically unsound in China. While China offers short waiting lists, those organs come from unwilling donors. Stories are now coming to light that innocent Falun Gong practitioners are being murdered and their organs sold to foreign tourists. These people are being persecuted for their spiritual belief, not because of a crime. Would you want an organ from someone who was murdered? Please take care. There are human rights reports out now about China's crimes against humanity (including organ harvesting from Falun Gong practitioners). Please read them.

Sent by Lee Randazzo | 8:47 PM | 3-8-2007

I know from firsthand experience the benefits of having medical and dental care done overseas. What can not be underestimated is the entire care given at hospitals-nursing, time with doctors, quality of the physical plant (building) and more in the recovery process. I have no insurance as I was dropped by my company 12 years ago. I have traveled to Thailand since then for all my needs and consider myself lucky when compared to the sobering and costly experiences others have related to me about the lack of care and outrageous prices in the USA. A year ago I broke my shoulder and tore all the ligaments in half. I was operated on at a hospital in Bangkok and recovered fully within a year. The experience inspired me to go into business, taking others to Thailand in order to take care of their health care and well being.
The one thing that I have noticed from talking to clients is the attitude that those doctors trained in english speaking countries are in some way superior to doctors trained overseas. While 50 years ago this was true, in todays modern computer driven world this is now a vestige of colonialism. Where is education stressed more these days? Just look around at graduate schools in the US and you will realize that people educated in Asia come from a much more competitive environment and, thus, are better educated.
I recently returned from Thailand this year where I had two crowns and two root canals as well as a colonoscopy. Price in the US would have been close to
$6,000. The price of the trip (one month staying in Thailand), flight and medical care was under $3,000. All was beyond first class, the food divine, the beach gorgeous. You do the math!

Sent by Rob Cooper | 9:22 AM | 3-9-2007

Just a quick note on the note from Mary about the ethics of medical tourism. The effects are entirely opposite of what she assumes. From the doormen, to the cleaners, to the cooks, from the nurses to the doctors all benefit. The jobs created, the money spent while traveling in country all go to improve the economy and the lifestyle on the country. I wonder if she only buys articles made in the USA and food grown organically by local farmers. In this day and age it is rather paternalistic to believe that folks seeking medical attention abroad are debasing the medical care that locals receive. Rather the opposite is true. If you don't believe this just go and look for yourself in Thailand. The bottom line is that I can not afford to get treated in the US. Would you rather that I receive no medical care because you believe in your ethical superiority.

Sent by Rob Cooper | 12:18 PM | 3-9-2007

Also to Mary. I find it interesting that you would start your post by quoting an economic principle, (TINSTAAFL) and end it by indicating that we should try to legislate change rather than letting the market drive it. Medical tourism is competition and it's basically the first taste of competition that the US Healthcare industry has had. Competition improves quality and reduces cost (see consumer electronics). Socialization sacrifices freedom of personal choice and supplier incentive. Individual consumers and their choices expressed through dollars are the keys to fixing our healthcare system, not elected officials owned by lobbies.

Sent by Aaron | 2:04 PM | 3-9-2007

One of my concerns with medical tourism is that the patient is not a potted plant. A family member may be able to accompany the patient, but that's very far from the full support system of family, church/synagogue/mosque, workplace, and lodge or other social groups. The amount of stress placed on both the patient and the family by the medical procedure itself should not be underestimated, and increasing it by making it impossible to get the same kind of support they would at home is not negligible - and has already been mentioned, travel in itself is stressful. Since my mother had a stroke just a couple of days after my dad got home from several weeks in the hospital - partly because of the 1972 insane visiting hours for ICU patients - and seeing how stressed out I've been dealing with my own and other family members' medical needs, I would hesitate a long time before becoming a medical tourist. I hope no one starts requiring it as a condition of treatment!

Sent by Martha Krieg | 7:36 PM | 3-9-2007

I think this is a valuable discussion, and too rare in our country. We very seldom recognize what conditions are like in other countries -- medical, crime rates, education, etc. -- and should factor this information into our thinking in a comparative way.

I was born in Mexico of U.S. parents, and grew up in both Mexico and the U.S., alternatively living in both countries. I had most of my dental work done in Mexico, over a period of years. Some of the dentists were in small towns, and yet, without exception, every one of them was competent and did excellent work.

Ironically, the only dental problem I have had has been due to the poor work of a highly trained U.S. dentist, who teaches dentistry at a highly rated U.S. medical school.

After decades, the Mexican dental work that I had done has held up without any problems whatsoever. An added plus has been the friendliness and generosity of Mexican dentists. Our American medical and dental practitioners have lost sight of the human dimension: dental and medical "conditions" rather than persons are treated.

Mexico, and I believe this is true of many other countries where men and women are attracted to dentistry and medicine for intrinsic reasons rather than mega bucks, hasn't lost sight of this human dimension. I've found Mexican dentists and doctors to be the most personable and caring people, who have the time, or will take it, to talk with you. They aren't rushed by an appetite for the next billable patient. This is a world of difference from my experience with U.S. health practitioners.

Whenever possible -- and not simply to save money -- I think it's wise to seek medical care beyond U.S. borders.

Sent by James Alexanderson | 1:00 AM | 3-10-2007

Medical tourism is different from regular foreign outsourcing because the United States does not really have a free market for medical care. Rather, essentially, the United States has an artificial shortage of doctors relative to the number of people who want to become doctors and who are qualified to become doctors. If the medical field were subject to a real free market, the supply of doctors would be similar to the supply of lawyers and MBAs; we'd have an oversupply and large amounts of price competition.

Sent by Ming Li | 5:35 AM | 3-11-2007

I have had plastic surgery in Costa Rica in Mexico and Costa Rica. I wish there was not such a negative stigma associated with this and I appreciate your show.
There is a forum and member community for patients of plastic surgeons outside the United States at www.plasticsurgeryjourneys.com (which Jeff mentions in his book) There you can get more first person info from others who have gone through this, see patient before and after photos, and reveiw doctor ratings.

Good luck and thanks again!!

Sent by MA in New York | 2:05 AM | 3-12-2007

I had great success with dental work in Hungary. Later I tried plastic surgery for a skin cancer on an eyelid. The quality of facilities seemed comparable to those here. I was able to get an appointment within a week. The doctor knew who I was when he was doing the surgery. The cost was under $250 for a procedure similar to one I had for $5000 here.

Sent by George Johnston | 10:38 AM | 3-12-2007

I agree with Jeff Shult this is one of the best forums yet for a broad discourse on international medical travel. Bravo NPR!

Just published yesterday, our new consumer guidebook, "Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism," reflects interviews with hundred of patients, healthcare providers, hospitals, clinics, insurance companies and more. Our research revealed that medical travel is--for the informed healthcare consumer--a very real way to obtain higher quality, lower cost treatment--safely. While not for every patient or procedure, medical travel can nonetheless provide a wide array of choice for millions of Americans who now find themselves aging into expensive procedures--with nowhere to turn but mortgage companies or bankruptcy courts for financial relief.

I just yesterday returned from a tour of 20 hospitals in three SE Asian countries, and can say that to a one, all were squeaky clean, customer service driven and filled with talented staff and state-of-the-art equipment. Sometimes our cultural biases get in the way of informed decision-making. I for one am happy to know these choices exist and would send my father, my sons, or myself to anyone of these places in a proverbial heartbeat.

Sent by Josef Woodman | 2:46 AM | 3-13-2007

I mentioned to my best friend that I am considering this for porcelain veneers, and possibly liposuction in the chin area.

She told me she saw an Oprah show about how dangerous it is to go abroad for medical procedures. After watching the show her opinion of medical tourism is extremely negative.

Has anyone seen this episode? So far, none of the comments here, or on the "Talk" episode, have mentionned bad results (as far as I can remember).

Sent by Lesli Bair | 10:47 AM | 3-16-2007

I've followed the medical tourism idea for some time, and in January decided to take the plunge and go south of the border for dental work. Despite reading lots of good referrals for dentists in Mexico, I went with a company out of Oregon that ran their business in Mazatlan - a bit of a twist, an American and Canadian running a Mexican dental clinic. Unfortunately I did not have good luck with their dentist's work. However, I did find three other dentists that provided excellent service. Some had been US trained, others strictly schooled in Mexico. Their equipment and skills were excellent even if their offices were smaller than the US . Like other say, you have to do a little research but the savings are good & I think the business also helps the local economy and patients.
Having a root canal and a surgical extraction done in one day may not seem like much of a vacation... but at least you have the beach and waves to recover to. (Now if I can just get my $$ back from the first US outfit there- I'll be happy!)

Sent by Lynn Boyd | 2:08 PM | 4-3-2007

Y'all had better get used to medical tourism. When the U.S. socializes medicine (it's only a matter of time) and your medical care is then tangled up in government bureaucracy, you'll still be taking your hard-earned dollars somewhere else in order to get TIMELY treatment and not sit on some waiting list forever. Ask a Canadian.
I'd like to hear some stories about the nightmare that ensues when medical procedures in other countries go awry. Anyone?
I am a single mother of three children paying out of my pocket for our health insurance (HMO). Now how can I manage that? Priorities, IMHO.

Sent by Susan | 7:38 PM | 4-12-2007

I am fairly new to the concept of medical tourism but it has given me a real attitude change. I joke with my friends that I don't go to the doctor because if something is wrong with me, it's not like I could afford to fix it anyway so I'd rather not know. How sad is that?

I've been pretty overweight for the last 15 years, and while I'm still very active and in great health, I feel the toll the weight is taking on my knees and joints. One of my reasons for not being serious about losing the extra weight is the fear of having hanging skin, and with no insurance and a regular joe job, there's no way I could afford expensive cosmetic surgery here in the US. At least now, my skin fits. After reading numerous testimonials and researching cosmetic surgery abroad, however, suddenly it's like a light went on in the tunnel. I could actually afford to have a tummy tuck, boob lift, etc if I had it done in India or Thailand, and get an awesome little vacation out of it to boot.

The malpractice suits, insurance companies, and general greed have put the US health care system completely out of reach for those of us who don't have insurance or 6 figure jobs. It will take me a year to save up the money, but I think I will be joining those who travel overseas for medical care just as soon as I can.

Sent by Krista | 6:38 PM | 4-24-2007

I am an American living in Mumbai, India. I have seen firsthand the incredible quality of hospitals here such as Wockhardt, Asian Heart Institute, and Shroff Eye Care. They are excellent and all have the JCI (Joint Commission International) Accreditation which is U.S. standard. There is a business here called America's Medical Solutions that will help anyone get high-quality health care they need here in India for a fraction of the cost it would be in America. I have seen that it works, and I believe it is an excellent way to get the health care needed. I feel most confident in the doctors here and in businesses like America's Medical Solutions. They have a website americasmedicalsolution.com that would be interesting to look at for more information. Low-cost health care is available if you are ready for it!

Sent by Teresa | 2:48 AM | 6-27-2007

I am a citizen of an India & 25 years old girl of a Dental Surgeon.I have heard that many people outside of India believe that there is not good facilities available in India. I like to tell all of them that the growth of India is superb in medical equipments. Here the doctors are very intelligent, active and successful.All the Hi-tech hospitals are available just like Hinduja Hospital, Jaslok Hospital Hospital of Mumbai and SAL Hospital, Apollo, Sterling Hospital, Rajasthan Hospital, Civil Hospital, Krishna Heart Institute of Ahmedabad, Gujarat,India and many more. Here doctors are feasible to do any type of surgery, transplantation or operation and at very low cost in the comparision of any other country. So if anybody wants to come overhere for any type of medical facility, I like to tell all of them that they will get the best result from Indian Doctors.

Sent by NIMISHA AMIT BAROT | 8:16 AM | 8-8-2007

I've become fascinated with medical tourism as a result of researching the topic for the Health Business Blog. I have recently started MedTripInfo.com, a website dedicated to the topic. I've conducted podcast interviews with 2 of the 3 people who were on this show.

Sent by David E. Williams | 8:23 AM | 8-14-2007

After getting shocked with a plan for $32,000 from my local dentist, I started looking at options. I came across www.mexicandentalvacation.com where apparently, they have a dentist from Seattle working there.

That same plan for $32,000 they will do for a little over $14,000!

I am scheduled to go there in November, and really looking forward to saving some money and catching some sun.

Sent by Terry | 9:33 PM | 8-15-2007

I have to agree with Teresa, above. Except that I have actually tried three of Mumbai's (Bombay, India's) medical tourism hospitals and have been astonished. I have used America's Medical Solutions which can be located here: www.americasmedicalsolutions.com , and am very impressed with their FREE helps. They get paid by the doctors and hospitals for their introductions, so it's free to us. Anyway, Indian medicine can be matched, but it cannot be beat. And no one beats their prices.

Sent by dan | 8:30 AM | 11-17-2007