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A Thai nurse checks the blood pressure of a patient from the United States following an operation at Yanhee General Hospital in Bangkok.
Faced with rising health care costs, more and more Americans are digging out their passports.
Numbers are hard to come by, but according to some estimates, as many as 500,000 Americans go abroad each year to get advanced medical care from lower-priced hospitals and clinics in countries like Mexico, India and Thailand.
Even with the costs of travel, accommodation and other expenses, getting these procedures abroad is often cheaper than getting them in the United States. The Journal of Financial Planning estimates that savings may range from 50 to 95 percent of the U.S. cost.
The medical tourism industry, as it's called, is only a few years old, and most tourists make arrangements through special agencies or the foreign hospitals themselves. As a result, it's hard to find reliable, independent information on foreign hospitals' standards, doctors' qualifications, or patients' legal protection.
With that mind, if you are considering a medical operation abroad, what do you need to know?
Q: How do I find out if a foreign hospital is accredited?
The Joint Commission, an American non-profit that accredits hospitals in the United States, has a division that does the same thing for foreign hospitals and other health-care facilities. Joint Commission International uses American medical standards to evaluate foreign facilities. The number of international entities accredited by JCI is expected to grow rapidly in the next few years, from 140 to almost 300. Most are in Asia.
Medical tourism agencies, which function much like other travel agencies, also offer information about doctors' and hospitals' credentials. However, you may want to do independent research if you rely on these agencies, since they have a financial interest in medical travel but don't actually provide health care. It's also important to realize that these agencies aren't necessarily subject to American laws.
There is no master list of foreign hospitals that accept medical tourists, but "most countries are known for a particular category of treatment," author Josef Woodman writes in Patients Beyond Borders.
"If you're seeking cosmetic surgery, Brazil, Costa Rica and South Africa rank among the most popular destinations," he writes. "Dentistry will have you exploring Mexico, Costa Rica, or Hungary. The more expensive, invasive surgeries, such as open-heart surgery or a knee replacement, make a longer trip to India, Thailand, Singapore or Malaysia well worth the cost, time and distance of travel."
Q: Once I locate a hospital, how do I check out a particular doctor's qualifications?
Usually patients work through medical tourism agencies that they find on the Internet, but you can also call a hospital directly. The agency or hospital can then arrange for you to speak with doctors or previous patients on the phone.
Dr. Ann Marie Kimball, a physician and professor at the University of Washington, offers some tips on screening a doctor:
"You can ask other people and you can ask your own physician to check out these physicians," she says. "Obviously, talent and skill are not confined to the United States. There are many talented and highly skilled surgeons working overseas who are well-trained, sometimes trained in U.S. medical schools, sometimes trained in Canadian, British, Indian medical schools."
Kimball agrees it is more difficult to check out an international surgeon. "But often, surgeons know surgeons, and if they're members of the same professional organization, they may well be aware of one another's reputation," she says.
Q: Will my insurance cover medical procedures performed abroad?
Generally, no. Although some major U.S. insurers — such as Aetna, Cigna and Humana — are increasingly considering it. And a few smaller companies do offer incentives to go abroad. Insurers are attracted to medical tourism by the low cost of these procedures — sometimes one-tenth or one-twentieth the cost of their American counterparts. But they are often more concerned that they'll face lawsuits if something goes wrong at hospital outside the United States. Call your insurer's customer service line to see if you're covered for visits to hospitals abroad.
Q: How much will it cost?
Prices vary widely. Some facilities' Web sites list the prices of various procedures they offer, but hospitals increasingly require prospective patients to fill out an online form and receive a quote, much like life insurance.
Quotes from different hospitals may be hard to compare, since the services offered vary from facility to facility. For instance, one hospital's quote may only cover the procedure itself, while another hospital's quote may include airfare, hotel, rehabilitation and follow-up care. Taxes and tariffs may also be left out. Ask an internationally based hospital for a breakdown of its quote before proceeding.
Woodman suggests a $6,000 rule: if your procedure would cost more than $6,000 in the United States, you would likely save money — possibly more than $1,000 — by traveling to a foreign hospital, including all other costs.
And don't forget about the non-financial costs: being far from home and family, taking an uncomfortable flight and missing work. If the medical procedure doesn't go exactly as planned, these may take longer than you expected. To make these risks easier to swallow, Woodman recommends, consider bringing a partner on your trip.
Q: If something goes wrong, what recourse do I have?
It depends on how you got there. The medical tourism business remains a fragmented one, with no clear authority in most cases. While Americans can rely on domestic malpractice laws and medical standards, these aren't necessarily effective in other countries.
If you paid a medical tourism agency to find a doctor, make travel arrangements and get you a hotel, they may be liable in some cases. If you didn't use an agency, you may choose to seek damages from the hospital or the doctor. But be advised that the host country may have strict laws against medical lawsuits, or it may have a legal system that takes years to hear your case.
Q: In general, what rules should I follow if I'm considering a medical trip abroad?
Do your homework and do it well in advance. Read as much as possible about the hospital and the doctor you're considering. Talk to former patients and others who can vouch for the quality of the hospital. And don't assume it will be a cakewalk.
"It's real important not to confuse it with a luxury vacation or a spa vacation," Dr. Kimball says. "It's really not a vacation. It's very serious, and to be taken with lots and lots of research, as much as you can do."
Kimball also says you should clue in your doctor, so that even if he or she disapproves of your trip, your post-operation care in the United States will go more smoothly.
And while low cost is a nice attraction, it's not all that matters.
"Looking at the finances is just a piece of the puzzle," she says. "Obviously people are more concerned about their own safety. And so I would say the best rule of thumb is, don't only go for the bottom line. Consider very carefully each step of the procedures and each step of the recovery, and whether your own doctor's going to be on your side and helpful, in terms of helping you sort out those risks, and welcoming you back to the post-operative period with good care and access. It's a complicated thing — I don't think it's to be taken lightly."