Insurance Industry Watches 'Medical Tourism'

More Americans are looking abroad for medical care. A hospital in Thailand is a leader in the field of "medical tourism," doing everything U.S. hospitals do at a fraction of the cost. U.S. health insurers are taking notice.

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Medical tourism is on the rise worldwide. Patients from wealthy Western countries go abroad for medical procedures that are less expensive and have shorter wait times than those available at home.

As NPR's Michael Sullivan reports from Bangkok, more and more Americans are becoming medical tourists.

MICHAEL SULLIVAN: Being stuck in a foreign hospital has to be right up there on the list of many American's worst nightmares, especially a hospital in a developing country. A few minutes at Bangkok's Bumrungrad Hospital though, may be enough to dispel that notion forever.

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SULLIVAN: There is a Starbucks, a Japanese restaurant, an Italian restaurant, even a McDonald's. There's also a richly appointed lobby with marble floors and expensive and comfortable chairs, and valet parking. All of which suggest a five-star hotel, not a hospital.

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SULLIVAN: And like many five-star hotels, Bumrungrad attracts an international clientele, tended to by an international staff, including 80 interpreters like this woman helping two Arabic speakers from the Gulf choose a checkup plan. There is also an in-house travel agent, a visa desk, and a meet and greet service at the airport.

Mr. RUBEN TORAL (Marketing Director, Bumrungrad International Hospital): We got around 430,000 international patients from over 150 countries last year. There is no hospital anywhere in the world that sees more international patients than we do.

SULLIVAN: Ruben Toral is Bumrungrad's marketing director. He says about 65,000 of those patients were Americans drawn here, he says, by...

Mr. TORAL: Good, quality care at a price that they can afford. Generally speaking, we're going to be anywhere from one-eight to one-tenth the price of private healthcare in the United States. So the cost savings, especially for high intensity treatment - cardiac surgery, orthopedic surgery, spinal surgery - is just going to be vast.

SULLIVAN: Getting past the stereotype, Toral says, is one of the biggest challenges when dealing with Americans but not an insurmountable one once they learn more about the hospital.

Mr. TORAL: It's accredited by the same organization that accredits all the U.S. hospitals. We have senior American management, people who have run U.S. hospitals. We have over 200 U.S. board certified doctors. We use G.E. equipment and Pfizer pharmaceuticals. So, for all intents and purposes, this is an American hospital that just happens to be 10,000 miles away.

SULLIVAN: Too far for some no matter how good the care, especially for those too sick to make the journey. But for many uninsured or under insured, hospitals like Bangkok's Bumrungrad or India's Apollo chain, can literally change their lives.

Ms. SHERRY LOUISE PINKLY(ph) (American Patient, Bumrungrad Hospital): My name is Sherry Louise Pinkly. I'm from Nilnilchik, Alaska.

SULLIVAN: Pinkly is 61 years old, uninsured, and came to Bumrungrad to have both knees replaced after a specialist in Anchorage told her told it would cost at least $100,000 to have the job done back home.

Ms. PINKLY: I thought, boy, that's an awful lot of money. Number one, we don't have it. And number two, I'm just in terrible pain here, and it's just getting worse every day.

SULLIVAN: The doctor advised her to wait four years when she'd be eligible for Medicare. And then Pinkly remembered a cousin who had used Bumrungrad for cosmetic surgery a few years back and raved about it. Pinkly did a little research and found out she could get both knees replaced at the hospital for about $10,000 each, a fifth of what it would cost back home.

Ms. PINKLY: I thought, gosh, that's doable. But not only that, the 10,000 includes the surgeon - in my case too - and the anesthesiologist, the hospital, the room, and physical therapy as well.

SULLIVAN: Deciding to go was the easy part. Convincing her doctor back home to surrender Pinkly's records and X-rays was a little harder.

Ms. PINKLY: I had to call this doctor and ask for those things. And his assistant was very upset. She said where are you going? Are you going to California for surgery? Are you going to Seattle? Are you going to the Mayo Clinic? Where? And I said no, we're going to Bumrungrad International in Thailand. So she called me back and she said the doctor thinks that's a very bad idea because it's a dirty place and professionals are sadly lacking, so we don't really want you to go. And I thought, well, that just puts the icing on the cake. Maybe we can get over here a day earlier, or so, than we planned.

SULLIVAN: She arrived in Thailand and checked into the hospital on Monday and had surgery the next day. Her husband, Gordon, is staying with her in her very comfortable room. And he shakes his head as he compares her experience to the one he had after back surgery in the U.S. a few years ago.

Mr. GORDON PINKLY (Husband): I saw my doctor one time after the surgery. But the doctors are in here once or twice a day. And there's always nursing staff here taking care of her, sometimes almost too much where it's almost overload. You know, it's beautiful thing. Third World hospital, to me, is a hospital in the United States where you lay on a gurney in the emergency room for an hour and a half before you're seen.

SULLIVAN: Bumrungrad's executives say they're able to achieve quality care for less for a number of reasons. Salaries in Thailand are much lower, everything is done under one roof and done quickly, and patients choose the services they want and pay up front in cash. Caps on malpractice claims and lower malpractice premiums help too. And insurance companies in the U.S. are beginning to take notice. Earlier this month, Bumrungrad struck a deal with Blue Cross/Blue Shield of South Carolina, though many U.S. insurance companies remain wary of sending patients overseas because of liability issues.

Mr. MACK BRENNER(ph) (CEO, Bumrungrad International Hospital): Medical outsourcing will be a part of the U.S. and worldwide healthcare systems. How significant of a part, it is yet to be determined.

SULLIVAN: Bumrungrad's CEO Mack Brenner has spent more than 30 years managing hospitals, both abroad and in the U.S.

Mr. BRENNER: This is not without some controversy, as you can imagine. Just like any outsourcing, there'll be groups in the states that will pinpoint the negatives of going overseas. What do you do about aftercare? What do you do about complications? And those are legitimate questions that people need to understand, and have in their own mind, they understand how they're going to deal with those.

SULLIVAN: If something does go wrong during surgery or after, Brenner concedes, patients can only sue for a fraction of what they might receive in the U.S. But when mistakes are made, he says, the hospital works with patients to make things right. In the end, Brenner says, healthcare isn't that much different from manufacturing, or call centers, or any other industry that's gone overseas to reduce costs. And if part of that savings is passed on to the consumer, say, with lower copayments and speedier treatment, Brenner says, more companies and more consumers will want in.

And for at least some of the 47 million uninsured Americans, hospitals like Bumrungrad or India's Apollo chain offer something they simply couldn't afford otherwise. For Sherry Louise Pinkly that means she may yet be able to do something she's always wanted to, walk and climb the Great Wall of China. Her doctor says she should be able to do so without pain by this time next year.

Michael Sullivan, NPR News, Bangkok.

MONTAGNE: This is MORNING EDITION from NPR News.

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