Insurers Eye Savings from Treatment Overseas

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A Thai cardiologist in Bangkok

A Thai cardiologist in Bangkok checks a Norwegian patient. Saeed Khan/AFP/Getty Images hide caption

itoggle caption Saeed Khan/AFP/Getty Images

Uninsured Americans are flying to Thailand for cheap surgery. But reporter Avery Comarow says U.S.-based insurance companies are studying the safety of sending patients to foreign countries for cheap major surgery.

RACHEL MARTIN, host:

So imagine flying to Costa Rica, not for the sun and sand, but for a hip replacement. Or to Bangalore, let's say, not to absorb the local culture, but to get a nose job. That kind of trip is more common than you may think. Thousands of people are reportedly leaving the U.S. every year to find cheaper options for elective procedures from the relatively minor, like a trip to the dentist, to the major stuff, like heart surgery.

Uninsured and underinsured Americans can sometimes up to 80 percent on hospital rates by going abroad. But there are some concerns, like how do you deal with post-operative care back home? And being the litigious Americans that we are, whom do we sue if something goes wrong? All this and more in a story about medical tourism that we ripped off...

(Soundbite of song "Law & Order" theme)

MARTIN: From the pages of U.S. News and World Report. Avery Comarow is the senior writer for U.S. News and World Report who wrote the interactive five-part special report on medical tourism. Avery joins me now. Hi there.

Mr. AVERY COMAROW (Senior Writer, U.S. News and World Report): Hi.

MARTIN: Thanks for joining us. So we've hear about medical tourism for a few years now, about people going abroad for plastic surgery, maybe some cheap dental work. But your article outlines an entirely new trend, traveling for not the cosmetic stuff, but often really serious - although elective - surgeries. What kind of procedures are we talking about here?

Mr. COMAROW: Mostly orthopedic and some heart and back surgeries. There was a recent survey done that showed that probably joint replacement, hip and knee replacements accounted for the majority of visits by Americans who visit abroad for elective - let's call it necessary - surgeries, as opposed to plastic or cosmetic surgery.

MARTIN: And are there particular places that have developed a reputation for being particularly good at certain procedures, like if you need hip replacement, everyone knows you go to Bangalore or Thailand for a nose job, or are there any big trends?

Mr. COMAROW: I think, well, I think this is still pretty much an unknown to most people. I think most people understand or have heard vaguely that people are going abroad for these things. I don't think it's gotten to the level that very many people understand that this hospital or this country is the place to go for a particular kind of procedure. For that matter, that would be true here, too. If you were told that you needed a joint replacement, would you know where to go? Probably not.

MARTIN: No. Well, that's my next question, Avery. How do people - it sounds a little overwhelming, if someone just sat down and decided, I'm going to go to Bangalore for my hip replacement surgery because my neighbor Thelma told me it was a good idea. How do they begin to do their research? How do they get hooked up with these hospitals?

Mr. COMAROW: The way it's happening most often now is that they hear from their neighbor Thelma that they had a hip replacement, in fact, and Thelma says, I had it at Wockhardt Hospital in Bangalore, and you say, oh, OK, and you look up Wockhardt Hospital on the web and that's one of the hospitals that's trying to attract Western patients. And you see on the website they actually have a special number and email for "international patients," as they call them.

All of these hospitals that are looking for Westerners have that kind of arrangements. And once you get in touch with them, they'll walk you through, step by step by step. What you don't know is whether Thelma went to the right hospital, and for that, you have to either do an awful lot of web and phone and email outreach or at the very least, you have to use one of these emerging travel arrangers, call them medical arrangers, who have a stable of hospitals, a number that they have bedded, presumably.

MARTIN: So a whole industry of middlemen has developed around this?

Mr. COMAROW: Yeah, you bet, because it is so overwhelming that that word is absolutely accurate. Everything from, what class of flight do I take? People don't think about that. These are long flights, if you're going to Asia.

MARTIN: Well, and who can afford...?

Mr. COMAROW: You don't want to sit there in economy.

MARTIN: That raises the question about prices, though. I mean, granted, we've said that you can save up to 80 percent on hospital rates. That's a lot. I imagine that that's the outside, though. It's still extremely expensive to fly from the United States to the subcontinent, for example. Is this specifically for people of excessive means, or upper-middle class?

Mr. COMAROW: Oh, I don't think so at all. Well, I went there. I went to India and Singapore to research this story. I talked to a number of patients in India, in Bangalore, and none of them fit that kind of profile. All of them lacked insurance for one reason or another, one woman had a pre-existing condition, and she was divorced, so she couldn't ride her husband's policy. There was a guy who was a self-employed contractor and a woman who was retired but short of Medicare.

All of these people had some savings that they could have plowed into these procedures back home if they'd been able to negotiate the prices with U.S. hospitals, but hospitals won't do that. But to your question, even after you throw in five or 6,000 bucks for plane fare, you are - actually, the 80 percent that I figured for one of the patients in this piece included 5,000 that he paid for airfare plus all of the incidentals, passport, you name it.

MARTIN: Avery, some big insurance companies have reported are responding to this growing trend. How are they trying to get a piece of this?

Mr. COMAROW: They don't know yet. It's sort of like years ago when people talked about cold fusion. It always seemed to be 25 years away, or five years away. For the last five or ten years, the big insurers have been talking about how that year was going to be the breakthrough year. Now they're all saying 2008 is going to be the breakthrough year when they know whether, in fact, this is something that they should get involved in or not, but there are the kinds of obstacles that you mentioned before.

There is the, you know, the post-op care, the continuity of care question. There's what do you do if there are complications. If you go back to your doctor, will your doctor even see you if you got care abroad? They're not sure what to do. What's in it for them? And what's definitely not it for them?

MARTIN: But they've recognized that this is definitely a trend and they're looking into it.

Mr. COMAROW: They can't ignore it. At this point, it's a little too big to ignore.

MARTIN: Avery Comarow, senior writer for U.S. News and World Report. Thanks for sharing your reporting. If you out there are interested in learning more about the issues surrounding international healthcare, medical tourism, so to speak, check out our website, we'll post a link to Avery's special report on npr.org/bryantpark. Thanks again, Avery.

Mr. COMAROW: Thank you. When we post that report, we should definitely title it "Thelma and New Knees."

(Soundbite of laughter)

PESCA: Sit on that one. Yeah, great.

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