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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

MELISSA BLOCK, host:

And I'm Melissa Block.

Let's say you're going to have surgery, a hip replacement or a heart bypass. Would you prefer to have it done at your local hospital or when in Singapore, Thailand or Costa Rica? More and more Americans are making that choice.

As part of our series on international medicine, NPR's Greg Allen has this report on the fast-growing field called medical tourism.

GREG ALLEN: The name can be misleading. While there are many people who choose a medical procedure in an exotic locale so they can enjoy the travel experience, medical tourism also includes people like Kevin Stewart.

Mr. KEVIN STEWART (Resident, Florida): I had cirrhosis of the liver. I saw a gastroenterologist who informed me that it has advanced in such a way that liver transplant was my only option.

ALLEN: Today, Stewart looks great. He's 49, tanned, relaxed and clearly enjoying his recuperation on Florida's Big Pine Key. Both he and his girlfriend have their boats moored in the canal that runs behind their backyard. But just a few months ago, he was desperate. Stewart had his own landscape maintenance business in Naples, Florida, but because of high premiums, had let his health insurance lapse. Fortunately, he had a potential donor — his sister — and he began calling hospitals to see how much a liver transplant might cost.

Mr. STEWART: It was $30,000 to be - for them to check me out to see how badly I needed a liver. And if they decided I needed a liver transplant, I should pay them $300,000 and they will work toward that.

ALLEN: That was more than he could afford. With his sister's encouragement, Stewart says he began looking to other countries for medical treatment. He contacted a medical tourism Web site, WorldMedAssist, that researched his situation and came back with two hospitals that could perform the liver transplant - both in India.

Stewart quickly settled on a hospital in New Delhi and a surgeon who, at that time, had already performed 120 similar liver transplants. He says it was an easy decision in part because it really was his only option. But others saw it differently.

Mr. STEWART: Everybody I spoke to thought I was a crazy person. Why would you go there, you know, you're going to get infected, it's a dirty place. Now, I'm certainly happy to spread the word to people that you do have choices. You don't have to lay down and die.

ALLEN: Four months after the transplant, Kevin Stewart is looking forward to getting out on his boat for snorkeling and fishing. The total cost of his medical treatment and his travel to India? Less than $90,000 - about a quarter of what he would have paid in the United States.

It's an extreme example, but by no means unusual. Last year, an estimated half-million Americans traveled to a foreign country for medical treatment. Many go to clinics just over the Mexican border that specialize in dental implants or LAP BAND surgery for obesity. But increasingly, large numbers are going further to hospitals in Costa Rica, Thailand and India for hip joint resurfacing, kidney transplants, prostate surgery.

Probably no institution serves more foreign patients than Bumrungrad Hospital in Bangkok - 450,000 last year alone.

Ruben Toral is a medical tourism consultant who works with Bumrungrad and other hospitals throughout Asia. He says the appeal is simple. It's about value.

Mr. RUBEN TORAL (Medical Tourism Consultant): Great quality, immediate service, service that you would never find in an American hospital or even a European hospital. Price, obviously, is going to be anywhere from one-half to one-eighth the cost of health care in the United States. And access, you can see a doctor when you want to see a doctor. There is no issues of waiting.

ALLEN: Toral and some of the hospitals he represents recently joined with other institutions in the U.S. and around the world to form a trade group, the Medical Tourism Association. They are working to bring some order to the rapidly expanding universe of global medical care. One goal, Toral say, is to make medical tourism appealing not just to the uninsured, but also to employers and health insurance carriers.

Mr. TORAL: If the insurance companies created essentially a international provider network where people could actually choose to go overseas for health care in exchange for lower premiums, lower co-pays, then that in fact would be a very attractive alternative for corporations who are looking at lowering their health care costs.

ALLEN: In fact, many health insurance carriers are looking at medical tourism. A few have already begun to offer it as an option to their members. One of the pioneers is OptiMed Health/United Group Programs, a health insurance carrier that more than a year ago began offering medical treatment abroad to its members.

Former company executive Jonathan Edelheit says overseas treatment is offered just as an option, but there are inducements. The company covers all travel and expenses, eliminates the member's deductible and co-pay, and now, in some cases, offers to pay the patient $5,000 in cash. With all that, he says, medical tourism is still a good deal for insurance companies and employers.

Mr. JONATHAN EDELHEIT (President, Medical Tourism Association): Oh absolutely, because for a heart procedure that might cost $100,000 here in the United States, it might cost $9,000 in Asia, which means at the end of the day, they still saved about 80 to $85,000.

Edelheit, now, is the president of the Medical Tourism Association. Although several insurance companies have joined his group, he concedes that most big carriers aren't yet ready to jump into medical tourism. One reason is liability. If there are bad outcomes, Americans who receive medical treatment abroad will find it difficult, if not impossible, to sue for malpractice overseas. Some insurance carriers are leery that might leave them vulnerable to lawsuits.

Another big issue is the quality of care. What assurances are there that a hospital in a foreign country measures up to American standards? Edelheit says his association is working on a project that will allow consumers to compare U.S. hospitals with those overseas.

Mr. EDELHEIT: Statistics that are addressing certain things like infection rates, success rates, mortality rates in the hospital that people can actually compare so they know the care that they're getting. They know that this hospital has a 3 percent infection rate per a thousand people versus this one that has an 8 percent. And obviously, you'd want to go to a hospital that has better care, which means lower infection rates and higher positive outcomes.

ALLEN: But as medical tourism grows, Nathan Cortez sees a danger. Cortez, is an assistant law professor at Southern Methodist University, who's publishing a paper soon on medical tourism. In signing waivers and agreeing to overseas treatment where malpractice lawsuits are impractical, he says patients should be aware they are assuming additional risk and he believes they should be compensated for it.

While patients should be free to travel overseas and reap savings if they wish, Cortez says one consequence may be that people who insist on receiving treatment only in the U.S. will end up paying more.

Professor NATHAN CORTEZ (Assistant Law Professor, Southern Methodist University): Yeah, we see this all the time with other industries. And health care has been notoriously a local industry, and now, you know, that's - it's succumbing to globalization like other industries have.

ALLEN: Concerns about outsourcing of American health care jobs have led some unions and employers to oppose medical tourism. But those opponents don't include leading members of the U.S. medical establishment. Both the American Hospital Association and the American Medical Association have looked at medical tourism, and so far at least, they are remaining neutral.

Greg Allen, NPR News.

BLOCK: And there's a checklist of items to consider before heading abroad for medical care. That's at npr.org.

NORRIS: This is NPR, National Public Radio.

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