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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

Imagine 24-hour room service and stretches of white sandy beaches as you recover from a hip replacement, a mastectomy, or an organ transplant. Until recently, most operation vacations involved cosmetic surgery at Second or Third World prices, but more and more Americans are going overseas for all kinds of procedures. India, Malaysia, Thailand and Panama are among the hotspots. Top-rated hospitals there offer low prices, maybe 20 percent of what you'd pay here at home, American-trained doctors, and state-of-the-art technology.

Patient care is solicitous, and after you're released you can go visit the Taj Mahal. There are lots of questions too about follow-up care, remedies for malpractice, and some complain that this is outsourcing, no different than relocating a manufacturing plant. But given the price differential, insurance companies are beginning to see advantages.

Later in the hour, the only Iraq vet who's a member of Congress, Democrat Patrick Murphy of Pennsylvania, just back from a return visit to Baghdad. But first, have you traveled overseas for medical care? Would you outsource your surgery if it saved you tens of thousands of dollars? Our number here in Washington is 800-989-8255. That's 800-989-TALK. E-mail is talk@npr.org. And you can see what other listeners have to say at our blog, npr.org/blogofthenation.

And we begin with Jeff Schult. In the spring of 2004, he headed to Central America for a dental makeover, and he wrote about it in the now-defunct Hartford Courant Sunday magazine. He joins us from a studio at Yale University in New Haven, Connecticut. Nice to have you on the program today.

Mr. JEFF SCHULT (Author, "Beauty from Afar"): Nice to be here, Neal.

CONAN: And you went to Costa Rica for dental work, how come?

Mr. SCHULT: I needed extensive dental work. The enamel on my teeth was - had worn off much earlier than it's supposed to. The teeth that are supposed to last me a lifetime just simply weren't.

CONAN: Mm-hmm.

Mr. SCHULT: By about 2001, 2002, I was aware I needed dental work, and I had it priced - looked at and priced here in the United States - and was told it would cost upwards of $15,000, possibly as much as $30,000, and that was out of the question on my budget.

CONAN: So you then investigated other possibilities, and I'm wondering how you found your doctor.

Mr. SCHULT: Well, I found my doctor online. Initially I had not contemplated going overseas. It just really wasn't on my radar until I ran across it in an online discussion group appropriately enough about outsourcing, and there was a post about it. It was a discussion of outsourcing of programming, call centers, etc., everything we've all hear of.

CONAN: Sure.

Mr. SCHULT: And somebody mentioned that, gee, it's not just those things, it's also medical services and went on to describe a trip that a friend of theirs had taken to Bumrungrad Hospital in Thailand. And I sort of looked at that and went, huh, I wonder if they do teeth. And I looked into Thailand. I looked into a number of different countries. At the time, at any rate, there seemed to be the most information about Costa Rica, and I found a dentist there, established a conversation online and a relationship over the course of a month that led to my realizing that in the course of many, many questions and e-mails that I knew more about this dentist in Costa Rica than I'd ever bothered finding out about a doctor of mine in the United States...

CONAN: So...

Mr. SCHULT: So I was confident enough to proceed.

CONAN: As opposed to maybe $30,000 here at home, it ended up costing...

Mr. SCHULT: The dental work itself cost about - a little over $7,000. The whole trip ran me about 9,000.

CONAN: And have you had any problems since then?

Mr. SCHULT: I - the work was wonderful. I had it looked at back here in the United States by a leading dental surgeon, who told me that they did wonderful work, that it was world class work, and that I got a great deal.

CONAN: Mm-hmm. But as you've looked into this - you know, you wrote this article for the Sunday magazine there - I know that you haven't covered some examples, that there are risks involved here.

Mr. SCHULT: Absolutely. I mean I looked into it and I, you know, read online extensively about patients going to, you know, every different country for every different kind of procedure. A great deal of it is cosmetic surgery and dentistry, and you really have to do your homework. But more and more, you know, since 2004, you know, just in the last two, three years, more and more hospitals, facilities and clinics are starting to cater to Americans, knowing how to cater to Americans, providing the credentialing information that patients would want, providing the references that patients would want, and it's becoming easier to research this on your own. I wrote "Beauty from Afar," a book, as a follow-up to the article essentially that I wrote, and it tells people how to think about it, how to approach it, how to look at it.

CONAN: And I guess the main question, a lot of concern that people would have is, what do I do if something goes wrong? My doctor's suddenly going to be X thousands of miles away.

Mr. SCHULT: That's absolutely true. You know, it's important to look at the pre-care issues and at the aftercare issues. I mean I certainly encourage people to make arrangements for aftercare, to make sure that they, you know, are in communications with their medical providers in the United States. More and more we're finding that doctors are used to this, hospitals are used to this, and insurers are, as you mentioned earlier, are looking at this. It's - the United States is part of a global medical network, and doctors are learning that they need to cooperate in this way.

CONAN: And I guess you hear the same arguments about outsourcing as you hear if you're shipping a manufacturing plant overseas. One side says this is a global marketplace. If these people can provide good services at reasonable prices, why shouldn't we use it? On the other hand, other people say, wait a minute, you're stealing work from people who need it at home.

Mr. SCHULT: Well, at this point, Neal, as we said, the insurance industry is looking at this. But it's being led and driven by consumers who for elective care and care that is usually covered by insurance - for the underinsured or the uninsured it's being driven by people who just go I can't afford it here and I have to have this. Literally hundreds of thousands of people going outside of the country and, you know, the business is following along behind in the outsourcing of this, trying to make it as seamless as possible for these people.

CONAN: Well, have you gone overseas for health care? Would you go thousands of miles if it saved you tens of thousands of dollars? 800-989-8255, 800-989-TALK. E-mail us: talk@npr.org. And Dee Dee's on the line, Dee Dee calling from Ithaca, New York.

DEE DEE (Caller): Hi, yes, Neal, a huge fan of your show. Thank you very much.

CONAN: That's kind of you. Thank you.

DEE DEE: Yes, I was just going to comment on a root canal job that I did India, and I had one done here in Ithaca as well. And I paid about 1,500 for the tooth, and then when I went to India, I had another tooth done there, so - and…

CONAN: And what was the price in India?

DEE DEE: What's that?

CONAN: What was the price in India?

DEE DEE: About $250.

CONAN: About $250, so that's a...

DEE DEE: Yes.

CONAN: But does that cover the price of a plane ticket to New Delhi?

DEE DEE: Actually, my parents live there, so...

CONAN: Ah, so you were on a visit home anyway.

DEE DEE: Yes, anyways, and then I would - I could say the job that I did there was much better than here because I still have pain and numbness in - like hot and cold sensation in the job that I did here.

CONAN: Uh-huh, yeah.

DEE DEE: Whereas the job that I did there, like I think the tooth's dead so it's not bothering anymore, so…

CONAN: Mm-hmm.

DEE DEE: But here I went back - kept on going back to the dentist that did the job, and then I had to go again and again, and after a while I just said like just forget it. That's too much...

CONAN: Hmm.

DEE DEE: So I would say I highly recommend.

CONAN: Thanks very much for the call, and we're glad you - we hope your problems with the touchy tooth...

DEE DEE: Thank you so much, Neal. A huge fan again.

CONAN: OK, thanks very much for the call. And it's - I guess it's common that people who live in states bordering Mexico are known to head south for dental procedures as well, Jeff Schult.

Mr. SCHULT: Absolutely. In the last couple of years, it's Thailand, India, Malaysia, as you said, that have gotten a lot of the media attention for this, you know, in part because of their doing, you know, very high-end procedures for Americans - hip resurfacing, heart valve surgery, etc. But for many years, the - and it's still the case - the bulk of the medical tourist traffic in this country is still along our southern border with Mexico, for dental, for cosmetic surgery.

In Southern California, actually, you can - if you live within 50 miles of the border, you can buy health insurance that says that you go to Tijuana, to Mexico, for non-emergency medical care, and that's providing - in some ways - a model for what might happen in the - in medical care for other countries.

CONAN: Let's get Victoria on the line, Victoria with us from Fairbanks in Alaska.

VICTORIA (Caller): Hello.

CONAN: Hi.

VICTORIA: Hi, thanks for your program. It's wonderful.

CONAN: Thank you.

VICTORIA: Listen, a lot of Alaskans go to Canada regularly for eye care, dental care, checkups of all kinds. Two years ago, I had to have a root canal for $2,500. I went to Canada and had it done for 700 Canadian dollars. Excellent care, reasonably priced, and it's just out of control in our states, that's all.

CONAN: Mm-hmm. And similarly I guess, Jeff Schult, there are a lot of Canadians who come south of the border when they need situations that their national health coverage does not do well - for example, hip replacements, that sort of thing.

VICTORIA: Uh-huh, uh-huh.

Mr. SCHULT: Yeah…

VICTORIA: Well, it's…

CONAN: I wanted to hear from Jeff on this. Excuse me just a moment, Victoria.

VICTORIA: OK.

Mr. SCHULT: Yeah, absolutely. I mean, there - certainly there are, you know, Americans going to Canada for health care. I mean, the costs in Alaska that you mentioned are, you know, much higher than you're going to find in the lower 48. But there are a lot of Canadians, also, who are waiting for procedures in their national health care system who find that, you know, they're going abroad for health care, either to the States - but they're also going to, you know, to India, Thailand, Europe, Central America.

CONAN: Hmm. Victoria, thanks - and your surgery worked out OK, no problems?

VICTORIA: Everything's been fine, sure.

CONAN: So - and you'd have no hesitation about going back.

VICTORIA: Not at all. I recommend it to everyone.

CONAN: OK, Victoria, thanks very much for the call.

VICTORIA: Thank you.

CONAN: And I wonder, Jeff Schult, are there conditions or, you know, limits to where you would go or what kinds of medical procedures you would consider having overseas?

Mr. SCHULT: Well, Neal, when I think about it - I mean, obviously, I started off this whole journey of mine - as far as my experience in writing about it -with dental care, which I felt was, you know, not exactly life-threatening, necessarily.

CONAN: Mm-hmm.

Mr. SCHULT: But, you know, when you look - as I looked more into it, when you look at the major metropolitan areas of the world, the medical care has caught up, and in some cases - as far as patient care - surpassed what is available sometimes in the United States. You'll hear patients - as we are today -talking about how wonderful their treatment was, and it's just as modern.

Certainly, very high-end treatments, you know, you have to look at - you know, for cancer, etc., you know, there are specific hospitals in the United States for research, advance treatment, where we are clearly still the world leaders, and you might want to look there. But we're also the most expensive for everything. We're not cost-competitive on these things.

CONAN: Jeff Schult, stay with us, if you would. We're talking about medical tourism and some of the concerns that come with traveling overseas for major surgery. If you've traveled abroad for surgery, let us know: 800-989-8255, 800-989-TALK. You can also send us e-mail: talk@npr.org.

I'm Neal Conan. We'll be back after the break. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan, in Washington.

More and more Americans are lured overseas for medical treatment, with savings of up to 80 percent on some surgeries. Today, we're talking about the pros and cons of medical tourism and why some people choose a dose of sightseeing with their surgery. Our guest is Jeff Schult, author of the book "Beauty from Afar." And, of course, you're welcome to join us. If you've traveled overseas for medical care, would you outsource your surgery if it saved you tens of thousands of dollars? 800-989-8244. E-mail us: talk@npr.org. You can also comment on our blog at npr.org/blogofthenation.

And joining us now is Patrick Marsek. He's managing director for MedRetreat, a company that helps to connect patients with hospitals overseas. He joins us today from our bureau in Chicago. Nice to have you with us.

Mr. PATRICK MARSEK (Managing Director, MedRetreat): Hi, Neal, thanks - nice to be here with you today.

CONAN: Jeff found a lot of the information for his trip and for his subsequent article and book on his own. Your company does the legwork for people. What are some of the things that clients want from foreign hospitals?

Mr. MARSEK: Well, Neal, mainly, over the past three and a half years, they've been looking for cosmetic surgery. However, in the past year and a half, I would say, they're looking for more procedures such as hip replacements, knee replacements, spinal fusions, spinal disc replacement, a lot of gynecological procedures such as hysterectomies, ovarian cyst removals, things like that -more complicated procedures as opposed to the cosmetic, elective surgeries.

CONAN: And how can you reassure them that a hospital and the doctor are safe?

Mr. MARSEK: Well, we've traveled throughout the world to find qualified hospitals to be able to offer to our clientele, so as a result, we have a very intricate process of qualification. And we've invested probably about a year and a half of our time and thousands of man hours and hundreds of thousands of dollars to be able to do this. We want to guarantee that when people travel overseas, they're working with the very best hospitals in respective countries.

CONAN: Mm-hmm. Well, many doctors, Indian doctors, come here for education, for learning their medical practice. And I wonder, do you specifically look for hospitals who have doctors trained in the U.S.?

Mr. MARSEK: Well, that's a great question. What we mainly look for - first of all, we look for hospitals that are accredited. There's an organization in Chicago called JCO. They have an international arm which is call JCI, Joint Commission International. That's always the best alternative.

Other than that, there are also hospitals that are ISO certified, as well as certified in their own countries. Although many of the doctors overseas are trained in either the U.S., the U.K. or Australia, they tend to go back home to work in their respective countries to kind of spend time with their families, you know. So it's a great situation for them to come here for the training.

With that being said, also, many of the hospitals we work with have affiliations here in the U.S. - hospitals such as Johns Hopkins, Mayo Clinic, Cleveland Clinic - and these hospitals have associations overseas where they cross-train with the doctors and they share their procedures. And it's a very good way for them to make this global health care issue actually a good alternative for Americans to go aboard.

CONAN: The first set of surgeries you talked about - cosmetic surgery -typically is not covered by medical insurance. That second set of surgeries you were talking about - the hysterectomies and the like - they typically are. Are the people who are going overseas - or are interested in going overseas - are they people who don't have health care coverage, health insurance, or are they being sent in some cases by health insurance companies?

Mr. MARSEK: Well, there - we have three divisions. One is our consumer division. Our consumer division consists of uninsured Americans, underinsured Americans, or those seeking elective cosmetic surgery. As well, the other divisions are business and institutional division and insurance division, which are seeking procedures for less cost. Now in the first case, with the consumer division, mainly these people do not have insurance, and they're paying out of their pockets. So they're receiving savings of between 50 and 80 percent on what they would have to pay here in the U.S. on their own.

CONAN: And there are concerns though, also, about aftercare and, you know, if a doctor messes up in the United States, you can sue the doctor.

Mr. MARSEK: Mm-hmm.

CONAN: Can you sue somebody in Thailand?

Mr. MARSEK: Truthfully, it would be very difficult to do that. You know, trying to sue someone overseas internationally is very tough. First of all, you'd be hard pressed to find an attorney that would take that on a contingency basis, so you would probably have to afford the expense of doing that on your own. What we like to say is if one of your major concerns is being able to sue if something goes wrong, you probably should not consider medical tourism because it would be very hard to do that.

(Soundbite of laughter)

CONAN: Yeah, you're chuckling there, Jeff Schult.

Mr. SCHULT: Yeah, I have told people pretty much the same thing. If your number one concern is, gee, if something goes wrong, can I sue? Probably the doctor is - you know, a doctor here in the United States is going to be pretty leery of treating you as well.

CONAN: Mm-hmm.

Mr. MARSEK: Yeah, you know, in fact, more to that point, you know, these people that are actually choosing to go overseas, they don't really have a choice. It's a matter of quality of life, so money's not really a big concern. But also, you have to know that a lot of these hospitals that are overseas do give a guarantee. They'll make you whole. Although they won't provide you with financial reward, they will do everything in their power to make you better.

CONAN: Wait a minute. You just said money's no concern. I thought the price differential was the principle attraction of this.

Mr. MARSEK: Money is no concern - well, money is a concern for the clients…

CONAN: Ah.

Mr. MARSEK: …but I'm saying - yeah.

CONAN: OK, all right.

Mr. MARSEK: You understand what I'm saying?

CONAN: Yeah, I get you. All right. Let's see if we can get a caller on the line. This is Josh. Josh is with us from Salt Lake City.

JOSH (Caller): Hey, how you doing today?

CONAN: Very well, thank you.

JOSH: Thanks for your show. Hey, my question and concern is with me and my wife. I've been having doctors tell me that in vitro or intrauterine fertilization to have a baby here in the States - for in vitro, it's going to cost anywhere from 20 to $24,000. And intrauterine, obviously, is a procedure that's a lot less expensive but…

CONAN: Still not cheap.

JOSH: …no guarantees.

CONAN: Yeah, and…

JOSH: I'm wondering if there's anywhere else out there that might be able to help us with those types of procedures.

CONAN: Patrick Marsek, is this one of the areas in which you have people approaching you with curiosity?

Mr. MARSEK: Yes, we do. Here's the thing with in vitro. You really have to spend quite a bit of time overseas. So although you're going to be saving money on the actual procedure, you also have to consider your cost of being there for a certain period of time. And many people can't get away for that period of time. It's best to be able to stay for two cycles…

JOSH: Mm-hmm.

Mr. MARSEK: …and, you know, that could be a month and a half to two months. So the question becomes do you have the time away from home to be able to do that? So it's more of a time issue than a cost-savings issue, and sometimes that's very prohibitive for people.

CONAN: Or, Josh, make sure you pick an interesting country.

(Soundbite of laughter)

JOSH: Yeah, no kidding. Well, my wife does teach school, so she does have the summers off, and that might be a possibility for me as well. But, yeah, it is an interesting procedure. Would you recommend any countries to do that?

CONAN: Well, maybe you want - might want to go to the Web site and deal with him directly rather than do that on the radio. OK, Josh?

Mr. MARSEK: That's a good idea.

JOSH: You got it. You guys have a good one.

CONAN: OK. Thanks very much for the call. And I wonder, getting back to this health insurance, you say companies are sending employees overseas. You can see their interest in the cost differential. But are health insurance - how interested are they, Patrick Marsek?

Mr. MARSEK: Well, we're in negotiations right now with several health insurance companies. We're trying to develop a model, a good model - a working model, by which we can facilitate this for them. There are many issues to be considered, and we're working through that right now. We have an insurance company that's looking to actually start offering this by the first of January of 2008. However, at this time, I'm not aware of anybody actually offering that full-blown type of a program.

CONAN: OK, Patrick Marsek, thanks very much for your time. Appreciate it.

Mr. MARSEK: It's my pleasure. Thank you, Neal.

CONAN: Patrick Marsek, directing - managing director for MedRetreat, and he's been talking to us from NPR's bureau in Chicago.

Well, let's bring Helen Darling into the conversation. She's president of the National Business Group on Health and a critic of medical tourism. She joins us here in Studio 3A in Washington. Nice to have you on the program today.

Ms. HELEN DARLING (President, National Business Group on Health): Thank you.

CONAN: Is this indeed a trend? I mean, we're talking about more and more people going overseas for health care?

Ms. DARLING: Well, there may be more that are going for discretionary care or something like dental care for which there frequently isn't coverage, or cosmetic surgery, or people who don't have any kind of coverage. But if the question is is it a trend among employers, either requiring it or doing it…

CONAN: Mm-hmm.

Ms. DARLING: …or even providing incentives to do it, or insurance companies, I don't believe so.

CONAN: Well, we heard that - Mr. Marsek said he's in negotiation with…

Ms. DARLING: Yes.

CONAN: …insurance companies. It means he doesn't have a deal yet.

Ms. DARLING: Right, an artful term.

CONAN: An artful term. What are the hesitations that you might suspect health insurance companies might have about sending patients overseas?

Ms. DARLING: Well, there are a lot of different concerns. Now there's a big difference between someone - one of the other callers talked about going to Canada from Alaska…

CONAN: Sure.

Ms. DARLING: …or across the border even in Mexico, as opposed to going for 16 hours on a plane - that's just on the plane, not counting to and from the plane and all that - to a place like India from the United States. I think the likelihood that employers or large health insurance companies will be sending people to places like that is very slim. Now they might - if they have employees in China…

CONAN: Mm-hmm.

Ms. DARLING: …they might have them all go to Singapore or India, because actually there's much superior care.

CONAN: Or in the Middle East to Dubai or someplace like that, yeah.

Ms. DARLING: Or the Middle East, exactly, exactly. I mean, there might be a lot of medical tourism around the world, where they're going for the best care, not because they're trying to get away from something, like just the slightly higher cost. So I don't think it's a trend. And some of the problems are - as a point you made in a question - complications.

I mean, it's actually hard enough if you just got care here - we're hear in Washington D.C. - from one group of doctors and there were problems and you had tried to go to another group of doctors. That would - you know, they're not eager to take on the problems that somebody else has created.

CONAN: Cleaning up somebody else's mess.

Ms. DARLING: Right.

CONAN: Yeah.

Ms. DARLING: So you're going to have problems right there. I mean, aftercare would be automatically problematic, including if it's your own physician.

CONAN: Mm-hmm.

Ms. DARLING: If there's travel involved, I mean anybody who travels knows that travel itself is stressful. So if you have a medical problem as opposed to you just want to look better…

CONAN: Right.

Ms. DARLING: …then right there you're putting yourself at risk. And frankly, if it's your employer or health insurance company, what's going to happen if you have an embolism on the way to flying to India to have, you know, cardiac surgery.

CONAN: That's a good question.

Ms. DARLING: Now, in this country you can be sure that everybody would be sued.

CONAN: Yeah. On the other hand, if there was an option for this, maybe, in a health insurance package. If - a lot of people took this - all of us might pay significantly less for healthcare coverage.

Ms. DARLING: Well, it would be very complicated to get a system to move in that direction. But even then, I mean, think about it. If a company - let's say you sign a waiver and you say it's not - I promise you I'm not going to sue anybody - and they could go in if something goes wrong and they'll say, well, I signed this but I really didn't know what I was doing and you made it so attractive for me. And so then both the company and the health plan could be liable. I mean, I just think it's a risk that seems unnecessary to take.

CONAN: Well, if you're talking about differences in costs of up to 80 percent, that's no minor deal.

Ms. DARLING: No, it's not, but the cost of the risk you're taking, the possible liability and all the problems, the complications - because you'll pay for the complications, too.

CONAN: Mm-hmm. We're talking with Helen Darling, president of the National Business Group on Health. Also with us still Jeff Schult, who's the author of "Beauty from Afar." If you'd like to join the conversation our number is 800-989-8255, 800-989-TALK. Our e-mail address is talk@npr.org. And you're listening to TALK OF THE NATION coming to you from NPR News.

Now let's get another caller on the line. This is Amanda. Amanda with us from St. Louis in Missouri.

AMANDA (Caller): Yes. Hi. I've actually been working in the health care industry for 15 years. Sort of as a jack of all trades thanks to my father who has been in hospital administration for over 35 years. And I guess I really had a bit of a qualm with JCAHO being referred to as a source of accreditation.

Anyone who has worked in the industry long enough sort of realizes that JCAHO is fairly superficial. It's not state or federally required. There are other better sources of accreditation, things that are required by federal and state sources. Of course, you can't necessarily get overseas, but I would think that there might be something better to look into.

And I'm actually going into a completely unrelated field now. I'm studying archaeology as a second career, specifically Southeast Asia. And after having been there, I would have no qualms about having a procedure done in Bangkok.

CONAN: Hmm.

AMANDA: And, in fact, many - you know, if something were to happen to you, say you were in Cambodia, they would fly you to Bangkok for an emergency procedure.

CONAN: Helen Darling?

Ms. DARLING: Yes. Well, there's - actually what I said doesn't have anything to say about whether care in places like India, Thailand, Singapore - are good or not. There actually is excellent care.

The question is - there's excellent care here too in some instances, and if you're sitting in the United States and you've got to decide are you going to go two blocks away to a hospital, or even go to New York City, or Boston, or Cleveland or something like that, or fly to India, then it seems to me it's going to be very hard to get people to want to do that. And especially if they haven't been there and they don't yet feel comfortable. I mean, if you grew up there but you live in the United States, that's one thing. But the idea that people would easily do it, I think is improbable.

CONAN: And Jeff Schult, on the accreditation point that Amanda was making?

Mr. SCHULT: I think that - I've certainly heard many people say what she has said about JCAHO and JCI and I think it's - you know, I can understand where she's coming from as far as it being perhaps superficial. I also think it's, you know, it's a way of comparing a way of holding up to a certain standard.

I think within the various countries and the hospitals there are other accrediting agencies, bureaus - that are evolving that I think, as this industry develops, we'll see, you know, how much weight they hold with consumers and within the medical profession.

CONAN: Amanda, thanks very much for the call. Good luck digging things up.

AMANDA: Thank you very much. Oh, thanks.

CONAN: Bye-bye. Let's see if we can squeeze in one last call. This is Bob. Bob with us from Orinda, California.

BOB (Caller): Yes. Hello. Well, I had a negative experience in the Philippines. I was there for a family wedding. I developed a kidney stone, and I was rushed to the hospital. And a cardiologist there, who knew the family, said, get your son-in-law out of here. The guy who's going to do the surgery, I saw one of his patients in - bleeding all over the recovery area.

So my brothers-in-law came, got me, put me in another hospital. And after five days of pain and agony, they said your kidney stone is gone. Here's the x-ray. They had put a shunt in. They said when you get home be sure to see your doctor to take it out. I came back and my doctor said let me see that x-ray. And he said, oh, there's your kidney stone. They haven't - it's still there.

CONAN: But this was a situation where you did not go there with the idea of having this procedure there, and it was I guess catch as catch can in the town where you went for health care and it came up sub par.

BOB: Well, yes, but my family is well connected. Those are the high profile hospitals.

CONAN: Uh huh. All right. Well, a cautionary tale that…

BOB: Beware that in countries where there's a lot of corruption, people can be hired to take your exams for you and there are various other things like that. And this is what we have discovered.

CONAN: Medical exams and that sort of thing.

BOB: But be aware.

CONAN: Ok. Bob, thank you for the caution.

BOB: You bet.

CONAN: Appreciate it. And we wanted to thank our guests for their time today. Helen Darling was with us here in Studio 3A. She's president of the National Business Group on Health. And we need to thank Jeff Schult, the author of "Beauty from Afar," who joined us from a studio on the campuses of Yale University in New Haven. Thank you both for your time. We appreciate it.

Ms. DARLING: Thank you.

Mr. SCHULT: Thank you, Neal.

CONAN: When we come back from a short break, Democratic Congressman Patrick Murphy, the only Iraq war veteran in Congress - just back from his first trip to Baghdad since leaving the service. He joins us and takes your calls. 800-989-8255, 800-989-TALK. E-mail is talk@npr.org. I'm Neal Conan. It's TALK OF THE NATION from NPR News.

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