High costs send patients overseas for medical, dental care

By KAREN GARLOCH McClatchy Newspapers

Patients in the United States travel to Duke University, Johns Hopkins or the Mayo Clinic for medical care.

Today some venture even farther — to far-flung places such as Costa Rica, Thailand, India and Singapore.

Last year, an estimated half-million Americans traveled overseas for medical treatment. It’s a growing trend among not only the well-to-do who want tummy tucks and face lifts, but the working-class uninsured searching for affordable heart surgery, knee replacements and dental work.

Businesses and insurance companies are looking at the potential savings of outsourcing medical care to developing countries where labor costs are low and malpractice suits are almost unheard of.

Two years ago, Howard Staab, a self-employed, uninsured Durham, N.C., carpenter, chose to travel to India for heart valve surgery. The cost in India was $6,700. At nearby Duke University, the same operation would have cost about $200,000.

Although the phenomenon has been called “medical tourism,� Maggi Grace, a friend who accompanied Staab to India, said they weren’t looking for an inexpensive, exotic vacation.

“We were fighting for Howard’s life,� she testified in June before a U.S. Senate committee hearing on the subject. “Howard had to travel across the globe at a time when his heart needed to rest.�

Hospitals in India treated 150,000 foreign patients in 2005, according to IndUShealth, a Raleigh, N.C., company that arranges overseas surgery. Costs for medical care are routinely 70 to 80 percent less in India compared with the United States.

In Bangkok, Bumrungrad International Hospital has fountains, white marble floors and a Starbucks in the lobby. In 2005, it treated 58,000 Americans, a 25 percent increase over the year before.

“It’s just one of the many ways in which our world is flattening,� said Arnold Milstein, chief physician at N.Y.-based Mercer Health & Benefits.

“These patients are not ‘medical tourists’ seeking low-cost aesthetic enhancement,� he wrote in a recent New England Journal of Medicine. “They are middle-income Americans evading impoverishment by expensive, medically necessary operations.�

Making long overseas trips — including 14-hour flights, language barriers and culture shock — is not for everyone. Patients are without the comforts of home, family and friends. Jet lag, traveler’s diarrhea and strange foods combine with the unpredictable, such as September’s bloodless coup in Thailand. Pollution, poverty and insane traffic are part of the experience in New Delhi.

“It is a Third World country,� Grace said of India. “There are cows in the street.�

But she and others say the medical care rivaled what they expected at home.

“The care is superb over there,� said Grace, who has been asked by so many people about Staab’s experience that she has written a book about it.

“Instead of having one nurse running around answering buzzers and call buttons and saying ‘I don’t have time,’ there are three nurses coming in at the same time, asking ‘Can I get you some water?’ �

Interest in overseas medical care is driven by a growing number of uninsured Americans, rising out-of-pocket expenses and insurance premiums that have increased beyond the grasp of many, according to Milstein.

Premiums for employer-sponsored health coverage have surged 87 percent over the past six years, according to the Kaiser Family Foundation. Family health coverage now runs about $11,500 annually, with workers themselves forking out nearly $3,000. In some low-wage industries, more than 75 percent of eligible workers turn down employer-provided health insurance, Milstein wrote.

High insurance costs prompted Blue Ridge Paper Products Inc., in Canton, N.C., to explore the idea of offering incentives to employees to seek medical care overseas.

Employee Carl Garrett volunteered to go to India in September for a gall bladder operation. He would have been the first U.S. employee sent abroad for medical care through an employer-sponsored program that allowed him to share the company’s savings. But the trip was canceled when his union, the United Steelworkers, objected.

“We don’t want to expose our members to the risks associated with providing health care in the Third World,� said Stan Johnson, a union spokesman. “This is perceived as voluntary, but voluntary programs tend to lead to mandatory programs.�

Some insurance companies will cover overseas care. Blue Shield of California and Health Net of California offer low-cost policies allowing members to seek care in Mexico. United Group Programs, based in Florida, offers a plan that sends patients to Bumrungrad; UGP says it will save employers more than 50 percent on major medical costs and slash employees’ out-of-pocket expenses to zero.

IndUShealth works exclusively with hospitals in India. The Raleigh company sent a few dozen patients in 2005, but this year it has sent several hundred, according to Rajesh Rao, CEO and co-founder.

By the second quarter of 2007, Rao projects the company will have contracts with businesses representing a half-million employees, compared with the 100,000 it covers today.
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