More Mix Travel With Surgery to Cut Costs

By Karen Shideler


Wanda Bough of Eureka combined surgery and a vacation and saved herself almost $23,000.

She’s among a growing number of Americans who are opting for medical treatment in a foreign country because of soaring costs at home.

It’s a trend called medical tourism or medical travel. It began a few years ago with cosmetic procedures but has evolved to include hip replacements, heart bypasses and stomach stapling.

Many of those going abroad don’t have health insurance or are having procedures not covered by their insurance, as was Bough’s case.

They find that airfare, accommodations, medical care and other expenses add up to far less than what care would have cost them at home.

And the care they get, say Bough and representatives of medical tourism companies, is first-class.

It’s not risk-free; no medical procedure is. And insurance companies and physicians say patients have to understand what they’re getting into.

David Boucher is president and chief executive of Companion Global Healthcare, created by Blue Cross Blue Shield of South Carolina. He heard about medical tourism in 2005 and visited Bumrungrad International Hospital in Bangkok as part of a vacation in 2006, “never thinking in a million years that it was going to turn into a business opportunity,” he said.

“I was amazed at what I saw,” he said: traditional Thai hospitality, highly trained physicians, and American medical equipment and pharmaceuticals.

Insurance companies and medical tourism

Bough, who is 30, was equally impressed in Costa Rica, where she had a hysterectomy. “You could eat off the floors there,” said Bough, a registered nurse. “The hospitals were spotless.”

She and her husband were greeted at the airport and housed at a “very nice hotel.” Her nurses were bilingual. When she left the hospital, a nurse accompanied her to the hotel, and her doctor gave her his home and cell phone numbers.

Boucher was so impressed by what he saw in Thailand that he pushed for expansion into medical tourism when he returned to South Carolina, where he worked for Blue Cross. At Companion, he helps patients make arrangements for treatment at Bumrungrad, six other hospitals and two dental clinics.

Blue Cross Blue Shield of Kansas hasn’t ventured into medical tourism, said spokeswoman Mary Beth Chambers. But the national Blue Cross Blue Shield Association is talking about “broadening the horizons.”

“We would certainly encourage anyone who is considering it to fully research what their options are and to consider all of their out-of-pocket expenses,” she said.

Denied by insurance

That’s what Bough did.

She had suffered for years from excessive bleeding, low hemoglobin and anemia. “I had tried most conventional treatments,” she said, and none worked. Her family doctor referred her to an ob-gyn, who scheduled her for a hysterectomy in mid-October.

“A week before I was supposed to have surgery, I got a letter from my insurance company saying it wasn’t a medical necessity,” she said. She appealed, but “it was just a no-go.”

Even with her employee discount at Via Christi Regional Medical Center, the cost for her hysterectomy would have been at least $15,000 and probably more than $30,000, she said.

That’s when she started researching medical tourism.

She found Healthbase, a company in Massachusetts. The hospitals it works with are accredited by the Joint Commission International or similar bodies. The Joint Commission International is affiliated with the group that accredits hospitals in the United States, “and I know how hard it is for us to pass” certification visits, Bough said.

The hysterectomy cost her $4,800 at Hospital Clinica Biblica in San Jose, Costa Rica. She spent a day and a half in the hospital, though her doctor encouraged her to stay longer. Accommodations were $1,000. Airfare was about $1,400 for Bough and her husband. The total: About $7,200 for the week-plus they were in Costa Rica.

Why costs are less abroad

Boucher said the average price for five major surgical procedures in South Carolina is $77,000. At the hospitals Companion works with, the averages range from $11,000 to $21,000.

Saroja Mohanasundaram, chief executive of Healthbase, said cost is the No. 1 factor for consumers, but quality is the top consideration for her company. In addition to accreditation, hospitals used by Healthbase must be prepared to handle international patients. Americans, for example, demand medical information; in some cultures, information isn’t fully divulged because patients don’t want it, she said.

Mohanasundaram said orthopedic, cardiac and spinal procedures are the most common among her company’s patients. The majority are uninsured, but many are underinsured and discover that co-insurance and high deductibles make it cheaper to go abroad.

Why is it less expensive?

“The No. 1 reason is labor charges,” she said. In addition, malpractice insurance is much cheaper, she said, as are the costs for devices such as artificial hips.

Wichita physician Steen Mortensen, president of the Medical Society of Sedgwick County, acknowledged that costs are lower abroad and that care can be superb.

The problem, he said, is that there are still too many questions in an evolving field. A patient who develops complications after returning home, for example, may discover that insurance won’t pay for care because the original procedure was done elsewhere.

On the other hand, he expects medical tourism to continue growing. Some insurance companies already are sending patients abroad, he said, much as they send patients to domestic “centers of excellence” for treatment.

Bough has spread the word about her good experience, which included scuba diving and a visit to a Costa Rican dental clinic. She and her husband had cleanings, cavities filled and teeth whitened. They paid $800.

Reach Karen Shideler at 316-268-6674 or


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Copyright (c) 2008, The Wichita Eagle, Kan.

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Source: The Wichita Eagle (Wichita, Kan.)

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