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20070702-HA-MEDICAL-FOREIGN-20070702

David Wenner, The Patriot-News, Harrisburg, Pa.

Jul. 2--Some hospitals in foreign countries are more focused on attracting American patients than treating people who live right outside their doors.

Some are as big as the largest U.S. hospitals. They boast the most modern equipment and more nurses per patient. Some entice patients with visions of recovering on the beach.

But the biggest attraction is they are much cheaper than U.S. hospitals. They are part of an industry called "medical tourism."

Such hospitals cater to Americans seeking affordable health care. They also attract people from countries with government-run health care programs seeking to avoid long waits.

There are no statistics on how many U.S. residents travel abroad for medical care, says Josef Woodman, author of a book on the subject. But he estimates that 150,000 people from the U.S. and Canada travel abroad annually for medical or dental care.

About 40,000 go to Mexico for dental or cosmetic surgery, he estimates. Another 40,000 go to other countries for cosmetic surgery. The rest, he says, are people who go to foreign countries for surgeries, joint replacement, cancer treatment and in vitro fertilization.

Most of them have no health insurance and are taking advantage of lower prices, he says.

Treatment costs in foreign countries are often 30 percent to 80 percent lower than in the United States, say Woodman and other experts.

Promoters tout that Americans can have major surgery at a foreign hospital, indulge in a luxurious vacation and still pay far less than they would at home.

Woodman's book, "Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism," is a guide to seeking such care.

Unless the procedure costs at least $6,000 in the United States, it's probably not worth it to go abroad for the medical care, he says.

Woodman says he evaluated hospitals in many countries and surveyed patients. Based on his research, he endorses about 22 hospitals in 14 countries, including Brazil, Costa Rico, Thailand, Singapore, India and the Czech Republic.

"If you travel to the biggest hospitals in any of those countries -- we're talking a very few, select hospitals -- chances are the care you receive will not only be as good, but it will be better care all the way across the board," he says.

More and more hospitals are focusing on medical tourists. They have a strong presence on the Internet. A growing number are accredited by the Joint Commission International, meaning they adhere to standards similar to those in the United States.

MedRetreat is a firm near Chicago that helps American and Canadian residents arrange trips to foreign hospitals. It handles all the details, including helping the patient select a surgeon and hospital, booking travel and picking the patient up at the airport.

The company served about 350 customers in 2006 and expects to serve 650 this year, says Patrick Marsek, the managing director.

Marsek says the company doesn't charge a fee to clients. It makes its money from discounts it receives from hospitals where it sends patients.

He agrees that the number of Americans traveling abroad for medical care is tiny compared with the number who obtain care in the United States. But he says it will soon explode.

Marsek wouldn't name them, but he says MedRetreat is in discussions with businesses and health insurers interested in using foreign hospitals to hold down costs. A drawback is that, fearing bad publicity, no company wants to be first, he says.

He points to the controversy that erupted last year when Blue Ridge Paper Products in North Carolina wanted to send an employee to India for gallbladder removal and shoulder surgery. It would have been the first case of someone with employer-sponsored health care being sent overseas for health care.

According to news reports, Carl Garrett, 60, liked the idea -- he would have shared in the cost savings. But his union, the United Steelworkers, objected and demanded that Blue Ridge provide a local option.

Dr. Robert Muscalus, medical director for Highmark Inc., the largest health insurer in the state, says he's unaware of Highmark ever discussing seeking lower-cost care in foreign countries.

He's cool to the idea. For one thing, it would be hard for Highmark to credential the foreign doctors and ensure quality standards, he says. In addition, sending patients to foreign countries would conflict with Highmark's mission of supporting local health care providers, he says.

Cliff Shannon, president of SMC Business Councils, a trade group that helps obtain health insurance for members, says he's unaware of Pennsylvania companies sending employees abroad for health care.

Shannon is a frequent critic of the quality of the U.S. health care system and the high cost. But even with the prospect of lower cost and high quality, he doubts foreign hospitals will ever be a popular option.

"It sounds pretty good on paper for somebody else to do it," he says. "But to be seriously ill, the prospect of getting on a plane and flying halfway around the world is pretty daunting."

Dr. Harold Paz, CEO of Penn State Milton S. Hershey Medical Center, doesn't see foreign hospitals as a serious business threat.

Two of the most important components of health care -- care for the critically ill or injured and preventive care -- are most practical and affective when provided close to home, he says.

He recognizes that U.S. health care costs are unaffordable to some. It reaffirms that U.S. hospitals must figure out how to provide more affordable care, he says.

Paz also points out that many people come to the U.S. seeking operations they can't obtain elsewhere.
Dr. Roger Longenderfer, CEO of PinnacleHealth System, also doubts that medical tourism will ever have widespread appeal.

"I think it's a little foreign, pardon the pun, to most people. I think most people would like to use local services," he says.

But he also says the fact that people can extol the cost advantages of foreign hospitals points to a problem with the U.S. health care system.

"I think we should look at it and say, 'What lessons can we learn? How can we serve the public better so they don't feel they have to leave?' " he says.

TRAVELING FOR HEALTH CARE

Here's some advice from Josef Woodman, who has written a guide to obtaining medical care in foreign countries:
--Be fully informed about your diagnosis and what kind of treatment you need and want. Working with your U.S. physician or dentist, obtain exact recommendations, and try to get them in writing.

--Use a good health travel planner that can help you find and evaluate a foreign health care provider and make travel arrangements.

--When you've narrowed your choices to two or three foreign doctors, try to interview them by phone. Don't be afraid to ask questions until you're comfortable with their ability. A health travel agent can help with this.

--Don't rely completely on the Internet when doing your research. Cross check your findings with sources such as news articles, word of mouth and a health travel agent.

--Insist on dealing with people who speak English.

--Get as much as you can in writing -- cost estimates, medical opinions, second opinions, travel-related expenses, etc. Take all documentation with you on the plane.

--Tell your local physician of your plans to obtain treatment in a foreign country.

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