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Hospitals abroad attract Americans

As health care costs go up, Americans are finding cheaper alternatives overseas.
Friday, November 3, 2006 | 12:00 a.m. CST; updated 12:14 a.m. CDT, Friday, July 4, 2008

NEW DELHI, India — She’s a rodeo barrel-racing champion who runs a 180-acre ranch in Oklahoma when she’s not bouncing across back roads selling farms. Dodie Gilmore is a 60-year-old who loves the outdoors, but when she could no longer straddle her faithful horse, River, she knew it was time for a new hip.

But how could she afford it? As an independent contractor for a small Coldwell Banker real estate franchise in Durant, Okla., she knew her privately purchased health plan would never pay up to $40,000 for the operation.

So she asked her boss about traveling to India where hip resurfacing alone would cost just $7,000. He not only gave her his blessing but offered to foot the bill, minus travel and hotels — making Gilmore one of the first Americans sent overseas for surgery by an employer.

“The doctors were wonderful,” Gilmore said days after being discharged, sipping coffee at a New Delhi roadside cafe with her sister, Carol, who was along for the whole trip. “The overall care was pretty darn good.”

With an estimated 45 million uninsured Americans, some 500,000 traveled overseas last year for medical treatment, according to the National Coalition on Health Care. Asian hospitals in Thailand, India and Singapore have long been swarmed by medical tourists looking for tummy tucks and face lifts, but many glitzy, marble-floored facilities are now gaining reputations for big-ticket procedures: heart surgery, knee and back operations.

More patients like Gilmore — who had never held a passport or tasted Indian food before her trip — are returning home and spreading the word about an alternative to America’s ailing health system. Businesses, insurance companies and even a state lawmaker are now also starting to eye the potential savings of outsourcing health from the world’s richest country to the developing world.

“It’s just one of the many ways in which our world is flattening,” said Arnold Milstein, chief physician at New York-based Mercer Health & Benefits, who’s researching outsourcing medical care for three Fortune 500 corporations. “Many companies see it as a natural extension of the competition they’ve faced in other aspects of their business.”

Some American hospitals already rely on places like India for X-ray readings and other diagnostics, while also importing foreign doctors and nurses.

But just as shipping U.S. manufacturing to China and call centers to India initially created loud opposition, some critics are already preparing to fight any possible mass exodus of Americans packing their bags to go under the knife overseas.

In September, Canton, N.C.-based Blue Ridge Paper Products Inc., was set to send one of its employees to India for a gall bladder operation. Carl Garrett would have been the first U.S. employee sent abroad for medical care through an employer-sponsored pilot program, which would have allowed him to share the company’s savings.

Shortly before Garrett was set to leave, the United Steelworkers, America’s largest union, pulled the plug.

“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 to be voluntary, but voluntary programs tend to lead to mandatory programs.”

Blue Ridge ultimately scrapped its plan for union members, but several other U.S. businesses and insurers are starting to explore the option.

United Group Programs, a Boca Raton, Fla.-based company that sells self-insurance policies to small businesses, is already offering a plan that sends patients to Bumrungrad International hospital in Bangkok, Thailand. UGP says the plan will save employers more than 50 percent on major medical costs and slash employees’ out-of-pocket expenses to zero.

In addition, West Virginia lawmaker Ray Canterbury plans to propose legislation next year that would give government employees the option of traveling abroad for necessary procedures, which could save the state up to $2 million annually. He wants to offer incentives, including extra sick leave and 20 percent of the cash saved by going abroad — allowing workers to make money on the deal.

But even with the growing momentum, big questions must be asked by anyone considering treatment abroad.

The comfort of having a major surgery near home with family at the bedside is a far cry from the experience in the developing world, where culture shock alone can be stressful.

Jet lag, traveler’s diarrhea and strange foods can be coupled with the unpredictable, such as September’s bloodless military coup in Thailand.

“There are a lot of risks,” said Rick Wade, a senior vice president at the American Hospital Association. “What happens if something goes wrong?”

In countries like Thailand and India, medical malpractice claims are rare; multimillion dollar awards are nonexistent.

“If there’s a mistake, we fix it,” said Curtis Schroeder, an American who is group CEO of Bumrungrad hospital, which requires all doctors to carry malpractice insurance. “But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the U.S.”

In February, Joshua Goldberg, a 23-year-old American who was traveling in Thailand, died at Bumrungrad after seeking care for a leg injury. His father, James Goldberg, has set up a Web site alleging the hospital administered a deadly drug cocktail to a patient with a history of substance abuse.

Bumrungrad insists the care given was appropriate. Thai authorities are investigating the case, as is standard with all unexpected hospital deaths. No conclusions have been reached.

“What I’m dedicated to doing is to try to alert people to at least do their homework and consider very carefully what they’re getting into. Why is this such a good deal?” Goldberg said by telephone. “You might not walk away. That’s what happened to my son.”

Many doctors working in facilities catering to medical tourists are trained abroad, often in the U.S. or Europe. About 100 foreign hospitals have been approved by the international arm of the Chicago-based Joint Commission on Accreditation of Healthcare Organizations, which also accredits American hospitals.

Six countries in Asia have accredited facilities, including Bangkok’s Bumrungrad.

The Max Super Speciality Hospital where Gilmore had her surgery on Oct. 10, is working to become accredited, but she said she felt comfortable from the very beginning. Even if her boss had refused to pay for the surgery, she said she likely would have made the two-day flight on her own because her insurance would never have paid to fix the pre-existing condition.

“It’s either that, or do it in the States for $28,000 to $40,000,” she said. “In the U.S. do you not sign forms? They’re not responsible. The risk of it didn’t really weigh on me.”


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