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Exorbitant Surgical Costs in the United States the Derivation
 of Growing Medical Tourism in Thailand, India and Malaysia
By Kathleen Kerr, Newsday, Melville, N.Y.McClatchy-Tribune Business News

Sep. 26, 2006 - A growing number of people across the United States are traveling to exotic destinations for surgery to fix their aching joints and other maladies.

As Americans head for countries such as Thailand, India and Malaysia, some see the sights first and head for surgery in local hospitals later -- often recuperating in lush, resort-style hotels.

For these travelers, vacation plans might include the Taj Mahal -- and a hip replacement.

Hundreds of New Yorkers have inquired about such vacation-surgery combos. It's all part of a growing business called "medical tourism."

And forget those mini-Eiffel Towers encased in glass snow globes -- for medical tourists, souvenirs take the form of new knees, noses, face-lifts, dental implants and even heart bypasses.

And for medical tourism businesses springing up here at home, the popularity of surgery in foreign countries means an opportunity to cash in.

At the root of medical tourism are exorbitant surgical costs in some countries, including the United States.

Anxious to avoid those costs, people from the United States are boarding jets for countries that offer medical procedures at bargain-basement prices.

Usually, these itinerant patients either have no medical insurance, want procedures insurance doesn't cover or cannot afford the deductibles and co-payments their health care plans require. Instead, they obtain loans or use savings to travel to places where surgery is significantly cheaper than in the United States.

'Comes with its own risks'

But such low-cost medical care comes with several cautions.

It is difficult to sue over surgery gone wrong in a foreign hospital. And checking up on problem doctors -- in New York, that's as easy as calling up a state Web site -- can be complicated. Additionally, if something goes wrong weeks or months after a procedure, finding a doctor to fix the problem in this country could be difficult.

"The attractiveness of cosmetic surgery with travel to exotic places sounds great, but it definitely comes with its own risks," said Dr. Lyle Leipziger, chief of plastic surgery at North Shore University Hospital in Manhasset. "How do you know you're in a safe environment?"

He says foreign doctors (many train in the United States) may be excellent surgeons, but it's difficult to check on them. For example, a cosmetic surgery patient in the United States can check a doctor's credentials with the American Board of Plastic Surgery, Leipziger said.

And he has concerns about follow-up treatments patients may need months after surgery and about them flying home soon after a procedure.

"If they're sitting [on the plane] the whole time and tired from surgery, they might get blood clots," Leipziger said.

Granting accreditation

A number of major hospitals involved in medical tourism have been accredited by the Joint Commission International, affiliated with the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO. JCAHO accredits U.S. hospitals. However, hospitals that don't seek accreditation from the Joint Commission International might be accredited by different organizations in their own countries.

Anne Rooney, executive director for international services at the Joint Commission International in Oak Brook, Ill., said the program is "heavily modeled on the JCAHO standards but there are differences to allow for differences" in medical practices and customs in other countries.

"The organization that is accredited has gone through a rigorous external evaluation process," Rooney said, noting that the commission's imprimatur is "the gold standard around the the world."

But worldwide, Rooney said, the Joint Commission International has accredited fewer than 100 hospitals. Bumrungrad International Hospital in Bangkok, Thailand, and the Apollo Hospital in Chennai, India -- both known for rolling out the red carpet and arranging lavish accommodations for medical tourists -- are among them.

Savings for employers

In what was seen as a groundbreaking move, at least one U.S. employer -- Blue Ridge Paper Products of Canton, N.C. -- recently said it planned to offer surgery abroad to its employees as an alternative to its regular health care coverage.

Blue Ridge Paper benefits director Bonnie Blackley said that when she first learned about medical tourism and suggested that a company task force consider sending employees abroad for surgery, "They started out thinking I had lost my mind."

But Blue Ridge soon had a change of heart. And benefits officers for other companies began calling Blackley for advice on how to save money through medical tourism.

Blackley says a Blue Ridge employee who inquired about a heart valve replacement was told it would cost between $68,000 and $198,000 in Iowa, where she lives, compared with $18,000 in India, including accommodations for her and a companion. That would have meant a tremendous savings for Blue Ridge, which is self-insured. The woman opted for Blue Ridge's traditional coverage and did not travel to India.

But Carl Garrett, 60, another Blue Ridge employee, decided to take the company up on its offer and planned surgery in September to have a rotator cuff repaired and his gallbladder removed. Surgeons at the Indraprastha Hospital in New Delhi -- part of the Apollo Hospital Group -- were to operate on Garrett.

Under the plan, Garrett would pay no deductible and no co-payment, and his airfare would have been covered, too. He said it was estimated that his two surgeries would total about $100,000 in the United States and that he would have to pay about $20,000 of that. Blue Ridge was willing to pick up the full cost of his surgery in India. The company was also going to pay Garrett's fiancee -- who would have traveled with him -- a financial incentive to reimburse her for time lost from work.

However, the United Steelworkers union, which represents some Blue Ridge employees, objected to the trip, saying such medical outsourcing would expose workers to unnecessary risk.

Leo Gerard, president of the United Steelworkers, said in a prepared statement on Sept. 11: "The right to safe, secure and dependable health care in one's own country should not be surrendered for any reason -- certainly not to fatten the profit margins of corporate investors."

As a result of the union's objections, Blue Ridge abandoned its attempt to offer medical tourism as a health care option. Garrett still has his gallbladder and a rotator cuff in need of repair; he said he's pondering his next step.

A developing industry

Some people travel by themselves when seeking surgery abroad; others bring a companion. Some spend their whole time in the hospital; others sightsee ahead of their surgery or spend time afterward at a nearby hotel.

Facilitating all this are medical tourism companies -- businesses that put people in contact with surgical centers abroad.

The companies help schedule surgeries, send medical records to doctors, book hotel rooms, arrange excursions and make air and ground transportation arrangements.

One such company, IndUShealth, a medical tourism business in Raleigh, arranges medical trips abroad. Rajesh Rao, chief executive of IndUShealth, said his company deals with four well-known hospitals in India; Rao said three of the hospitals are accredited by the Joint Commission International and one has been accredited by another group. IndUShealth arranges cardiac, orthopedic, cosmetic and dental procedures.

"They have done what is needed to make sure they can provide the level of care that is expected," Rao said. "We did a careful analysis."

He said IndUShealth handles 20 to 30 patients a month. Costs for a trip, including the surgery and airfare, ground transportation and accommodations for two people are typically about $12,000 to $13,000, Rao said.

"We have focused on the more expensive and more important services, which people have maybe put off because the cost of having it done here is maybe too much," he said.

Primary focus on health

At MedRetreat, based in Illinois and Maryland, managing director Patrick Marsek says that since 2003, the company has arranged more than 500 foreign medical visits, 80 percent of them cosmetic procedures.

MedRetreat plans to open a corporate division next year to help self-insured businesses offer medical tourism as an option to their employees. Marsek said Penang Adventist Hospital in Malaysia is the most popular medical tourism destination for his clients.

"We downplay the tourism part," Marsek said. "We don't like that term. We stress receiving safe, state-of-the-art care at a huge cost savings."

However, MedRetreat will set up excursions if requested as well as bilingual assistance, nursing care and concierge service.

Marsek said MedRetreat has screened the hospitals it deals with and that company officials have traveled to them to check for quality.

"We've denied over half the hospitals," Marsek said.

Anil Maini, president of Apollo Hospitals Group, based in New Delhi, said about 10 Americans arrive each month for surgery with 40 to 50 more scheduling dental work, eye exams and CT scans. Patients also are having cardiac and gastric bypass procedures.

"We get about 100 queries a day, and most of them are from the United States," Maini said in a telephone interview from India.

Maini said a heart bypass operation, including an all-inclusive 10-day stay for a patient and a companion in a hospital room that looks like a hotel suite costs about $6,500.

"We don't charge a penny beyond that," Maini said.

Some companies that handle surgical trips abroad are new to the field and still struggle to build a customer list.

Anil Joshi, a vice president for Quebec-based Speedy Surgery, says the company started last November and so far, has sent 15 patients to Apollo Hospitals in India and to Bumrungrad Hospital in Bangkok. Speedy also sends patients to Mexico for general surgery and cancer treatments, Joshi said.

Joshi said Speedy Surgery will not become profitable until it has processed 200 medical tourists. He said Speedy Surgery does not emphasize vacationing during a surgical trip.

"I don't believe that somebody who's going to have heart surgery is going to the Taj Mahal," Joshi said.

Cheaper in India

Comparison of surgical costs in the United States and India

Heart Bypass

India: $6,000

U.S. estimate (low): $55,000

U.S. estimate (high): $86,000

Angioplasty

India: $6,000

U.S. estimate (low): $33,000

U.S. estimate (high): $49,000

Hip-replacement

India: $5,000

U.S. estimate (low): $31,000

U.S. estimate (high): $44,000

Spinal fusion

India: $8,000

U.S. estimate (low): $42,000

U.S. estimate (high): $76,000

SOURCE: INDUSHEALTH, INC. TO SENATE SPECIAL COMMITTEE ON AGING

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Copyright (c) 2006, Newsday, Melville, N.Y.

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