The Facts About Medical Tourism

The Baby Boom of the 1940s and '50s was a global phenomenon. World War II soldiers returned home to the United States, Europe, Australia, and Japan and made up for lost time by starting large families. Now those post-war babies are growing old, all over the world. Not only that, but they are collectively experiencing a longer lifespan than any previous generation. And if there is one thing older people need, it's medical care.

The oldest of the baby boom generation turn 69 this year. Many are affluent, and while money can't always buy good health, it can certainly pay for quality medical care – wherever it may be.

Welcome to the age of "medical tourism." The rising demand for medical care has spawned a new industry of treatment options. Medical tourism is a term used to describe patients who travel to another country specifically to seek medical care. For the sake of collecting statistical data, the term does not include expatriates currently living in another country, tourists seeking emergency medical care while traveling, or companions who accompany medical tourists.

Medical Tourism Benefits
While greater demand is the driving impetus for people to seek medical care in other countries, there are other motivating factors.

Savings
Many times a particular treatment is less expensive in another country. The U.S. is the only industrialized nation that does not have universal healthcare. Our free market economy with few government controls is one of the reasons that medical expenses have increased exponentially in this country. Insurance premiums, deductibles, co-pays and other out-of-pocket medical expenses continue to rise, as do the costs of both critical and elective procedures.

Patients who have rich insurance plans that cover all or most of the cost of a procedure may not appreciate how much money is spent on their behalf. However, those who are underinsured, have a high deductible, or pay a high percentage of bills may find the cost untenable. In this scenario, the savings for medical care sought abroad can be significant even when you include airfare and accommodations.

For example, heart bypass surgery in the United States generally costs about $88,000, according to data compiled by AARP. However, in Costa Rica it costs only $31,500. A hip replacement in the U.S. may cost about $33,000, but only $12,400 in Thailand. In the U.S., cosmetic surgery on your nose will run about $6,200, but you can have the same surgery in Mexico for about $2,800 – plus spend your recuperation time in a beautiful seaside resort where no one knows you.

Familiarity
In the U.S., many medical tourists are immigrants who prefer to return to their home country for medical care due to lack of insurance coverage, lower cost, the opportunity to recuperate with family, or due to language and/or trust issues.

Luxury
On the other end of the income spectrum ... for some people it's not about saving money, but spending more for a higher level of pampering than they would receive at their local hospital. In fact, many of the top destination medical tourism hospitals are designed to provide a high level of luxury and efficiency. At Bumrungrad International Hospital in Thailand, for example, each floor has its own pharmacy and outpatient clinic. An onsite blood lab processes samples in an hour, the waiting room looks more like a five-star hotel than a hospital, and patient recovery rooms overlook the beach.

Immediacy
Affluent patients also can avoid long waits for treatment in U.S. facilities. By expanding their options for medical care or a specific procedure across the global spectrum, they can schedule treatment when they want and where they want.

Skirting Legalities
When money is no option, literally a whole new world opens up. This is particularly true when an affluent patient needs an organ transplant. Whereas the U.S. imposes strict rules and a prioritized waiting list, money can move mountains – if not organs – in more impoverished countries. This has bred a subset of medical tourism known as "transplant tourism" – in which a patient travels to another country for the specific purpose of receiving an organ or tissue purchased from an unrelated donor for transplant. This issue is most prevalent among the poorest and most vulnerable countries and populations. China, the Philippines, and Pakistan are a few of the largest organ-exporting countries. One of the greatest concerns of international organ trafficking is safety, as impoverished countries may not offer high-quality providers, procedures, facilities, and drugs generally required for transplant surgery and recuperation.

Most Popular Procedures
The most popular procedures sought in the medical tourism industry include:

• Cosmetic surgery
• Dentistry (general, restorative, cosmetic)
• Cardiovascular heart surgery (angioplasty, CABG, transplants)
• Orthopedics (joint and spine; sports medicine)
• Cancer (often high-acuity or last resort)
• Reproductive (fertility, IVF, women's health)
• Weight loss (LAP-BAND, gastric bypass)
• Scans, tests, health screenings and second opinions

Top Destinations
The top destinations for medical tourists include Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, and Turkey. The following offers an overview of medical services and procedures offered in some of these countries. Note that, as this is a multi-billion dollar industry, many of the top destination hospitals in countries like Malaysia, India, Turkey, and Thailand are considered to meet or even exceed Western standards.

Mexico
It is estimated that Mexico played host to between 200,000 and 1.1 million patients in 2013. The imprecise range is due to the fact that it is difficult to pinpoint exactly how many undocumented Latinos who presently reside in border states like California, Arizona and Texas return to Mexico for medical treatment. Mexico benefits substantially from its proximity to the U.S., and reportedly more than 50,000 Americans a year will make the short trek across the border for dental work alone. Cities like Monterrey, Tijuana, and Juarez cater to American demand for uncovered but specialized weight loss programs and surgery. Savings can run 40-70 percent of the cost of treatment in the U.S., with the added bonus of anonymity during a purported "rejuvenating" vacation.

India
India is known for high-quality care and luxury accommodations, where many hospitals resemble 5-star resorts. The Fortis Memorial Research Institute near Delhi is a good example, boasting a breath-taking hospital lobby with a larger-than-life sculpture and a trapezium ceiling. The hospital spans 12 acres and features retail stores, play areas for children, a state-of-the-art wellness center, café, food court, and movie theater.

In India alone, the medical tourism market accounted for $3.9 billion in 2014 – a growing industry that has doubled in just the last few years. Its highly rated medical facilities treat more than 250,000 international patients a year in large cities such as Bangalore, Chennai, Hyderabad, Mumbai, and New Delhi. The most popular procedures sought by medical tourists include fertility, orthopedic, cardiac, oncology, and organ transplants. In addition to quality and luxury, many facilities offer cost savings. For example, according to the Medical Tourism Resource Guide, heart valve surgery can run $15,000 compared to $150,000 in the U.S.

Thailand
Thailand is known for its specialization in cosmetic surgery, including gender reassignment. Bangkok is home to Bumrungrad International, one of the world's best known hospitals for medical tourists. Patients also benefit from 50 to 70 percent savings for treatments compared to U.S. prices.

Singapore
Medical tourism has become such a major industry in Singapore that the government promotes it as a regional center of excellence for general surgery, cardiology, oncology, and organ transplants. The Gleneagles Hospital in Singapore has been ranked one of the world's top-10 hospitals for medical tourism by the Medical Travel Quality Alliance.

Risks of Medical Tourism
While there are risks inherent with traveling to any foreign country, there are substantially more issues to consider when seeking treatment. In some areas, English may not be universally spoken, so you may not be able to communicate adequately with pre- and post-operative caregivers, surgeons and specialists. In impoverished areas, doctors have been known to reuse needles among patients or engage in other unsafe injection practices, increasing the risk for infection and diseases such as hepatitis and HIV. Medications may be counterfeit, of poor quality, or prescribed incorrectly. Blood banks may not be properly screened. Moreover, travel may not be an option soon after a procedure, so it could be difficult to seek proper treatment if a procedure goes awry or an infection undiagnosed.

Planning Tips
For patients interested in exploring medical tourism as an option, it's important to check the qualifications of all healthcare providers who will be managing the treatment, as well as the credentials of the facility. Obtain a written agreement with the healthcare facility or group arranging the trip, with a detailed description of the treatments, supplies, and care that will be covered by the cost of the trip. There are private companies or "medical concierge" firms that specialize in assisting medical tourists identify and vet foreign health care facilities and make travel arrangements.

In the U.S., there are some insurers, large employers, and major medical universities that have established alliances with overseas hospitals to help control healthcare costs. The Harvard Medical School Dubai Center, the Johns Hopkins Singapore International Medical Center, and the Duke-National University of Singapore are some of the better known U.S.-affiliated facilities.

The following are additional issues to consider before engaging treatment abroad:

• Foreign language – determine ahead of time how to communicate with physicians and other providers
• Obtain copies of medical records, including allergies
• Obtain copies of all prescriptions and make a list of any other medicines or supplements (including brand name, generic name, manufacturer, and dosage)
• Arrange for follow-up care for when you return home
• If combining medical treatment with a vacation, consider whether to take the vacation part first, as activities such as sunbathing, drinking alcohol, swimming, hiking and touring may not be feasible post treatment
• Make sure to return home with copies of all medical records detailing treatment and medications received abroad

A Growing Market
It is estimated that the medical tourism market is growing by 15 to 25 percent each year. Patients Beyond Borders reports that approximately 1.2 million Americans contribute to the 8 million total number of patients globally who seek out-of-country treatment each year. This represents a $38.5 to $55 billion (USD) industry, which has every reason to continue to grow – and rapidly – to meet rising demand.

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