May 1, 2008 By Avery Comarow
If he could have, Brad Barnum would have kissed the ground when he climbed
out of the car in Ruidoso, N.M., at the end of March. But the 53-year-old
building contractor had undergone major remodeling himself—and his new knee and
two new hips ruled out kneeling for a few more weeks. Still, he was ecstatic.
More than two months after leaving for the hospital, he was home, and he had
afforded the otherwise unaffordable. By having the work done in India, at
Wockhardt Hospital in Bangalore, he’d gotten his new joints for just $23,000.
Even after adding about $5,000 for airfare, passport, visa, and incidentals, the
total was nearly 80 percent less than the $125,000 or more he easily could have
been charged by a U.S. hospital. And that bill wouldn’t have included physician
fees and "ancillary charges."
Barnum is one of thousands of Americans—estimates range from an
ultraconservative 5,000 to 500,000 annually if minor procedures are counted—who
are leaving the States for surgery when they have to come up with funds
themselves. They may be self-employed or work for a small business and lack
health insurance, for example, or their procedure may not be covered. More than
1 in 4 workers earning at least $60,000 a year went without insurance in 2006,
according to a Census Bureau survey; too well-off to be eligible for medical
assistance, they can often wring tens of thousands of dollars out of hospital
"rack rates" by going abroad. Some employers and big insurers like UnitedHealth
and Blue Cross and Blue Shield are so intrigued by "medical tourism" that
they’re beginning to sniff for signs that it might be smart to cover it. "I was
totally amazed not just at the quality of the medical care but at the quality of
the service," says David Boucher, an assistant vice president of healthcare
services at BlueCross BlueShield of South Carolina who has visited many
facilities abroad. "The initial driver may be price, but patients’ positive
experiences will do a lot to advance the movement."
So far, there’s been mostly talk, with little action from employers and health
carriers. In fact, the first verified case of major surgery abroad as an
employee benefit took place only earlier this year. (The patient reportedly paid
nothing out of pocket for a knee replacement—in fact, the company, a North
Carolina manufacturer, paid him a tidy sum for saving so much money.) Wockhardt,
where the procedure was done, won’t name the company.
Meanwhile, patients are finding their way abroad on their own. Wockhardt’s
hospitals in Bangalore and Bombay operated on about 850 U.S. patients in 2007,
more than double the 2006 total. In Thailand, Bangkok’s Bumrungrad Hospital says
it treats more than 38,000 Americans a year—a somewhat inflated figure that
represents "patient encounters," not individual patients, and includes
expatriates. Other hospitals in India and Thailand, as well as centers in
Singapore, are actively courting Americans, and the governments of South Korea
and Taiwan are about to launch campaigns.
Low-budget dentistry, Botox-ing, lipo, and other cosmetic work have for years
drawn Americans into Mexico and to other Latin American countries. But the
growth in serious elective surgery halfway around the world is new. Josef
Woodman, who publishes the Patients Beyond Borders series of guidebooks to
finding good care, thinks about 50,000 patients a year leave the country for
major noncosmetic elective procedures such as joint replacement, coronary artery
bypass, new or repaired heart valves, or back repair.
Many, like Barnum, do the legwork on their own. But concierge services like
MedRetreat.com and IndUShealth.com are multiplying, to help with lists of
potential hospitals, appointment scheduling, arranging airport pickup and
drop-off, and general hand-holding. (Information from Woodman’s annual hospital
survey has been incorporated into the World Hospital Finder, a U.S. News search
tool for people who are seeking care abroad.)