05:21 PM EDT on Friday, June 22, 2007
By Felice J. Freyer Journal Medical Writer
When Anne Grant needed surgery on a painful arthritic hip, she didn’t go to a hospital in Rhode Island. She didn’t even go to Boston.
Instead, she packed her bags for India.
Yes, India — where Indian doctors and nurses performed the procedure that Grant wanted for a fraction of the cost in the United States. Five months later, the 61-year-old Providence woman says she’s walking and swimming without pain.
As surprising as her choice may seem, in heading to India, Grant joined tens of thousands of other Americans who are going overseas for medical care — to India, Thailand, Brazil, Singapore, to name a few places…
…“Our research showed us a very large group of aging baby-boomers were beginning to age into expensive treatment without being able to pay for it,” said Josef Woodman, author of a new book on the trend called “medical tourism.” Many are too young for Medicare but don’t have insurance — and they’re looking for help overseas.
Woodman estimated that last year, 150,000 Americans went abroad for medical treatments. Based on interviews with travel agents and reports from international hospitals, Woodman made the educated guess that half sought dental care in Mexico and cosmetic surgery in Brazil or the Caribbean, and the other 75,000 went for major, necessary procedures at international hospitals in Asia.
…Then, at a dinner party last year, her friend Lisa Grant — a neighbor, but no relation — mentioned that she, too, had a bum hip, and she was going to Belgium to have it fixed. From a 60 Minutes episode, Lisa Grant had learned about hip resurfacing, a new approach to hip replacement that preserves more of the thigh bone and is reputed to last longer. (See related story.) Although performed in Europe for more than 10 years, hip resurfacing is new in the United States, having received FDA approval only in May 2006.
Lisa told Anne about email@example.com, an Internet listserv rich with patients’ reports of their hip-resurfacing experiences. ..
Asked about Americans seeking cheaper care overseas, Lonks said, “You get what you pay for.”
He raised numerous concerns. “What happens if you have the procedure, come back to United States and you develop a complication? Who’s going to take care of it? Will your insurance cover it? … How do you know about the sterility and quality of their equipment? How about if you need a blood transfusion in India? … How about malaria? … How about typhoid or measles? Measles is a common disease in India.”
In an e-mail responding to The Journal’s questions about the risk of infections, Grant’s surgeon, Vijay Bose, said that “the patients are in a protected environment” and called the chances of catching something like malaria “very remote.”
“Over the last three years where I have been doing a large volume for American patients, we have not had a single case of malaria or other infectious diseases,” Bose wrote. He also said the hospital’s blood bank is comparable to any in Europe or North America, so patients who need a blood transfusion face the same low risks as anywhere. (Grant did not need any blood.)
As for the low cost, Bose had this comment: “I personally do not think that the cost is cheap in India. It is just the actual and appropriate cost for various procedures. The converse is true, it is artificially boosted and very high in the U.S…
…LARGE BUSINESSES and health insurers looking for lower-cost health care are watching the medical tourism trend with interest. But, says Mohit M. Ghose, spokesman for America’s Health Insurance Plans, the national trade group for health insurers: “What you have not seen is a rush by our sector to jump on board.”
He said insurers are worried about “legal and quality issues,” particularly who is responsible for patients’ care upon their return. Patients often cannot collect compensation if they are injured. So who will pay for the care at home if there are complications?
Ghose thinks the global competition will further boost a trend already under way in the United States — to develop “centers of excellence” that do many procedures, provide consumers information on how well they perform and compete on the basis of quality.
Ghose says he knows of only one health insurer that has gone as far as offering an overseas option to subscribers: BlueCross BlueShield of South Carolina.
In February, David Boucher, South Carolina BlueCross’ assistant vice president of health care, founded Companion Global Healthcare, a medical tourism agency that has a relationship with the Bumrungrad International Hospital in Bangkok. To address concerns about follow-up care, Companion contracted with a large network of South Carolina doctors to take care of patients when they return from overseas treatment.
“We’re not contemplating mandating care abroad,” Boucher stresses. “This is an option — we just want to help them make it a little bit easier.”
So far, South Carolina BlueCross’ offer to pay for medical care overseas has attracted lots of media attention and inquiries from other insurance companies — but no patients.