The Rise of "Medical Tourism"

Early to Rise, Wednesday June 29 2005

By Jon Herring

Several weeks ago, I enjoyed an amazing vacation in Costa Rica. Not long after my arrival, I found myself reclining in a comfortable leather chair. The air was cool, and I was looking out at the flawless blue skies and steep, misty mountains that surround the city of San Jose. Soft, soothing music played in the background, and I was beginning to drift off when a smiling young woman walked over and put her hand on my shoulder. "Good afternoon, Jon. I hope you're comfortable. Can I adjust the chair for you? Would you like something to drink?" she asked in perfect English. "No, thank you. I'm doing just fine." I told her. A few moments later, Dr. Telma Rubinstein walked in and sat down beside me.

"We have a long day ahead of us, Jon. Are you ready to begin?" she asked. I nodded my approval - and with that, she flipped a switch on the light above my head and began to examine the inside of my mouth. Seven hours later, after three specialists had completed 10 separate dental procedures, I was walking out the doors of Prisma Dental, near San Jose's popular La Sabana Park. I was a little sore and very numb, but I was ready to enjoy the rest of my "vacation."

For the next week, I traveled in Costa Rica and Nicaragua, returning to San Jose to have Dr. Rubinstein complete the work in my mouth. My trip to Central America is just one example of what has become known as "medical tourism." For a variety of reasons, people from around the world are traveling to other countries to obtain dental, medical, and surgical treatment ... while also enjoying a vacation. Because this is a relatively recent development, there are few reliable statistics regarding this niche industry. But in an article two years ago, India's BusinessWorld Magazine provided numbers suggesting that millions of travelers spend more than $40 billion a year on combined medical and travel expenses.

Four countries in Asia - Thailand, Malaysia, Singapore, and India - attract well over a million medical travelers each year, and these numbers are growing rapidly. In most cases, patients are traveling from the developed countries of the United States, Canada, Great Britain, Australia, and the Middle East to less-developed countries.

Why would someone travel for healthcare?

For two decades, the standards of healthcare have rapidly improved in a growing number of "third-world" countries that now offer world-class medical services that meet the high standards of the U.S. and Europe. These countries boast a variety of modern hospitals and state-of-the-art outpatient facilities with newer technology and better equipment than many of those in the states. In many cases, the doctors and specialists in these facilities were trained in the top medical and dental schools in the U.S.

When you consider the affordability of international travel, favorable exchange rates, and high-quality care at a fraction of the cost, it's easy to see why medical tourism is booming. But these are not the only reasons people are traveling for healthcare.

Surging demand for healthcare in the developed world is exposing the flaws in our system.

In Canada and the UK, for example, patients who wish to receive treatment under the government's socialized healthcare plan are required, in many cases, to wait several YEARS to receive the treatment they need TODAY. And the U.S. medical system is a massive paper-pushing bureaucracy, plagued by fraud, inefficiency, and waste. Combine this with outrageous malpractice insurance fees, and the cost of healthcare in this country has risen to the point of being ridiculous.

What about the service?

Doctors, dentists, and hospitals that cater to medical travelers actually have to meet a higher standard of service than those in our home country. That's because many of these facilities and practitioners get their business via word-of-mouth referrals. And unless you have a high-quality experience, you are unlikely to spread the word.

Options exist for full-service travel arrangements, private chefs, dedicated staff, and a number of tailor-made services. In addition, the staff goes out of its way to make you feel comfortable and right at home. And an appointment with a specialist, diagnostic testing, and follow-up can completed within hours. In the U.S., that would usually require several appointments and hours upon hours in waiting rooms.

All of these factors play a role. But the primary factor driving the growth of medical tourism is the cost savings. Procedures start at around 10% of the cost of the same procedures here in the states. In some cases, the cost might approach half of what you would pay here. But in almost all cases, a significant savings can be achieved, justifying not only the cost of travel, but also lodging, meals, and entertainment while in the host country.

Medical tourism began primarily with elective and cosmetic procedures that are not covered under insurance - and many people still travel for this reason. Today, though, growing numbers are traveling for life-saving and medically necessary procedures, such as joint replacements, cataract surgery, bone marrow transplants, and even bypass surgery.

To have a total hip replacement surgery in the United States would cost $40,000+. The same surgery in India or the Philippines would cost less than $8,000.

In the Unites States, heart surgery averages $50,000+. The same operation with comparable rates of success and complications costs only $10,000 in Bombay's top hospital.

A $250,000 bone marrow transplant can be obtained for around $25,000 in India.

India is emerging as the leader in the medical tourist industry, especially when it comes to complex surgical procedures. But throughout Southeast Asia, modern hospitals are springing up near tourist destinations to service this growing market.

Large numbers of people are also traveling to Central and South America, which offer high-quality, affordable healthcare and the chance to convalesce in the tropical air and healing sunlight.

Why I went to Costa Rica to have my teeth fixed ...

One of the fastest-growing areas of medical tourism is dentistry, in part because very few people have comprehensive dental insurance. In my case, although almost all of my work was necessary, virtually none of it was covered by insurance.

In the past two to three years, several of my old fillings fell out and needed to be replaced. I also needed a root canal and two implants. On top of all that, there were two gaps in my smile, because I neglected to wear a painful retainer when I was younger. As an adult, I wanted to have those things fixed.

When I priced all this work here in the states, the total came to more than $16,000. But based on my research, I knew there were a number of first-class dental practices in Costa Rica, and that the cost of dental care is very low in that country. When I found the husband and wife team of Drs. Telma Rubinstein and Josef Cordero at Prisma Dental, I knew I was in the right place. After I spoke with Telma on the phone, I made plans for the trip.

Prisma Dental is a bright, clean ,and modern facility. It also happens to be the friendliest and most accommodating dental practice I have ever visited. At no time did I wait for anything. As soon as I arrived, I was greeted by Dr. Rubinstein with a big hug, and she immediately led me to the examining room.

But more important than how compassionate and accommodating they are, the dental work they performed is better than any I have ever received in the past. (And, in case you're wondering, no, I did not - and will not - receive any sort of discount or commission for giving you this recommendation.)

By getting the work done in Costa Rica, I received as good or better results than I could have expected here in the states, and it cost me about one-third of what I was quoted in this country. My entire bill for the trip, including travel and lodging, was less $6,000.

That amounts to a savings of more than $10,000 - and a free vacation in Costa Rica. Not a bad testimonial for "medical tourism."

What are the downsides?

You can get some of the best healthcare in the world here in the United States - and some of the worst. The same can be true in other countries as well. Under certain circumstances, there can be many advantages to traveling for healthcare. But there are some obvious downsides to consider. For example:

Your insurance policy may not cover treatment - and even if it does, you will probably have to pay first and wait for reimbursement.

All surgeries and medical procedures carry a certain level of risk, no matter where they are performed. The same risk of complications exists overseas as it does here.

There is little opportunity for follow-up care. So it might be a good idea to give yourself a few extra "cushion" days after your last appointment and before you plan to leave the country.

Part of the savings you achieve in a foreign country is because they are not strapped by the same malpractice litigation we see in the states. This could also mean that you have little legal recourse should something go wrong.

Remember the "tourism" angle to all of this. If you receive great medical care and get mugged while out shopping, it might not make for a great trip. As always, be careful while traveling.

I hope I've opened your eyes to the many possibilities that exist for elective and medically necessary healthcare and dental work that you might not have known about. This is a rapidly expanding aspect of modern healthcare, so you are sure to hear more and more about it.

As always, my best advice to you is to focus on “health care” so you don’t need "medical care". But if you find yourself or a loved one in a position where a medical or dental procedure is needed, now you know that you have options.

(References: Medical Tourism: Need Surgery, Will Travel and The Health Travelers)