Growing Number of Americans Leave the Country for Treatment
FRESNO, Calif. _ Three years ago, James Dodd of Hanford, Calif., weighed more than 400 pounds.
He had trouble breathing at night and doing work around his house. He was desperate for help.
But when Dodd, 54, started looking into lap-band weight reduction surgery for relief, his insurance company denied coverage, calling the procedure “experimental.”
An Internet search for alternatives turned up Bajanor Hospital in Tijuana, Mexico, where doctors perform the procedure for $7,200 _ less than the $37,000 he said he was quoted at the time.
He got the surgery and is happy with the results, despite serious complications.
“Everything in life is a risk,” said Dodd, now recovered and slimmer. He said he also could have had complications in the United States, adding, “It would have bankrupted me here.”
Dodd is among an increasing number of Americans venturing out of the country _ to places like Mexico, Thailand, the Philippines and India _ for medical treatment because of the high cost of health care.
Patients can save as much as 80 percent on procedures done by medical professionals often educated and trained in the United States at hospitals increasingly accredited for meeting U.S.-like standards.
An estimated 150,000 people traveled abroad last year for medical treatment, and the number is expected to double by 2010, said Josef Woodman, author of “Patients Beyond Borders: Everybody’s Guide to Affordable, World-class Medical Tourism.” Nearly half had medically necessary surgeries, such as hip replacements or spinal work, heart surgeries, even cancer treatment.
The book, released in March, tells how patients can save 25 percent to 75 percent on anything from LASIK eye repair to neurosurgery by traveling outside the U.S.
Health industry representatives said U.S. health care costs more, in part, because of skyrocketing medical malpractice insurance and the higher wages and benefits paid to hospital workers.
Costs are high, said Woodman in a telephone interview, “because Americans demand from cradle to grave, the most expensive treatment, the most extensive testing.”
He said the American health-care system is “stuck” because insurance companies are dictating what can and can’t be covered, and consumers are unable to negotiate direct payment to providers.
Dr. Steven Parks, a longtime surgeon and clinical professor for the University of California, San Francisco’s Fresno-based medical education program, said that while he has been all over the world and knows there is great medical care available, he advises caution.
He said there are also plenty of Third World countries with hospitals and doctors that don’t meet U.S. guidelines and restrictions but offer huge discounts. Hospitals here have to meet certain standards, he said.
Those who choose to go abroad? “I think it is probably dangerous, and you are probably taking a risk with your life.
“I think you should find a way to get it done at the good hospitals in town,” Parks said.
Woodman has traveled abroad for his own care. He went to Costa Rica for dental work _ a root canal, implants and follow-up care _ after looking at several other countries. He said he saved about $2,000.
The key to a good experience, he said, is to do your homework, find out about the doctors and try to interview them beforehand then ask about success rates and find out about the facility: “If they don’t speak English, then move on.”
Interest in traveling abroad for medical treatment has spawned a new industry: medical tourism. Companies are playing the role of travel agent and medical-care coordinator and linking American patients with overseas hospitals for a fee.
MedRetreat, based near Chicago, was one of the first when it started in 2003.
The company describes itself as “a medical gateway to health care abroad … where smart medicine and exotic travel come together.”
Company spokesman Patrick Marsek said MedRetreat organized care for 200 people in 2005, about 350 in 2006 and expects to have helped 650 patients this year get treatment in places such as Malaysia and Thailand.
Fresno-based HealthMed Tourism is hoping for similar success.
Owners Emily Higby and Fely Guzman have backgrounds organizing specialty getaway packages _ wine-tasting excursions to South Africa, for example.
Higby, who has spent two decades in the travel business, became interested in medical tourism because she suffers from polycystic kidney disease, a genetic disorder characterized by growth of cysts that can reduce kidney function and lead to renal failure.
A kidney transplant could be in her future. “I could probably get it anywhere in Asia for 75 percent less,” she said.
Guzman owns a medical staffing company in the Philippines that hires out nurses and physical therapists to Asian health facilities.
The women have toured hospitals in Asia and plan another trip this summer. They said they will send people only to places they have visited personally and where they feel comfortable.
Higby and Guzman said the care provided in other countries, especially to the increasing number of Americans, is exceptional. Many package deals include a post-surgery stay in a luxury resort hotel.
Dodd ran into some difficulty after his operation. He had serious complications after he returned home to Hanford. His stitches opened up, and his local doctor suggested he go back to Mexico to see his surgeon.
Dodd said his doctor thought his original surgeon would better be able to take care of him and that he was OK to travel.
Dodd said he has an old car and doesn’t like to drive long distances and remembers a long ride by train and bus to Tijuana.
On the journey, his condition worsened and he said his hands were stained from trying to stem the bleeding. “The blood was running down my leg,” he said.
He had several additional surgeries and a “gastric sleeving” to replace the lap-band. He ended up staying in Mexico for about three months.
The comment from a medical assistant in Fresno rang in his ears when he was at his sickest. She had told him: “If you go to Mexico, you might as well get a cheap Mexican funeral while you’re at it.”
Today, he talks about his Mexican surgery experience matter-of-factly, boasting of his less than 200-pound weight on his 5-foot 9-inch frame.
“My quality of life has gone up 100 percent. I’m thinking about cruises,” he said, something he would have never considered before.
Although he went through a horrific ordeal, he said he harbors fond memories of watching the sun go down over Rosarito Beach and the many visits from the young son of one of the Mexican surgeons _ it made up for the pain and suffering.
Dodd said the hospital didn’t charge for treating his complications and the additional hospital stay. “Jimmy, you were our guest,” he said doctors told him.
He has since retired from his job as a standards inspector at the Kings County Agricultural Commissioner’s Office and has canceled his health insurance _ which cost him $500 a month. He said he’ll pay cash for routine care and go abroad for surgery.
“They are more compassionate,” he said. “Here, all they care about is if you have insurance.”
Dodd is checking prices for hernia-repair and excess-skin-removal surgeries. He is looking at Mexico, India, Thailand and Hong Kong _ but said he is leaning toward Mexico because it will be easier and cheaper to return if he requires follow-up care.
Dr. Carlos Alessandrini, director and owner of Bajanor Hospital, who came to know Dodd well, said about 98 percent of the hospital’s weight-reduction surgery patients are from the United States, and the rest mostly from Canada.
He said most of his American patients don’t have insurance and pay out of pocket.
Dodd said he remembers meeting patients during his stay at the hospital from Texas, New Hampshire, Chicago and Alaska.
Bajanor Hospital does about 30 weight-reduction surgeries a month and is part of a larger acute-care hospital, Alessandrini said. The specialty center has 10 private suites.
People are not impressed when they see the Tijuana hospital _ one of about 200 in the city, said Alessandrini, who received his medical training in Mexico and speaks fluent English.
“You might look at the building and think it is not very high-tech,” he said.
“The size of the hospital does not determine the quality; the quality comes from the people taking care of you.”
The American Hospital Association in Washington, D.C., doesn’t have an official policy on the issue of medical treatment abroad.
But spokeswoman Elizabeth Lietz said there are serious considerations people ought to think over before going to foreign hospitals.
“You might not have services and care like you have here,” she said.
She said family members aren’t always able to come along, leaving the patient to recover alone without a support network. Access to medical records for American doctors providing follow-up care is another concern, she said.
“The U.S. is recognized globally for its medical treatment, and we are leading the way in advancing treatment of diseases and improving people’s health,” Lietz said.
Increasing demand for health care abroad prompted the Joint Commission on Accreditation of Healthcare Organizations in 1998 to start an international accreditation branch.
A large part of the demand _ at least initially _ came from U.S. companies with American citizens working overseas that wanted to make sure they were offering good care to their employees.
JCAHO International’s accreditation has patient care and safety and goals similar to U.S. hospitals.
International accreditation requests more than doubled from 2004 to 2006. There are now about 125 accredited organizations _ 117 of which are hospitals.
Marsek, the spokesman for MedRetreat, said many foreign hospitals have affiliations with renowned American institutions such as Johns Hopkins Hospital, the Mayo Clinic and Harvard Medical School.
Not all of the hospitals MedRetreat works with are accredited by JCAHO International. However, Marsek said many of the doctors are American-educated and meet U.S. standards.
“Our (Malaysia) plastic surgeon is U.S. board-certified and a member of the American Society of Plastic Surgeons,” he said.
Marsek said countries have developed reputations for certain procedures: Malaysia for plastic surgery, orthopedics and gynecological procedures; Thailand for orthopedics; Brazil for cosmetic surgery; and Costa Rica for dental care.
MedRetreat’s fee is about 20 percent of the medical treatment costs, and the company will not arrange trips unless they result in substantial savings. For example, Marsek said while the medical treatment may be relatively inexpensive, the savings might be minimal after factoring in the flight and hotel stay.
The concept is finding converts at some insurance companies.
In California, several insurers now cover health care in Mexico. HealthNet offers Salud con Health Net, primarily aimed at Spanish-speaking customers, providing the option of access to care in Mexico.
If more Mexican hospitals sought and received JCAHO accreditation _ the Bajanor Hospital has not _ author Woodman said it might boost credibility, making it even more convenient for American border states to take advantage of lower health-care costs in Mexico.
Woodman said the practice requires people to follow post-surgery instructions from their doctors, noting that several who did not have died after receiving care abroad: “Medical travel isn’t for everybody.”
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(c) 2007, The Fresno Bee (Fresno, Calif.).
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