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“Medical tourists” are increasingly heading to other countries, such as India, to save money on common surgeries, cosmetic work and other medical services. Photo courtesy of stockxpert.com |
When the pain in Karen Stocking's right knee worsened several years ago to the point that it became difficult for her to walk, she decided to consult with an orthopedic surgeon for treatment options. That's when the real agony began.
Stocking, a 55-year-old uninsured retiree from Spokane, Wash., was shocked to learn it would cost her nearly $35,000 for a total knee replacement.
"I was appalled by what [the hospital and my orthopedic surgeon] wanted to charge me," she said. "It didn't bother me that my surgeon wanted $150 just to walk in the door for an office visit, nor did I have a problem paying $80 apiece for X-rays. But I was offended that he wanted to charge me $5,000 for a one-hour surgical procedure, and that it would cost me $27,500 for a three-day stay in the hospital."
A co-worker suggested she consider getting the procedure done overseas.
"I work with a gal who had just come back from Thailand from having some cosmetic surgery done," Stocking said. "She came back with a whole knew body, and it cost her less than $15,000. She recommended that I look into it."
Stocking turned to the Internet to look for cheaper alternatives. She discovered that through a third-party company, she could get her knee repaired at a hospital in India for about one-quarter of what the procedure would cost her in the United States. Stocking contacted the SAAGII Corp., a Santa Clara, Calif.-based firm that facilitates surgical procedures in overseas hospitals for uninsured Americans, for more information.
Company officials negotiated on Stocking's behalf with Apollo Hospital in New Delhi to have a U.S.-trained surgeon repair her knee for about $9,000. Add in travel and incidental expenses and Stocking estimates she will spend between $10,000 to $11,000 during her two-week "medical vacation."
"They did all the work for me, just like a concierge service," said Stocking, who will depart Spokane for India on February 27. "They forwarded all of my medical records and got everything lined up for my trip."
With this medical sojourn, Stocking will join the swelling ranks of "medical tourists." The phrase was originally coined by travel agencies and the media to describe a rapidly growing industry where people — Westerners in particular — travel to foreign nations to obtain medical care.
As word has spread about high-quality medical care available at cut-rate prices in developing nations such as India, Malaysia, Thailand, Singapore and Brazil, uninsured and underinsured Americans are boarding airplanes for nonemergency procedures such as hip-and-knee replacements, heart surgeries, dental procedures and even cosmetic surgeries.
The parent company of Apollo Hospital in New Delhi, Apollo Hospitals Group, treated approximately 60,000 non-Indian patients between 2001 and spring 2004, according to company figures. McKinsey & Co., a private New York-based management-consulting firm, estimated last year that 150,000 foreigners visited the subcontinent in 2005 for health treatment. The firm also projected that number will rise 15 percent annually for the foreseeable future.
That's still far below the millions of surgeries performed yearly by the $2 trillion U.S. health-care system, but a major shift is underway. It's one that could put significant pressure on American hospitals as hundreds of thousands of surgeries worth billions of dollars are siphoned off by overseas medical centers. Because elective procedures are a key moneymaker for all hospitals, even a small drop off can cut deep into their profits.
A driving force behind this trend are skyrocketing health-care costs in the United States, which have forced a growing number of U.S. corporations to give serious consideration to medical outsourcing. One of the first companies to do so was Blue Ridge Paper Products of Canton, N.C., which announced last year that it would offer its employees the option of traveling to foreign countries, such as India, for nonemergency medical procedures in an effort to cut costs. In return, employees would get to pocket some of the savings the firm stood to gain from the program.
Blue Ridge planned to send one of its workers to India in September 2006 to have his gallstones removed and his rotator cuff repaired. Company officials estimated the procedures would have cost about $100,000 in North Carolina versus just $20,000 in India. But Blue Ridge management was forced to cancel those plans — and the program — when officials with the United Steelworkers union threatened to file suit against the company over concerns that it would eventually make the voluntary program mandatory.
The rationale behind this interest is fairly simple: many large U.S. corporations are self-insured, which means they cover most of the costs of their employees' health care. That's why three major corporations that collectively cover about 240,000 individuals tapped Dr. Arnold Milstein, the chief physician at the New York-based consultancy Mercer Human Resource Consulting, to identify the best countries to outsource elective medical procedures.
Milstein concluded that surgeries in Thailand and Malaysia cost just 20 to 25 percent as much as comparable procedures performed in the United States; the best Indian hospitals, he found, sell their services at even steeper discounts.
Entrepreneurs such as Lalit Goel, founder and chief executive officer of SAAGII Corp., are exploiting the health-care price gap between the United States and foreign hospitals with great success.
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| Goel |
"We are an affordable health-care alternative for people who do not have insurance," Goel said. "And since the number of uninsured Americans continues to rise every year, they will seek the expensive medical procedures they need wherever they can save money. That's our mission, to supply our clients with the highest quality health care at competitive prices. Our goal is to keep people healthy by offering them affordable health-care alternatives to what is currently offered by the U.S. health care system."
SAAGII works closely with Medical Excursions Inc., a Delray Beach, Fla. company that specializes in helping North American clients arrange elective and nonemergency medical care at Indian hospitals. Founded in 2005 by entrepreneur Shyam Van Nath, Dr. Manish Gupta and Goel, the company facilitates a variety of medical services, including heart surgeries, knee and hip replacements, infertility treatments and cosmetic surgeries.
"Our research found that there are approximately 44 million Americans without health insurance," Van Nath said. "That's 44 million people who likely would not be able to afford the cost of a major medical procedure even if they needed it. We developed Medical Excursions with those individuals in mind - our goal is to provide our clients with a list of the best facilities in India for a variety of medical and related procedures at an economical cost."
In addition to providing assistance to individuals, Medical Excursions and SAAGII have also developed medical outsourcing programs for small businesses looking to reduce their per-employee health-care costs.
Goel declined to identify any of the SAAGII's corporate clients, but he said the company has "been successful in showing employers that they can attain substantial savings by offering their workers the option of receiving their treatment outside of the United States."
Currently, no major U.S. insurance companies or corporations offer voluntary medical outsourcing programs to their clients or employees. But some medical professionals in the United States — including ranking members of the American Medical Association and the individual state medical associations — feel that it's only a matter of time before they do. And once that occurs they say, voluntary medical outsourcing could soon give way to mandatory, "take-it-or-leave-it" programs.
"It appears that there are a growing number of smaller insurance companies that are offering these [voluntary] programs," said Dr. Nicole Jamali, an Organized Medical Staff Section delegate to California Medical Association's House of Delegates and a member of the Joint Commission for Accreditation of Healthcare Organizations. "If the smaller companies are doing this, then it will affect a smaller portion of the workforce. But just imagine if the larger companies do it, then it will be an uphill battle for physicians to protect their patients."
Jamali, who was appointed to the Joint Commission by the American Medical Association, said she isn't opposed to the programs so long as they are offered to individuals as a choice. But "medicine that is good for some isn't good for all," she said.
"Patients have to decide if the hospital that they are traveling to for treatment is up to par with Western standards," she said. "What if you have a complication during or after surgery performed in a foreign country — can you sue your doctor there? No, because the procedure was performed outside the United States."
Jamali led an effort last October by the California Medical Association's Organized Medical Staff Section to raise its concerns about medical tourism with the American Medical Association. She authored a resolution that asked the organization to "study the trend of outsourcing health care overseas in order to better understand the magnitude of the practice and its impact on U.S.-based physicians having to 'pick up' the pieces after a procedure is done overseas without follow-up care by the overseas provider …"
The resolution passed.
Thus far, however, the American Medical Association has not yet taken a position on the issue of medical tourism. It only encourages Americans to consider all factors before choosing to have a medical procedure done overseas.
"As physicians, we support our patients taking an active role in their health care. It is important for patients to be fully aware of and confident in the qualifications of the health care professional providing their care, as well as, the safety standards of the hospital or clinic where the care will be given," association president Dr. William G. Plested said in a statement.
"Equally important in medical care is follow-up care. Patients must be sure that when receiving care abroad, they have a plan in place to receive the proper follow-up care with a physician.
"Many factors must be considered when choosing to go overseas for health care and price should not be the only concern. Safeguarding your health is of utmost importance and the decision of where and from whom to receive this care should not be arrived at lightly." |