Medical tourists flock to Thailand, spurring post-coup economy

Monica Topliss pauses while eating breakfast in her Bangkok hotel to explain why she flew 7,300 kilometres from her home in Australia to go under a Thai plastic surgeon’s knife.

Foreigners seeking treatment for everything from open-heart surgery to gender reassignment have made Thailand the world’s No 1 destination for so-called “medical tourism,” luring as many as 1.8 million overseas visitors in 2013.

"The whole thing, airfares and hotel included, cost me AU$15,000 (428,000 baht), when back home, it would have been twice as much," Ms Topliss, a 48-year-old executive chef and author of cookbooks, said of the breast-enhancement procedures and cosmetic dentistry she has just undergone.

"And the surgeon did such a good job. It's like the clock has been turned back 20 years. What's more, I'm having a wonderful two-week holiday as well. Even the hospitals are like five-star hotels."

Come for the gold-spired temples and sun-kissed beaches; stay for the low-cost, US-accredited medical services. Or vice versa. That's the "Land of Smiles" today. Foreigners seeking treatment for everything from open-heart surgery to gender reassignment have made Thailand the world's No 1 destination for so-called "medical tourism," luring as many as 1.8 million overseas visitors in 2013, according to Patients Beyond Borders, a consulting firm based in the US state of North Carolina.

That ranks Thailand, a developing nation with a per capita gross domestic product of just $5,700, ahead of the US - and also Thailand's more prosperous Southeast Asian neighbours, Singapore and Malaysia - as the preferred destination for international patients. Last year, medical tourists pumped as much as $4.7 billion into the Thai economy, according to government statistics. "While the US is still first choice for the ultra-rich, Thailand is unquestionably No 1 among everyone seeking affordable care," Patients Beyond Borders founder Josef Woodman says.

People walk inside Bangkok Hospital May 19. Despite the military coup that took place three days later, tourists continue to flock to Thailand for medical services, with as many as as many as 1.8 million overseas visitors coming for the beaches and staying for the hospitals in 2013.

A gauge of 15 Thai hospital stocks, boosted by medical tourism, leapt 54% in 2014 as of Nov 18. Among the prime beneficiaries of these soaring valuations are three of Thailand's billionaire dynasties.

Hospital stocks
They include the family of the late Chaleo Yoovidhya, who in 1987 co-founded Red Bull GmbH, the world's biggest energy-drink company, with Austrian billionaire Dietrich Mateschitz. The media-shy Yoovidhyas, whose 51% stake in Red Bull is worth about $10 billion, according to the Bloomberg Billionaires Index, own Bangkok's Piyavate Hospital, where Ms Topliss underwent her breast surgery.

Prasert Prasarttong-Osoth, 80, a physician-turned-entrepreneur who founded Bangkok Airways Co, Thailand's oldest private carrier, owns 20% of Bangkok Dusit Medical Services Pcl, Thailand's largest hospital operator. Bangkok Dusit stock rose 55% through Nov 18.

And the Sophonpanich family, whose patriarch, Chin Sophonpanich, founded Bangkok Bank Pcl, Thailand's biggest lender by assets, owns 45% of Bumrungrad Hospital Pcl. Shares in Bumrungrad, which markets itself as Southeast Asia's largest private health-care facility, have also jumped 55% this year.

"Hospital operators are among our top picks," says Peerapong Jirasevijinda, who helps manage $15 billion at Bangkok-based BBL Asset Management Co. "We are still really upbeat even though they have rallied so much recently."

The Thai military, which has staged 12 coups since 1932, hasn't always inspired such confidence in investors. After the previous putsch, in 2006, the junta briefly imposed capital controls, prompting fund managers to dump stocks. This time, investors have been betting that the current crop of generals, led by army chief-turned-Prime Minister Prayut Chan-o-cha, will get it right.

Amid such challenges, medical tourism is one industry in which Thailand can compete - on services, prices and style. Patients flying into Bangkok's Suvarnabhumi Airport are greeted at special arrival desks before being whisked to hospitals where, in grand hotel-type lobbies, English-speaking concierges, as well as interpreters skilled in some 30 other languages, shepherd them to private rooms.

Five-star hotels
Once discharged, patients can recuperate in five-star hotels that charge as little as $100 a night. Medi Makeovers, a Sydney-based medical-travel agency, is now the biggest corporate customer of Bangkok's 500-room Grande Centre Point Hotel Terminal 21, according to Somchai Meesri, the hotel's general manager.

Chatree Duangnet, chief operating officer at Bangkok Dusit Medical Services Pcl, poses at Bangkok Hospital in this May 19 file photo. Bangkok Hospital is one of 30 facilities in Thailand to win accreditation from the Joint Commission International, the global arm of the main standards-setting body for US hospitals.

"They take 10% of our rooms, ahead of Japanese clients such as Toyota and Honda," says Mr Somchai, whose hotel is owned by Land & Houses Pcl, Thailand's biggest residential-property developer. Medical tourists also stay longer, resting up after their procedures. "The average stay for other guests is three nights," Mr Somchai says. "For medical tourists, it is ten."

Though Thailand has long aspired to medical excellence - HM the King's father graduated as an MD from Harvard University in 1927 - it wasn't until 1997 that it began to tap a global market. That year, Bumrungrad opened the 500-bed Bumrungrad International Hospital with money borrowed in US dollars.

Six months later, Thailand was at the epicentre of the Asian financial crisis. The Thai baht collapsed along with the domestic market for premium private hospital care. "Our US-dollar debt doubled on a local-currency basis," says Chai Sophonpanich, Bumrungrad's chairman.

Wooing foreigners
In desperation, the hospital began to woo wealthy foreigners and expatriates living in nearby Asian countries, where medical services were less developed. Then, after the Sept 11, 2001 attacks in the US, a new market in the Middle East opened up.

"Patient flow increased as a result of more-stringent immigration policies by the USA and European countries for Middle East travellers," Mr Chai said. Within a decade, the number of Bumrungrad's Middle Eastern patients leapt to 130,000 a year from 20,000. In 2002, Bumrungrad became the first hospital in Asia to win accreditation from the Joint Commission International, the global arm of the main standards-setting body for US hospitals. Since then, 29 more Thai hospitals have also received that accreditation, including Bumrungrad's main rival, Bangkok Hospital, the flagship of Bangkok Dusit.

Last year, Bumrungrad attracted 250,000 medical tourists, including 20,000 Americans and 8,000 Australians. Three weeks after paying $7,500 to have her nose reshaped and breasts enhanced in Bangkok, Australian Calli Graham sips coffee beside Sydney's Bondi Beach and declares herself content. "It's the best money I ever spent," Graham, 30, says. "I got fantastic treatment and the satisfaction of knowing I am helping the economy of a developing country. It's a win-win."

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Medical tourism gains popularity with health insurers

Cost challenges under healthcare reform have caused major U.S. health insurers to jump onto the medical tourism trend.

Some uninsured or underinsured Americans already travel overseas for bargain priced elective procedures and treatments. Now UnitedHealth Group, WellPoint and Humana are looking to curb expenses by encouraging their members to receive medical tourism procedures abroad through cross-border plans, Medical Tourism Magazine reported.

Blue Cross Blue Shield of South Carolina has been embracing medical tourism strategies with its subsidiary Companion Global Healthcare, Inc., which has contracts with hospitals in Singapore, Thailand, Ireland, Turkey and Costa Rica. Add to the list MediExcel, a cross-border HMO that offers San Diego-area employers group healthcare coverage, including 24/7 access to routine doctor visits from delivery networks in the Mexican cities of Mexicali and Tijuana, the article noted.

Similarly, Aetna has a benefits plan that provides members and eligible dependents 100 percent coverage for qualified preventative care, such as immunizations and wellness exams, obtained in Mexicali, Tecate and Tijuana, Medical Tourism Magazine noted. Furthering its medical tourism efforts, Aetna in February launched a new partnership with Mexico's largest health insurer to give about 30,000 people who buy high-end plans access to its provider network both in this country and abroad.

Aetna's medical tourism partnership comes as many Mexican immigrants and naturalized citizens living in states like California and Texas cross the border to access healthcare services, given treatments in Mexico usually cost less and the doctors speak their language.

While Medical tourism is gaining ground among U.S. health insurers, the growth is falling short of industry expectations. A recent study found healthcare organizations that have a financial interest in increasing medical tourism have promoted the concept even if it's not based on any data or hard evidence, FierceHealthcare previously reported. The researchers also found fewer people are prepared to travel internationally for medical treatment than conventional wisdom holds.
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US healthcare: Obama talks to curb medical tourism to India

US President Barack Obama on Tuesday said his aim was to change the US healthcare system to discourage Americans from seeking medical treatment in India and Mexico. His healthcare reforms - called Obamacare by critics - is being opposed by Republicans on the ground that it will add up to the country's expenses, thereby worsening the debt situation.

"My preference would be that you don't have to travel to Mexico or India for cheap healthcare," he said in response to a question about why US health insurance won't cover medical expenses incurred abroad.

"I'd like you to be able to get it right here in the United States of America that's high quality."

Obama also said that prices of prescription drugs must be brought down "so that you don't feel like you're getting cheated because you're paying 30% more or 20% more than prescription drugs in Canada or Mexico."

In the run up to the elections in November, Obama had repeatedly brought up off-shoring to India and how he intended to change rules to keep US jobs from going to India.

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Indian hospitals say Obama prescription won’t work

US president Barack Obama’s appeal to his Americans not to visit India for cheaper medical treatment is seen by the healthcare industry here as restrictive. But big hospital chains like Apollo, Fortis and Medanta are not perturbed.

The Obama prescription came on Tuesday in Virginia hours ahead of India’s commerce minister Ana-nd Sharma’s talks with a group of US Senators to explore ways to improve trade and investment ties between two countries.

Addressing students of Northen Virginia Community College, president Obama said, “My preference would be that you don't have to travel to Mexico or India to get cheap healthcare." He said so while trying to hardsell his administration’s new healthcare plan that had many critics.

Captains of the Indian healthcare industry, which does Rs 70,000 crore business a year, were expectedly critical but not unduly worried.

"For the president of a country to admit that healthcare is cheaper elsewhere shows the deficiency of that country. But India is not about cheap healthcare but affordable high quality healthcare. The success rate of heart surgeries in some top Indian hospitals is 99.8 per cent. Indian doctors are skilled," said Dr Naresh Trehan, chairman & MD of Medanta - The Medicity.

He gave examples of how Indian healthcare was much cheaper than in the US. For instance, a joint replacement costs $11,000 in India but $50,000 in the US. Similarly, a cardiac surgery costs about a seventh of US costs which range from $65,000 to $100,000. This is why private hospitals employ world-class doctors – a draw for American patients.

Assocham in 2009 estimated that over 1,80,000 foreigners visited Indian medical centres in the first eight months of 2008. Currently, only 5 to 10 per cent of all overseas patients treated in India are Americans. The numbers coming from West Asia and Africa are much more. What has come to be known as medical tourism is worth $330 million in India.

Gautam Mahajan, president of Indo-American Chamber of Commerce and Industry, played down the impact of Obama’s statement. “People who are well aware of the availability of high-class medical facilities in India at comparatively lower prices will certainly avail of the services despite all such advice,” Mahajan said.

Fortis hospitals which receive over 20,000 overseas patients every year, did not officially comment but a senior official said Obama would not dare impose any restriction on travel to India for medical treatment. "This will not earn him any goodwill," the official said.

Data with the US Centers for Disease Control and Prevention showed that 46.3 million Americans, or about 15.4 per cent of the country’s population, did not have health insurance in 2009. The new US healthcare reform bill is being marketed to cover more Americans under this new plan.

Rajeev Boudhankar, vice-president of Kohinoor Hospital, said, "The major issue during US presidential elections was healthcare reforms. Till Tuesday, all Americans were saying that healthcare was very expensive in the US."

Sangita Reddy, executive director of operations at Apollo Hospitals, said insurance agencies in the US themselves recommend some patients for treatment in India. "Healthcare costs have not come down in the US and Obama’s statement may not have much impact out here,” she said. Delhi’s Apollo Hospital alone treated over 10,000 foreigners in the past two years.

While India's medical tourism revenues are not heavily dependent on the US market, the biggest number of patients from Asia and Africa will be unaffected by Obama's protectionist moves, industry players maintained.

"Without doubt, India is more cost-effective and this has helped us cater mainly to patients from Asia, Africa and Latin America and a huge part of our medical services revenue is contributed by patients from these regions. The US is nowhere near the top revenue generator," Rajesh Sharma, director general of the Services Export Promotion Council, said. “India is at par with the European Union and the US in terms of medical facilities, but the costs are 40 per cent cheaper here,” he said.

Dr Ramakanta Panda of Mumbai’s Asian Heart Institute did not see a drop in the number of American patients coming to India following the Obama exhortions.

This is not an isolated instance of Obama administration pursuing protectionist trade agenda though it has been a signatory to G-20 Pittsburgh resolution rejecting such measures by member countries. Last year, US had proposed the Foreign Manufacturers Legal Accountability Act under which an Indian exporter would have to shell out anywhere between $15,000 and $20,000 to retain a legal agent in the US. Prior to this US had, under the Emergency Border Security Supplemental Appropriations Act, 2010 hiked the fee for certain categories of H-1B and L1 visas by at least $2,000 for five years — hitting Indian export-oriented sectors.

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Finding Affordable Health Care in Foreign Hospitals

WHEN Ben Schreiner, a 62-year-old retired Bank of America executive, found out last year he would need surgery for a double hernia, he started evaluating possible doctors and hospitals. But he didn’t look into the medical center in his hometown of Camden, S.C., or the bigger hospitals in nearby Columbia. Instead, his search led him to consider surgery in such far-flung places as Ireland, Thailand and Turkey.

Ultimately he decided on San José, Costa Rica, where just a week or so after the outpatient procedure and initial recovery, he and his wife were sightseeing throughout the country, then relaxing at a lush resort on Costa Rica’s Pacific Coast. He was home four weeks later, with no complications.

Mr. Schreiner is what’s known in the health care world as a “medical tourist.” No longer covered under his former employer’s health insurance and too young to qualify for Medicare, Mr. Schreiner has a private health insurance policy with a steep $10,000 deductible. Not wanting to spend all of that on the $14,000 his operation would have cost stateside, he paid only $3,900 in hospital and doctor’s bills in Costa Rica.

“I didn’t have to fork over my entire deductible,” Mr. Schreiner said. “What’s more, they bent over backwards there to take care of me — no waiting, a friendly staff, everyone spoke English. “

At least 85,000 Americans choose to travel abroad for medical procedures each year, according to a recent report by the consulting firm McKinsey & Company. Treatment includes dental implants, hip and knee replacements, heart valve replacements and bypass surgery. The cost of surgery performed overseas can be as little as 20 percent of the price of the same procedure in the United States, according to a recent report by the American Medical Association.

Medical tourism is expected to expand quickly in the coming years because of rising health care costs in the United States, the increasing availability of international facilities with United States accreditation, and the fact that American insurers and employers are beginning to embrace the practice.

Blue Cross Blue Shield of South Carolina, for example, has started a subsidiary company, Companion Global Healthcare, to offer medical tourism services to individuals and businesses. Hannaford supermarkets in Maine recently added an international option for hip replacements to its health care plan, administered through Aetna.

At the moment, however, the bulk of medical tourism candidates are uninsured and underinsured individuals paying their own bills and looking for low-cost alternatives to American care. Medical tourism advocates argue that the quality of care overseas is often equal to or better than that of the United States. Many countries have high success rates, American-trained English-speaking doctors and the newest facilities, which are often built specifically to attract foreign patients.

But so far there are no comprehensive data that adequately compare overseas surgical outcomes or other quality measures to those used in the United States, said Dr. Sharon Kleefield of the Harvard Medical School and an expert on overseas health care quality measures.

“No matter how high your hospital is rated, there are issues with regard to quality and safety when you travel for medical treatment,” she said.

The American Medical Association, also worried about the risks associated with overseas medical travel and the difficulty in getting adequate follow-up care, issued guidelines on medical tourism last June.

With those cautions in mind, here’s what you need to know if you are considering an international medical option:

Determine whether you are a good candidate. “Traveling for surgery is a big deal,” said Josef Woodman, author of “Patients Beyond Borders: Everybody’s Guide to Affordable World-Class Medical Tourism.” Recovery time is often compressed, and a long flight home can cause complications like a blood clot. You’ll need to provide a thorough health history and have a physical stateside before you go to make sure you can withstand the trip.

Mr. Woodman also points out that not every condition should be treated overseas. “Orthopedic and nonemergency heart procedures have some of the highest success rates,” he said. “But with something like cancer, you need the ongoing relationship with your oncologist and health care team.”

Get a reliable middleman. Dozens of medical tourism facilitators and planners have sprung up in the past decade hoping to capitalize on the growing trend and simplify the process for consumers. “Unfortunately, plenty of unreliable firms have sprung up, too,” said Jonathan Edelheit, president of the Medical Tourism Association, a nonprofit organization made up of hospitals and facilitators that cater to traveling patients. .

Good firms, said Mr. Edelheit, will match your medical needs with the best overseas hospitals and physicians; make your travel, lodging, visa and local transportation arrangements; handle billing; and help arrange follow-up care when you return. Once you narrow down your search, ask each potential firm for references and former patients you can interview.

Check out quality yourself. Although medical tourism firms will say they work only with the highest quality international hospitals and physicians, you’ll still need to check the records for yourself. Don’t be swayed by the luxurious private hospital rooms, gourmet food and other amenities splashed on the Web sites. You want to be sure you’re going to a hospital accredited by the Joint Commission, the organization that reviews both American and international medical and dental facilities, using United State standards.

Be sure to read carefully, a commission spokeswoman, Elizabeth Zhani, warned. You may find a facility’s name on the accreditation list, but it may be that only an affiliated lab or ambulatory clinic is accredited, not the entire facility.

“Keep in mind that commission accreditation is the floor, not the ceiling,” said Dr. Kleefield. You’ll want to ask your own questions about the facility’s blood safety, medication safety, infection rates and unexpected morbidity rates for the procedure you’re undergoing, and discuss the data with your American doctor.

Just as you would in the United States, you’ll want to interview the physician handling your case before you arrive. Ask if he or she was trained in the United States and fluent in English, how often he or she has done the procedure you’re traveling for, and what the long-term outcomes have been. Conducting this interview on the phone or via e-mail beforehand will also help you establish a rapport with your doctor before you go under the knife.

Arrange your follow-up care in advance. “The biggest stumbling block with medical travel is getting care when you return,” said David Boucher, chief executive of Companion Global. Doctors will often balk at treating complications from an overseas surgery because they are unfamiliar with the procedures or prosthetics used or they are worried about liability.

Meet with your general practitioner and any specialist who may have been treating you before you go, said Dr. Ted Epperly, the president of the American Academy of Family Physicians: “They’ll be able to provide your medical records, either electronically or on paper, to your overseas doctors.”

Give your doctors in the United States specific details on where you are going for your procedure and contact information for your overseas doctors. And be sure to ask what medical records and information you need to bring home to complete your care.

Finally, before you leave, do your best to arrange a phone or e-mail conference between your doctors at home and abroad so communication will be established before a problem arises.

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Employers make a push for 'medical tourism'

U.S. health care costs have gotten so outrageous that some small employers save money by flying workers to foreign countries for inexpensive medical procedures.
FORTUNE Small Business Magazine
By Walecia Konrad, FSB Magazine
May 15 2007: 4:00 PM EDT

(FSB Magazine) -- Steve Chavez is willing to go to extremes to combat rising health care costs. The president of Integrated Control Systems, a 180-employee Albuquerque construction firm, Chavez has watched costs for his workers' orthopedic claims - damaged rotator cuffs, etc. - soar over the past three years.

Health insurance premiums for Integrated (icsicontrols.com) jumped 32 percent last year, bloating its overhead by 12 percent. That's why, starting this spring, Chavez is taking drastic measures, encouraging workers in need of major medical procedures to seek care in such far-flung locales as Costa Rica, India and Singapore - a growing practice known as medical tourism. Chavez estimates that overseas treatment will cut his medical costs by more than 10 percent year over year and help him avoid "another 20 to 30 percent rise in premiums."

Until recently, medical tourists were mostly individuals seeking low-priced cosmetic and elective surgery not covered by insurance. But more than one million Americans will travel overseas for procedures this year, and a rising proportion are getting insurers or employers to pay part of the cost.

It's easy to see the appeal for a cash-strapped employer. Surgery overseas costs 30 to 80 percent less than it does in the U.S., thanks to lower fees for even top-quality doctors and hospitals. The average charge for a coronary artery bypass is about $75,500 in the U.S., vs. $11,400 (including roundtrip airfare) at the Fortis Mohali hospital in India. A knee replacement in Singapore runs about $17,800 - roughly half the typical U.S. price.

While global medical tourism has yet to make major inroads with U.S. employers, some small employers and benefit providers such as BlueCross BlueShield of Texas (bcbstx.com) are starting to take the idea seriously. As FSB went to press, benefits providers, employers and health care executives were scheduled to meet in Las Vegas on April 30 at the industry's first trade show. "Medical tourism is starting to take off in the U.S.," said Senator Herbert Kohl (D-Wisconsin) at a recent hearing. Experts predict that the medical tourism industry will grow to $40 billion by 2010.

There is, of course, a huge stumbling block to growth: convincing workers to fly 12 hours or more to have surgery. That's where GlobalChoice healthcare (globalchoicehealthcare.com), an Albuquerque firm that helps connect U.S. employers and patients with foreign physicians, comes in. The firm, which is actively courting business owners, finds hospitals, sends records and schedules surgeries. It acts as a concierge, arranging air travel, hotel reservations and even sightseeing excursions. But perhaps most important, it aims to reassure patients that they will receive quality care.

GlobalChoice uses providers in India, Mexico and Singapore, and screens doctors to make sure they speak English and were trained in Europe or the U.S. It works only with hospitals that have received accreditation from the Joint Commission International (jointcommissioninternational.com), a subsidiary of the group that screens U.S. clinics and hospitals. "Quality overseas can be much better than it is at home," says Jeffrey Seders, an insurance broker in Los Gatos, Calif., who works with GlobalChoice. "There are hospitals within driving distance that I wouldn't go in."

GlobalChoice serves small and midsized companies in two ways. Self-insured firms deal directly with GlobalChoice to arrange employees' travel and treatments. Other employers use GlobalChoice through their health insurers. Either way, GlobalChoice charges a per-employee, per-month fee, much like a health-insurance premium. Employees might be responsible for a co-pay or deductible, depending on their health plan. GlobalChoice then covers all medical and travel expenses for an overseas surgical procedure. So far GlobalChoice has signed up two providers, including McKee Benefits Service (mckee-enrollment.com), says CEO Ken Erickson.

Erickson, 45, launched the company in 2005, catering to early retirees for whom Medicare coverage had not yet kicked in. To expand, he is also targeting self-insured companies such as Integrated Control that can barely afford benefits for workers. "Seeking treatment overseas may mean the difference between offering health insurance or offering no benefits at all," says Erickson. A handful of other U.S. firms, including IndUShealth (indushealth.com) and PlanetHospital (planethospital.com), arrange medical trips, but GlobalChoice is the first to target businesses.

Not everybody is welcoming medical tourism. Last year Blue Ridge Paper Products, a self-insured firm in Canton, N.C., was set to send one of its employees to India for rotator cuff and gall bladder surgery. The United Steelworkers union intervened, sending letters of protest to the Senate and House committees with jurisdiction over health care. Employees "are now being confronted with proposals to literally export themselves," the letter read. Blue Ridge canceled its plans.

Hoping to avoid that kind of conflict, Chavez will continue to provide some domestic coverage for doctor visits, including post-surgical care. At Integrated Control, employees now pay 50 percent of the cost of major medical procedures performed in the U.S. and 25 percent for those done overseas. "Once a few daring souls try it and everything turns out all right, other employees will embrace the idea," says Chavez. To that end, he is willing to be a guinea pig. "I need my rotator cuff done," he says, "so I'll probably go first."

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Many Americans go abroad for health care

More than 45 million people in the U.S. have no health insurance. So, where do they go when they're sick or hurt?

Many leave and head out of the country where they can afford to pay for the care they need on a trip becoming known as medical tourism.

A torn bicep caused searing pain, and a dilemma for Stephen Hoyle. He could not afford the surgery to fix it.

"We are one of America's 20 million uninsured families, and started looking at costs approaching $20,000," Hoyle said.

Hoyle was priced out of the U.S. Health Care System, so he flew to Costa Rica, where medical costs are dramatically lower.

Hoyle joined an estimated 500,000 Americans traveling out of the U.S. every year for some type of medical care. Care they can't afford here.

Stephanie Sulger, R.N. and Medical Tour Operator, said people go to great lengths for cheaper care.

"People are going everywhere," Sulger said. "They're going to Russia, China, Pakistan, south central American, Europe, south east Asia."

For a flat fee, medical tourism companies arrange for airfare, travel and health services. Many surgeons are U.S. trained, and post operative recovery is often booked at plush resorts and typically includes 24-hour private nurses.

Hoyle said his experience was outstanding.

"I got extraordinarily good medical care from a doctor who has supervised medical residents from American medical schools, you know, in a world class hospital for a fifth of the cost of doing it here," Hoyle said.

Arnold Berlin, M.D. at the Albert Einstein College of Medicine, said you have to know what you are getting into.

"I think the one thing to first remind people is that it's not a vacation," Berlin said. "One needs to understand that there are risks to any surgical procedure."

Berlin said those risks include infection, heart and lung failure and even death.

Sulger said the situation can be problematic.

"Having desperate people looking for medical care outside of the United States, and you've got a situation that's really a set up for problems," Sulger said.

Experts suggest you find out all you can about the hospital and the doctor before the visit. Track the credential online, speak to other patients and know that medical tourists should arrive a few days early to meet the surgeon before going under the knife.

Legal experts say buyer beware: most foreign countries don't have malpractice systems, and offer no recourse if things go wrong.

Several major U.S. insurance companies, like Blue Cross Blue Shield of South Carolina and southern California are now considering sending patients overseas for surgeries.

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Mexico Builds Hospitals to Lure Medical Tourists From America

The only way Bridget Flanagan, a 21-year-old college student from Olympia, Washington, could afford the obesity surgery she needed was to go to Mexico. Her health insurance didn't cover the treatment.

Traveling 2,000 miles for gastric banding surgery at Hospital San Jose in Monterrey, Mexico, saved her $6,600, making it affordable. The procedure was a success, allowing five-foot- tall Bridget to drop 45 pounds so far off her peak weight of 275.

Health-care companies and investors see a new market in patients like Flanagan. Tecnologico de Monterrey, the private university that owns San Jose Hospital, plans a $100 million medical center in Monterrey. Grupo Star Medica, the builder of seven Mexican centers in five years, is accelerating an expansion aimed at Americans, funded partly by billionaire Carlos Slim.

``This is a great opportunity not only for Mexico, but also to reduce health costs in the U.S.,'' said Marco Antonio Slim Domit, Carlos Slim's son and chief executive officer of his Mexico City brokerage Grupo Financiero Inbursa SAB. The firm took an undisclosed stake in Star Medica, a privately held hospital chain based in Morelia, Michoacan, in southern Mexico.

While Mexican authorities declined to estimate how much the country's health-care industry is expanding to handle medical tourism, companies are building new hospitals, clinics and surgical centers.

Industry Expansion

U.S.-based companies are also investing in Mexico. Christus Health, a nonprofit based in Irving, Texas, owns six hospitals in Mexico after opening one in Reynosa near McAllen, Texas. Dallas-based International Hospital Corp., the operator of three hospitals in Mexico, is building a fourth in the central city of Puebla.

Grupo Empresarial Los Angeles, Mexico's largest private hospital chain, is spending $700 million to build 15 hospitals over the next three years, said Victor Ramirez, the chief operating officer of the company's hospital unit. Oca Hospital, a family-owned company in Monterrey, is building a 200-bed facility there.

``In diverse cities that are attractive to Americans, we can offer hospitals that are very competitive and at a very good price,'' Ramirez said.

Grupo Angeles has a marketing campaign targeting Americans. The goal is for foreigners to make up 20 percent of patients within two years, up from 5 percent now, Ramirez said. At the company's hospital in Tijuana, Americans accounted for 40 percent of the 100,000 patients the facility admitted in 2007, he said.

Medical Spending

Health spending in Mexico in 2005 was about $49 billion, or 6.4 percent of gross domestic product. In the U.S., the world's biggest economy with a population almost three times Mexico's, health-care spending reached $2.2 trillion last year, 16 percent of all goods and services.

The number of private hospital beds in Mexico rose 28 percent to 34,576 in 2005 from 27,015 in 2000, according to the census bureau. Private doctors more than doubled to 55,173 from 21,565 during the same period. Surgery rooms in private hospitals jumped 46 percent to 4,545 in 2005 from 3,115 in 2000.

U.S. employers are prodding insurance companies to lower costs by providing incentives for workers to travel abroad for treatment. About 47 million Americans lack health insurance altogether.

For decades Mexico has attracted U.S. residents looking for cheap, basic health care. Border cities such as Tijuana and Ciudad Juarez across from El Paso, Texas, are dotted with clinics hawking bargain dental braces or discount eye exams and pharmacies that sell prescription medicines over the counter.

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Senate considers small biz healthcare reform

FSB Online (Washington, D.C.) -- Today the Senate Finance Committee considers options to expand health care coverage for small business employees. Half the nation's 47 million uninsured workers are employed by small businesses, according to a committee press release, and coverage offered to small business employees is declining rapidly.

The hearing is expected to cover a smorgasbord of ideas: making coverage more portable, creating multi-state pooling arrangements (also known as association health plans), reducing the cost of individual market coverage for sole proprietors, and creating health care tax credits for businesses or individuals.

In a recent Discover Card suvey of 1,000 U.S. small businesses with fewer than five employees, 75% of respondents provided no health coverage. About a third of businesses that did offer health benefits were thinking about ending coverage because of rising costs.

The dearth of health insurance for small business employees has emerged as a major national issue. Presidential candidates from both parties have released health care reform proposals, and several states have tried their own experiments. That momentum is putting the issue front and center in Washington.

Employers embrace "medical tourism"

Skyrocketing health insurance costs hurt small businesses disproportionately, says Linda Blumberg, a health care expert at the Urban Institute in Washington, D.C. (urban.org) "If a small firm has even one sick worker it has a very significant impact on the average cost," says Blumberg, who is scheduled to testify at Thursday's hearing.

The hearing will examine whether insurance regulations should be changed so that smaller companies can band together to buy insurance as a group. In theory, such association health plans should drive down premiums by spreading risk across a larger pool of workers. But critics argue that member companies with healthier employees would be likely to seek lower cost options, increasing coverage cost for the remaining companies in the group.

Canadian firms offer Cuban healthcare to U.S., Canadian patients

In the burgeoning business of traveling overseas for medical treatment, two Canadian companies hope to make an imprint by offering healthcare to Canadian and U.S. residents in socialist Cuba.

''We looked throughout Latin America or the Caribbean for a cheap source of medical services,'' says Daren Jorgenson, owner of Choice Medical Services in Winnipeg. ``Cuba is well known for high standards of healthcare.''

Some experts dispute the reference to high standards, but no one disputes the prices. Hip replacement, which can cost up to $38,000 in the United States, can be done in Cuba for $7,600, Jorgenson says. A tummy tuck can be had for $2,800, compared with $5,200 in the United States.

Soaring costs in the United States and a growing number of uninsured have emboldened patients to look overseas for healthcare. The Florida-based Medical Tourism Association estimates that several hundred thousand Americans now travel for health services each year.

For Americans without health insurance, Cuba's lower prices are the lure. A Georgia carpenter says he was delighted to get Cuban care. ``I've been hurting, and I was looking outside the United States for something I could afford.''

The carpenter, who refused to reveal his name because he was violating U.S. law by breaking the embargo, talked with The Miami Herald in a phone interview set up by Choice Medical.

The man, in his early 60s, suffered from a torn rotator cuff that made working impossible. Without insurance, shoulder surgery could have cost him $14,000 to $20,000 in the United States.

After researching on the Internet, he found that Choice Medical could arrange for the same surgery for $4,000 at Clínica Cira Central García in Havana. The price didn't include airfare but did cover nine days in the country, a personal tour guide and some sightseeing while recovering.

Later, the man talked with The Miami Herald from Havana. ''It came out real good,'' he said of the surgery. The hospital was ``better than I expected. All the people are so friendly.''

Asked if he was given special treatment because it was rare for them to see a U.S. citizen, he said, ``No, there are a lot of Americans down here.''

More people seek healthcare in Latin America

No one has exact numbers, but the new Medical Tourism Association, based in West Palm Beach, estimates that hundreds of thousands of Americans are now traveling out of the country for care.

Borders are no barrier to affordable healthcare

Our "best in the world" self image continues to take a battering. This article suggests that at some point "the best offshore hospitals will routinely be included in networks offered to insured Americans." Will we take advantage of the best healthcare other countries have to offer and then cheat them on reimbursements? - a new kind of Healthcare imperialism?

Exploding medical costs have prompted many Americans to travel to get quality treatment for 30% to 80% off.

When David Woodman announced he was going to Puerto Vallarta, Mexico, for major dental work, his son Josef thought his dad had lost his mind. He had visions of untrained dentists burrowing into his father's mouth, clutching fistfuls of rusty needles.

So the younger Woodman tagged along to make sure his father would not fall victim to foreign quackery. "Instead of what I feared, he got a board-trained dentist in a great clinic, with state-of-the-art instruments and panoramic X-rays," says Woodman, who was so impressed that he ended up researching and writing the book "Patients Beyond Borders" on the phenomenon of medical tourism. "And he saved $11,000 on a mouthful of teeth."

Countries such as India, Thailand, Mexico, Costa Rica, Malaysia and Singapore cater to well-heeled foreigners. In fact about 150,000 Americans a year go abroad to have medical work done and the industry is growing by about 15% to 20% annually. The quality of care in top hospitals is said to beat most American hospitals, while providing savings of 30% to 80%. In fact, in 10 to 15 years, "the best offshore hospitals will routinely be included in networks offered to insured Americans," predicts Arnold Milstein, chief physician for the consulting firm Mercer Health & Benefits.

As Josef Woodman discovered, the steep discounts are not because of ramshackle venues and dodgy doctors. Bumrungrad Hospital in Bangkok, for instance — which caters to an estimated 400,000 foreigners a year — is known for its marble floors and luxury amenities that make it look more like a resort hotel than a healthcare facility. source: LA Times

photo source Healthcare Tourist

NJ Hospitals Struggle With Medical Tourists

"North Jersey hospitals are treating increasing numbers of foreigners who travel to the U.S. for medical care -- and leave without paying their bill. Mindful that U.S. emergency rooms must take all comers, these medical tourists head from the airport straight to the hospital -- sometimes armed with CT scans and doctor's notes. As soon as they're well, they're back on the plane home. They're leaving hospitals -- and taxpayers -- on the hook for millions at a time when 40 percent of the state's hospitals are operating in the red..."If this doesn't stop, hospitals will go bankrupt," Ferguson said. They already have in California, where 84 hospitals have closed, overwhelmed by free health care to non-citizens.
(link to article in The Record, Bergen County, New Jersey)