Medical Tourism: It’s No Vacation?>

Medical Tourism: It’s No Vacation

by Larry Lindner

Your dentist says you need two crowns and an implant that together will cost more than $12,000. The problem is, your dental insurance covers only up to $1,600 (if you have dental coverage at all). Or you need cardiac surgery but have a $10,000 deductible on your medi­cal plan that will be a hardship. Or maybe you desire a cosmetic proce­dure that your insurance plan won’t pay for because it’s not medically necessary. The price tag could render some medical decisions dead in the water.

But what if you could have these or other procedures—root canal, cataract sur­gery, in vitro fertilization, prostate surgery, a kidney transplant, to name a few—at a mere fraction of the U.S. cost, just by trav­eling abroad and having the work done by health care professionals in other countries?

You can. In fact, more than 1.4 million Americans went abroad in 2017 to take advantage of highly competitive rates on various medical procedures—up to a 90 percent discount in some instances—with the number of dollars spent on such travel expected to rise up to 25 percent a year for the next several years.

Even with the cost of airfare, hotels, and incidentals taken into consideration, the price for overseas surgeries and other procedures is far less than what it is here in the U.S. Consider that a coronary bypass costs well over $100,000 in the States but is closer to $10,000 in India, according to the World Health Organization (WHO).

In addition, several health insurers have begun developing alliances with overseas hospitals, and some companies are even encouraging their employees to go to other countries for procedures by reim­bursing their out-of-pocket expenses.

From Mexico to Thailand

Traveling abroad for health care is called med­ical tourism, with most people leaving the U.S. for lower costs on dentistry, cardiac surgery, orthopedic surgery (think joint replacement), weight-loss surgery, cosmetic surgery, transplants, and dermatologic procedures. As noted in a paper in the American Journal of Medicine in 2019, the top destinations for U.S. residents are Costa Rica, India, Malay­sia, Mexico, Singapore, South Korea, Tai­wan, Thailand, and Turkey. Some medical tourism websites cite Brazil and Israel as other popular places.

Traveling for Medical Care? Don’t Count on Spa Time

The word “tourism” in the phrase “medical tourism” notwithstanding, traveling abroad for surgery or other significant medical treatment is a serious matter—and it might look a lot different than an exotic vacation.

No one country has a monopoly on a specific type of surgery or procedure, but broadly speaking, people often go to Mexico and Hungary for dentistry, Asia for open heart surgery or joint replacement, and Latin America for cosmetic surgery. Brazil, for instance, is famed for “body sculpting,” including the BBL (Brazilian Butt Lift).

The expertise is often fully equivalent to what you would get in the U.S., sometimes with hospital rooms that feel more like five-star hotels than medical facilities. You might even be able to get a procedure done sooner overseas than you would in the U.S. But it’s critical to know what you’re getting into beforehand and take special care to ensure that the medical attention you receive will be comparable to what you would get in the U.S.

Facilitating the process

A number of medical tourism agencies and medical concierge services have sprung up to arrange a trip abroad, with services that include identifying the appropriate health care providers and arranging hos­pital admission, as well as booking hotels and air travel. But such companies should not be your final go-to for deciding which is the right facility or who is the right doc­tor to use. They are facilitators—medical travel agents or brokers, so to speak—not a part of the health care team. Here’s your homework.

Check the hospital

Find out if the hospital or other facility, such as a dental clinic, at which you’re considering treatment has been accredited by the Joint Commis­sion International, or JCI. This nonprofit group has the same standards as the Joint Commission, which accredits health care facilities in the U.S. Reliable accredita­tion may also be awarded by DNV-GL, headquartered in Norway. Another group that can help you determine whether the facility you’re considering meets acceptable standards is the International Society for Quality in Health Care.

Note that several major U.S. medical schools have developed joint initiatives with overseas providers, resulting, for example, in the Johns Hopkins Singapore Interna­tional Medical Center and the Harvard Medical School Dubai Center. The Cleve­land Clinic, University of Pennsylvania, and Duke University are among others that have gotten in on the act. Such facilities are excellent bets accredita­tion-wise, but be aware that their prices may be higher than those of facilities not affiliated with a U.S. institution (though usually still less than the cost of having the procedure done in the U.S.).

The fact, however, that a foreign hos­pital is not associated with a U.S. medical school—and may have a lower price— does not mean its standards are poor or that its physicians are not well-creden­tialed. Many overseas doctors participat­ing in medical tourism went to medical school in the U.S. or received board cer­tification for their specialty here. (On the flip side, bear in mind that many doctors practicing in the U.S. received their med­ical training abroad.)

Check infection rates

While inquiring about the facil­ity’s accreditation, you may want to find out about its infection rates, including catheter-associated urinary tract infections, central line-associated bloodstream infections, surgical site infec­tions, and C. difficile infections. JCI does check infection control in its accreditation process, but it’s not a bad idea to ask about the rates for these health care-associated infections and discuss them with your pri­mary care physician at home before having the procedure abroad.

It’s worth keeping in mind that anti­biotic-resistant strains of bacteria not com­monly seen in the U.S. can cause serious infections. In 2014, the CDC reported that 19 women from the U.S. who had cosmetic surgery at a facility in the Dominican Republic—mostly liposuction, abdomino­plasty, and breast implants—contracted an unusual bacterial surgical wound infection, which, in most cases, necessitated hospital­ization once the women returned home.

There have also been reports of infec­tion among people who received live sheep cell injections in Germany. (The practice of injecting various animal cells is claimed to miraculously help with a variety of med­ical conditions but is overhyped and unproven and not available in the U.S.)

Check the doctor

Make sure the physician or den­tist is board-certified in the U.S., U.K., Canada, or another developed country, or has other training creden­tials that are essentially equivalent. The American Board of Medical Specialties provides a database of U.S. board-certified surgeons and other specialists practicing outside the country (you can search by the doctor’s name at certificationmatters.org). To check whether an overseas dentist is board-certified in the U.S. or another developed country, start by contacting the American Dental Association at ada.org. Try to speak to the doctor by phone or, if it’s easier, communicate via email before making a decision. Contact the hospital directly—staff there should be able to put you in touch with the doctor, as well as with previous U.S. patients who used the same facility and health care provider.

Medical Tourism: A Pre-Travel Checklist

In addition to carefully vetting the provider and hospital you plan to use, here are other important steps to take and things to know before you sign up to have a medical procedure abroad.

Bottom line

If your health insurance does not cover a needed surgery or other procedure—or you have a very high deductible that you can’t afford—traveling to another country for medical care can be a reasonable option, especially if it’s the only way you can get the treatment. But certain risks may accrue beyond those that may arise when having the same treatment in the U.S.; you’ll have to do even more homework than usual in choosing a facility and doctor, and put more safeguards in place to help ensure a good outcome.

We advise against going abroad for any procedures that are considered experimental in the U.S. and are not approved here by the FDA, such as the previously mentioned sheep cell injections, as well as many dubi­ous cancer and stem-cell therapies. They are not approved for a reason—usually because they have not been proven effective or safe. Lastly, keep in mind that you typically have to pay in full before the service is rendered, unlike at home where payment can usually be deferred or made in installments.

This article first appeared in the UC Berkeley Wellness Letter.

Also see 6 Misperceptions About Travel Health.