Featured Article | THB Undercover
The Rise of “Medical Tourism”
Several years ago, I enjoyed an amazing vacation in Costa Rica.
Shortly after I arrived, I found myself reclining in a comfortable leather chair. I leaned back and relaxed, staring at the flawless blue sky and the steep, misty mountains surrounding San Jose.
Soft, soothing music played in the background. I was beginning to drift off when a young woman walked over. She placed her hand on my shoulder.
“Good afternoon, Jon. I hope you’re comfortable,” she said, in perfect English. “Can I adjust the chair for you? Would you like something to drink?”
“No, thank you. I’m 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, Jon. Are you ready to begin?” she asked.
I nodded – 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 walked out the doors of Prisma Dental. My mouth was sore and numb, but I was ready to enjoy the rest of my “vacation.”
For the next ten days, I traveled in Costa Rica and Nicaragua. At the end of my trip, I returned to San Jose, where Dr. Rubinstein completed my dental work.
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 abroad to obtain dental, medical, and surgical treatment. In many cases, the cost savings are so substantial that the “tourism” aspect of the trip is an added bonus.
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An article in India’s BusinessWorld Magazine states that “medical tourism” accounts for more than $40 billion a year in medical and travel expenses. A study performed by Deloitte Consulting suggests that more than three million Americans will travel for medical procedures in 2010. And these numbers are growing rapidly.
The top regional destination for medical tourists is Asia. Singapore, Thailand, Malaysia and India attract well over a million medical travelers each year. But large numbers of people are also traveling to Central and South America. They are able to enjoy high-quality, affordable healthcare. And at the same time they enjoy numerous options for tourism and convalescing in the tropical air and healing sunlight.
Why Would Someone Travel for Healthcare?
Over the last 20 years, the standard of healthcare has rapidly improved in a growing number of lesser developed countries, especially in private hospitals. In many cases, the doctors and specialists in these facilities were trained in the top medical and dental schools in the U.S.
These emerging countries boast a variety of modern hospitals and state-of-the-art outpatient facilities. Often, the technology is newer and even more advanced than the equipment used in facilities here.
The bottom line is that many lesser developed countries now offer world-class medical services. In fact, they often exceed the standards you would expect in the U.S. or Europe – but at a small fraction of the cost.
Medical tourism began primarily with elective and cosmetic procedures. Today, growing numbers are traveling for life-saving and medically necessary procedures, such as joint replacements, cataract surgery, bone marrow transplants, and even bypass surgery. Virtually any medical procedure can be safely obtained for pennies on the dollar in a foreign country.
A recent CNN article told the story of 61-year old, Sandra Giustina. Without insurance, she had no way to afford the heart surgery she needed to correct an abnormal heart rhythm. The surgery would have cost $175,000 in the United States. Instead, she traveled to New Delhi, India. There she had the operation for less than $10,000. That included the cost of travel… and a brief vacation after her recovery.
And her experience was not unusual. According to the Medical Tourism Association, here are the approximate costs of several procedures:
| Heart Bypass | $150,000 in the U.S. | $8,500 in India |
| Liver Transplant | $315,000 in the U.S. | $75,000 in Latin America |
| Dental Implant | $2,500 in the U.S. | $1,000 in Costa Rica |
| Face Lift | $15,000 in the U.S. | $4,000 in Singapore |
| Knee Replacement | $40,000+ in the U.S. | $10,650 in Mexico |
| Hip Replacement | $50,000+ in the U.S. | $8,000 in Philippines |
| Bone Marrow Transplant | $250,000 in the U.S. | $25,000 in India |
When you consider the costs, it is easy to see why medical tourism is booming. But cost is not the only reason why people are traveling for healthcare.
Surging demand in the developed world is exposing the flaws in our system. Under the socialized healthcare plans in the in the U.K and Canada, for example, some patients are required to wait years for treatment they need today.
In the U.S., the wait times are not as long, but the medical system has become a massive paper-pushing bureaucracy. It is plagued by fraud, inefficiency and waste. And the costs of healthcare have risen to the point of being ridiculous. Those who are uninsured have very few choices, within the current system.
In fact, before the financial and housing crisis, the number one cause of bankruptcy in the United States is due to medical expenses. This is not surprising when you consider that 45 million Americans have no health insurance coverage.
What about the Service and Standard of Care?
Doctors, dentists, and hospitals that cater to medical travelers actually have to meet a higher standard of service than those in your home country. These facilities and practitioners have to compete in the free market for cash-paying customers.
They also get much of their business from word-of-mouth referrals. Unless their patients receive a high-quality experience, they are unlikely to spread the word.
In some cases, options exist for full-service travel arrangements, private chefs and adjoining suites where family members can stay close to their loved ones.
An appointment with a specialist, diagnostic testing and follow-up can often be completed within hours. In the U.S., that would usually require several appointments and hours upon hours in waiting rooms.
Why I went to Costa Rica to have my teeth fixed…
One of the fastest-growing areas of medical tourism is dentistry. That is because most people don’t have comprehensive dental coverage.
In my case, most of the work was necessary. I had a broken tooth. I needed a root canal and an implant. And I needed to have a few fillings replaced. On top of that, I wanted to fix two gaps in my smile.
When I priced all this work here in the states, the total came to more than $18,000. And none of it was covered by insurance.
Based on my research, I knew there were a number of first-class dental practices in Costa Rica. It is a quick flight to get down there. And the cost of dental care is very low there, compared to the U.S.
I chose a practice called, Prisma Dental. The facility is bright, clean and modern. It also happens to be the friendliest and most accommodating dental practice I have ever visited. More importantly, the dental work that they performed was better than any I have received in the past. (And, no, I did not - and will not - receive any discount or commission for 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 less than one-third of what I was quoted here. My entire bill for the trip, including travel and lodging, was around $6,000.
That amounts to a savings of more than $12,000 – and a free vacation in Central America.
What are the downsides?
You can get some of the best health care in the world here in the United States – and, in some cases, some of the worst. The same can be true in other countries as well. But there are some obvious downsides to consider:
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Your insurance policy may not cover treatment (although more and more plans are offering coverage). If your plan does offer coverage, you may have to pay first and wait for reimbursement.
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All surgeries and medical procedures carry a certain level of risk. This is true, no matter where they are performed. But if a procedure goes wrong overseas, you have the added complication of being far from home.
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There is little opportunity for follow-up care. 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.
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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. High-quality facilities still have full coverage, of course. But due diligence is imperative.
I hope I’ve opened your eyes to the many possibilities that exist. As always, my best advice is to focus on “health care” so that you won’t need “medical care”. But if you find yourself or a loved one in a position where a medical or dental procedure is necessary, now you’re aware of other options you may consider.
Jon Herring
Editorial Director Total Health Breakthroughs
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thank you - it is becoming too expensive here in Australia to have extended dental treatment - the waiting lists for
medical procedures are horrendous.
I am a psychologist, natropath and trainer living and working in India and based in Goa. I can completly concur with this article as I have many patients coming from all over the world here for a variety of treatments from rehab to dental to heart surgery
David
Thanks for the great article! I’m sending this to a fried who could benefit!
Dr. Telma Rubenstein is the wife of Dr. Bernardo Rubenstein, one of the best opthalmologists I have evr met. He will perform my cataract surgery in the summer.
I had a bi-lateral (double) hip replacement done at CIMA hospital in San Jose Costa Rica. Dr. Jaime Ulloa is a truly outstanding orthapedic surgeon and did an extraordinary job. The hip replacement cost me about 5% of what my out of pocket cost would have been in the US (my insurance from Denmark pid for most of it). The total cost, including extensive pre-op testing, 17 days in the hospital (private room), 20 days at a rehab center and all post op was about 10% of the cost of the same services in the US (without insurance). I rate the medical care at all levels as much better than in the US — it’s nice to be considered as a person instead of an insurance number. You are welcome to email me for references to Dr. Ulloa, Rubenstein, CIMA Hospital and the rehab center.
Hi Jon,
This is really a great article which can help people considering the combination of vacation and medical/dental care. They do not get to read first hand experience written by an Editor every day. I really appreciate it.
Jag
http://www.TourNCare.com
On Line Medical Tourist Community
The root canal does not sound like a good idea, Jon. It is frequently linked to cancer. My daughter had one about 3 years ago, & I am offering to pay for her to have it removed.
Here in the UK, even life-saving operations have long waiting lists, & even if you do have medical insurance, you have to pay up to half of the costs yourself.
I live in you call it socialized ” Healthcare country Canada and you are telling “Fibbies” You do not wait years for a procedure. This is false and has been dreamed up by people in your Country against Health care reform in your Country.
Yes you sometimes have to wait if the needed procedure is not Life-treatening. We are a small” population” Country ( 30 Million) and a country as big as your own. Considering this we are doing a fantastic job covering everybody.
If GM had put all their Auto plants in Canada where their people would have been covered by our ( Socialized) Health Care, GM would not have gone broke. GM could not afford the Health Care package for a worker in the USA.Traveling for medical treatment is going to be normal and perhaps the Way to go for the USA. Your Health Insurance will not allow a Health Care reform in your Country and even Obama cannot push a good plan that will lower cost so sent the people to the countries you mentioned in your piece. I just had 2 implants placed here in Canada ( $2000)
Good piece . Have fun.
This article is informative and truthful. I believe U.S.
citizens will continue to explore our options. When it
comes to quality and affordable medical attention, we
have the right to take advantage of every opportunity
available.
John,
It was not my intent to disparage the medical system in Canada. I don’t know enough about it to comment.
It is true, however, that people in Canada and the U.K. are traveling for health care to avoid waiting. There might not be a long waiting time for emergency care, but what the system sees as an emergency and what the patient sees as an emergency are sometimes two different things.
My mom, for example, is having a hip replacement in a few days. She is hardly able to walk and getting to and from work has become very difficult. Despite the hardship and pain, her procedure would probably not be considered an “emergency” in Canada.
How long would she have to wait there? I don’t know. But I did find this in the following article at CBC News:
http://www.cbc.ca/health/story/2007/10/15/waittimes-fraser.html
“Despite government promises and the billions of dollars funneled into the Canadian health-care system, the average patient waited more than 18 weeks in 2007 between seeing their family doctor and receiving the surgery or treatment they required.”
In any case, my intent was not to shine a light on healthcare in Canada… but to point out that there are many options out there that people have not considered.
For those who may be interested, there were a few numbers transposed in the table included in this article. The cost of procedures in the U.S. and abroad are generally correct, but there were a few numbers that were off.
Here is a link to the Medical Tourism Association list of patient costs:
http://www.medicaltourismassociation.com/procedures.html
Jon
Excellent article. The benefits consulting and medical travel company that I lead, Companion Global Healthcare, includes Prisma Dental as one of 3 Costa Rican dental clinics in our network. Our members’ experiences have closely mirrored yours. As you note, most Americans can save 50-70% on their dental work by visiting Prisma!
I too have been a patient at Prisma and I can attest that the care and service is first class.
I just had a total hip replacement in Germany. The surgery went very well but the hospital care was not up to average standards because, as my German doctors and surgeon explained to me, the socialized medical system in Germany has (over the past 10-15 years) been undermined by the government’s attempts to economize, since about 30% of the population is supporting 100% of the medical program there(unemployment, immigration, retirees). There are no RN-equivalents (nurses do not run IV’s, they drop off your med’s at 5:30 AM and walk away, and in emergencies occurring in a patient’s room, they call the doctor on a cellphone and “hope he calls back” while they fluff your pillow and then walk away, closing the door behind them!) Hospital professionals are not well paid, so facilities don’t attract the type of people they would have attracted in the past. Consequently in a once medically top-rated country,hospital care is below our standard, and you must bring your own towels, soap, and an advocate to get you a bed pan when you need one. Rehabilitation, however is absolutely superb. Three weeks in a sport-hotel facility provides intense and excellent care, plus room and board, at very low rates and with very high standards that only millionaires could expect in the USA. We certainly could learn A LOT from socialized medicine, including how to do things (rehab) and how NOT to do things (dismal hospital care). A learning experience we miss at our peril.
It’s always interesting to hear about poor conditions in UK, Canadian and European hospitals. In the US we have lot’s of attorney ads about poor care at nursing homes with bedsores, falls, mistakes etc. exhorting viewers to stand up for grandma.
Just think if Americans had to put up with increased wait times, dirty ERs, bringing their own linens to the hospital and bed sores at hospitals. If US medicine devolves into that type of experience, we will have a massive wave of litigation. Failure to diagnose lawsuits will become common because doctors will be too rushed or not be allowed to get an mri scan. And how about all the patients that seem too cranky, potentially litigious or otherwise difficult to treat? Will those patients get seen or will providers simply say that they can’t help?
I notice that you did not mention Brazil. My jeweler had eye surgery done in Rio and paid one fourth what it would have cost in America. He recuperated in a four star hotel and came home very pleased. Thanks to the Brazilian love of the beach and Dr. Pitanguey, the Brazilians have put themselves at the top of the charts in plastic surgery. For patients, there is the added lure of privacy in a foreign country. I have not been to Brazil but patients could contact Dr. Pitanguey for referrals. He is ranked one of the best in the whole world. Their follow-up care is done in four star hotels with a nurse in attendance. With the new health care bill,it will certainly be interesting to see how much medical care (and doctors) go abroad from now on. Also, I think it would be agood idea if you considered the issue of human rights in your inquiries. In China, activists say that doctors choose a convict and execute him to get a body part for transplanting. This is offensive to all civilized people and whenever foreign care is sought, there ought to be a diligent effort made to make sure that the practices of that nation do not include such horrors. When you consider the travel of pedophiles to Thailand to victimize children, you realize that some people do not have this civilized instinct, however. This is like all things very much a matter of Caveat emptor….let the buyer beware. Our good condition ought not to come at the price of someone else’s life or health.
Here in HK, we have to wait a long time for our specialist appointment or imaging studies in public hospitals which are virtually free.
We have the choices of going to local expensive private facilities or to mainland China which has notorious hygienic conditions ( some hospitals reuse their disposable needles or operative knives) and substandard unconventional treatments (eg. bear bile eyedrops ).
Not many buy medical insurance and usually the plans cover hospitalization and surgeries only. So we usually go North for imaging or kidney transplants only. Going for body checks in Thailand and South Korea for plastic surgery are also becoming popular. There is no perfect heathcare system that I know of as every one of them is subject to abuse / waste but I think that multiple options is the way to go.
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Nicely done THB undercover!! This is a well written and informative article outlining the many advantages of Medical Tourism and Global Healthcare alternatives. As director of the non-profit MIRA Global Health Advocacy, I work directly with some of the more established Medical Tourism provider hospitals that focus on serving patients from North America. We fully support the responsible growth of Medical Tourism providers and must agree that, in many cases, the treatment received from a top quality Medical Tourism Provider is superior to that in our domestic hospitals that are burdened with mountains of insurance paperwork before they can even begin focusing on the patient’s true health needs. The top providers we work with, such as Atlantic Health International, actually contract with and fly in some of the top American based orthopedic, ENT, bariatric and general surgeons to perform the actual medical procedures. Anyone reading this, please feel free to contact our offices for additional information about the most important criteria to evaluate to help you choose the right global healthcare provider for your needs.
http://www.miraglobalhealth.org
Regards,
Gregory Garbero
MIRA Global Health, Director