One night in Bangkok …

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Thailand isn’t known solely for its beaches and brothels – the country is quickly becoming the top destination for face lifts, knee replacement surgeries and organ transplants.
And as health care costs – aided by the escalating costs of malpractice insurance, as well as rising insurance premium rates – skyrocket, more people are booking passages to India, Singapore and other points in Southeast Asia, searching for quality care at better prices.
“I’m a practicing medical tourist,” said Regis University Professor Mark Durand. “I go to Bangkok, Thailand, for a couple of reasons. The first is price. The second is the quality of health care.”
The prices for health care overseas are about one-tenth those in the United States, and patients from America and Europe are traveling for elective surgeries, cosmetic surgeries and dental surgeries.
Countries are quickly becoming “specialists.” Need invitro fertilization? Book a trip to South Africa. Need plastic surgery? Go to India or Singapore. Looking for routine surgical procedures, such as knee replacement surgery? Go to Thailand. Need dental work? Go to Mexico or the Philippines.
An estimated half million Americans are boarding planes to take their “medical vacations.” It’s an appealing idea: combine elective surgery with travel to an exotic location. And India is frequently the destination, performing an estimated $700 million in “medical tourism” each year.
For example, a heart valve replacement in India costs about $11,000, including the doctor’s medical malpractice insurance, travel and hotel for both the patient and doctor. In the United States, that same surgery would cost $55,000.
A liver transplant in the United States costs $450,000. In Delhi or Mumbai, it costs $40,000.
Durand swears by the hospital in Bangkok, Bumrungrad International. The hospital is accredited by the Joint Commission, the sole accrediting body of U.S. hospitals, and most of the doctors there were trained in the United States.
“I travel a lot in Asia,” he said. “So I went to Bumrungrad for the executive check up I have there every year. They have a complete line of services; chest X-rays, blood work, ultrasounds, whatever you need. It costs $200.”
As the result of the chest X-ray, the doctors at Bumrungrad noticed a shadow, and recommended that he have a CT scan. When told the cost at his doctor’s office in Fort Collins, he decided to have it done in Thailand. Doctors were against it.
“I called Bumrungrad and told them what I needed,” Durand said. “And they said they couldn’t do that test, because their equipment was more sophisticated. When I reported back to the doctors in Colorado, they agreed the Bangkok hospital had the ‘latest, greatest’ equipment and would be fine for me to go there.”
The shadow turned out to be nothing and the cost for the CAT scan: $190 in Bangkok, compared to $3,600 in the United States.
But the decision to seek treatment overseas isn’t all about the cost, Durand said. Often, it’s also about the quality of service.
“It’s not only cheaper, it’s more personal,” he said. “Here, there’s one nurse for every 10 patients. There, they have 10 nurses for every patient. The facilities are top-notch, similar to a four-star hotel.”
The Bumrungrad Hospital International markets to U.S. and European consumers, and more doctors across the world are doing the same. Mexico has become a destination for some dental work – but it isn’t seeing the travel that other places are.
“It’s closer,” Durand said. “But people worry about going there. In India and Thailand, you don’t have to worry about the quality. It’s farther away, so people are beginning to gravitate to Mexico.”
Durand said that some major insurers will waive deductibles and pay for travel – all because overseas procedures are so much cheaper. Blue Shield of California and Health Net of California offer low-cost policies allowing members to seek care in Mexico. United Group Programs in Florida offers a plan for the Bumrungrad Hospital in Thailand.
“It’s done on a case-by-case basis,” Durand said. “The market’s is so new, that they don’t have policies in place yet.”
Colorado’s largest insurer, Anthem, does not cover medical tourism.
“Although Anthem Blue Cross and Blue Shield would cover emergency care in foreign countries if the policy you’ve purchased includes this type of coverage, we would not cover ‘medical tourism’ or care that Colorado members decide they wish to have done in a foreign country,” said Dr. Art Jones, medical director, Anthem Blue Cross and Blue Shield. “Here’s why in a nutshell: Patients should bear in mind that foreign health care systems may provide a less well established quality of care than they have grown used to in the U.S. Foreign practitioners are subject to substantially different credentialing and regulatory oversight than those in the U.S. On occasion, their advertised results don’t bear up under scrutiny. In many cases, patients have gone abroad seeking care that has not been established as either safe or effective and would not be covered in the U.S. We are not willing to expose our members to the risk of inadequate, unnecessary or unsafe medical care.”
However, the field of medical tourism is growing quickly. Specialty travel agents book travel, as well as medical procedures, for clients. The field is small, but growing at about 40 percent a year.
“It isn’t making a dent in the U.S. health care market,” Durand said. “But as it becomes more prevalent, it could well become a problem.”
U.S. health care is a $570 billion industry, but the medical destination market could cut into those profits. It’s consumer-driven, said marketing expert Joe Markwith.
Markwith’s firm, TMA Guild, is exploring online marketing options with several Indian doctors and health care providers. He is hoping to strike a deal to market Indian health care to U.S. consumers.
“We’re still working on it,” he said, noting that the firm has come up against some legal challenges. “But it’s something we feel we have to do – consumers are driving this and it’s not going away.”
The litigious atmosphere in the United States – one of the things driving up the cost of health care – is one reason Markwith is moving cautiously.
His company has been faced with several issues: if something goes wrong, who gets sued? Would the marketing firm, even though it’s not a health care provider, be liable if it recommends doctors and hospitals in India? Markwith said the field is so new, there’s been no case law to determine fault when a patient is harmed by overseas treatment.
“It’s going to be extremely difficult to sue the doctor in India if something goes wrong,” he said. “So we are going at this slowly, to make sure that we won’t be held responsible, possibly sued.”
Amy.Gillentine@csbj.com