Is medical tourism worth the savings?

Jennifer Nelson

medical tourismIn 2008, Robin Rothman of Denver, traveled to Piedras Negras, Mexico to undergo vertical sleeve gastrectomy, a type of weight loss surgery where the surgeon reduces the size of the stomach to around 25 percent of its original size. At the time, this surgery was only being performed by a handful of U.S. doctors and wasn't covered by health insurance. In the U.S., vertical sleeve gastrectomy can cost between $15,000 and $20,000. In Mexico, the same procedure costs $10,000.

But the price wasn't the only thing that sent Rothman south of the border.

While researching the procedure online, Rothman heard rave reviews about Dr. Guillermo Alvarez, a Mexican physician who had performed 800 vertical sleeve gastrectomies, unlike many U.S. doctors who had little experience with the procedure.

Rothman isn't alone. A 2009 Deloitte Center for Health Solutions report on medical tourism projected that outbound medical tourism could reach upwards of 1.6 million American patients by 2012, and continue to rise by 35 percent each year after that.

Who is turning to medical tourism?

Even if you have health insurance, often the high deductibles and co-pays can put surgical procedures out of reach. Pramod Goel, CEO of PlacidWay, a medical tourism facilitator site, and author of Evolution of Medical Tourism - from Cottage Industry to Corporate World, says, "The cost of [insurance] premiums are rising and 50 million American don't have health insurance. We started seeing a rise in people asking for medical services they weren't able to afford locally."

Many people choose medical tourism for their surgical procedures because of time and availability but primarily because of cost: Medical fees are typically 50 to 80 percent less in other countries than they are in the U.S.

Also, more people want procedures that are either not FDA-approved or not allowed in the United States. "We are seeing a rise in certain procedures that aren't available in the U.S., like stem cell treatment for chronic disease," Goel says.

Popular medical tourism destinations include Mexico, Costa Rica, India, Thailand and Turkey.

Popular medical tourism procedures

Americans typically travel abroad for cosmetic, dental, chronic disease, stem cell, weight loss and fertility procedures. In the U.S., the cost of one in vitro fertilization cycle (where a woman's egg is fertilized by sperm outside of the body) is $10,000 versus $3,000 to $3,500 abroad.

Lori Payne, a patient coordinator for Reveert, a plastic surgery clinic in Guadalajara, Mexico says Americans and Canadians come to her clinic for face lifts, breast implants, tummy tucks and liposuction. Breast implants cost about $4100 in Mexico whereas they can cost up to $10,000 in the United States.

And it's not just the cost that is satisfying medical tourists. Rothman says that the care she experienced in Mexico was some of the best she'd ever had. Her weight-loss surgery went well and she has since lost 120 pounds.

What you can expect from medical tourism facilities

Typically, hospitals and clinics that specialize in medical tourism are modern and clean; staff and doctors speak English. And importantly, there is a high standard of care. "These hospitals and clinics are getting American certifications and educations," Goel says. Many hospitals are Joint Commission International (JCI) certified, an accrediting organization that assesses medical facilities abroad to make sure they meets basic standards and requirements involved in providing quality of care, and are managed to American standards.

However, medical tourism has drawbacks. If you go abroad to get surgery then suffer complications due to negligence or incompetence, you will most likely be unable to sue for medical damages as many U.S. health insurers don't cover medical treatment abroad. Also, you may have to pay for your own follow-up care in the U.S.

Do people with health insurance become medical tourists?

In 2009, the Medical Tourism Association, an international nonprofit that includes international hospitals, health providers, medical tourism facilitators and insurance companies, revealed in a survey that 42 percent of U.S. citizens surveyed used some medical insurance coverage when they traveled overseas for treatment.

Several U.S. insurers have launched medical tourism pilot programs within their health benefits plans. Insurers are hopeful that medical tourism may help reduce treatment costs while employers may encourage it as they continually look for ways to reduce health costs. United Group Programs, an employee benefit specialist company in Florida, promotes medical tourism to more than 200,000 members that are covered through self-funded health plans and mini-med plans (health plans with limited benefits).

For example, Health Net Inc., a managed health care company that offers health plans and government sponsored managed care plans, offers "Salud con Health Net," a program for California members to see a doctor in Mexico.

However, insurers covering medical tourism are still relatively uncommon. Most major insurers are reluctant to cover medical tourism for a variety of reasons, including concern about the credentials of a clinic abroad, how claims processing will work and the quality of the care.

But patient-driven need for access to cost-effective overseas care will likely make medical tourism more and more popular.