Going Over the Border // Myths and realities about medical tourism

The story was splashed across social media. It claimed that four people from the Jewish community had gone to Mexico for a weight-loss surgery, only to find out later that one of their kidneys had been stolen.
The story, it turned out, was an elaborate game of broken telephone.
Rabbi Yisroel Kahan, the community medical liaison for the Westchester Medical Center system, told Ami that the initial story was, indeed, based on the statement of a medical professional dealing with one patient who is concerned about the possibility that something untoward happened to one of his or her kidneys.
The hysteria around this story matches the craziness regarding the perennial urban legend about kidney theft from travelers that has been repeatedly shown to be fabricated. But it also highlighted that foreign countries are increasingly being seen as a good alternative to care within the US, or within other countries. Why is that? And how can it be done safely?

A whole new set of teeth
from Mexico
Say the word “tourist”—for example, in the phrase “medical tourist”—and you may conjure up an image of wealth and leisure. But according to Josef Woodman, the founder of the medical tourism reference company Patients Beyond Borders, that assumption is inaccurate. The real “typical” medical tourists, he told me, are working poor—lower middle-class or upper working class.
“They’re one paycheck away from losing their mortgage,” he said, or they’re trying to make sure that they can save for their children’s college tuition. Medical travel, for them, is purely a question of saving money. And those savings can run from 30 percent to 70 percent, he said, depending on the procedure and the country.
The perception is that medical tourism involves flying far overseas. However, “about 60 percent of US outbound medical travel,” Mr. Woodman told me, “is Americans crossing the border into Mexico for dental work. And even there, most of those patients are coming from Texas, Arizona and Southern California, traveling nearby for cheaper care.”
He said that similar border crossings exist elsewhere. Germans and Austrians, for example, travel into Hungary for dental care. These kinds of trips are often regular, yearly trips to their favorite dentists.
Patients Beyond Borders is a series of books and a website that advises patients on how to travel for medical care and where to go for safe and quality care. But Mr. Woodman didn’t start off as an expert in the medical field; he’s worked as a publisher. It was Mexican dental care that led him to become an expert in this industry.
“Back in 2005, my father, who is somewhat eccentric, announced that he was heading to Mexico for a mouthful of new teeth,” Woodman told me. His father was then 72, and this idea seemed alarming.
“I followed him there, and it was a real eye-opener, because I saw all kinds of Americans in the lobbies of these dental clinics.
“One thing led to another, and I ended up writing a book over the next year, with some researchers and a small editorial team. We introduced it in Singapore in 2007, and the ministry of health came to us and said, ‘Hey, we could fill up an entire book just on Singapore.” The country has a great healthcare system, and it is a popular destination for medical travelers.
Woodman ended up working with Singapore’s ministry of health to produce a traveler’s guidebook to medical facilities in the country, which the ministry financed. “They agreed to give up all intellectual property rights and give us editorial control.
“We ended up doing the same for Korea and Thailand, and we became a sort of Lonely Planet guidebook of medical travel, with some 12 editions published.”

How to know what’s good
Researching the books required a great deal of legwork, Woodman told me. He visited 200 hospitals around the world and interviewed patients to find out how their experiences were. Ministry of health statistics were helpful to determine the best hospital systems, but international accreditation organizations were also increasingly important.
In the US, one of the most well-known and respected hospital accreditation organizations is the Joint Commission. In 1994, the Joint Commission created an international arm, Joint Commission International, which gives accreditation to medical networks worldwide.
Just like in the US, that accreditation not only covers medical practices in hospitals and clinics, but also covers things like credentials of employees and fire safety.
As Elizabeth Zhani, a media relations manager at the Joint Commission, explained to me, JCI doesn’t provide accreditation to individual providers, just to medical networks. In general, most of the JCI-accredited facilities are hospitals, or clinics attached to hospitals. For independent clinics, there is accreditation by two international branches of American accreditation organizations: the Accreditation Association for Ambulatory Health Care International and the American Association for Accreditation of Ambulatory Surgery Facilities International.
JCI, like the Joint Commission in the US, isn’t aimed at medical tourism; it helps everyone in the country feel confident about the medical facilities. Woodman told me that medical tourists need a few more pieces of knowledge than citizens of a given country will, however.
“There are cultural differences, language differences, and issues surrounding travel and hospitality,” he said.
Obviously, being able to accurately communicate with hospital staff is a necessity, and cultural differences can be an issue, as well. But Woodman noted that an extended hotel stay is also going to likely factor into many medical travel plans.
“You should stay in the country for at least eight to ten days after a significant invasive procedure, because that is the usual window in which complications occur.” Being near the doctor who did the original procedure in case of any complications is important.
Bringing back your information to your doctor at home is also a necessity. Patients Beyond Borders got a complaint from a person who had used their guide to find an overseas facility, at which he had surgery, but his doctor back at home refused to see him afterward. When PBB investigated, they found that the patient had left his post-op records at the overseas hotel he had stayed in. Because he had nothing to show his doctor, the doctor was unwilling to fly blind in treating him.

The good and the bad
While Patients Beyond Borders’ publications aren’t aimed at the wealthy, who Woodman said often access ultra-high-end boutique clinics that cater to such customers, business travelers getting incidental care done has become a new trend, he said. “They recognize that if they need light care, they can get it for cheap while traveling.”
He noted that he had some personal experiences with that. “A couple of years ago, my son joined me in Bangkok. He had gotten off the plane and rested up a bit, and I suggested that we go out. But he said to me, ‘Didn’t you tell me that you can get really cheap dental care here?’
“I said yes.
“He said, ‘I’d like to do that.’”
Woodman took his son to a high-end dental clinic; he remembers that a dealership selling the most expensive types of luxury cars was next door. It ended up costing his son $92 for a couple of fillings and a cleaning.
“It would have cost over $400 in San Francisco,” he told me.
A few years ago, Woodman’s arm was injured while doing heavy physical work. “I tried to get a quote from Duke University Medical Center. At first they couldn’t tell me how much an MRI would cost. When I finally found out, from some dusty accountant in the back office, it was somewhere between $1,800 and $3,400.
“I stayed in pain and waited until I got to Bangkok, where I went to Bumrungrad Hospital.” The hospital is one of the best in Asia and a popular destination for travelers. There are 400,000 cross-border patients a year, among them 25,000 Americans.
When he asked for the price of an MRI, he was immediately told that the regular price was $426; if he was willing to take one at two in the morning, it would cost just $210. After that was done, he paid $82 for a consultation with an orthopedist who wrote him a prescription for physical therapy that he was able to take back to the US.
Price transparency, Woodman said, is generally much better in these medical tourism destinations than it is in the US. In fact, Bumrungrad publishes prices for a number of types of surgery, including heart bypass surgery, on its website. “You can almost always get a price quote from one of the top hospitals before surgery,” he said.
Sometimes, however, there are scams. He said that Indian hospitals had been pulling bait-and-switch scams for a while, offering low prices and then requiring a lot of add-ons when patients actually got to the hospital.
He said that he has never heard of as egregious a story as the one reported about kidneys going missing. But he said that there have been some facilities that he knows of that have been dangerous for patients. The Hospital Jerusalem in Tijuana, for example, which offers cosmetic surgery and bariatric surgery, has had poor outcomes and has injured patients.

Across the border for bariatric surgery
To understand what the experience is like for someone going out of the US for a major procedure, I spoke with a frum Jewish woman who had bariatric surgery in Mexico two years ago. For her, the experience was an exceptionally positive one.
“I went to Mexico to have the gastric sleeve procedure,” she told me. “Three of my children, however, had it here.” Other relatives of hers also had this procedure in the US. And her experience, she said, was much better than the rest of her relatives.
She had wanted the procedure because of high blood pressure. But insurance wouldn’t pay for it, because she was not overweight enough. Paying for it herself would cost $21,000; in Mexico, at the clinic she eventually chose, it cost her just $6,500.
She cautioned that looking into the place she was going to use took her a lot of time. “I did a lot of research,” she said. That meant consulting with doctors, former patients, and other medical experts.
All of her pre-op was done in the US, and all of her doctors were okay with her going to have the procedure. But she noted that as soon as she called the clinic, she was immediately put in touch with the clinic’s nutritionist, who began discussing the preparation for the procedure and its aftermath with her.
She flew to San Diego, and then the clinic van picked her up and brought her across the border into Tijuana, where they put her up in the Marriott. “There were only heimishe ladies at the clinic, and I had a private room,” she said.
The follow-up, after the procedure, was much better than what she had seen happen to her children. “The next day, they gave me a barium swallow test to ensure that there was no leakage of fluids. That didn’t happen here in the US,” she said.
The stay—while she waited to make sure there were no adverse effects—was pleasant, as well; she took the time to go sight-seeing. And the follow-up care continued even after she returned home. She said that even two years later, she still receives emails and phone calls from the clinic, inquiring about her condition and health. That contrasted starkly with the perfunctory way in which her children were treated by their US providers. The Mexican clinic, as she described it, treated her like a valued client, not a cog in the medical system.
It’s clear that not every patient who goes outside the US or their home country for medical care has an experience like this woman did. Still, for her and thousands of other consumers, medical tourism has provided a comfortable and affordable way of getting the treatment they couldn’t at home.

Side Bar:
Nine Dos and Don’ts for Medical Tourists

In the third edition of the world edition of the Patients Beyond Borders guidebook, Chapter Six goes through some quick pointers for medical tourists. Here are ten, adapted from the book.

Do plan ahead—Remember that you’re competing with other types of tourists for everything from plane tickets to hotel rooms. Make your plans as early as possible.

Don’t rely only on the Internet for your research—When you’re looking for information about your doctor, using the Internet alone isn’t enough; consult medical experts, accrediting agencies, and other patients, among other sources of information.

Do get it in writing—Just confirming prices and procedures over the phone isn’t enough; at least get an email with the details. The language barrier alone is a good reason for this.

Do demand they speak your language—Even if you think that you have a good command of the local language, planning a medical procedure isn’t a good time to try it out.

Don’t schedule too tightly—A good rule of thumb is to add one day for every five days that you definitely need, to ensure that a delay of any kind won’t lead to massive air or hotel expenses.

Do tell your doctors back at home—Even if they may feel a bit hurt that you’ve decided to travel out of the country, you may still need them once you return, so maintain the relationship.

Don’t stay too far away from your treatment center—Adding the stress of traffic to the stress of a medical procedure is unwise. And avoid “cheap” lodging offerings, which can be unsavory.

Don’t settle for second best—If you’re traveling out of your home country for care, get the best healthcare possible. If you want to save money, do that in regard to airfare or hotels, not your health.

Do trust your intuition—If anything seems wrong, question it.

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