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On average a U.S. patient traveling abroad for a medical treatment can save 40 to 50 percent, according to Medical Tourism Association.

Medical tourism grows rapidly with mounting ethical and legal concerns.

by Zongwei Li
June 14, 2013


Zongwei Li/MEDILL

Cosmetic surgery, dentistry and cardiovascular treatments are among the most popular specialties for medical travelers, according to Patients Beyond Borders.

A few years ago when Chicago area resident Natalia Bonfante Ginez wanted a gastric sleeve operation – the removal of part of the stomach to facilitate weight loss – she was told that she wasn’t qualified.

“I would have to be a lot heavier than I was,” Ginez said.

But that didn’t stop her from trying. In 2009, Ginez headed to Mexico, where she was eligible for the treatment.

“I was definitely expecting the hospital to be top of the line, but I wasn’t expecting the care they provided alongside,” Ginez said. Her medical provider in Mexico arranged transportation and accommodation for her and a friend, and provided post-surgery care in her hotel.

“The doctor would come in to see me in the morning, and in the afternoon, the nurse would come in and check on me.”

Ginez paid approximately $5,200 for the whole trip, including $3,500 for the surgery. She would have paid around $8,000 if she had received the same treatment at home.

Ginez is a typical medical tourist – someone who travels abroad for health-care treatments. The industry is growing rapidly around the world, particularly in the U.S., where soaring medical costs have soared and health-care services are strictly regulated.

Patients Beyond Borders, a six-year-old U.S. publication about medical travel, estimates that the worldwide medical tourism market is growing at a rate of 25 to 35 percent annually, with a current market size of around $20 billion to $35 billion worldwide.

“We estimate some 750,000 Americans will travel outside the U.S. for medical care this year,” the publication said on its website. Patients Beyond Borders estimates that annually some 7 million patients worldwide are spending an average of $3,000 to $5,000 per surgery.

The extra care that Ginez received as part of her medical trip are actually typical components offered by an increasing number of health-care providers in their cross-border medical packages. “You have to become almost their guide,” said Marcy Rogers, CEO of SpineMark Corp., a California-based company building a global network of centers that specialize in treating spinal deformities and injuries. SpineMark recently opened its first international site in Spain.

Rogers partners with a doctor in Louisiana to boost his medical tourism business. In that partnership, Rogers helps patients with transportation and accommodations abroad but she also recommends local restaurants, attractions and events. And to make patients feel more comfortable, “We hook them up with local patients like buddy,” Rogers said.

Doctors without borders

And doctors in the U.S are doing more than that to embrace the fast-growing industry. Sometimes they will cross the border as well.

“I’ve seen many American doctors traveling to remote locations to see and treat patients,” Rogers said. She cited an organization that set up a facility in Cyprus that helps American doctors obtain licenses and credentials for practicing there. “And they bring their U.S. patients there to do specialized procedures that may not be approved here in the U.S.”

For example, California-based Dr. Behrooz Akbarnia, an orthopedic spine surgeon who specializes in pediatric scoliosis, has treated spinal deformity around the world using a technology called magnetic rods. The length of the rods, which contain rare earth magnets, can be extended noninvasively as children grow. Although produced by a California company, that technology hasn’t yet been approved by the Food and Drug Administration for general use in the U.S. but it is available outside the country.

“We have new technology that takes longer in the United States because of the FDA regulations than Europe and outside of the U.S,” Akbarnia said. “I think it’s a good thing that we are more careful about the results, but at the same time, we can be a little bit behind.”

Of course, that leads to legal and ethical discussions about the medical travel industry. Should U.S. patients and doctors be held accountable for seeking or conducting surgeries that are not approved, or are even illegal, in their home country?

Akbarnia says he has had patients come to him hoping to get certain surgeries that they know are available abroad.

“Knowing that it is going to help the patient, it’s hard for me to say no,” Akbarnia said. He added, however, that he handles such requests on a case-by-case basis, carefully reviewing studies and clinical results. “Every effort should be done to make sure that the surgery and the product is safe.”

Legal experts, however, are concerned about some of the more serious and controversial surgeries – particularly those that are illegal in U.S. such as paying living donors for organ transplants.

Currently most criminal statutes in the U.S. cannot be applied extra-territorially, some critics have questioned whether that should be changed.

“A lot depends on what the underlying justification for the criminal prohibition at home is, and whether it’s the kind of justification that seems to apply equally well when the act is done abroad, or is it the kind of justification that really has only pertinence in the home country,” said Glenn Cohen, assistant professor at Harvard Law School.

Cohen cited that some parts of Australia make the hiring of commercial surrogate mothers a crime both at home and abroad. Similarly, Turkey makes artificial insemination illegal for citizens anywhere in the world.

Insurance playing a bigger role

One factor that might fuel additional growth in medical tourism is insurance companies, which are picking up the tab for a growing amount of the industry, according to Cohen.

The rollout of Obamacare may be a double-edged sword.

“The result is that there is going to be increased demand for low-cost insurance products. One way to produce low-cost insurance products is to incorporate certain medical tourism,” Cohen said. “I actually think Obamacare will reduce the market for uninsured Americans going abroad, but increase the market for insured Americans going abroad.

At the same time, Cohen expects to more regulations will be placed on insurers to limit access to legally controversial treatments.

Currently, most medical travel by U.S. citizens is self-funded but some employers and insurers have begun pilot programs to test the waters. Some industry players are more optimistic, believing that the Affordable Care Act, as Obamacare is officially known, will force more patients to cross borders.

“We are going to see potentially 40 to 50 million people jumping into the health-care system that’s already overpriced and overburdened. You are going to see longer wait times to access a specialist or a physician,” predicts Renee-Marie Stephano, president of the Medical Tourism Association, a membership-based trade group that includes hospitals, health-care providers and insurance companies.

Stephano adds that some health-care providers are already dropping Medicare patients because they believe the government’s reimbursement rate is too low. “As more and more medical patients see their choices becoming more limited in terms of selection of specialists and physicians, and given the increasing amount of information on the Internet regarding quality of care and the price of care, you are going to see more and more people making better-educated decisions and perhaps crossing more borders,” Stephano said. Her association saw a 10 percent increase in the patient inquiries last year.

“On average you save 40 to 50 percent,” said Stephano, who counts Costa Rica, Brazil, Mexico, Germany and Thailand among the most popular destinations. “We see a lot of cosmetic treatments and dental treatments.”

Making the decision

Amid the rapidly developing market, many medical travel websites, associations and organizations have emerged to help patients locate doctors and hospitals overseas.

At the moment they act only as middlemen – compiling a database of health-care providers and helping arrange price quotes. They don’t provide medical advice or recommend providers, which means, at the end of the day, it’s still the patient’s responsibility to choose the right care and provider. In effect, if something goes wrong, patients are on their own and can’t apply to U.S. courts for relief.

“In general people travel abroad for health care will have a very hard time recovering medical malpractice for injuries,” Cohen said.

That means patients must do a lot of research.

“I make sure that I did my homework regarding the doctor’s background and the hospital’s background as well. I checked with other people who have gotten the same operation with the same doctor in the same hospital,” Ginez said.

Stephano said patients now are looking beyond the quality of the care – patient experience also weighs a lot. That’s why she suggests patients ask for more from providers. “Look for video testimonial; ask for a video tour of the facility in advance so you know what exactly you are getting into.”

Ginez considers her medical trip a complete success.

“I’m happy with the change that I made,” she said, adding that she was very depressed because she couldn’t get the surgery done in the U.S. The impact was life changing, she says. “Part of that – I was able to actually get pregnant, so that made a huge difference.”