Care beyond borders: As consumer interest in medical tourism grows, phenomenon remains leap of faith for payers

ALTHOUGH THE NUMBER of North Americans and Europeans seeking care abroad is relatively small-about 150,000 Americans traveled abroad for care in 2005-it's expected to grow as more patients learn about the option and as overseas hospitals, healthcare travel firms and insurers lay the groundwork to accommodate them.

To date, the movement has been entirely consumer-driven. Consumers looking for inexpensive cosmetic procedures and other surgeries not covered by insurers were the first to jet off to other countries. But in recent years, the practice has been adopted by a growing number of patients with serious health problems.

Doug Stoda of Tomah, Wis., is a classic example. Stoda, an uninsured 53-year-old janitor, injured his hip a dozen years ago and needed a replacement. Stoda couldn't afford the surgery and feared it would incapacitate him. He searched the Web and learned about hip resurfacing, a procedure that was unavailable in the United States at the time. Sold on the merits of the surgery, Stoda flew to Chennai, India, in January 2006 for the operation and a week of post-operative physical therapy. Three weeks and $11,500 later he returned to the United States. Today he works a 10-hour shift-nearly twice as long as he was able to work before-and is pain-free.

For the more than 44 million uninsured and millions more underinsured in this country, overseas care represents an affordable alternative worthy of consideration. And as more people learn about the option-Time, Newsweek, USA Today, "60 Minutes" and National Public Radio have all run stories in the last two years-experts say the trend is bound to accelerate. As consumer interest grows, however, the question remains: Will self-insured employers and third-party insurers join the fray?

THE TREND BEHIND THE TREND

Across the globe, patients have different reasons for seeking care beyond their borders. Patients from countries with socialized medicine may take matters into their own hands to avoid a wait for surgery.

As for Americans, it's no secret why they are seeking care in Thailand, Singapore, India and half a dozen other countries: money.

Thanks to lower labor and operating costs and malpractice laws that dramatically reduce patient's financial recourse in the event of a problem, Americans seeking care overseas can expect to pay anywhere from 25% to 75% of what they would pay for a comparable procedure in the United States. For an uninsured individual or someone seeking a procedure not covered by a typical plan, it's not hard to do the math.

In fact, foreign hospitals make the arithmetic extremely easy. Just visit the Web site for Bangkok's Bumrungrad International Hospital and click on "Packages & Pricing." Bumrungrad treated 900,000 patients last year, roughly 350,000 of whom were from 150 other countries.

Beyond price, hospitals competing for international patients offer a level of service unheard of in the United States. "It sounds trivial, but the leap of faith that it takes to say, 'I'm going overseas for healthcare,' is not as great as the little niggling issues like, 'How do I get to the hospital from the airport,' and, 'How do I change my currency?'" explains Ruben Toral, group marketing director for Bumrungrad International. The hospital, located in the capital of Thailand and touted in scores of consumer articles, offers a marble lobby, comprehensive concierge service and 80 interpreters.

"The first reaction of everybody who walks through the doors of our place is, 'Wow!'" Toral says. "The development and design of Bumrungrad was intentional to make the hospital experience very different from the hospital experience that we all know and hate."