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FEATURE

Roundtable Discussion on Medical Tourism Published

A diverse group of experts in the field of medical travel recently came together to address several key issues relating to the industry. Organized by Ms. Laura Carabello and moderated by Dr. Ronald C. Merrell, the roundtable discussion appears in the January/February 2008 issue of Telemedicine and e-Health.

Participants included:

Ronald C. Merrell, M.D., Virginia Commonwealth University, Richmond, Virginia

David Boucher, M.P.H., FACHE, BlueCross Blue Shield of South Carolina, Columbia, South Carolina

Laura Carabello, Publisher, Medical Travel Today, and, CPR Strategic Marketing Communications, Elmwood Park, New Jersey

Devon M. Herrick, Ph.D., National Center for Policy Analysis, Dallas, Texas

Victor Lazzaro, Tivis Capital and BridgeHealth International, Greenwood Village, Colorado

Linda Ludwick, Health Care Compliance Association, Tucson, Arizona

Ruben Toral, MedNet Asia, Bangkok, Thailand

Joseph Woodman, World-Class Medical Tourism Chapel Hill, North Carolina

Charles R. Doarn, M.B.A., Advanced Center for Telemedicine and Surgical Innovation, University of Cincinnati, Cincinnati, Ohio

A portion of the discussion is reprinted with permission below, courtesy of the publishers, Mary Ann Liebert, Inc. The full roundtable discussion is available at www.liebertpub.com/tmj

On workers’ compensation…

RONALD C. MERRELL: I can see that employers are always interested in the rapid recovery of their employees. They want to get people back. They want to have good outcomes and not pay an arm and a leg. Can you see a role of medical tourism in workers’ compensation injury?

LINDA LUDWICK: I could, if it was a long-term issue. Many workers’ comp issues are emergent, so that would take out the medical tourism aspect. However, if it was a long-range issue, I could see us involving workmen comp issues into that, or problems.

VICTOR LAZZARO: I would support that. I don’t know the incidence, for example, of some of the orthopedic procedures that are non-emergent, such as knee or hip replacement, which would fall under workmen’s comp. But theoretically, a case could be made for that. I would not see that being a leading offering.

RONALD C. MERRELL: I was thinking about it in terms of the chronic back injury and the repetitive action injuries and hernia that are in the workers’ compensation area. An acute injury on the job would probably not be at issue but a work-associated problem with a potentially surgical solution might be a matter for medical tourism.

VICTOR LAZZARO: From our perspective, when we look at which procedures fit best from an international standpoint, we categorize them two ways. I mentioned the incidental tourist item where the trip does not have to be justified in the cost savings. But so many procedures now can be done on an outpatient basis, in and out, and some of the costs have dropped such that from a transportation standpoint, the savings become smaller unless we’re going to a nearby Central American country.

On costs…

RONALD C. MERRELL: Our next category is financial drivers. I propose we first ask why is it so much less expensive to have certain medical procedures done in countries other than the U.S.?

JOE WOODMAN: Well, first the spread between the retail and the wholesale price in the U.S. has become untenable for an uninsured or an underinsured healthcare consumer, a patient. Many of these expensive procedures, especially cardiovascular, orthopedic, and oncological, price themselves out of the market at the retail level.

On the other hand, you have a collapsing or telescoping of the bureaucracy across the water, less malpractice and lower surgeons’ salaries—anywhere from a third to a fifth what a surgeon in the U.S. would command. Most of international market is for surgical procedures. And that combination creates kind of a perfect storm, at least for now, where a 30 to 80 percent savings can be realized.

On the subject of electronic medical records…

VICTOR LAZZARO: The electronic medical record (EMR) is not routine in the U.S. Until the EMR is routine, communication and information flow will remain as issues in continuity throughout the system…The VA has been a noteworthy leader in EMR and proven that it can happen. Of course, from a medical tourism standpoint, I do not know that the VA is going to fund their patients going abroad.

DAVID BOUCHER: I certainly do. I am reading an article that just came out a few minutes ago—at www.USCensus.gov. An increasing number of folks are turning 62—365 Americans just turned 62 while we’ve been on this call. Fifty-one percent of those people do not have Medicare and won’t have it for another three years unless they’re drawing early Social Security. And 95 percent of those patients do not have an employer-sponsored medical plan.

If you keep doing the math, and the numbers continue to go up exponentially every single year, it may very well be that today Medicaid and CMS do not cover out-of-country care, but my guess is by necessity they will have to in the future. If you look at the numbers, a significant percentage of folks in those age cohorts are, in fact, healthcare workers. The average age of a nurse in the state of South Carolina is 48.9 years. It’s gone up 10 years in the last 6. So we have a combination of, in some states, not enough younger people going into nursing and other healthcare professions, while in our state, several of those programs have years-long waiting lists to get in. So there’s going to be a significantly increasing demand and a sharply decreasing supply over the next eight or nine years. My guess is the conjecture based on health economics alone—that different payers—Medicare, Medicaid, potentially TRICARE, and the VA—may, in fact, not only want to use international outsourcing, they may embrace it.

On telemedicine…

RONALD C. MERRELL: We can do a lot of things with technology such that being cared for abroad or in other places is really not altogether different from being cared for in the U.S. I am most interested in what the group here with us today has to say about what telemedicine should be doing to support medical tourism.

LAURA CARABELLO: Telemedicine is going to be a very key component of ensuring that aftercare and follow-up care is streamlined and coordinated.

RONALD C. MERRELL: It would seem to me continuity has to come back to the managing medical people in the U.S.—primary care or a peer in the same specialty or a rehabilitation specialist. This should be an area where telemedicine could make medical tourism stronger. How strong is it right now in terms of the handover of care from the international facility back to the U.S. for rehabilitation?

RUBEN TORAL: I was involved in this extensively over the last eight years. Right now it is very poor and very fragmented. In the U.S., it is very difficult to get medical records and medical information from your doctor in order to pass them on to another institution or doctor overseas. And on the reverse, if you do get your procedure done overseas and you do have your x-rays and CT scans and discharge report sent to the U.S., the U.S. doctor is going to say, “I can’t really comment on this. I didn’t do the work. This isn’t coming from someone I know. How am I supposed to respond to this?” So again, there is that lack of continuity and integration of care providers. Telemedicine is definitely the link. But there is an attitudinal issue as much as technical.

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SPOTLIGHT
Dr. Rome Jutabha, MEDS Global Healthcare

Ask the average consumer what they know of medical tourism and many will spout off something about lounging on the beaches of Thailand before going under the knife. It’s precisely that idea that Dr. Rome Jutabha and his colleagues at MEDS Global Healthcare (www.medsglobalhealthcare.com) are looking to recast.

Medical Travel Today recently had the opportunity to talk with Dr. Jutabha about MEDS Global Healthcare and how they’re approaching the idea of patient care and education.

MTT:Thank you for talking with us today. To begin with, why don’t you tell us a bit about your background and how you first became involved in medical travel.

Dr. Rome Jutabha (RJ): I am a board certified gastroenterologist, and an attending physician and faculty member of the UCLA School of Medicine for the past 18 years. Prior to that, I received my medical degree and Internal Medicine training at Northwestern University Medical School in Chicago. As an academic physician, this encompasses three primary roles including the teaching of young physicians, clinical research, and patient care.

As for how I got into global healthcare, I have been involved with international collaboration throughout my entire medical career in all three facets. As a teacher, I have taught and trained numerous medical students, residents, and fellows from all over the world. As a researcher, I have conducted multi-center, international clinical studies through collaboration with numerous academic medical centers in Europe and Asia. With respect to patient care, I treated countless international patients who have traveled from around the world to Northwestern University and UCLA Medical Center for state of the art medical treatment. So you can see that I’ve made this my life’s mission to develop these collaborative global healthcare projects. My involvement with MEDS Global Healthcare was a natural extension of my goal to build and strengthen international collaboration to improve healthcare.

Unfortunately like everyone, I have watched and experienced first hand, the many challenges that are facing our healthcare system in the United States. The challenges are multi-faceted: some of which were within my control; most unfortunately beyond the reach & scope of a practicing physician. For example, we are all seeing more and more uninsured or underinsured patients who can no longer afford health care; patients losing their medical coverage due to rising premiums or pre-existing illnesses; doctors treating more and more patients and spending less time with each of them; hospitals & emergency rooms closing down due to financial hardship, etc....

Because of these various factors, I found that a number of my patients who were first generation immigrants, would seek out alternative sources of health care in their home countries. After the 9/11 attacks, we noticed a dramatic decline in patients coming to our institution in Los Angeles. During one of my trips to Bangkok, I saw that many of these patients from the Middle East were traveling to Bangkok for medical care because of Thailand’s high quality and affordable healthcare.

I also have a connection to Thailand – I’m from Thailand originally. Both of my parents are practicing physicians in Arizona. They receive their medical education in Thailand, and completed their post-graduate training here in the United States. Because of our longstanding professional and personal relationships with Thai physicians, nurses, and adminstrators, many of our colleagues are working together with us on this exciting international initiative. And it helps that I speak the language.

That’s essentially how MEDS Global Health Care formally began in 2004. I, along with other concerned physicians, set out to find a way to get our patients the care they could afford at facilities with professional health care teams we trusted completely.

As a physician, you really have to think about what’s best for your patient. In order to deliver the highest quality of care possible, we have been working with several large university hospitals in Thailand to build various clinical and research programs that feature the latest technologies and techniques. These state of the art treatments are then available to both local Thai patients as well as international patients from around the world.

We were, and still are, concerned about how medical tourism is sometimes positioned. This isn’t a holiday add-on—or, at least, shouldn’t be. The patient really needs to understand where they’re going, the type of care they’ll receive, and they need to involve their doctors before and after the procedure. Having said that, I believe there is a role for good quality medical tourism companies who can work with us. on the travel and tour aspects. We focus on delivering outstanding healthcare; the medical tourism companies can manage the travel related logistics such as airplane reservations, hotel accommodations, guided tours, etc…

MTT:In your opinion, how is MEDS Global Healthcare different from other global care providers?

RJ: Well, since day one, we approached the model of delivering care as if we were physicians at an academic medical center rather than a business. This is the approach I’ve taken to patient care my whole life so it was very natural to apply this model to MEDS Global Healthcare. I think it makes the best sense in terms of providing quality care.

Taking that approach, we started collaborating with physicians in Thailand to develop innovative programs that deliver cutting edge technology and medical care to those who are appropriate candidates for travel. We work with both public and private sector hospitals to establish various Centers of Excellence. We know what technology, techniques and equipment they’re using, because we’re involved in their development. We’re confident in the quality of care they provide and assess the outcomes on an ongoing basis.

More importantly, our patients are reassured knowing that our US and Thai physicians are working closely to coordinate their care here and abroad. That’s a level of understanding and collaboration that medical travel companies do not offer. And it’s very focused on the care, not the glamour, if you will.

Now back here in the US, our physicians are busy evaluating patients. Our goal is not to solely send patients overseas for care. Our job is to get them the proper care for their given need. When we can get them treatment here in the US, we do. But on the occasion where patients can’t cover the cost of care here in the US, we are able to offer them another option.

Most of our current patients who do go abroad are ones seeking care for issues related to cardiac, gynecological issues, cancer orthopedics, and GI related disorders. These treatments tend to involve very expensive procedures here in the US.

MTT:You recently hosted a conference in Las Vegas on medical care in Thailand. How did that go?

RJ: We were very happy with it. It was well attended and we had outstanding speakers. The audience was very diverse, ranging from patients who were interested in traveling to Thailand for medical care, to US physicians who were interested in learning more about this growing trend, as well as companies researching the business opportunities and risks associated with international healthcare.

This was our first official project with the Tourism Authority of Thailand to promote the country’s outstanding healthcare services here in the United States. That was exciting as they are really looking to promote global healthcare & medical tourism at the governmental level.

Previously, medical travel to Thailand was primarily driven through the private sector and hospitals. The government was always supportive; and now they’re engaged on a formal basis.

I work with and have longstanding relationships with many physicians, businessmen, and politicians in Thailand and have discussed the pros & cons of the globalization of healthcare over the past several years. Over time and through engaged conversation, I’ve noted a growing acceptance of this idea amongst the various groups including physicians, hospital administrators, Ministry of Public Health, Thai Medical Council, politicians, and most importantly, amongst many Thai patients who see the benefit from this collaboration. And when we have better facilities, new techniques and technologies, better-trained & service-minded staff, it can only mean good things for the entire country.

The meeting was also interesting because we had a number of US physicians who have traveled to Thailand and have actually helped established programs there. This was nice because here you had physicians speaking to physicians about what medical travel to Thailand is all about. I think a lot of the audience members reached a new level of comfort with the idea of sending patients abroad because they heard it from peers who had firsthand experience about the level of care, technology, and service that is now available in Thailand.

MTT:Thank you again for your time. We look forward to hearing more from you in the future.

MEDS Global Healthcare was founded in 2004, as a response to the growing need for high quality and affordable healthcare. For more information, visit: http://www.medsglobalhealthcare.com

PERSPECTIVES

Ruben Toral is a recognized leader in medical tourism and healthcare globalization. Formerly Group Marketing Director for Bumrungrad International, Toral is widely recognized as one of the driving forces behind medical tourism and Bumrungrad’s position as the world’s premier medical tourism destination. Now owner and operator of a healthcare marketing company, Mednet Asia Ltd., Toral has extensive healthcare experience.

Toral shares his perspectives on the growing industry with Medical Travel Today on a monthly basis.

Ruben Toral, CEO and Founder of Mednet Asia Ltd.

In December 2007, I spoke at the International Medical Tourism Conference in Washington DC and posed a question: Is medical tourism simply version 1.0 of healthcare globalization?

Despite all the hype over medical tourism as the next “big” thing, it is still a grass roots movement, in its infancy, operating within a B to C model serving primarily the underinsured and uninsured with enough cash or credit to pay out-of-pocket for medical services and international travel. But these early adopters are exposing the tip of the iceberg in healthcare reform led by the convergence of three forces: globalization, consumerism and the internet.

The promise of global care is that buyers can use the web to search for doctors, hospitals and medical services from around the world; compare services and prices; select the provider, place and product right for them and transact on-line. This happens every day, a million times a day in other industries, like travel, so why not healthcare? Why can’t healthcare look and feel more like Travelocity?

Globalization in healthcare is all about delivering more options and choices for healthcare consumers. Thirty years ago, when you bought a car your options were Ford, GM and Chrysler. Today, they include Toyota, Nissan and Honda. Globalization drives transparency, competition and efficiency…just ask Ford, GM and Chrysler.

But this is medicine, the argument goes, and can consumers really be trusted with managing their own healthcare? Sure they can. To borrow the old adage, you just have to teach them how to fish again. Throw away the paternalistic notions that people cannot manage their healthcare and empower them to do it and the healthcare revolution will drive itself.

Over simplistic? Maybe, but in the seven years I worked at Bumrungrad International I met thousands of patients who did just that. These were people from all walks of life who literally traveled halfway across the world for medical treatment using the internet as their primary tool of information and communication. Medical tourism has shown that consumers can and do make informed choices about their healthcare treatment, and when empowered with the right information, tools and incentives, make appropriate choices based on what’s right for them.

The promise of global care will be realized when insurers expand their networks and build products around them; international providers substantiate their claims of quality using standardized reporting systems; stop gap liability coverage for patients traveling overseas is available; and patients, payers and providers can connect seamlessly on the web.

The good news is that commercial solutions exist for each of these, and that they are readily available. The bad news is that it will take another 12-18 months of gestation time to deliver a new and improved global care model. In the meantime, we’ll just keep pushing.

Ruben Toral
Bangkok, Thailand

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IMS Global Limited: A Three-Part Series on World-Class Care in Israel

Ira Nissel, CEO IMS Global Limited

Editor's Note: In our last issue of Medical Travel Today, we continued a conversation with the founder and CEO of IMS Global Limited (www.medicaltourismforyou.com). In this issue we continue that conversation and take look at the company's pediatric and adult services.

Medical Travel Today (MTT): Let's talk a bit about the Pediatriac side of IMS business. Tell us a bit about the services you offer, the care and treatments available, and what makes it unique in the world of medical tourism.

Ira Nissel (IN): Sure, I'm happy to talk about that. The most important thing to know about IMS's pediatric services is that we're the only medical service firm providing multidisciplinary, comprehensive care solely to children. The Pediatrics medical centers we work with are literally setting new standards of medical excellence in all areas of pediatric medicine. I'm sure that sounds like puffery but it's not.

These physicians have the best training and work with state-of-the-art equipment. But just as important, they take a unique multidisciplinary approach to care to ensure the patient, the child, receives the best and most appropriate treatment available.

The other thing we recognize, is that children are children. They're not just little adults. Their emotional needs and, really, requirements are so very different from adults. We really treat the whole child—and sometimes the whole family—to make whatever treatment's needed go smoothly and the healing to progress more quickly. We try to make the medical care as non-disruptive as possible. That goes for both treatment and any rehabilitation that might be necessary.

MTT:Where to do most of your pediatric patients come from and what types of treatment are they typically seeking?

IN: From all over. I don't say that lightly. We've treated and are treating patients from the United Kingdom, Canada, The United States, Jordan, Turkey, Russia, Latvia, Cyprus, Greece, Ethiopia, and many, many other places.

There really is no "typical" treatments. We do just about everything, from bone marrow transplants and neurological issues to reconstructive surgeries and repairs to the heart. Many of our patients come from countries where these cutting edge technologies simply aren't performed. We do it and we do it extremely well.

What many people don't realize is that much of the world's best medical technology was actually pioneered here in Israel. Some of the most significant pieces of equipment and types of technology, including cardio and laser devices, were developed, in part, here in Israel.

So when it comes to treating conditions, we've not only got the technology, we've often got the people who were involved in it's development working for us and the patient.

The other thing I want to emphasize that I think is particularly important when it comes to pediatrics is the all-encompassing service and care we provide.

When you're taking your child abroad for care it's stressful enough. We really, really take every effort to make sure the family is cared for at every step. It's so important to make sure the family understands everything that's happening, that their transportation their check-in, all of that, goes smoothly. They have a translator with them at all times to make sure they're fully informed about their child's care; what's happening, what's going to happen next, how he or she is doing, and so on.

It's very time and labor intensive on our part but it's too important to just cover, you know, on an "as need" basis. That need is really 24/7 and it begins before the family arrives and continues even after they leave.

I think, in large part, that's why we're seeing the kind of growth that we are.

MTT: In our last issue we spoke about IVF services. Do you provide other adult services?

IN: By all means, yes. Women's health, plastic surgery, elective surgeries and adults are very important. We're continuously developing our services and units to meet our patients needs.

We offer heart surgery, including minimal invasive cardiac surgery, neurosurgery, using a Navigator (an innovative instrument that makes it possible to "navigate" in the brain through the use of computerized imaging, thereby minimizing damage to healthy tissue), orthopedic surgeries, including joint replacements, spinal surgery, eye surgery, really, anything that someone could need.

Imaging procedures are also big. MRI, Cardiac CT (64 slices), CT, PET CT, heart scans, general scans, as well as advanced ultra-sound institutes, we offer it all.

An important aspect of all these services is, of course, the physicians. Right now, IMS is building a comprehensive specialists list of all of Israels' top professors and doctors. We are signing agreements with these specialists to provide IMS patients the best care possible. This means IMS patients will have the best physicians, the best facilities, and the best technology at their disposal.

For example, Professor Halperin is an icon in the field of orthopedic surgery. We have taken him and his team to manage all of the cases IMS brings to Israel. His team is comprised of two of the best young orthopedic specialists Israel has to offer. All the cases we receive are first reviewed by this team and then IMS decides on how to handle each individual case. This also insures that prices are reasonable.

To the best of my knowledge we're the only organization offering this type of contact with doctors.

Right now we're in the midst of developing similar relationships with doctors in every field.

Developing the lists and the relationships is time consuming and labor-intensive but it allows our patients to receive the absolute best care. And that's really what matters most.

About Ira Nissel

Ira Nissel is the founder and CEO of IMS Global, Inc., a global health care firm specializing in medical travel to Israel (www.medicaltourismforyou.com). Prior to founding IMS, Nissel honed his blend of business acumen and altruism as part of an emergency response system in Istanbul, Turkey. In that capacity, he established and served as general manager of Nexus Health and Technology, Inc., an organization that provided front-line relief services for the elderly, children, and foreign citizens, among others. In only its second year, Nexus numbered more than 3,000 members and had revenues exceeding $1.3 million.

Previously, Nissel served as the Corporate Director of Business Development & Sales for InkSure, Inc. (INKS), an OTC forensic security technology firm with headquarters in Israel and the US, and worked for several international companies specializing in security technologies and products.

Nissel can be reached at: ira.nissel@medicaltourismforyou.com.

International Medical Services Global, Ltd. Introduces Low-Cost, High-Success Substance Abuse Rehab Program

Petach Tikva, Israel/Clarence, NY – February 19, 2008 – International Medical Services Global, Ltd. (IMS), a global healthcare firm specializing in medical tourism in Israel, has introduced a specialized substance abuse rehabilitation program with proven, low rates of recidivism and at far lower costs than American or other international programs (http://www.medicaltourismforyou.com/drugrehab.htm). Operated by the largest clinic in Israel and the Middle East, and under the oversight of the Anti-Drug Authority of Israel, the government organization that develops programs for substance abuse, the eight-month work-study program costs $5,500 USD per month and includes housing, food and all services.

“We understand the monumental challenges faced by alcoholics and addicts as they struggle to get clean and sober,” says Ira Nissel, CEO of IMS. “To address the varied needs of those suffering from chemical dependency, we offer a comprehensive menu of services, all of which are based on proven methodologies that do not utilize any substances to control behavior.”

The Israel Anti-Drug Authority is responsible for creating and supervising a wide network of treatment and rehabilitation services for drug abuse victims.  These include long term, residential, therapeutic communities, short term, outpatient, treatment centers and community based treatment and rehabilitation programs and halfway houses. 

Many international patients and Israelis have already accessed services, with Americans – both Christians and Jews – expected to take advantage of this cost-effective treatment. Located in northern Israel on a Moshav, a type of cooperative agricultural community, the facility has a nearby motel for family members who choose to visit during appropriate timeframes.

“In response to widespread dissatisfaction with expensive, 28-day programs and other available treatment options, Americans can now access a program that maintains their privacy and is proven to generate successful outcomes,” says Nissel.

Health Matters: The next wave of medical tourists might include you
The Wall Street Journal
By LAURIE MCGINLEY
February 16, 2008

You might become a "medical tourist" sooner than you think. And your boss, of all people, might be the one pushing you out the door.

A burgeoning medical travel industry, including hospitals in India, Israel and Ireland and middlemen throughout the U.S., is aggressively wooing older patients by offering joint-replacement surgeries and non-emergency cardiac procedures at 40% to 80% less than in the U.S.

The "sweet spot is the 45- to 65-year-olds," says Ruben Toral, a former marketing director at Bangkok's Bumrungrad International Hospital and now a consultant to that hospital and others. "These are people who use more medicine, and more expensive medicine." Many are still working and "can't be hobbled by medical conditions."

Currently, most older adults who go overseas for cheaper care are uninsured. But even the insured might soon be encouraged by their employers, via financial incentives like lower out-of-pocket costs, to go abroad. "Employers are beginning to include in hospital networks the option of getting care outside the U.S.," says Arnold Milstein, the San Francisco-based chief physician of Mercer Health & Benefits, a business owned by consulting firm Mercer Human Resource Consulting.

Of course, there are special risks. The term "medical tourism" notwithstanding, getting your knee replaced or having spinal fusion isn't much of a vacation. You might have more than one medical problem and need substantial follow-up care. So, you'll need to take extra steps to try to find the best possible treatment -- while realizing that, if you don't get it, you might not have the legal recourse to do much about it.

Cheaper Alternative

For Dianne Cramer, going to Costa Rica a year ago for a hip replacement was a boon. Before the operation, the Lakeland, Fla., resident was in so much pain, she says, "that I couldn't get out of the car without crying."

At 64, she was too young for Medicare, which starts at age 65. Her husband, who owns an advertising company, had canceled their insurance because of soaring premiums.

So, through the Internet, Ms. Cramer's son found a medical-tourism agency that provided information about overseas hospitals, including Hospital CIMA in San Jose. She ended up paying about $14,200 -- including $10,000 for the doctor's fees and a three-day hospital stay, an additional $2,500 for 10 days at a rehabilitation facility and $1,700 for round-trip first-class airfare -- compared with the $44,000 she says it would have cost her for the surgery and hospital stay back home.

"The doctor did a really good job," she says, "and I don't hurt anymore."

Employer Option

Now, some employers are offering overseas options for their workers. Hannaford Bros. Co., a supermarket chain based in Scarborough, Maine, is one of the first companies in the U.S. to include a foreign hospital in its network of providers. On Jan. 1, the company added National University Hospital in Singapore -- but to start, just for hip and knee replacements. The cost for hip replacements is about $10,000 to $15,000, compared to more than $40,000 in the U.S.

Generally, under the Hannaford health plans, the company pays 80% of an employee's medical costs -- until the worker reaches an out-of-pocket limit of $2,000 to $3,000. For an employee who goes to Singapore for a hip replacement, Hannaford will pay the entire medical tab; the worker won't have any out-of-pocket costs. In addition, the firm will pay for travel costs, including airfare and lodging for the patient and a companion, up to $10,000.

The company's savings "may be a couple of thousand dollars -- perhaps up to $5,000," says Peter Hayes, director of associate health and wellness for Hannaford. The savings aren't higher because of the airfare and hotel costs. He says the company wanted to save workers money. Also, some of the firm's U.S. hospitals have taken notice and are talking about medical costs.

Things to Consider

Even with the pluses, many people remain skeptical. "It's very hard to assess doctors remotely," says Ann Marie Kimball, a physician and professor in the School of Public Health at the University of Washington in Seattle.

But with health costs rising, outsourcing is likely to keep growing. (Medicare doesn't cover overseas care except if an emergency occurs while an individual is traveling.) If you're considering visiting a doctor or hospital abroad -- or if your employer raises the possibility -- keep the following in mind:

• Select a hospital accredited by the Joint Commission International, the Chicago-based affiliate of the Joint Commission, which accredits hospitals in the U.S. JCI has accredited 150 hospitals in 28 countries, says Karen Simmons, president and chief executive. To be accredited, the hospitals must meet safety and quality standards.

• Research the surgeon to see how many procedures he or she has done and the outcomes. Use only a physician who has trained extensively at a well-regarded academic health center in the U.S. or another advanced Western country, and is currently board-certified in the relevant specialty. Try to get your doctor to make a referral.

• Take a companion, preferably a retired doctor or nurse, as an advocate.

• Know the medical-malpractice situation. In most cases, says Laura Carabello, managing editor of the online newsletter Medical Travel Today (medicaltraveltoday.com), "you sign innumerable waivers when you leave the country."

 

Medical Tourism Association President, Jonathan Edelheit, Featured as a Visionary in US Healthcare