To save money, boomers and retirees are going abroad for operations and dental work

Used to be, you’d only hear about medical tourism after a celebrity would go to Europe for a face-lift. These days, you’re more likely to hear about your neighbor going to Mexico for new teeth. Yet despite its democratization, medical travel remains in many ways a cottage industry, fraught with potential perils for unsuspecting patients.

An estimated 900,000 to 1 million Americans will cross international borders for medical treatment in 2013, up from an estimated 150,000 in 2006, according to Patients Beyond Borders, a publisher of consumer and reference information on medical tourism. At an estimated 45% to 50%, U.S. residents traveling to Mexico or Costa Rica for dental work make up the largest segment of this roughly $10 billion market, according to Patients Beyond Borders.

The savings on medical procedures can be considerable, ranging from 25% to as much as 90%, depending on the procedure and location. In one example, Josef Woodman, CEO of Patients Beyond Borders, said that a patient needing extensive dental work who was quoted $60,000 for a mouthful of new teeth in the U.S. was charged $17,000 for the same work in Costa Rica.

Boomers make up a disproportionate number of the Americans seeking treatment abroad, experts say. That’s hardly surprising, given that some of the most popular procedures done abroad, such as dental work and orthopedic surgery, are most often performed on those whose bodies have started to show some wear and tear. Some medical travelers are underinsured or uninsured, while others seek treatment that isn’t covered by their health plans, such as cosmetic surgery or dental procedures. Medicare doesn’t cover routine dental work, making dental-procedure travel particularly attractive to the 65-and-over crowd.


Apollo Healthcare
The Apollo Hospital in New Delhi, India is one of several foreign medical facilities that are catering to budget-conscious American patients.
Starting next year under Obamacare, most people must have health insurance or pay a penalty. What’s more, health insurance will become more accessible to those with pre-existing conditions. But some consumers will still face high out-of-pocket costs, which could make medical care abroad look like a competitive option. And it’s possible that the growing ranks of the insured will lead to longer wait times for specialists, leading more patients to travel abroad for prompter treatment, Woodman said.

There are plenty of top-flight medical facilities abroad, but also plenty of doctors eager to attract—and potentially take advantage of—relatively wealthy patients, experts say. “To some providers a patient is a meal ticket, and a North American patient is an even bigger meal ticket,” said Shai Gold, managing partner at International-Triage, an international managed-care network provider that handles claims management and administration for medical care in Latin America and the Caribbean.

While some U.S. employer-sponsored health plans cover medical care abroad, for the most part individual (non-group) plans do not, experts say. Self-paying individuals looking to travel internationally have a bewildering array of options. So-called facilitators or health-travel planners connect U.S. patients to medical providers abroad. Some offer referral services only, while others also handle travel arrangements and some oversee treatment and aftercare.

While some facilitators are small operators in business for themselves, there are larger firms, such as Boston-based HealthGlobe, that refer patients to doctors they have vetted and coordinate all aspects of the travel and medical procedure logistics, such as booking appointments and transferring medical records, for a fee to the patient.

Many facilitators work on commission, creating a potential conflict of interest if they steer clients to the doctor who pays them the fattest cut, said Christina deMoraes, CEO and founder of the International Medical Tourism Chamber of Commerce. DeMoraes also runs a Brazil-based medical concierge firm that charges fees to patients, rather than collecting commissions from providers. She said she started the Chamber of Commerce a year ago in hopes of fostering standards to protect patients in the medical travel industry.

Experts offered some tips for people considering venturing abroad for medical care:

Keep expectations realistic

Before you research your international treatment options, visit a trusted doctor in the U.S. for a consultation. That way, you’ll have a baseline treatment plan as a point of comparison when talking with international providers.

Your home doctor’s assessment might also serve to keep your expectations in check. Often, patients traveling abroad are eager to make the most of their short trip and try to schedule more work than is safe in the allotted time, said Ilene Little, CEO of Traveling4Health.com. “They think about it like a 2-for-1 shoe sale,” she said. And doctors eager for business may not say no to patients’ unrealistic expectations—such as, say, getting dental implants without the required healing time before the new teeth are placed.

It’s also important to be realistic about the cost savings. If you get quoted a $4,000 price to do a dental bridge in Ohio, you’re not going to experience much if any overall savings if you get the same procedure done in Panama once you factor in travel and lodging costs, Gold said. India offers some of the steepest bargains—gastric bypass surgery, for example, costs about $9,300 there, versus $35,000 to $52,000 in the U.S., according to Patients Beyond Borders. But a weight-loss surgery patient who can’t comfortably travel in a coach seat and needs to pay for a first-class plane ticket is going to see much of that savings disappear, Woodman said.

Woodman has a general rule of thumb that if your total bill for a procedure in the U.S. is $6,000 or more, you’ll probably save money going abroad for treatment, even including travel and lodging expenses.

Do some sleuthing

Joint Commission International is an organization that accredits medical facilities world-wide. JCI-accredited facilities adhere to standards similar to, if not exceeding, those offered by hospitals in the U.S.

While this accreditation is a useful benchmark, the lack of it doesn’t necessarily mean a hospital is subpar, experts say. JCI accreditation is expensive, and smaller medical centers might not want to pay for it.

Beyond issues of accreditation, you want to go to the place that offers top-notch expertise in the procedure you need, since not all facilities excel at everything equally. Patients Beyond Borders has published a guide to medical travel that includes contact information for JCI-accredited hospitals throughout the world, along with a list of essential questions to ask potential doctors. One of them is, “Who’s holding the knife during my procedure?” You’d hate to travel for a specific surgeon only to find his protégé actually doing the work.

Another good question to ask, Woodman said, is how many of your specific treatments for your condition your prospective doctor has personally performed. While acceptable numbers vary according to procedure, you’ll want to see at least 50, Woodman said.

Expect a different legal climate

In many other countries, you can forget about suing your doctor if something goes wrong—or at least, forget about suing with any hope of success. “In Latin America, there’s no such thing as medical malpractice,” said Gold, who is based in Panama. “The culture is different—no one sues their doctor here.”

Your best bet to lessen the chance that something will go wrong enough to merit legal action, Gold and others say, is to check a hospital’s success rates, complication rates, accreditation, the doctor’s own credentials and other quality assurance measures beforehand. You can ask these questions of your health travel agent or directly of the doctor himself. Initial questions can help establish a dialogue, Woodman said. If a facility’s staff or physician is evasive, consider moving on. It might not always be comfortable asking direct questions of a doctor either at home or abroad, but interviewing prospective physicians is an informed patient’s right, experts say.

Line up aftercare

Your research doesn’t end with the selection of a doctor. While this decision is of course important, you’ll only be in the doctor’s direct care for a short part of your stay in a foreign country, deMoraes said. And complications such as infections can ensue after even the most successful procedure if there isn’t proper aftercare, she noted. (Of course, this is an issue with medical care in the U.S., as well as abroad.)

DeMoraes’s firm specializes in weight-loss surgery and the plastic surgery that often follows it. She has personal experience with such procedures—following bariatric surgery in the U.S. and a 175-pound weight loss, deMoraes underwent multiple reconstructive surgeries in Brazil that trimmed excess skin from all over her body. Her firm employs nurses who visit clients daily, helping them handle their wound care and other postoperative concerns.

Aftercare doesn’t end when you return home. Go back to your doctor in the U.S. for follow-up visits as needed, experts advise. Ideally, you will have alerted your physician to the fact that you’re going abroad for a procedure, instead of surprising her after you get back.

To that end, make sure you don’t leave the hospital without your complete medical records. Your orthopedist in the U.S. needs to know what device the overseas surgeon implanted in your knee, for example, to give you the best care. In some cases, U.S. doctors will decline to treat a patient who’s experienced complications from a procedure abroad if that patient doesn’t have a clear record of what’s been done, Woodman said.