Think twice before leaving U.S. for care

Traveling to another country for medical care is not new. But in the past, it was mostly foreigners traveling to the U.S.

In the last few years, a worldwide industry has developed. Instead of people coming to the U.S., we are going to other countries for medical care.

What caused this?

The ability to receive specialized treatments in some countries is one reason. Second, and most importantly, the cost of care in other countries is often a fraction of that in the U.S. Finally, going abroad is more like a vacation, with a stay at a resort often included in the package..

When Don Ho was totally incapacitated from heart failure after exhausting all treatment options here, he went to Bangkok for stem cell treatment. He reported his strength and endurance had dramatically improved, and he went on to develop a new stage show. He eventually died from a different cause, but he enjoyed this last period of his life.

Why Bangkok?

He couldn’t get this in the U.S. Clinical trials in the U.S. are now well under way at the Texas Heart Institute, but this treatment is not yet generally available in the U.S.

In the past several years, foreign countries, especially in Asia, are luring back high-level specialists originally from their countries who had gone to the U.S. for training. They offer top facilities, minimal outside control of their work, large financial incentives, etc. The Singapore government built a state-of-the art facility for urological procedures performed by world renowned experts.

But the major issue is cost. For procedures that are not covered by insurance, primarily cosmetic surgery, going abroad makes feasible expensive procedures at a reasonable cost.

Brazil has been a center for cosmetic surgery. On a Rio beach several years ago, dozens of surgeons, operating under tents, had an all day surgical “cook-off” to set a world record for number of procedures.

In Brazil, this is a multibillion-dollar industry, and, like many countries, is doing what they can to encourage travel for surgery to their country.

Most medical tourism occurs through agencies that package the total procedure, including airfare, all medical costs, pre- and post-hospital care, often in luxury hotel-type settings with private nurses. Often, a two-week stay in a nearby resort will be included before the flight home. The entire price is often far less than the cost of the surgery alone in the U.S.

Ready to pack your bags and get your body sculpted? Hold on.

In these countries, there may be no recognized quality standards that a patient can check. Reading a “medical tourism” Web site and flying to a foreign country may not be the wisest thing to do. Who is the surgeon doing that hip resurfacing or that tummy tuck? Before going abroad, it would be wise to stick with surgeons who have published in respected journals. Many foreign centers publish their data for a specific procedure. A well known urologist in Thailand has published results of large series of “robotic” surgeries for prostate cancer. Blood loss, incontinence, impotence, etc. were all reported for hundreds of patients.

This, of course, is not the norm. Hospitals in many countries, especially Latin America, are calling themselves medical tourism sites. They are setting aside floors of their hospital for luxurious rooms, nurses assigned to an individual patient, excellent food, etc But that doesn’t, in any way, indicate the abilities or track record of the surgeon cutting you open.

Complications from surgery done outside the U.S. are common, mostly in cosmetic surgery. Patients return with active infections and hope to get the problem resolved in the U.S. Often, repeat surgeries are needed, which are not covered by insurance and are very expensive. Also, since a “good result” in cosmetic surgery is subjective, patients are often disappointed when they return.

In summary, medical tourism is an inexpensive way to get medical care. And with very thorough research, a patient may be able to determine the quality of the foreign provider. However, in the case of cosmetic surgery, it is almost impossible to do the necessary research.

Before anyone goes abroad, they need to have a well thought-out plan in the event of problems. The best plan is often not to go in the first place.

Charles Barta retired to Green Valley after 10 years as a medical director for several health care insurers. Before that, he was physician-in-charge of Kaiser Permanente of Colorado and a private internist in Las Cruces, N.M. He had previously held a management position in the Medical Systems Division of Pfizer. His column is published Sundays. He can be reached at Cbar52@aol.com.