Companies explore overseas healthcare
August 16, 2006 Christian Science Monitor

To cut its insurance costs, a US papermaker plans to let workers seek medical care abroad in 2007.
By Patrik Jonsson | Staff writer of The Christian Science Monitor

Garrett's medical care alone may save the company $50,000. And instead of winding up $20,000 in debt to have the operations in the US, he may now get up to $10,000 back as a share of the savings. He'll also get to see the Taj Mahal as part of a two-day tour before the surgery.  His two operations could cost $100,000 in the US; they'll run about $20,000 in India.  With US health insurance costs soaring, cash-squeezed companies such as Blue Ridge and poor states such as West Virginia are considering affordable plans that may require their employees to travel to India, Thailand, or Indonesia.

Critics say that limited malpractice laws in foreign countries makes such travel risky as well as the prospect of spending 20 hours on an airplane after invasive surgery. Despite the concerns, "medical tourism" is morphing into "global healthcare."  "Global healthcare is coming and American healthcare, which is pricing itself out of reach, needs to know there are alternatives" in order to improve, says Alain Enthoven, senior fellow at the Center for Health Policy in Stanford, Calif.  The average American hospital bill was $6,280 in 2004, twice that of other Western countries, according to the National Coalition on Health Care (NCHC) in Washington.

The cost savings have prompted a few hundred Americans this year to fly to India, Jakarta, or Bangkok for serious medical conditions, receiving heart stints and hip replacements. But most of the some 150,000 "medical tourists" nationwide go for a tooth filling or plastic surgery and a week at a sunny beach resort where the dollar stretches like lycra.  More companies - especially those with smaller company-run plans - are investigating people's claims of good overseas hospital care. The International Standards Organization in Geneva accredits these hospitals and audits American hospitals, too.

Companies are also attracted to the relatively inexpensive price tag for care at foreign hospitals, which have been reported to be up to 80 percent less than in the US. In New Delhi, for example, the Apollo chain of hospitals gives resort-style convalescence care for $87 a night. 

• Insurers Health Net of California already contracts with medical clinics on the Mexico side of the US border.

• A West Virginia state legislator introduced a bill this year that would encourage state workers to seek treatment overseas using incentives such as cash bonuses and family travel.

• United Group Programs in Florida, which administers self-insurance programs for small companies, has contracted with a Thailand hospital for its employer clients.

For critics, Americans heading overseas for care shows the severity of the country's healthcare crisis - especially as employers' health insurance premiums have risen 73 percent while average employee contributions have risen 143 percent since 2000, according to the NCHC. Rising costs stem from poor management, inefficiencies, waste, fraud, and lack of competition, critics say. "We're seeing some employers who are seriously beginning to think about doing [global healthcare] and not giving employees an option," says Joel Miller, vice president of operations at the NCHC. "And that has implications for quality of care, and what recourse people have if something goes wrong overseas."

Hospital officials say only a sliver of business will be lost to overseas providers. Yet going overseas for expensive medical services, such as heart bypass surgery, cut into US hospitals profit centers - such as heart units - that are used to underwrite emergency rooms and indigent care.  "[Global healthcare] will limit the amount of money that's available for everybody else to have access to the system and starts to jeopardize access to healthcare for everybody in the community," says Don Dalton, a spokesman for the North Carolina Hospital Association.

Garrett, meanwhile, anticipates movie-star treatment in India. Doctors will operate on his gall bladder and left shoulder, he says, and he will have a 24-hour nurse working only for him while he's recovering. Garrett's experience could affect whether Blue Ridge will proceed with its plan to give its workers the option of going overseas for medical care, the company says. "Everyone can see this thing could really become a big thing, so they're going to go out of their way to make sure everything is above and beyond the average in the United States," Garrett says.

Rising popularity of international medical travel reveals
deterioration of U.S. healthcare system

This realization is now hitting the general public, and they are increasingly leaving this country to find offshore locations and assess quality medical care and surgical procedures elsewhere. This phenomenon is called "international medical travel."   With international medical travel, patients who might normally undergo some sort of medical procedure in the United States, usually a costly surgical procedure, would instead travel outside the U.S. to have the procedures done in a world class internationally accredited facility.

As a result of traveling outside the U.S. for medical care, Americans get excellent medical care, personalized treatment, and save an enormous amount of money. International medical procedures can be performed for as little as one-tenth the cost of what would normally be charged here in the United States. Modern internationally accredited hospitals are often newer; better equipped; higher quality trained staff (lower RN to patient ratio); better technology; and newer equipment than what is available in most U.S. hospitals. International medical centers are typically staffed by English speaking personnel and U.S. or European trained physicians. International medical surgical procedures are performed with the same technology and expertise, yet international medical care is only a fraction of the price charged to uninsured Americans here in the U.S.

For example, a knee replacement surgery in a high-tech international hospital performed by a U.S. trained surgeon could cost as little as $7,000.  The same  surgery in the U.S. could easily exceed $60,000. Heart bypass in an international world class hospital costs around $10,000. In the US, a patient could be charged well over $100,000. Gastric bypass surgery in the U.S. can cost $30,000. Internationally it can be done for $10,000.

So where do the cost savings come from? How can international hospitals offer world class services at much lower prices? The answer lies in the economics of healthcare in the United States and the amount of waste that is present in the U.S. healthcare system. 

The U.S. has an antiquated bureaucratic health care delivery system. Due to taxpayer-funded health insurance and private health insurance, hospitals and medical providers are top heavy with expensive non-clinical personnel. In other words, things would be a lot simpler and far less expensive if prices were lower and Americans were allowed to price shop for the medical procedures they need.  Rather than having to go through a monstrous bureaucratic system, a medical traveler in another country eliminates the need to help pay for an expensive bureaucracy and saves as much as 80%. As a medical traveler, the dollars are actually going to the surgeons, anesthesiologists and other hospital workers who are attending to the patient.

Another reason international surgical procedures are so much more affordable in outside the U.S. is because of the liability issue. In the United States, doctors and hospitals must carry extremely expensive medical malpractice insurance policies. Thus, international medical travelers save a fortune by essentially not funding the legal fees, settlements and malpractice insurance costs normally found in the U.S. healthcare system.  Due to higher quality more affordable medical care, an increasing number of American are opting to have their surgical procedures done outside the U.S.

Powai Lake International Medical Travel

India is a Primary World Class Quality Medical Travel Destination

India is considered the leading country promoting international medical travel, and it is now moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries.  India's National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." Government and private sector studies in India estimate that international medical travelers could bring between $1 billion to $2 billion into the country by 2012. The reports estimate that international medical travel to India is growing by 30 per cent a year.

India's top-rated education system is not only creating large numbers of computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year.