This article is based on excerpts from the second edition of Patients Beyond Borders (2008), the flagship of a landmark series of consumer guides to international medical travel that have helped thousands of patients plan successful health journeys abroad. Healthy Travel Media, publisher of the guides, has become a global clearinghouse for useful information about medical and wellness travel.
More than a million patients worldwide visit hospitals and clinics each year in countries other than their own. Here are 13 questions frequently asked by medical travelers—and the answers you need to know before you decide whether to journey abroad for medical care.
- Is Healthcare Overseas Safe?
- If Healthcare in Other Countries Is So Good, How Can It Be So Cheap?
- How Much Can I Save?
- Is It Safe to Travel Overseas?
- What Medical Treatments Are Available Abroad?
- How Do I Know Where to Travel for Treatment?
- Can Someone Go With Me? I Don't Like Traveling Alone.
- What if They Don't Speak English?
- How Realistic Is the "Vacation" Part of the Trip?
- What if Complications Arise After I Return Home?
- Will My Health Insurance Cover My Overseas Medical Expenses?
- Can I Sue?
- Can I Finance My Treatment?
1. Is Healthcare Overseas Safe? Interestingly, the friends and family members of patients considering healthcare abroad ask this question more often than do the patients themselves. In fact, at least one friend or family member is virtually guaranteed to balk at the thought of your heading overseas for treatment. Most of these concerns are unfounded. They usually arise either from a lack of knowledge or from cultural myopia.
Although no medical procedure is 100 percent risk free anywhere in the world, the best hospitals and clinics abroad maintain health and procedural standards equal to, or higher than, those you encounter in the United States. Many hospitals abroad are accredited by an arm of the same U.S. organization (the Joint Commission) that certifies hospitals here.
It's not hard to find overseas physicians, dentists, and surgeons who received their medical training and degrees at first-rate medical schools in the United States, Great Britain, Canada, Switzerland, or Germany. All the countries listed in Patients Beyond Borders enforce strict governmental and private standards for healthcare, hospital, and clinic certification.
Finally, many hospitals—particularly the larger institutions in Asia and Southeast Asia—boast lower morbidity rates than in the United States, particularly when it comes to complex cardiac and orthopedic surgeries, for which success rates higher than 98.5 percent are the norm.
2. If Healthcare in Other Countries Is So Good, How Can It Be So Cheap? This question is best answered by another question: Why is U.S. healthcare so expensive? High facilities costs, unpaid hospital bills totaling billions of dollars, high-priced medical education, costly research, and excessive malpractice litigation all add up to exorbitant prices for healthcare in the United States.
In addition, U.S. physicians who perform elective and specialty procedures—such as cosmetic surgeries, in vitro fertilization, and certain hip, spine, and cardiac procedures—command astronomical fees from patients willing and able to pay, leaving those of more modest means in the lurch and seeking alternatives.
Healthcare in other countries is also less costly because standards of living are more modest, doctors and staff command lower wages, government-subsidized healthcare keeps private healthcare costs down, and malpractice attorneys are, if not docile, at least considerably more restrained.
3. How Much Can I Save? Your savings will depend on your treatment, your selected destination, and your travel and lifestyle preferences. Patients who travel to India for complex heart-bypass surgery will probably save $50,000 or more over the price in the United States. People traveling to Costa Rica for reconstructive dentistry or extensive breast and abdominal cosmetic surgery can save ?$10,000 or more.
A good rule of thumb is what I call the "$6,000 Rule": If your U.S. specialist quotes you a price of $6,000 or more for a treatment, chances are good that one or more foreign countries can offer you the same procedure and quality for less, even including your travel and lodging expenses. If your U.S. quote is less than $6,000, you're probably better off having your treatment at home.
4. Is It Safe to Travel Overseas? For many, a medical trip is their first journey abroad. That can be a scary prospect. Post-9/11 news is fear-inducing enough to make any novice international traveler think twice about packing a suitcase. Yet it's easy to forget that most other countries enjoy far lower crime rates than ours. In fact, many citizens outside the United States are afraid to travel to this country because of the well-publicized rates of violent crime here.
Your own behavior will determine much of your experience abroad. If you follow the common-sense rules of courtesy and observe cultural norms, you should be safe in any country featured in this book. Outcomes have proved that's true. Hundreds of thousands of international health travelers return home safe and sound each year.
Health travelers can be further reassured because, from the moment of arrival in another country until departure on a homebound plane, most are under the nearly constant supervision of a hospital, health travel broker, tour agency, or other third-party agent. Most health travelers are met at their airport arrival gate and whisked to an American-style hospital or hotel. From that point, they're usually under someone's care in a treatment center, getting a bite in a restaurant, or resting in a cozy hotel room.
5. What Medical Treatments Are Available Abroad? Although nearly every kind of treatment is possible abroad, most westerners head overseas for orthopedics (hip replacement, knee replacement, spinal disk repair); cardiovascular surgery (bypass, valve replacement, heart transplant); cancer diagnosis and treatment; dental care (usually more extensive cosmetic or restorative surgery); or cosmetic surgery. In addition, U.S. patients seek specialty treatments (such as fertility and in vitro fertilization procedures), weight-loss procedures (such as bariatric surgeries), and therapies not yet allowed in this country (such as certain stem cell treatments).
What all those treatments have in common is great expense. The huge savings to be garnered abroad can outweigh the challenges of traveling overseas for treatment.
6. How Do I Know Where to Travel for Treatment? Most countries are known for a particular category of treatment, and your diagnosis will distill your list of choices down to a handful of destinations. If you're seeking cosmetic surgery, Brazil, Costa Rica, and South Africa rank among the most popular destinations. Dentistry will have you exploring Mexico, Costa Rica, or Hungary. The more expensive, invasive surgeries, such as open-heart surgery or a knee replacement, make a longer trip to India, Thailand, Singapore, or Malaysia well worth the cost, time, and distance of travel.
7. Can Someone Go With Me? I Don't Like Traveling Alone. That's good, because we don't recommend you travel alone. We've found that most health travelers fare better with a companion in tow—a spouse, family member, or friend. Companions don't greatly increase the overall costs of a trip, and they can actually save you time and money in the end, because they are looking out for your interests every step of the way.
Even if you cannot travel with a companion, or prefer not to, you won't be going it alone in-country. If you're staying in a hospital, the quality of care and attention you'll receive in the better centers is truly remarkable, with low nurse-to-patient ratios and a host of staffers, orderlies, physician's assistants, and dietitians in and out of your room with great frequency. You'll make fast friends during your stay.
If you're not planning to travel with a companion, we strongly recommend you engage the services of a health travel agency that offers concierge services. A good agent is with you almost daily, particularly at the more stressful junctures, such as arrival in-country, medical consultations, and immediately before and after a surgical procedure.
8. What if They Don't Speak English? Every country catering to international health travelers offers a host of English-speaking physicians, staff, and third-party agencies. If English is your native tongue and you're uncomfortable speaking another language, then insist on English. If hospitals or clinics you've contacted can't furnish English-speaking doctors, don't be embarrassed. Politely thank them and move on. Your continued research will lead you to professionals who can converse in your native tongue.
9. How Realistic Is the "Vacation" Part of the Trip? That depends on the type of treatment you're seeking, how much time you have, and how comfortable you feel combining leisure travel with the medical side of your trip. Most patients who take a vacation as part of a healthcare journey are either planning to travel anyway or have allocated a good deal of additional time for recreation as well as recovery. There's a big difference.
We encourage patients to focus more on their treatment and recovery than on tourism, even for the less invasive procedures. Websites and health travel brochures peppered with zealous promotion ("Enjoy Fabulous Rainforest Vacation While Recovering From Your Tummy Tuck!") ignore the realities of health travel. Long flights, post-treatment recovery, and just plain being alone in a faraway place can be overwhelming, even for the most optimistic health traveler.
Think of your medical journey more as a business trip than a leisure junket. Consider socking away some of your savings for a separate vacation you and a loved one can take after the primary challenge of managing your immediate health need is behind you. Then, by all means, break out the champagne at a far-flung exotic hideaway, and celebrate your health and good fortune.
10. What if Complications Arise After I Return Home? Depending on your treatment, your physician or surgeon will usually strongly advise you to stay in-country for at least a few days post treatment. Your doctor will want to make sure that your treatment went well, your medications are working as they should, you're settling into any recommended physical therapies, and required follow-ups are going according to plan. Thus, by the time you board the plane home, your risk of complications will be greatly reduced.
In the unlikely event that you develop complications after returning home, you'll need to decide whether to make a return trip or continue your treatment at home. Some procedures, such as dental work, are guaranteed; so it may well be financially worthwhile, albeit inconvenient, to return. If you choose not to, most overseas dentists and surgeons are happy to talk with your hometown physician to discuss complications and recommend further action.
Prior to traveling abroad for treatment, be sure to let your local doctors know your plans. It's better to alert them beforehand than to surprise them after the fact.
11. Will My Health Insurance Cover My Overseas Medical Expenses? As of this writing, probably not. While the largest U.S. employers and healthcare insurers—not to mention our ever vocal politicians—struggle with new models of coverage, most plans do not yet cover the costs of obtaining treatment abroad. Yet, with healthcare costs threatening to literally bust the economy, pressures for change are mounting. Recognizing that globalization of healthcare is now a reality—and that the United States is falling behind—insurers, employers, and hospitals are now aggressively beginning to form partnerships with payers and providers abroad. By the time you read this, large insurers may already be offering coverage (albeit limited) across borders. You may want to check with your insurer for the latest on your coverage abroad.
12. Can I Sue? The United States is well known as Earth's most litigious nation. For better or worse, most countries outside the United States do not share our attitude toward personal and institutional liability. While all countries listed in Patients Beyond Borders have established channels of legal recourse, the intricacies of working with foreign statutes, legal systems, and counsel make such action impractical except in the most egregious cases.
The best defense is a good offense. International patients should focus on success rates, accreditation, and other quality-assurance measures that help to mitigate the chances of complications that would trigger legal claims. Here's another good rule of thumb: If legal recourse is a primary concern in making your health travel decision, you probably shouldn't head abroad for medical treatment.
13. Can I Finance My Treatment? Increasingly, established hospitals abroad and some health travel agents offer financing plans in the form of loans or delayed payment. Ask your agent or clinic for details. Most hospitals, clinics, and health travel brokers accept credit cards, but many charge an additional fee to cover their processing costs. Ask beforehand.
Nearly all hotels, restaurants, retailers, and businesses abroad happily accept major credit cards. Automatic teller machines are common in most cities and towns, and it's fun to watch your cash come out in an unfamiliar currency.