If he could have, Brad Barnum would have kissed the ground when he climbed out of the car in Ruidoso, N.M., at the end of March. But the 53-year-old building contractor had undergone major remodeling himself—and his new knee and two new hips ruled out kneeling for a few more weeks. Still, he was ecstatic. More than two months after leaving for the hospital, he was home, and he had afforded the otherwise unaffordable. By having the work done in India, at Wockhardt Hospital in Bangalore, he'd gotten his new joints for just $23,000. Even after adding about $5,000 for airfare, passport, visa, and incidentals, the total was nearly 80 percent less than the $125,000 or more he easily could have been charged by a U.S. hospital. And that bill wouldn't have included physician fees and "ancillary charges."
Barnum is one of thousands of Americans—estimates range from an ultraconservative 5,000 to 500,000 annually if minor procedures are counted—who are leaving the States for surgery when they have to come up with funds themselves. They may be self-employed or work for a small business and lack health insurance, for example, or their procedure may not be covered. More than 1 in 4 workers earning at least $60,000 a year went without insurance in 2006, according to a Census Bureau survey; too well-off to be eligible for medical assistance, they can often wring tens of thousands of dollars out of hospital "rack rates" by going abroad. Some employers and big insurers like UnitedHealth and Blue Cross and Blue Shield are so intrigued by "medical tourism" that they're beginning to sniff for signs that it might be smart to cover it. "I was totally amazed not just at the quality of the medical care but at the quality of the service," says David Boucher, an assistant vice president of healthcare services at BlueCross BlueShield of South Carolina who has visited many facilities abroad. "The initial driver may be price, but patients' positive experiences will do a lot to advance the movement."
So far, there's been mostly talk, with little action from employers and health carriers. In fact, the first verified case of major surgery abroad as an employee benefit took place only earlier this year. (The patient reportedly paid nothing out of pocket for a knee replacement—in fact, the company, a North Carolina manufacturer, paid him a tidy sum for saving so much money.) Wockhardt, where the procedure was done, won't name the company.
Meanwhile, patients are finding their way abroad on their own. Wockhardt's hospitals in Bangalore and Bombay operated on about 850 U.S. patients in 2007, more than double the 2006 total. In Thailand, Bangkok's Bumrungrad Hospital says it treats more than 38,000 Americans a year—a somewhat inflated figure that represents "patient encounters," not individual patients, and includes expatriates. Other hospitals in India and Thailand, as well as centers in Singapore, are actively courting Americans, and the governments of South Korea and Taiwan are about to launch campaigns.
Low-budget dentistry, Botox-ing, lipo, and other cosmetic work have for years drawn Americans into Mexico and to other Latin American countries. But the growth in serious elective surgery halfway around the world is new. Josef Woodman, who publishes the Patients Beyond Borders series of guidebooks to finding good care, thinks about 50,000 patients a year leave the country for major noncosmetic elective procedures such as joint replacement, coronary artery bypass, new or repaired heart valves, or back repair.
Many, like Barnum, do the legwork on their own. But concierge services like MedRetreat.com and IndUShealth.com are multiplying, to help with lists of potential hospitals, appointment scheduling, arranging airport pickup and drop-off, and general hand-holding. (Information from Woodman's annual hospital survey has been incorporated into the World Hospital Finder, a U.S. News search tool for people who are seeking care abroad.)
Large insurers and employers are watching with interest—and skepticism—to see what happens as demand grows. "It's very nice to say that India, to take one example, can handle Americans, but there are only three to five hospitals there" with enough capacity to absorb a surge, says Ori Karev, CEO of UnitedHealth Group International, an arm of UnitedHealth that offers health consulting services to companies abroad. Moreover, he wonders, can high quality be sustained "with hundreds of thousands of patients traveling for care? I have my doubts." Then there are fundamental questions of safety and postoperative care back home. "Say I get treated overseas and something goes wrong," says Karev. "Who do I sue? Where do I sue? Who owns that hot potato of accountability—my insurer? My employer?"