More Americans head overseas for health care

Serious questions remain
But even with the growing momentum, big questions must be asked by anyone considering treatment abroad.

Despite the five-star facades of some hospitals — fountains, white marble floors, even a Starbucks and McDonald’s inside Bumrungrad’s lobby — the comfort of having a major surgery near home with family at the bedside is a far cry from the experience in the developing world, where culture shock alone can be stressful.

Pollution, poverty and insane traffic are all part of the experience when visiting hospitals like the Indian-owned Max Healthcare facilities in New Delhi, where it’s not uncommon to see people urinating along roadsides. Jet lag, traveler’s diarrhea and strange foods also can be coupled with the unpredictable, such as September’s bloodless military coup in Thailand, which ultimately had little impact on daily life.

Language and cultural barriers also can make communication with doctors and nurses frustrating for some Americans, who are used to being direct with their physicians, often peppering them with tough questions and expecting straightforward answers.

Some Asian cultures also rely more on hints and subtleties to communicate, and doctors in some countries are regarded as authority figures who often aren’t questioned. Follow-up care back in the U.S. also can be an issue for some patients.

'There are a lot of risks'
“There are a lot of risks,” said Rick Wade, a senior vice president at the American Hospital Association. “What happens if something goes wrong?”

In countries like Thailand and India, medical malpractice claims are rare and multimillion dollar awards are nonexistent.

“If there’s a mistake, we fix it,” said Curtis Schroeder, an American who is group CEO of Bumrungrad hospital, which requires all doctors to carry malpractice insurance. “But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the U.S.”

But not everything is fixable. In February, Joshua Goldberg, a 23-year-old American who was traveling in Thailand, died at Bumrungrad after seeking care for a leg injury. His father, James Goldberg, has alleged on a Web site he set up that the hospital administered a deadly drug cocktail to a patient with substance abuse problems.

Bumrungrad insists the care given was appropriate. Thai authorities are investigating the case, as is standard with all unexpected hospital deaths. No conclusions have been reached. Goldberg did not return e-mails and phone calls seeking comment.

It’s ultimately up to patients themselves to investigate hospitals and physicians before considering surgery abroad. The Internet is loaded with resources that range from doctor bios to patient blogs, detailing the positives and negatives.

More countries arrange patient packages
As the phenomenon grows, more countries are trying to get in on the action. The Philippines began a campaign this year aimed at attracting Filipinos living abroad and Asians within the region. Packages offering city tours, day spas and even golf have been combined with health checkups and cosmetic surgery.

Some experts predict greater access to options like these will eventually drive more people to take control of their own health care.

Medical tourism facilitators like California-based PlanetHospital are banking on it, already working to make the journey less stressful for patients traveling abroad by arranging everything from visas and airport pickup to sightseeing.

Many doctors working in facilities catering to medical tourists are trained abroad, often in the U.S. or Europe. About 100 foreign hospitals have been approved by the international arm of the Chicago-based Joint Commission on Accreditation of Healthcare Organizations, which also accredits American hospitals.

Six countries in Asia have accredited facilities, including Bangkok’s Bumrungrad; five in India, with three belonging to the Apollo Hospital group; and 11 in Singapore.

The Max Super Speciality Hospital where Gilmore had her surgery on Oct. 10, is working to become accredited, but she said she felt comfortable from the very beginning. Even if her boss had refused to pay for the surgery, she said she likely would have made the two-day flight on her own because her insurance would never have paid to fix the pre-existing condition.

“It’s either that, or do it in the States for $28,000 to $40,000,” she said. In the U.S. do you not sign forms? They’re not responsible. The risk of it didn’t really weigh on me.”

In addition to saving thousands — the three-week trip totaled about $12,000, including the surgery, travel and lodging for two and a tour of the Taj Mahal — she also underwent a new technique just approved this year in the U.S.

Instead of total hip replacement, which limits mobility and requires the top of the femur to be cut off and a long shaft inserted, hip resurfacing uses only a small ball-and-socket device that enables patients to maintain their flexibility for activities like yoga, praying or even racing horses.

Gilmore’s Indian physician, Dr. S.K.S. Marya, chief surgeon at the Max Institute of Orthopedics & Joint Replacement, has performed some 150 hip resurfacing operations over the past two years. About one American comes to him for the surgery each week, and Gilmore is just the latest in a growing number of satisfied patients who plan to keep their passports renewed.

“Every day I feel better. I can get around on one crutch now,” said Gilmore, who plans to be back in the saddle within six months and out selling ranches soon after returning home. “I don’t have near the pain. I can already move my leg a lot more than I could before. I can actually go up the stairs without pain, that’s something I couldn’t do before.”

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