The Wall Street Journal-20080216-Encore -A Special Report-- Health Matters- The Next Wave Of Medical Tourists Might Include You

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Encore (A Special Report); Health Matters: The Next Wave Of Medical Tourists Might Include You

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You might become a "medical tourist" sooner than you think. And your boss, of all people, might be the one pushing you out the door.

A burgeoning medical travel industry, including hospitals in India, Israel and Ireland and middlemen throughout the U.S., is aggressively wooing older patients by offering joint-replacement surgeries and non- emergency cardiac procedures at 40% to 80% less than in the U.S.

The "sweet spot is the 45- to 65-year-olds," says Ruben Toral, a former marketing director at Bangkok's Bumrungrad International Hospital and now a consultant to that hospital and others. "These are people who use more medicine, and more expensive medicine." Many are still working and "can't be hobbled by medical conditions."

Currently, most older adults who go overseas for cheaper care are uninsured. But even the insured might soon be encouraged by their employers, via financial incentives like lower out-of-pocket costs, to go abroad. "Employers are beginning to include in hospital networks the option of getting care outside the U.S.," says Arnold Milstein, the San Francisco-based chief physician of Mercer Health & Benefits, a business owned by consulting firm Mercer Human Resource Consulting.

Of course, there are special risks. The term "medical tourism" notwithstanding, getting your knee replaced or having spinal fusion isn't much of a vacation. You might have more than one medical problem and need substantial follow-up care. So, you'll need to take extra steps to try to find the best possible treatment -- while realizing that, if you don't get it, you might not have the legal recourse to do much about it.

For Dianne Cramer, going to Costa Rica a year ago for a hip replacement was a boon. Before the operation, the Lakeland, Fla., resident was in so much pain, she says, "that I couldn't get out of the car without crying."

At 64, she was too young for Medicare, which starts at age 65. Her husband, who owns an advertising company, had canceled their insurance because of soaring premiums.

So, through the Internet, Ms. Cramer's son found a medical-tourism agency that provided information about overseas hospitals, including Hospital CIMA in San Jose. She ended up paying about $14,200 -- including $10,000 for the doctor's fees and a three-day hospital stay, an additional $2,500 for 10 days at a rehabilitation facility and $1,700 for round-trip first-class airfare -- compared with the $44,000 she says it would have cost her for the surgery and hospital stay back home.

"The doctor did a really good job," she says, "and I don't hurt anymore."

Now, some employers are offering overseas options for their workers. Hannaford Bros. Co., a supermarket chain based in Scarborough, Maine, is one of the first companies in the U.S. to include a foreign hospital in its network of providers. On Jan. 1, the company added National University Hospital in Singapore -- but to start, just for hip and knee replacements. The cost for hip replacements is about $10,000 to $15,000, compared to more than $40,000 in the U.S.

Generally, under the Hannaford health plans, the company pays 80% of an employee's medical costs -- until the worker reaches an out-of- pocket limit of $2,000 to $3,000. For an employee who goes to Singapore for a hip replacement, Hannaford will pay the entire medical tab; the worker won't have any out-of-pocket costs. In addition, the firm will pay for travel costs, including airfare and lodging for the patient and a companion, up to $10,000.

The company's savings "may be a couple of thousand dollars -- perhaps up to $5,000," says Peter Hayes, director of associate health and wellness for Hannaford. The savings aren't higher because of the airfare and hotel costs. He says the company wanted to save workers money. Also, some of the firm's U.S. hospitals have taken notice and are talking about medical costs.

Even with the pluses, many people remain skeptical. "It's very hard to assess doctors remotely,"says Ann Marie Kimball, a physician and professor in the School of Public Health at the University of Washington in Seattle.

But with health costs rising, outsourcing is likely to keep growing. (Medicare doesn't cover overseas care except if an emergency occurs while an individual is traveling.) If you're considering visiting a doctor or hospital abroad -- or if your employer raises the possibility -- keep the following in mind:

-- Select a hospital accredited by the Joint Commission International, the Chicago-based affiliate of the Joint Commission, which accredits hospitals in the U.S. JCI has accredited 150 hospitals in 28 countries, says Karen Simmons, president and chief executive. To be accredited, the hospitals must meet safety and quality standards.

-- Research the surgeon to see how many procedures he or she has done and the outcomes. Use only a physician who has trained extensively at a well-regarded academic health center in the U.S. or another advanced Western country, and is currently board-certified in the relevant specialty. Try to get your doctor to make a referral.

-- Take a companion, preferably a retired doctor or nurse, as an advocate.

-- Know the medical-malpractice situation. In most cases, says Laura Carabello, managing editor of the online newsletter Medical Travel Today (medicaltraveltoday.com), "you sign innumerable waivers when you leave the country."

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Ms. McGinley is The Wall Street Journal's deputy bureau chief for global economics in Washington. She can be reached at [email protected].