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Some U.S. companies, insurers consider sending employees abroad for surgery

Associated Press | November 6, 2006

NEW DELHI, India — Dodie Gilmore is a spry 60-year-old, a onetime rodeo champion from Oklahoma who loves the outdoors. But when she could no longer straddle her faithful horse, River, she knew it was time for a new hip.

But how could she afford it? As an independent contractor, she knew her privately purchased health plan would never pay up to US$40,000 (€31,000) for the operation since it was a pre-existing condition. So she asked her boss about traveling to India where hip resurfacing alone would cost just US$7,000 (€5,500). He not only gave her his blessing but offered to foot the bill, minus travel and hotels — making Gilmore one of the first Americans sent overseas for surgery by an employer.

"The doctors were wonderful," Gilmore said days after being discharged, sipping coffee at a New Delhi roadside cafe with her sister, Carol, who went along for trip. "The overall care was pretty darn good."

Gilmore is among the hundreds of thousands of so-called medical tourists — 500,000 from America alone last year — who are flocking to hospitals in developing nations.

They're coming from the U.S. to avoid soaring costs. They're coming from Europe and Canada to avoid long waits choking national health systems. They're coming from the Middle East for better care and service — especially after 9/11 when many Arabs are nervous about whether they'll be welcomed in the United States, where they often went for care.

Asian hospitals in Thailand, India and Singapore have long catered to people wanting tummy tucks and face lifts, but many of these facilities are now gaining reputations for big-ticket procedures including heart surgery and back operations.

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.

More and more patients like Gilmore — who had never held a passport or even tasted Indian food before her trip — are returning home and spreading the word about an alternative with some added risks.

In the U.S., health care costs are getting so high that some businesses and insurance companies are starting to eye the potential savings of outsourcing health care.

"It's just one of the many ways in which our world is flattening," said Arnold Milstein, chief physician at New York-based Mercer Health & Benefits who's researching the feasibility of outsourcing medical care for three Fortune 500 corporations. "Many companies see it as a natural extension of the competition they've faced in other aspects of their business."

Premiums for U.S. employer-sponsored health coverage have surged 87 percent over the past six years, according to the Kaiser Family Foundation, putting a huge burden on both companies and employees. Family health coverage now runs about $11,500 (€9,000) annually, with workers themselves forking out nearly $3,000 (€2,350).

An estimated 45 million Americans don't even have health insurance, forcing some to seek affordable medical help abroad.

But just as shipping U.S. manufacturing to China and call centers to India initially created loud opposition, some critics are already preparing to fight any possible mass exodus of Americans packing their bags to go under the knife overseas.

In September, North Carolina-based Blue Ridge Paper Products Inc., was set to send one of its employees to India for a gall bladder operation. Carl Garrett would have been the first U.S. employee sent abroad for medical care through an employer-sponsored pilot program that would have allowed him to share the company's savings.

Shortly before Garrett was set to leave, the United Steelworkers, America's largest union, pulled the plug.

"We don't want to expose our members to the risks associated with providing health care in the Third World," said Stan Johnson, a union spokesman.

While Garrett's company ultimately scrapped its plan for union members, several other U.S. businesses and insurance companies are starting to explore the option of exporting patients and others already have the option of treatment overseas.

Blue Shield of California and Health Net of California offer lower-cost policies allowing members to seek medical care in Mexico.

Florida-based United Group Programs, which sells self-insurance policies to small businesses, offers a plan that sends patients to Bumrungrad International hospital in Bangkok, Thailand. It says the plan will save employers more than 50 percent on major medical costs and slash employees' out-of-pocket expenses to zero.

The Thai hospital began heavily recruiting overseas patients after the 1997 Asian financial crisis. It drew 55,000 Americans last year — and nearly 350,000 other so-called medical tourists.

Among those others was Bernard Baldwin, 67, from Kent, England, who has had two operations at Bumrungrad in as many years to remove cancerous tumors. At home, he could have had the procedures for almost nothing in the national health service — but then he was told he would have to wait ages four weeks until government doctors got to him.

"Cancer is a serious business, and if you don't catch it in time, you will lose your life," he said by telephone. "In the UK, you're not told anything. You're like a mushroom — you're kept in the dark."

But even with the growing momentum for treatment overseas, big questions must be asked by anyone considering that option.

Despite the five-star facades of some hospitals — fountains, white marble floors — the comfort of having 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, diarrhea and strange foods also can be coupled with the unpredictable, such as September's bloodless military coup in Thailand.

Language and cultural barriers also can make communication with doctors and nurses frustrating. In some countries, doctors are regarded as authority figures who are not used to being questioned and sometimes communicate through hints and subtleties. Follow-up care also can be an issue.

"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, 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."

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 set up a Web site alleging the hospital administered a deadly drug cocktail to a patient with a history of substance abuse.

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.

"What I'm dedicated to doing is to try to alert people to at least do their homework and consider very carefully what they're getting into. Why is this such a good deal?" Goldberg said by telephone. "You might not walk away. That's what happened to my son."

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.

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