Can Medical Tourism Save Us From Obamacare?

The rise of first-rate hospitals abroad may provide a vital lifeline for Americans.


Outside of the United States, going to another country for medical care can lead to survival and recovery for patients otherwise facing certain death or long waits for treatment at home. Nigeria has no oncological care to speak of, so cancer-stricken citizens are increasingly going abroad for modern care. Battle-wounded Syrians are getting life-saving surgeries in Turkish hospitals. Canadians come to the U.S. to avoid average wait times of four months for non-emergency procedures.

If the double whammy of Obamacare, which will be fully up and running in 2014, and a rapidly aging population creates pronounced health-care shortages, more and more Americans may soon start looking abroad for fast, affordable, and effective treatments for all sorts of medical problems.

The global health-care industry is booming, which is creating new opportunities for medical travelers to purchase everything from discount dental work to state-of-the-art heart surgery. The international accreditation agency known as Joint Commission International evaluates the quality of hospitals around the world. It has given its stamp of approval to 546 hospitals worldwide and the list is growing faster than ever.

Hospitals accredited by the Joint Commission International |||

Foreign governments and hospitals are staking big dollars on promotion and infrastructure in an effort to burnish their reputations as medical destinations. That enthusiasm was on display last October at a medical tourism industry conference in Miami, which drew participants from 90 countries. Turkey, which paid close to $100,000 in exchange for prominent branding at the conference, drew 500,000 foreign patients in 2011. Medical tourists brought the country $3.5 billion in revenue in 2011, according to the head of the Turkish Healthcare Travel Council, Emin Çakmak.

Josef Woodman is the founder of Patients Beyond Borders and the author of several guidebooks to the medical tourism industry. He says foreign hospitals face more pressure to keep their costs down than their U.S. counterparts because their patients generally pay their bills out of pocket. And even highly skilled doctors in most countries earn significantly less than in the U.S. In India, heart-valve replacement surgery costs one-tenth of what U.S. hospitals charge. A knee replacement in Thailand runs about one-third of the U.S. price. In South Korea, gastric bypass surgery can be had for half the U.S. price.

Syrian patient receives treatment in a Turkish hospital |||

The globalization of health care means countries are specializing in certain kinds of care. Turkey excels in pediatric cardiology. Singapore is a destination for oncological care. Chinese heart patients needing top-notch angioplasty go to Japan. Israel and Barbados excel in fertility treatment. Costa Rica and Hungary have become dentistry destinations. Thailand excels in a wide range of specialties thanks in part to its renowned Bumrungrad International Hospital, which serves 400,000 foreign patients a year.

Port Charlotte, Florida-based orthopedist Sam Hess is part of a group that's working to open a full-service hospital on the Caribbean island of St. Maarten. Hess says he's grown tired of the legal and bureaucratic headaches of practicing medicine in the U.S. "I still love what I do, but the issues I have to deal with that have nothing to do with patient care take a lot of wind out of my sails," explains Hess. "We have to assign more and more of our staff to address insurance concerns and approvals. We order tests we don't need to cover ourselves legally."

Hess would also like the freedom to offer treatments that aren't legal yet in the U.S. Medical tourism offers doctors and patients a way around the FDA's often slow-moving approval process. Consider an orthopedic procedure called Birmingham Hip Resurfacing that gives younger patients an alternative to a total hip replacement. It was invented by a British Surgeon in 1991, but the FDA didn't approve the technique until 2006. In the interim, patients flocked to Chennai, India, to be treated by star surgeon Vijay Bose.

Medical travelers don't always make wise choices. Many seek out bogus stem-cell treatments for disorders like autism, multiple sclerosis, Down syndrome, and depression. Researchers anticipate that one day stem cells will be used to treat a broad range of diseases and conditions, but so far they've have been clinically proven effective only for certain blood disorders.

Thailand's Bumrungrad International Hospital serves 400,000 foreign patients a year. |||

Harvard Law professor I. Glenn Cohen, the author of a new book about the globalization of health care, says the stem-cell industry could be largely self-regulating if patients had access to better information online. The scarcity of reliable performance data is a major problem in the medical tourism industry, according to Harvard Medical School Professor Sharon Kleefield, who is working on developing better methods for gathering information from foreign hospitals. There's no ranking of the best global hospitals by specialty, which Kleefield thinks would go a long way towards convincing skittish U.S. employers and insurance companies to partner with foreign health-care providers.

Most medical tourists traveling out of the U.S. are seeking procedures that traditional health insurance companies don't cover - such as dental work, plastic surgery, and in vitro fertilization (IVF). But that's likely to change as health care becomes scarcer. Obamacare, which will be fully enacted in 2014, increases the demand for health care without doing much to grow the number of doctors, nurses, and hospital beds necessary to meet that demand. The aging of the baby boom generation (those born between 1946 and 1964) is already putting a strain on resources. By 2025, there will be 64 million Americans over the age of 65. That's almost double the number at the start of the century.

Some U.S. patients will follow in the footsteps of the nearly 50,000 Canadians a year who forego their insurance coverage and pay out of pocket for better and immediate treatment abroad. Medical tourism may also flourish within the regulatory confines of Obamacare. Southern Methodist University's Nathan Cortez argues in an soon-to-be published essay that there's nothing in the Affordable Care Act that specifically prohibits insurance companies from encouraging their clients to use foreign providers. It's also possible that insurance plans that utilize medical tourism could be offered on the state-based insurance exchanges, although the U.S. Department of Health and Human Services may choose to interpret the law in ways that makes that difficult.

Whatever the hurdles, the often-impeccable quality and low prices available abroad will lead more patients to travel for treatment in the coming years. "You're going to see huge competitive forces coming to bear on the U.S. health care system," says Josef Woodman of Patients Beyond Borders. "And god knows, we need it."

Video shot, edited, narrated, and written by Jim Epstein.

Approximately 4 minutes.

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    1. I've been to Puerta Vallarta for elective surgery for my wife. It was one fourth the price in the US. We stayed at a resort and went scuba diving before the operation.

  1. Some companies have been outsourcing many surgical procedures to Costa Rica for years.

  2. Medical tourism/expatriation; poTAYto/poTAHto.

  3. Where's Dr Groovus fit in?

    1. Dr. Podruga Groovova, konechno. **giggles**

      Seriously folks, this is exactly what Dr. Groovus does for a living now.

      In fact, I have some time ATM, so I can share a quick anecdote that happened this week:

      Had a patient come in and needed a Ukrainian speaker and had an *unusual* complaint.

      He had heard of my recent arrival and needed my specialized services, and since we only accept cash (and in VERY limited circumstances, third-party payer), it's helpful to know I am getting paid at the POE/POS.

      So, I am doing the exam without what's called a "medical guide" (basically a medical translator; I prefer not to have them unless the patient wants them) at his request (he's a VIP and has privacy concerns) and it was not noted that he only will speak in UKR (he left this blank on the form. Did I mention the language divide here is REALLY pronounced?) I greet him in Russian and start asking questions. Dead, resentful silence. I ask if he is deaf. Sour look. I speak UKR. DING!!! Lights up like a Xmas tree, and I get through most of the interview OK, but I did have to call for the MG with the patient's permission (I don't want to lose anything in translation. This is also precisely the reason I want all immigrants to the USA to know English.)


      1. (cont)

        He was so impressed with my thoroughness and attention to detail (particularly his diet) that he told me, "You show respect for me. You care. You learn my language and help me. I trust you totally and want you to TX my family (all five of them). I very important and rich man. Do you know doctor for my wife's needs? (Dr. PG FTW!)" The Medical Guide is all smiles and giving *thumbs up*, as this patient is a man of considerable import and specifically wanted an American doctor (Due to the comprehensive training American medical schools provide, American trained doctors are highly sought worldwide).

        The type of procedure needed would take him 6 to 7 months to get in the State System (assuming he even qualifies for care, forget queue).

        I will be operating on him next week.

        Fuck you, Barack Obama.

        1. I'm really impressed that you speak Russian AND Ukrainian and are fluent in not just a conversational but a technical aspect. And that you planned all this and went over and did it.

          I don't know if American doctors are actually better trained than European ones--having known both I'd say lean towards the American doctors I've known certainly being smarter, but in general I find Americans to be either smarter or much dumber than Europeans.

          1. I don't know if American doctors are actually better trained than European ones--having known both I'd say lean towards the American doctors I've known certainly being smarter, but in general I find Americans to be either smarter or much dumber than Europeans.

            Our training is longer on the whole, which is why I am qualified to do primary direct care as well as surgery (for concierge and Skype Doc). I am self-taught UKR (and barely passed my language exam on it), and it's getting much better, colloquially. Russian, I learned from one of my med school profs (who also wrote both my residency and fellowship letters. She's a fucking GENIUS!)

            Euros generally have less of a comprehensive knowledge base and their first year of training is the weed out; then they go straight to a specialty. Their medical schools take less time (depending on the specialty and country. Russia takes 5-6 years to get through med school and residency, for example), but on the whole, less comprehensively competent.

            Also keep in mind with centralized, State planned care, it's almost impossible to sue your provider (including private care), and that's probably true in Czech-sylvania.

            1. The biggest problem with a bureaucratic state-run system that can't be sued is that there's going to be as much accountability as you'd expect in a state-run bureaucracy.

              I don't know what it's like for private care providers, but there is much less of a sue-happy culture here and a lot more difficulties in getting huge torts.

              1. I regard it as disgusting, the fact that government healthcare is (what do you know?) grants itself immunity from contract law and legal recourse.

                Nice gig if you can get it, not if you have to live under it.

                1. *can grant

            2. You remind me of a doctor we got to know during our time running a private clinics website in Canada. In that ONE year we learned a lot about the rigidity and irrationalism of the Canadian health care system. Most Canadians have no clue.

              The old saying is, "the system is fantastic, until you're really seriously, sick."

              Canada DOES ration its care. It's total and utter bull shit to think otherwise.

              Anyway, we met this doctor in Ontario. He had a macabre, dead-pan sense of humor (his email address was Draculablood) and boy was he angry at the government. You see, in Ontario you all go through the same schooling, get the same accreditation etc. BUT, if you choose to go "private" (which is an evil term in Canada), the government TELLS you what surgeries you can and can't perform.

              In his case, he was an orthopedic specialist who wasn't allowed to perform ACL surgery.


              And yes, fuck you Barack Obama AND Tommy Douglas.

      2. This bol'nica is located in Odessa and an example of private medicine in UKR.

  4. Have paid out of pocket for all medical/dental work in Mexico for the past 12 years. My crowns cost less than most people's copay up north. I can buy most meds over the counter, and my doc consults cost $35. MRI's cost $300, basic blood work costs $30.
    Its amazing what happens when the price is dictated by what people are willing/capable of paying

    1. It's amazing what happens when people have to spend their own money, instead of a bottomless well of other people's money.

      1. It's also amazing when the patient can't sue the shit out of the provider and the patient doesn't lie to the practitioner and insurance company, yet still expects us to perform miracles or has unrealistic expectations of outcome.

        Since patients know everything and all practitioners are idiots and feel it's perfectly acceptable to commit insurance fraud.

  5. and not mutated by insurance and heavy regulation

  6. The amusing thing is that even as many countries have government-run healthcare for their own citizens, they allow foreigners to fly in and pay free market prices, skipping the waiting list. The reason being it helps bring in cash that finances medical care for citizens.

    I forsee a future where everyone who can afford it goes to another country to get medical care, in what is largely an international free market. Everyone who can't suffers through the "free" subsidized system.

    1. Well a lot of these countries have tiered access. Here in Czechia, you are covered automatically but you can upgrade stuff, better rooms, private rooms, etc.

      There are also higher quality private doctors and hospitals here, but cheaper than in the States since they can higher doctors at much lower prices.

  7. Dean Baker came up with some crackpot scheme about sending Americans to England for treatment. The whole thing was so convoluted and ridiculous, I blotted most of the details from my mind.

    Another intellectual triumph for the Center for American Progress.

  8. This is what seasteaders should focus on. It worked for casinos, sort of.

    1. You just gave away the plot of my Great American Novel!

  9. Responding to the title:

    "Can Medical Tourism Save Us From Obamacare?" From the costs, Hell no. Obamacare's financing is a patch work mirage. We are going to pay stiff taxes (embedded in our insurance premiums) to pay for the subsidized users. And as the premiums go up, fewer businesses will offer health insurance, which will mean more subsidized users in a vicious loop until private health insurance collapses. I would say this was a case of unintended consequences, but they clearly aren't unintended.

    In a related note, the cycle has already started:
    "A panel appointed by Mayor Rahm Emanuel to review taxpayer-subsidized health insurance for retired government workers suggested the city could drop coverage to help erase a financial shortfall. ... Phasing out coverage for most retired city workers would leave the bulk of retirees dependent on the Affordable Care Act, also known as Obamacare."


  10. Having tiered access is the best way to deal with our current healthcare crisis. Having basic medical needs is a human right and should be covered automatically but like everything in life, you can/should have the ability to upgrade your doctor,hospital,food etc.

    The problem i see is mainly with the way insurance/medical billing happens. The previous system was rotten to the core so im not exactly sure what/how obamacare will solve anything.

  11. A friend of mine traveled to Bangalore (India) for the kidney transplant surgery. There were some hurdles with the local transport but the experience in the hospital was good. It's been over a year now, after his successful surgery. COst of the surgery is around $17000 in India. Source : India surgery cost

  12. There are many people who would rather save up a little and travel to another country to have medical procedures that are not covered by their medical insurance or that are not available in their home country. There is a medical insurance company in Sydney that offers medical insurance to people who are traveling specifically gearing their services to procedures which are not covered by local medical insurance and travel insurance. visit their site at with the increased popularity of medical tourism it is a benefit to have an insurance company that will pay for procedures that are normally not covered!

  13. I have a friend who had an Orthopedic surgery in Mexico. The procedure went well, she's happy now 🙂 Here's some of the Best Orthopedic Hospitals in Hermosillo Mexico

  14. Use of Nanotechnology in Orthopedics
    The benefit of nanotechnology to regenerative medicine is immense. Firstly, when attaching biomaterial such as stem cells to a scaffold, that material may not grow due to the material not attaching to the scaffold properly. When using a scaffold for bone tissue, the osteoblasts need to adhere to the scaffold and be able to grow on it. Secondly, keeping the area clean while the cells develop can also be an issue. Nanotechnology is still young. However it is being shown that it has promise in solving both of these issues. Here are some of the most recent breakthroughs we find to be very promising.

    Nanotechnological Antimicrobial Surfaces
    AcryMed has developed an antimicrobial surface that primarily uses the properties of silver combined with nanotechnology to keep implants clean. AcryMed refers to it as silver antimicrobial technology, wherein silver nanoparticles bind to the surfaces of any device.
    Over time, the scientific community has learned that almost all medically relevant microbes can establish a fast-mutating, adherent lifestyle wherein the organism attaches to a surface in the body where it forms colonies that spread. A cohesive film-like layer forms over the colony to protect it?hence the term "biofilm." Once attached to an orthopedic device's surface, this biofilm can be a major cause of infection spreading in the body.
    For more information, click here.

    For more information-

  15. I bet everyone is missing president Obama now.
    Reading this with hindsight is LOL.

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