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Introduction to the Second Edition

When the First Edition of Patients Beyond Borders was released in 2007, I was immediately and unexpectedly overwhelmed with responses—from the media, from industry leaders, and from patients. The Washington Post called. National Public Radio and Fox News called. AARP and AMA called. The phone never stopped ringing, and all my callers had the same questions: Why are people traveling outside their home country to save money on healthcare? How are such savings possible? Can it really be safe for patients to do such a thing?

The book had obviously hit a huge nerve, and the need for information was varied and vast: Fully insured patients who had been in chronic pain for a decade had been turned down for hip replacements. Employers who could no longer afford their health plans were seeking alternatives. Uninsured Americans were aging into expensive and financially ruinous medical procedures. Canadians and Britons were tired of the months-long waits for "covered" surgeries. Sons and daughters of patients were trying to figure out how to pay for their loved ones' otherwise unaffordable care. The list goes on.

In the nearly two years that have passed since the release of the First Edition of Patients Beyond Borders, I have traveled to a dozen countries and visited more than 100 hospitals, meeting with surgeons, healthcare administrators, and their patients. Nearly every encounter reinforced the facts that our medical world is indeed becoming smaller and that healthcare consumers from all countries now have choices in quality medical care that did not exist even five years ago. That's why I wrote Patients Beyond Borders and why we are incorporating new information into the revised and expanded Second Edition you now hold in your hands.

In less than two years since the publication of the First Edition, much has changed in the medical travel arena. There were fewer than 50 JCI-accredited hospitals when our initial research began; now there are more than 240. That number is expected to double by 2010, offering patients seeking high-quality care abroad an even wider array of choice and comfort. Information has become more available—and trustworthy—as the medical travel road becomes four-laned. More countries are joining the ranks, offering excellent facilities and infrastructure to the international patient. Indeed, as employers, insurers, hospitals, and large third-party players become more involved in global healthcare, the idea of heading abroad for medical care is becoming as ordinary as owning a German or Japanese automobile.

What's New in the Second Edition?

For those who read the First Edition and are wondering what's new in this edition, here are the highlights:

Fourteen new destinations in eight new countries: Israel, Jordan, New Zealand, Panama, the Philippines, South Korea, Taiwan, and Turkey
Dozens of new hospitals, health travel agents, hotels, and recovery accommodations
The latest, up-to-date, checked, and verified contact information for top hospitals worldwide
Information on the English-language-friendly hospitals most recently accredited by JCI
New information on getting low-cost medical care in the United States
All-new cost comparisons and price information (gathered from direct surveys of a large sample of hospitals in 22 countries)
All-new glossary and index
Expanded answers to health travelers' frequently asked questions:
- Can I sue?
- Can I carry prescription medications through customs?
- How can I prevent medical complications such as deep vein thrombosis (DVT) when traveling long distances by air?
- How can I safely transfer my medical records out of the country?
- Will my insurance cover my treatment abroad?
- What immunizations do I need?
- How can I best protect myself against complications post-procedure?

Beginnings

Despite all that has changed since the First Edition of Patients Beyond Borders hit the bookstore shelves, I still think back to what started it all: when my father, age 72 at the time, announced he was heading off to Mexico for extensive dental work. I well remember my first reaction upon hearing his plans: a mixture of bewilderment and fear, then resignation, knowing that despite my protestations, he was going anyway. In spite of my concerns—some of them quite real—I'm pleased to report a happy ending. Dad and his wife, Alinda, selected a US-trained dentist in Puerto Vallarta and spent around $11,000—which included two weeks noodling around the Pacific Coast. They returned tanned and smiling, Dad with new pearly whites and Alinda with an impromptu skin resurfacing. The same procedures would have cost them $24,000 in the US.

After his treatment, when I told the story of my father's trip, most friends responded with the same shock and disbelief that I had felt initially. Then, when I explained the quality of care and the savings, more often than not those same folks followed me out the door, asking for Dad's email address. I even had an airport customs agent abandon his post and follow me to the boarding gate, seeking additional information for his son, who he had just learned required heart surgery.

Not long afterward, I developed an infected root canal and found myself following my father's example. My research led me abroad for extraction and implant work. While pleasantly surprised at the quality of care, the prices, and the all-around good experience of the trip, I nonetheless made a number of mistakes and created unnecessary difficulties and discomforts for myself. Had I done some simple things differently, my trip would have been more successful and more economical.

In seeking additional data on medical travel, I found no reliable source of information. Everybody had something to sell or a political axe to grind. Books, magazine articles, and newspaper reports seemed more like tourists' brochures than health-travel references. Thus the idea for Patients Beyond Borders was born: a well-researched guide, written in plain English, which would offer an impartial look at contemporary medical travel, while helping prospective patients ask the right questions and make informed choices.

As we contemplate our options in an overpriced, overburdened US healthcare environment, nearly all of us will eventually find ourselves seeking alternatives to costly treatments—either for ourselves or for our loved ones. Americans are in the midst of a global shift in healthcare service: in a few short years, big government investment, corporate partnerships, and increased media attention have spawned a new industry—medical tourism—bringing with it a host of encouraging new choices, ranging from dental care and cosmetic surgery to some of the more costly procedures, such as hip replacement and heart surgery. Those patients who take the time to become informed about our changing healthcare world will be pleasantly surprised by a smorgasbord of affordable, high-quality, American-accredited medical options abroad. Those who do not may find themselves grappling with an ungainly, prohibitively expensive healthcare system and a rising absence of choice.

There is no single type of health traveler. In researching and writing Patients Beyond Borders, I talked with wealthy women from Beverly Hills who, despite their affluence, prefer the quality of treatment and attention they receive in Brazil or South Africa to medical care California-style. I met a hardworking couple from Wisconsin who, facing the prospect of refinancing their home for a $65,000 hip operation here in the US, headed to India instead. I interviewed a Vietnam vet who wearied of long waits and red tape. He said "bon voyage" to this country's ever-deteriorating healthcare system and headed overseas for treatment.

From these patients' experiences, and many more like them, you'll learn when and how health travel abroad might meet your medical and financial needs. And you'll become a more informed healthcare consumer—both here and abroad.

You Deserve an Impartial Perspective

This new phenomenon of medical tourism—or international health travel—has received a good deal of wide-eyed attention of late. While one newspaper or blog giddily touts the fun 'n sun side of treatment abroad, another issues dire Code Blue warnings about filthy hospitals, shady treatment practices, and procedures gone bad. As with most things in life, the truth lies somewhere in between.

In short, I've found the term "medical tourism" is something of a misnomer, often leading patients to emphasize the recreational more than the procedural in their quest for medical care abroad. Unlike much of the hype that surrounds contemporary health travel, Patients Beyond Borders focuses more on your health than on your travel preferences. Thus, throughout this book, you won't see many references to the terms "medical tourism" or "health tourism." In the same way business travelers don't normally consider themselves tourists, you'll begin to think more in terms of medical travel and health travel.

My research, including countless interviews, has convinced me: with diligence, perseverance, and good information, patients considering traveling abroad for treatment do indeed have legitimate, safe choices, not to mention an opportunity to save thousands of dollars over the same treatment in the US. Hundreds of patients who have returned from successful treatment overseas provide overwhelmingly positive feedback. They persuaded me to write this impartial, scrutinizing guide to becoming an informed international patient. I designed this book to help readers reach their own conclusions about whether and when to seek treatment abroad.

What Exactly Is Medical Tourism?

Last year, more than 180,000 Americans packed their bags and headed overseas for nearly every imaginable type of medical treatment: tummy tucks in Brazil, heart valve replacements in Thailand, hip resurfacing surgeries in India, addiction recovery in Antigua, fertility diagnosis and treatments in South Africa, thalassotherapy in Hungary, or restorative dentistry in Mexico.

Currently, at least 28 countries on four continents cater to the international health traveler, with more than 2 million patients visiting hospitals and clinics each year in countries other than their own. The roster of treatments is as varied as the travelers.

If the notion of complex medical procedures in far-flung lands seems intimidating, don't feel alone. That's why I wrote this book, drawing from the varied experiences of hundreds of patients who, for dozens of reasons, have beaten a well-worn path to successful treatments abroad.

Why Go Abroad for Medical Care?

Cost Savings

Most people like to get the most for their dollar. The single biggest reason Americans travel to other countries for medical treatment is the opportunity to save money. Depending upon the country and type of treatment, uninsured and underinsured patients, as well as those seeking elective care, can realize 15-85 percent savings over the cost of treatment in the US. Or, as one successful health traveler put it, "I took out my credit card instead of a second mortgage on my home."

As baby boomers become senior boomers, costs of healthcare and prescriptions are devouring nearly 30 percent of retirement and pre-retirement incomes. With the word getting out about top-quality treatments at deep discounts overseas, informed patients are finding creative alternatives abroad.

Margaret S., a patient from Santa Ana, California, was quoted $6,600 for a tooth extraction, two implants, and two crowns. One of the 120 million Americans without dental insurance, Margaret had heard of less expensive dental care abroad. Through a friend, she learned about Escazú, Costa Rica, known for its excellent dental and cosmetic surgery clinics. Margaret got the same treatment in Costa Rica for $2,600. Her dentist was a US-trained oral surgeon who used state-of-the-art instrumentation and top-quality materials. Add in airfare, lodging, meals, and other travel costs, and this savvy global patient still came out way ahead.
Doug S., a small-business owner from Wisconsin, journeyed with his wife, Anne, to Chennai, India, for a double hip resurfacing procedure that would have cost more than $55,000 in the US. The total bill, including travel for him and his wife, lodging, meals, and two-week recuperation in a five-star beach hotel, was $14,000. "We were treated like royalty," said Doug, "and I'm riding a bicycle for the first time in six years. We could not have afforded this operation in the US."

Better quality care

Veteran health travelers know that facilities, instrumentation, and customer service in treatment centers abroad often equal or exceed those found in the US. Governments of countries such as India and Thailand have poured billions of dollars into improving their healthcare systems, which are now aggressively catering to the international health traveler. VIP waiting lounges, deluxe hospital suites, and staffed recuperation resorts are common amenities, along with free transportation to and from airports, low-cost meal plans for companions, and discounted hotels affiliated with the hospital.

Moreover, physicians and staff in treatment centers abroad are often far more accessible than their US counterparts. "My surgeon gave me his cell phone number, and I spoke directly with him at least a dozen times during my stay," said David P., who traveled to Bangkok for a heart valve replacement.

Excluded treatments

Even the most robust health insurance plans exclude a variety of conditions and treatments. You, the policyholder, must pay these expenses out of pocket. Although health insurance policies vary according to the underwriter and individual, your plan probably excludes a variety of treatments, such as cosmetic surgeries, dental care, vision treatments, reproductive/infertility procedures, certain nonemergency cardiovascular and orthopedic surgeries, weight-loss programs, substance abuse rehabilitation, and prosthetics—to name only a few. In addition, many policies place restrictions on prescriptions (some quite expensive), post-operative care, congenital disorders, and pre-existing conditions.

Rich or cash-challenged, young or not-so-young, heavily or only lightly insured—folks who get sick or desire a treatment (even one recommended by their physician) often find their insurance won't cover it. Confronting increasingly expensive choices at home, nearly 40 percent of American health travelers hit the road for elective treatments. In countries such as Costa Rica, Singapore, Dubai, and Thailand, this trend has spawned entire industries, offering excellent treatment and ancillary facilities at costs far lower than US prices.

Specialty treatments

Some procedures and prescriptions are simply not allowed in this country. Either Congress or the FDA has specifically disallowed a certain treatment, or perhaps it's still in the testing and clinical trials stage or was only recently approved. Such treatments are often offered abroad. One example is an orthopedic procedure known as hip resurfacing, for most patients a far superior, longer lasting, and less expensive alternative to the traditional hip replacement still practiced in the US. While this procedure has been performed for more than a decade throughout Europe and Asia, it was only recently approved in the US, and its availability here remains spotty and unproven. Hundreds of forward-thinking Americans, many having suffered years of chronic pain, have found relief in India, where hip resurfacing techniques, materials, and instrumentation have been perfected, and the procedure is routine.

Shorter waiting periods

For decades, thousands of Canadian and British subscribers to universal, "free" healthcare plans have endured waits as long as two years for established procedures. "Some of us die before we get to the operating table," commented one exasperated patient, who journeyed to India for an open-heart procedure.

Here in the US, long waits are a growing problem, particularly among war veterans covered under the Veterans Administration Act, for whom long queues are becoming far too common. Some patients figure it's better to pay out-of-pocket to get out of pain or to halt a deteriorating condition than to suffer the anxiety and frustration of waiting for a far-future appointment and other medical uncertainties.

More "inpatient-friendly"

As US health insurance companies apply increasing pressure on hospitals to process patients as quickly as possible, outpatient procedures are becoming the norm. Similarly, US hospitals are under huge pressure to move inpatients out of those costly beds as soon as possible. Medical travelers will welcome the flexibility at the best hospitals abroad, where they are often aggressively encouraged to spend extra time in the hospital post-procedure. Furthermore, staff-to-patient ratios are usually higher abroad, while hospital-borne infection rates are often lower.

The lure of the new and different

Although traveling abroad for medical care can be challenging, many patients welcome the chance to blaze a trail, and they find the creature comforts often offered abroad a welcome relief from the sterile, impersonal hospital environments so often encountered in US treatment centers. For others, simply being in a new and interesting culture lends distraction to an otherwise worrisome, tedious process. And getting away from the myriad obligations of home and professional life can yield healthful effects at a stressful time.

What's more, travel—and particularly international travel—can be a life-changing experience. You might be humbled by the limousine ride from Indira Gandhi International Airport to a hotel in central New Delhi, or struck by the simple, elegant graciousness of professionals and ordinary people in Thailand, or wowed by the sheer beauty of the mountain range outside a dental office window in Mexico. As one veteran medical traveler put it, "I brought back far more from this trip than a new set of teeth."

Who Should Read Patients Beyond Borders?

You’ll benefit from reading this book if

You're one of 85 million uninsured or underinsured individuals and wish to explore less expensive options for a treatment often covered by health insurance.
You're one of 120 million Americans without a dental plan and wish to take advantage of the full range of affordable dental procedures in other countries.
You wish to pursue an elective treatment (such as cosmetic surgery, in vitro fertilization, or homeopathy) not normally covered by health insurance policies.
You're exploring one of many treatments either not offered or not approved in the US.
You feel a friend or family member might benefit from learning more about health travel, yet that person might lack the confidence or focus to launch an inquiry.
You plan to join a family member or friend for treatment abroad (see Chapter Seven, "For Companions").

What Patients Beyond Borders Will (and Won’t) Do for You

Patients Beyond Borders isn't a guide to medical diagnosis and treatment, nor does it provide medical advice on specific treatments or caregiver referrals. Your condition, diagnosis, treatment options, and travel preferences are unique, and only you—in consultation with your physician and loved ones—can determine the best course of action.

Should you decide to investigate traveling abroad for treatment, we do provide you with all the resources and tools necessary to become an informed medical traveler, so that you'll have the best possible travel experience and treatment your money can buy.

Our job is to

help you become a knowledgeable, confident health traveler;
assist you in planning and budgeting your trip and treatment;
provide you with up-to-date information about the most popular, widely used treatment centers;
make your in-country visit as comfortable and hassle-free as possible;
recommend good lodging and recovery accommodations; and
provide tips, tricks, and advice for a successful medical travel experience —before, during, and after treatment.

Your job is to

consult with your local doctor(s) to ensure you've reached a satisfactory diagnosis and recommended course of treatment;
decide, based on your research and the material featured in this book, whether you wish to travel abroad for treatment; and if so,
select a travel destination, treatment center, and physician based on the information you find in this book and elsewhere.

It's a truism: every journey begins with the first step. Health travel is no exception. Once you've taken that first step toward learning more, you'll find that your friends, family, this book, and a trusty Internet connection will speed you on your way.

How to Use This Book

Before you dive into Part Two, "The Most-Traveled Health Destinations," you'll want to carefully read Part One, "How to Become a Savvy, Informed Medical Traveler." It provides you with the basic resources and tools you'llPneed to do your research and make an informed decision.

Chapter One, "What Am I Getting Into? Some Quick Answers for Health Travelers," addresses the questions and concerns most often voiced by patients (and their loved ones) considering a medical journey abroad.

Chapter Two, "Planning Your Health Travel Journey," helps you design your trip step by step. The chapter provides data and advice culled from interviews with hundreds of patients and treatment centers. You'll learn how to cut through the chaff quickly to find the right clinics, determine physician accreditation, narrow your destination choices, choose the right companion, and more.

Chapter Three, "Budgeting Your Treatment and Trip," walks you through the financial basics of a medical trip and gives you the tools you need to prepare an estimated budget. Our "Patients Beyond Borders Budget Planner" helps you determine specific cost-savings and avoid financial surprises.

Chapter Four, "Choosing and Working with a Health Travel Planner," shows you how to avoid hassles and save money by finding and engaging the right health travel agent.

Chapter Five, "While You're There," provides valuable information on what to expect from your treatment center and physician, plus general tips for dealing with local cultures, language barriers, and more. A section on communicating while on the road includes pointers on using cell phones and computers to communicate with physicians in-country, as well as loved ones back home.

Chapter Six, "Home Again, Home Again," helps you get settled in post-treatment, offering practical advice on working with your hometown doctor, shaking off the "post-treatment blues," coping with discomforts and complications, and getting back on your feet.

Chapter Seven, "For Companions," is written especially for those caring family members or friends who accompany patients on health journeys.

Chapter Eight, "Dos and Don'ts for the Smart Health Traveler," helps you avoid common speed bumps and potholes on the health travel road.

Part Two, "The Most-Traveled Health Destinations," features 37 destinations in 21 countries, with up-to-date information on hospitals and clinics, specialties, accreditation, recovery centers and recuperation resorts, transportation, communication, and more. You'll use the information in this section to get a good idea about where to travel for your particular procedure and what to expect for the costs of common treatments.

Part Three, "Resources and References," provides additional sources of medical travel information and helpful links, plus a glossary of commonly used medical terms.

As you work your way through decision-making and subsequent planning, remember that you're following in the footsteps of tens of thousands of health travelers who have made the journey before you. The overwhelming majority have returned home successfully treated, with money to spare in their savings accounts.

Still, the process—particularly in the early planning—can be daunting, frustrating, even a little scary. That's normal, and every health traveler we interviewed experienced "the Big Fear" at one time or another. Healthcare abroad is not for everyone, and part of being a smart consumer is evaluating all the impartial data available before making an informed decision. If you accomplish that in reading Patients Beyond Borders, we've achieved our mission.

Let's get started.