The Medical Vacation
Published: April 2009
By Louisa Kamps
State-of-the-art hospitals from Bangkok to Cape Town are luring American travelers with low prices and packages that include side trips to local attractions. But are they safe?<em>Louisa Kamps</em> reports
Spurred by the fertility success stories she read about on IVF Connections' Web site, Jennifer Leeds* made plans to visit the Instituto Valenciano de Infertilidad (I.V.I.), in Valencia, Spain. Leeds, a 44-year-old real estate appraiser from Crofton, Maryland, had already seen a number of fertility specialists—she knew she'd need to have in vitro fertilization (IVF) treatments if she wanted to have a baby. But she also knew she and her husband weren't up for spending $28,000, the price a private fertility clinic charged for the outpatient procedure, which wasn't covered by their insurance policy. "Could we afford it?Yes. Did we want to pay it?No," Leeds says.
Besides receiving excellent treatment at I.V.I., which was "cleaner than some hospitals I've visited in the States" and getting pregnant at the clinic, Leeds and her husband had a two-week vacation, visiting museums and sampling the region's famous paella. The entire trip—clinic fees plus the couple's airfare, hotel, and meals—ended up costing them only $12,000 and was so positive overall, says Leeds, now the mother of a 20-month-old son, that they're returning this summer for another procedure.
Frustrated with the high cost of medical care in this country and by insurance companies that don't cover elective procedures such as IVF, medically savvy consumers are driving a new trend known as medical tourism. As Leeds discovered, the total price of an overseas treatment—with airfare, accommodations, and even a few days of vacation tacked on—is often far less than the procedure by itself would cost in the United States. According to a recent report by the Singapore-based travel supplier and ticketing firm Abacus International, Asia's medical-tourism industry is expected to generate more than $4.4 billion dollars by 2012. The region already attracts more than 1.3 million medical tourists a year; the majority of these travelers come from within Asia, but the long-haul market is "important and growing," the report says. India's medical-tourism business is expanding by 30 percent per year, according to the Abacus survey. Meanwhile, South Africa, Israel, and Spain are developing reputations as affordable destinations for IVF, Costa Rica specializes in outpatient procedures such as dentistry and cosmetic surgery, and Cyprus is attracting Europeans for its cheap high-tech hair-implant treatments. However, although some international medical centers, such as Bumrungrad International, in Bangkok, and India's Wockhardt hospitals, are accredited by reputable organizations such as the U.S.-based Joint Commission International, most are not, making them potentially risky propositions. Critics of medical tourism also point out that once patients get back home, they have little legal or practical recourse if something goes wrong.
The vast majority of medical tourists are heading to clinics and hospitals that have not been held to rigorous international standards. Sue Jensen, a 48-year-old Atlantan, was impressed with Surgical Attractions, a South African company that arranges trips combining elective medical care with spa stays and safari tours, despite the fact that it wasn't an internationally accredited facility. The price Surgical Attractions charged for a breast reduction and a tummy tuck, along with three weeks' deluxe accommodation afterward—$11,000—was "half the price of the surgery alone in Atlanta." The doctor assigned to her called Jensen before she left Atlanta to introduce himself and answer her questions. Once she arrived in South Africa, Surgical Attractions "took care of every detail" during Jensen's time in Cape Town, where she relaxed after surgery, receiving massages at a guesthouse with a pool and a garden. "I was treated like a queen," she says. "Breakfast was delivered every day, and I was within walking distance of the Victoria and Alfred Waterfront area—it was great to get back on my feet and enjoy Cape Town."
Experiences like Jensen's are not a given, however. Because there is still no international accreditation board for plastic surgery, and few countries enforce the stringent regulations for medical care that exist in the States, Dr. Roxanne Guy, president elect of the American Society of Plastic Surgeons, says that traveling abroad for cosmetic procedures is "truly buyer beware." Not only should prospective patients verify doctors' credentials, Guy says, but they must also remember that "surgical wounds heal best with rest" and that the stress of travel can leave patients vulnerable to infection. And she is strongly suspicious of the promises made by some companies, such as Surgical Attractions and Plenitas, a Buenos Airesbased agency that bundles face-lifts with tango classes: "Serious complications can occur after any surgery, including cosmetic plastic surgery. Would you like to tango to the nearest help, or ride in an all-terrain vehicle through the jungle for it?" But Plenitas press director Marina Harvey says Plenitas doctors would never risk endangering a patient's health. "The idea is to travel to Iguazú Falls and tango before the surgery, never after," Harvey says.
Despite the risks, medical tourism may be here to stay. There's no better exemplar of the trend than Bangkok's Bumrungrad International, which looks more like a high-end hotel than a state-of-the-art hospital. In addition to having a Starbucks, a McDonalds, and on-site valet parking, Bumrungrad also provides a visa-extension center, a team of interpreters to help with language problems, and 123 hotel-like rooms and suites where patients can recuperate. In 2005, the hospital treated 58,000 American patients, a 25 percent increase from 2004. "We receive about 400 new e-mails a day from the United States," Bumrungrad's group marketing director, Ruben Toral, says. Bumrungrad has recently partnered with tour operator Diethelm Travel Asia to help travelers arrange trips to nearby attractions. According to Toral, there are two types of medical tourists: the leisure tourist who gets a little medicine on the side—usually outpatient procedures such as dental or Lasik, and some cosmetic surgeries—and the patient who has come for a more serious surgery (orthopedic, cardiovascular, and more intensive plastic surgeries) but who also wants to get in some pre-op excursions to local tourist sites. "The prevailing wisdom," Toral says, "is 'If I've traveled this far, then I should at least take a few days to do some sightseeing.'"
Louisa Kamps is a contributing writer for Elle. Her work has also appeared in Food & Wine, The New York Times, and The New Yorker.
If you're contemplating traveling overseas for necessary treatment that can be scheduled ahead, check to see if the hospital is accredited by either the Joint Commission International (www.jointcommissioninternational.org) or MEDEX Assistance (www.medexassist.com).
Since 1999, JCI has been accrediting international hospitals around the world; today, 81 hospitals, including Bangkok's Bumrungrad International, Johns Hopkins Singapore International Medical Center, the American Hospital Dubai, and India's Wockhardt hospitals, have met JCI's rigorous standards, which include on-site visits from a team of American physicians, nurses, and hospital administrators every three years.
MEDEX Assistance is a travel-health insurance company that evaluates doctors, hospitals, and clinics abroad to treat American travelers in emergency situations. Those that pass inspection qualify for medex's Global Network. Robert Currie, chief of operations at medex Assistance, cautions that some of the promises hospitals make in an effort to woo patients from overseas aren't always true. MEDEX inspected one facility in Tibet that had been actively courting new patients from overseas and discovered the staff reusing needles, Currie says. "That facility clearly earned its 'Do not use' rating in the MEDEX Assistance database."
On its Web site, MEDEX offers a list of tips to help prospective medical tourists plan a safe trip. Among them: Seek advice from the expatriate community living in the country you're traveling to, don't travel alone to seek treatment, and be prepared to turn around and come home if something doesn't seem right about the facility or your treatment.—L.K.
Despite high prices, Americas hospitals are still some of the best in the worldand for that reason they continue to attract well-heeled patients who travel from near and far. Mobile baby boomers, seeking out top specialists for procedures theyd rather not trust to their local hospitals, are traveling to these cutting-edge research hospitals, many of which have added hotel-like services such as "medical concierges" and offer special rates for patients and their families at adjacent hotels.
Here are just a few:
The Cleveland Clinic, Cleveland (www.clevelandclinic.org)
Best known for: urology, cardiac care, orthopedics, gynecology
Special perks for travelers: pagers to keep family members in touch with patients at all times; "medical concierges" to help out-of-town patients with everything from scheduling and confirming airline reservations to arranging visits to the Rock and Roll Hall of Fame; private security people on call 24/7.
Johns Hopkins Hospital, Baltimore (www.hopkinsmedicine.org)
Best known for: cancer, hormonal disorders, eye and ear surgery, urology
Special perks for travelers: second-opinion appointments available for patients contemplating traveling to the hospital for longer-term care; guest-services staff who schedule appointments, assist with travel and accommodation arrangements, and obtain reduced rates at most hotels in downtown Baltimore for patients; "deluxe" accommodations available in the Marburg Pavilion.
Memorial Sloan-Kettering Cancer Center, New York (www.mskcc.org)
Best known for: cancer, cardiology, neurology, orthopedics
Special perks for travelers: Integrative medicine center, where patients can book massages and join yoga and tai chi classes at any time; patient care coordinators trained to help out-of-towners find whatever theyre looking for in Manhattan; in-house travel clinic.
UCLA Medical Center, Los Angeles (www.medctr.ucla.edu)
Best known for: cancer, digestive disorders, ophthalmology, respiratory disorders
Special perks for travelers include: 800/UCLAMD1 hotline, a physician referral service; special visitor passes for patients and family members to work out at university gym, nondenominational spiritual counseling.