Clean, Not Sterile: Patients come to Bumrungrad and Bangkok Hospital for the surgery -- but stay for the espresso. | photograph by Steve Bronstein
Not a Hotel: The main lobby at Bumrungrad offers up a global cross section of humanity. Your recovery suite awaits. | photogragh by Tony Law
"They say, 'It's outsourcing, you're trying to drive [patients] out,' " Toral says mockingly. "Well, I'm not trying to drive them out; the American system is driving them out! My product is just as good as it was 5 or 10 years ago. The only thing that has changed is you. You're now unaffordable, unreachable, and you've got 47 million uninsured. So you do the math." At one particularly effusive moment during our dinner in Bangkok, Toral announces that a patient pipeline flowing from the United States to Bangkok or Singapore and back would galvanize practitioners and clue Americans in on the most intractable cost problem facing the industry today: the aggregate expenses of surgery, hospitalization, and administration. "Right there, you've saved maybe 40% of the total cost," he says, "and all of a sudden the pressure to overhaul the U.S. health-care industry is off you, because you've solved the most vexing problems out there."
The American system is driving patients out; says Toral: "You're now unaffordable, unreachable, and you've got 47 million uninsured. So you do the math."
But can a free-market solution actually produce meaningful change, measured in terms of more care, better care, and lower costs? Toral is right to insist that the 24-hour flights, the Indian doctors, and the hospitals with unpronounceable names are red herrings; the real issue is whether these choices will eventually fix the system or simply extend it around the planet. But Johnson also is right: The recent history of health care is marked by elective improvements that soon enough hardened into the status quo. "Before this, there was 'first dollar' coverage," Johnson says, ticking them off. "Then there was the 'miracle' of HMOs, all of which were voluntary, and all of which quickly morphed into something quite less. It was the same thing with PPOs, and every new gimmick the health-care community can come up with." Will the promise of cash prizes go away, replaced by implied threats? Will our choices simply disappear?
It's hard to imagine how the insurers -- operating in the same Hobbesian universe as the rest of us -- won't eventually winnow the choices down to having our care paid for in Bangkok or making us cover it if we opt to stay close to home. It's hard not to notice that their argument seems to boil down to, "Trust us."
The odds are good that the future of health care in this country will not be mapped by a grand visionary in government or some grim actuary buried at the bottom of an insurance conglomerate. It will more likely be the sum of many thousands of decisions made by well-meaning employers in places that look a lot like Myrtle Beach, South Carolina.
The morning I was in Washington, D.C., to meet UnitedHealth's Karev, I also had coffee with David Boucher, an early-rising bureaucratic do-gooder at Blue Cross Blue Shield. Boucher is an Army brat with inexhaustible energy and laserlike focus. He's no radical, however, having started at Blue Cross Blue Shield of South Carolina while still in grad school. He later left to run a few hospitals before returning in 1999 to oversee a BCBS call center. And yet, Boucher has done more than Karev and Toral combined to make global medicine a reality, at least for his 1.5 million members in the Palmetto State.
His Saul-on-the-road-to-Damascus moment came in the summer of 2006, when he and his wife elected to take their summer vacation at Bumrungrad. He had been tipped that it was the foreign hospital to see, and so they reserved an apartment at the Bumrungrad Hospitality Suites (normally reserved for recovering patients) and proceeded to take in the sights. By day, he toured the hospital's ER, ORs, and ICUs before dining at one of the hospital's various restaurants each evening. The eureka moment came as they were leaving, when his wife (evidently still on speaking terms) offered this non sequitur: "If I or anyone in my family needs an operation, we're coming here."
"Women make the decisions about health care in families," Boucher says over coffee. "If my wife felt comfortable about sending a loved one there, then I thought there might really be something to this." Once he was back in the office, he proposed launching a medical travel agency under the banner of BCBS, which compared to its hidebound siblings in other states is run like a pirate ship. "Thinking outside the state wasn't unusual for us but outside of the country was," he says.
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Recent Comments | 30 Total
April 18, 2008 at 12:13am by Healthbase Medical Tourism
Medical tourism is a rapidly growing industry and is here to stay until our domestic health care system is fixed and for as long as there is affordable care avaialble overseas which beats the US in quality. For more information about the process of medical tourism and to meet medical tourists, check out http://www.healthbase.com.
April 18, 2008 at 10:26am by Dirk Nuehouse
I used a company called PlanetHospital to help our 48 employees get affordable care and for the first time we did not see increased premiums in our healthcare costs. I am surprised they were not mentioned in this article.
April 19, 2008 at 12:14pm by Jeff Schult
I'm going to have to ask Ruben about the comparison to George Clooney -- he may never live that down! ;-)
Jeff Schult
Author, Beauty from Afar, the medical tourism book ...
April 25, 2008 at 3:25pm by Gabriel Biller
I am a graduate design student who worked last year on a project about this very topic:
http://www.gabrielbiller.com/pdfs/SPW_Expedia_Report_final.pdf.
As the son of a physician, I am certainly concerned about the idea of medical care being treated like any other manufactured product or service, but the reality is that we live in a flatter world than ever before, and our American system is screwed up. Administrative costs are out of control, and healthy competition is good for the end-users: the patients. We do have to face the facts that other people in the world can do things as well as or better than we can. And that medical care needs to be viewed as a larger system/experience of providing care and assistance to patients (not only in the hospital).
I would have liked to have seen some more details about WHY our costs are so high, which I understand to be the administrative costs (stupid insurance companies and hospitals and way too much paperwork and manpower devoted to pencil-pushing in order to avoid covering expenses) as well as a highly-litigious environment where doctors and hospitals have to protect themselves from lawsuits. I'm not saying that doctors don't ever make mistakes, but the reality is that nothing in life is guaranteed, so when people abuse their bodies and expect a doctor to make a quick fix but it doesn't work, something needs to be done about this mindset of Americans that they are entitled to 100% satisfied outcomes.
Does the author have anything to add about the legal rights of patients of globalized health care? Isn't it the case that those rights are much more limited than within the U.S.? Also, physicians make less money overseas, in general, than in the U.S. Does this mean a different quality of life for practitioners of this profession? Less respect?
April 29, 2008 at 1:03pm by jonathan edelheit
Anyone researching medical tourism should start with the Medical Tourism Association, which is the international non-profit association for the medical tourism industry. They also have an annual convention in San Francisco, September 9-12th of each year. www.medicaltravelauthority.com
May 4, 2008 at 1:48am by Carlos Perez
My sister needed dental work that would have cost her about $3000 (after insurance)in the U.S. She had visited several dentists in the U.S. and none could treat her problem (she needed extensive root canal, cap, etc) She contacted "New Medical Horizons" in NYC and they arranged her treatment in India which only cost $250. She said she didnt see any difference between her dental care in the U.S. and India (same knowledgeable dentist, same medical requipments, same dental procedures, etc).
In fact, she said that the dentist she visited in India was more concerned about about fixing her problem whereas in the states, the dentist(s) were more focused on immediate patch up treatments (maybe because they were trying to stay within the insurance budgets) that eventually left her in continued pain. Anyway, she is back and now pain free. Her dental work went smoothly and the dentist still personally emails her to make sure she is fine.
May 4, 2008 at 1:50am by Carlos Perez
My sister needed dental work that would have cost her about $3000 (after insurance)in the U.S. She had visited several dentists in the U.S. and none could treat her problem (she needed extensive root canal, cap, etc) She contacted "New Medical Horizons" in NYC and they arranged her treatment in India which only cost $250. She said she didnt see any difference between her dental care in the U.S. and India (same knowledgeable dentist, same medical requipments, same dental procedures, etc).
In fact, she said that the dentist she visited in India was more concerned about about fixing her problem whereas in the states, the dentist(s) were more focused on immediate patch up treatments (maybe because they were trying to stay within the insurance budgets) that eventually left her in continued pain. Anyway, she is back and now pain free. Her dental work went smoothly and the dentist still personally emails her to make sure she is fine.
May 6, 2008 at 11:56am by Robbie Neely
Two other reasons this trend is growing is 1) to avoid waiting lists, especially in Canada; and 2) to get access to procedures not commonly practiced in at home. Take the case of Kevin Stewart. He had a live liver transplant in India last August, facilitated by www.WorldMedAssist.com. He not only would have had to pay $350,000 in the U.S. but worse, he was in a waiting line for a liver from a deceased person that was longer than his life expectancy without a transplant. His sister donated a lobe of her liver to save Kevin Stewart's life. Listen to his story: http://www.worldmedassist.com/liver-transplant-India-video.htm.
An example of a procedure done more commonly overseas than in the US is hip resurfacing, a less radical alternative to hip replacement. This procedure was approved in the US only in 2006, so the track record of US doctors is nowhere near what it is in places like Belgium and India.
May 16, 2008 at 2:47am by John Hughes
In a globalized world, shopping for health care is an inevitability, and if travelling abroad for treatment should prove the best option, it becomes a natural consequence. As the article points out, perceptions on hospital care differ in different parts of the world and face value can sometimes prevail over medical standards. It’s important to do thorough research and a number of sites exist that can help:
www.discoverythailand.com/medical
www.travelfish.org/feature/63
www.tourismthailand.org/activities/general_information
www.medical-tourism-in-thailand.com/
www.en.wikipedia.org/wiki/Medical_tourism
May 26, 2008 at 12:58pm by Carter Newton
Terrific article and good comments. I am a cardiologist totally grossed out by the cost of medical services and pharmaceuticals and yet aware of how reduction of financial incentives leads to disinterested providers who will do poor work. So I don't support universal healthcare. But, here we have something of a free market in healthcare services. The idea of affordable fee for service, I had given up on the concept. But the more I think about it I would even think of working in an outsourced system: where the hospital and is a friend and not a foe and where a malpractice a ttourney is not lurking behind every bush.
May 27, 2008 at 9:47am by Scott Mills
I would like to have seen a sidebar on international legal remedies for medical procedures that do not go well for these medical tourists. If any of these people had an unfortunate result do they have the same legal avenues of restitution/retribution that are available in America?
It seems that we often hear the success stories of international medicine - what about the failures that require some legal remedy? And what is the legal exposure of employers who register employees for medical care that includes offshore major medical procedures offshore?
Americans need to understand that every medical procedure in America carries an inherent premium for potential legal involvement. Without this built-in premium our health care would cost noticeably less money. As we debate health care reform it is imperative that everyone recognize that healthcare reform also means tort reform.
June 5, 2008 at 1:38pm by Tim Tymchyshyn
it is strange on how our medical systems can't do anything without costing a fortune. maybe we are pricing ourselves out of the game instead of playing the game
August 28, 2008 at 6:02pm by Michelle Smith
Medical tourism has a bright future. with 45 million Americans uninsured, there does not see any other solution. www.MedicalTourismCo.com is one company that is addressing this growing oversear medical travel demand.
April 20, 2009 at 4:43pm by Michael Dunage
As more individuals become unemployed, the cost of Healthcare has remained very much the same. We speak to people everyday that tell us how they have been referred or told about the option of medical travel abroad to save a chunk of money. We facilitate the medical travel to and from the U.S. Canada as well as the UK. For more information about medical travel abroad for specific health concerns, please visit us at http://www.medpathgroup.com
July 13, 2009 at 3:41pm by Ken Fyre
Countries like Malaysia, South Africa, India and others are taking the lead in medical tourism, equipped with 5-star hotel treatment for recovery rooms, not to add that medical procedures could be a third of the cost of similar procedures in the U.S.
Health Classifieds | Local Doctor Reviews and Ratings
August 11, 2009 at 4:29am by Quincy Q
John Hughes, one of Hollywood's most successful directors and screen writers, whose movies during the 1980s helped to define that era and became cultural touchstones, has died at age 59. Hughes, who directed the "The Breakfast Club;" "Ferris Bueller's Day Off;" "Sixteen Candles", and "Planes, Trains and Automobiles," died of a heart attack during a walk while he visited family in Manhattan, according to reports.
September 4, 2009 at 12:27am by FMT Taiwan
At Formosa Medical Travel, we offer Americans the opportunity to receive a knee or hip replacement in Taiwan at a fraction of the price in the United States. While Thailand and Bumrungrad hospital have blazed a trail in the medical travel industry over the last few years, Taiwan is ready to enter the market as a viable option for medical tourists.
More medical tourism links:
Knee replacement cost | Knee replacement alternatives | Knee replacement India
September 16, 2009 at 7:37am by FMT Taiwan
It's unfortunate that medical tourism has been left out of the US Healthcare Reform debate. There are a number of intelligent people out there that believe little is being done to reduce the inherent costs in our system that make overseas care so attractive.
September 28, 2009 at 1:26am by Medical Tourism Companies
There are now a number of medical tourism companies that offer healthcare packages to many destinations around the world. Many of these companies don't charge any additional fees to the patient - instead, they take a commission percentage from the hospital. For patients looking to pursue medical travel, it is worth researching these "facilitation" companies.
September 30, 2009 at 10:16am by Pat Jewett
That fact that this is taking off speaks volumes. How can we not recognize that there is a problem with the US Health Care system if people are flocking overseas for treatment. As Medical insurance coverage gets debated in Washington, we need to let Congress know how we feel.