March 17, 2010

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By JOSIE HUANG Staff Writer

— By JOSIE HUANG

click image to enlarge

Staff photo by Doug Jones : Tuesday, April 22, 2008: Gayle Curtis of Camden went to Malaysia for cosmetic facial surgery at a fraction of the cost of the same procedure in the US. She wears a silk jacket purchased on her trip.

Staff Writer

The prospect of getting two root canals at a time didn't scare Lisa Stewart. The price tag was another story.

Stewart, who does medical billing out of her home in Jackman, did not have health insurance, or the $4,000 to $5,000 she was told she would have to pay out of her own pocket.

She searched online for a better deal and found it just south of the California border in Mexico through a medical tourism company called Planet Hospital. A $1,200 package that included the root canals, travel and accommodations sounded so reasonable to Stewart that she booked a trip to Tijuana for four days in November. Stewart wants to head next to Costa Rica, which she heard is a good place to get weight-loss surgery.

''It'd be nice to see a different country,'' said Stewart, 43. ''And, what better place to recover than in a resort?''

As the cost of health care rises, so are the number of Americans globe-hopping to countries such as Malaysia, Turkey and South Africa for procedures priced at a fraction of the U.S. cost. Not only can they save more than 50 percent on everything from face lifts to heart bypasses, they can squeeze in some sightseeing and try local delicacies.

Last year, 150,000 Americans left the U.S. for procedures, mostly surgeries, according to ''Patient Without Borders,'' a new book on medical tourism by Josef Woodman. They are setting aside fears of cultural barriers and quality of care, as offshore medicine rises in reputation, and more countries recognize the value in promoting it.

Most of the patients are uninsured, have high-deductibles or plans that do not cover certain procedures, such as cosmetic surgery. But the market is beginning to widen as pioneering insurance companies and businesses look for ways to cut costs.

HANNAFORD SETS EXAMPLE

In January, Scarborough-based grocery chain Hannaford Bros. started to offer overseas care to employees. Its 27,000 workers, including about 7,000 in Maine, have the option of getting hip and knee replacements at Singapore's National University Hospital.

In addition to covering the employee's share of the medical bill -- $2,000 to $3,000 -- Hannaford will fly the employee and a traveling companion to Singapore and pay hotel charges for the couple weeks the patient will need to recover and undergo rehabilitation.

Peter Hayes, who manages Hannaford's health benefits program, said the company could save thousands of dollars per procedure. A hip replacement, for example, can cost $40,000 to $60,000 in the U.S., but ranges between $10,000 to $15,000 in Singapore.

A handful of employees are currently considering the offer, said Hayes, who predicted interest will pick up after the first employees go abroad. ''We can communicate all we want through written materials but what works really best is the grapevine,'' he said.

Hayes, who started researching medical tourism after reading an article in Reader's Digest last year, broached the idea to scores of Hannaford workers in the summer. Medical tourism has been controversial among some union groups, who say workers should not have to go halfway around the world for affordable care. But Hayes said almost all of the Hannaford workers he surveyed were open to traveling for health care, as long as the quality matched that of U.S. hospitals.

OTHER COMPANIES CAUTIOUS

In Maine, outsourcing health care is nothing new. Many Maine hospitals are already hiring overseas companies for medical transcription and reading X-rays. For years, Mainers crossed the border to buy cheaper prescription drugs in Canada. But there appears to be a slower take-up of medical tourism. Major Maine employers such as L.L. Bean, Unum, Bath Iron Works and Cianbro say the idea is not on the table.

It's difficult enough persuading employees to go to a hospital in another state, even if the procedure can be performed better there, said Cianbro's Rita Bubar, the human resources and wellness manager at the Pittsfield-based construction company.

Patients like being close to home, seeing familiar physicians and getting visitors in the hospital, Bubar said. Going abroad, she said, would make that impossible and require the extra hassle of getting passports.

''We haven't overcome the how-do-we-get-them-to-Boston issue, let alone how would we get them to Asia,'' Bubar said.

But Thomas Keesling, whose Raleigh, N.C.-based company IndUShealth arranges medical trips to Indian hospitals, which are known for the most competitive pricing, said more employers will have no choice but to consider medical tourism. The U.S. continues to outspend every other developed country on health care for reasons ranging from high-priced prescription drugs to overuse of expensive services and administrative costs. With health care costs growing faster than the economy or wages, offshoring care offers businesses a way to keep providing current levels of coverage.

Right now, about 80 percent of IndUShealth's business comes from individuals, and the rest is from corporations. ''My guess is that within the next 12 to 18 months, it will flip around,'' Keesling said.

Keesling said companies should offer financial incentives for employees to go abroad, and capitalize on their desire to see another country. Indeed, a sense of adventure is what drove Gayle Curtis of Camden to go to Malaysia for a face lift.

SURGERY AND A VACATION

Curtis, a 56-year-old landscaper, used a medical tourism company called MedRetreat to set up a two-week trip to go to Penang by herself, against the protests of friends who told her she was ''crazy.''

The procedure, done by an American-trained plastic surgeon at the private Penang Adventist Hospital a year ago, cost about $6,000, and included work on her brow, eyes, cheeks and chin. Travel and accommodations cost an additional $4,000. That's compared to the $4,000 Curtis was quoted by a Bangor plastic surgeon for just an eyelid lift.

After several days of recovering in an ''impeccably clean'' hospital with attentive, English-speaking nurses, Curtis was well enough to be ferried around the island by a driver hired by MedRetreat, and given tours by an American expatriate recruited by the company.

''I'm not a real city girl, so I wanted get out of town right away. I went into the rain forest, I was totally unhindered,'' Curtis said.

Curtis didn't experience any of the complications that her friends warned her about. But it is a risk that medical tourism operators acknowledge happens overseas.

Patrick Marsek, the Chicago-based managing director of MedRetreat, said that his company tries to avoid problems by partnering with private hospitals with proven records of quality.

''We're sharing maybe the same hospitals used by a king, or diplomats, government officials and very wealthy people,'' Marsek said. ''Knock on wood, we only had two complications in over 1,200 patients.''

Risk is further mitigated by having patients stay in the hospital and undergo rehabilitation for longer than they would in the U.S. Marsek said. But should something go terribly awry, patients would have to contend with something they wouldn't have to in the U.S. -- navigating a foreign legal system.

VIP TREATMENT

Hannaford executives considered that when they chose Singapore, where English is an official language and there is a tort law system modeled after Great Britain. Hayes said patients would have to hire representation in Singapore in a malpractice suit.

Hayes noted the chances of complications arising from a joint replacement, elective surgery with a relatively fast recovery time and low mortality rate, are small. The Singapore hospital the company chose also has a lot of experience and success with the procedure, he said.

Hayes visited the Singapore hospital for a week in November along with a medical team from Aetna, the insurance company that administers Hannaford's self-insured plan. He was ''blown away'' by how patients were treated -- each are picked up at the airport by limousine and get to stay in hospital suites complete with mini-fridges. Physicians are always prompt; their bonuses are tied to how long they keep patients waiting.

Aetna, which had looked into hospitals in Thailand and India for Hannaford, also approved of the hospital because it had received a quality certification by an accrediting body, the Joint Commission International. The insurer also was pleased with how the blood supply was controlled, the training physicians get in the U.S., Canada or Great Britain and the widespread use of electronic medical records and other technology. All doctors on staff are required to carry cell phones, and are texted as soon as a patient's lab results are ready.

''We really felt quite confident that they were providing good quality care,'' said Dr. Charles Cutler, Aetna's national medical director.

As news of Hannaford's entree into medical tourism has spread, Hayes has received offers from hospitals and medical practices across the U.S., who say they can match overseas prices.

Hayes' hope is that medical tourism will revitalize the national dialogue on health costs, and eventually drive down the price of care domestically. Until that happens, though, Stewart, the 43-year-old from Jackman, said she will keep looking outside of the country for medical services.

She said she had such a positive experience with her dentist in Mexico, and touring Tijuana, that she would go back again.

''If I didn't live so far away, I would go there for cleanings,'' Stewart said.

Staff Writer Josie Huang can be contacted at 791-6364 or at:

jhuang@pressherald.com

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