Businesses may move health care overseas

Businesses and insurance companies are starting to eye the potential savings of outsourcing health care from the world's richest country to the developing world.

"It's just one of the many ways in which our world is flattening," said Arnold Milstein, chief physician at New York-based Mercer Health & Benefits, who's researching the feasibility of outsourcing medical care for three Fortune 500 corporations. "Many companies see it as a natural extension of the competition they've faced in other aspects of their business."

With an estimated 45 million uninsured Americans, some 500,000 trekked overseas last year for medical treatment, according to the National Coalition on Health Care. Asian hospitals in Thailand, India and Singapore have long been swarmed by medical tourists looking for tummy tucks and face lifts, but many glitzy, marble-floored facilities are now gaining reputations for big-ticket procedures including heart surgery, knee and back operations.

Some American hospitals already rely on places like India for X-ray readings and other diagnostics, while also importing foreign doctors and nurses. But the U.S. health care industry has been largely immune to overseas competition — just one reason behind soaring costs.

Premiums for employer-sponsored health coverage have surged 87 percent over the past six years, according to the Kaiser Family Foundation, putting a huge burden on both companies and employees. Family health coverage now runs about $11,500 annually, with workers themselves forking out nearly $3,000.

But just as shipping U.S. manufacturing to China and call centers to India initially created loud opposition, some critics are already preparing to fight any possible mass exodus of Americans packing their bags to go under the knife overseas.

In September, Canton, N.C.-based Blue Ridge Paper Products Inc., was set to send one of its employees to India for a gall bladder operation. Carl Garrett would have been the first U.S. employee sent abroad for medical care through an employer-sponsored pilot program, which would have allowed him to share the company's savings.

Shortly before Garrett was set to leave, the United Steelworkers, America's largest union, pulled the plug.

"We don't want to expose our members to the risks associated with providing health care in the Third World," said Stan Johnson, a union spokesman. "This is perceived to be voluntary, but voluntary programs tend to lead to mandatory programs."

Blue Ridge ultimately scrapped its plan for union members, but several other U.S. businesses and insurance companies are starting to explore the option of exporting patients.

"I get the impression that they're all waiting for someone else to take the first step," said Jason Yap, director of health care service for the Tourism Board in Singapore, another major medical tourism destination. "They're all interested in doing the homework now so they can move ahead when the time comes."

United Group Programs, a Boca Raton, Fla.-based company that sells self-insurance policies to small businesses, is already offering a plan that sends patients to Bumrungrad International hospital in Bangkok, Thailand. UGP says the plan will save employers more than 50 percent on major medical costs and slash employees' out-of-pocket expenses to zero.

Blue Shield of California and Health Net of California also both offer lower-cost policies allowing members to seek medical care in Mexico.

In June, David Boucher, an assistant vice president at BlueCross BlueShield of South Carolina, traveled to Bangkok for a close-up look at Bumrungrad. The Thai hospital began heavily recruiting overseas patients after the 1997 Asian financial crisis. It drew 400,000 foreigners last year — including 55,000 Americans.

"I was thoroughly impressed," Boucher said. "We're taking a serious look at this as an alternative" for the health plan's 1.5 million members.

In addition, West Virginia lawmaker Ray Canterbury plans to propose legislation next year that would give government employees the option of traveling abroad for necessary procedures, which could save the state up to $2 million annually. He wants to offer incentives, including extra sick leave and 20 percent of the cash saved by going abroad — allowing workers to actually make money on the deal.

Dodie Gilmore is a rodeo barrel-racing champion who runs a 180-acre ranch in Oklahoma when she's not bouncing across back roads selling farms. Gilmore is a spry 60-year-old who loves the outdoors, but when she could no longer straddle her faithful horse, River, she knew it was time for a new hip.

But how could she afford it? As an independent contractor for a small Coldwell Banker real estate franchise in Durant, Okla., she knew her privately purchased health plan would never pay up to $40,000 for the operation.

So she asked her boss about traveling to India where hip resurfacing alone would cost just $7,000. He not only gave her his blessing but offered to foot the bill, minus travel and hotels — making Gilmore one of the very first Americans sent overseas for surgery by an employer.

"The doctors were wonderful," Gilmore said days after being discharged, sipping coffee at a New Delhi roadside cafe with her sister, Carol, who was along for whole trip. "The overall care was pretty darn good."

More and more patients like Gilmore — who had never held a passport or even tasted Indian food before her trip — are returning home and spreading the word about an alternative to America's ailing health system.

Gilmore's boss, Martin VanMeter, who owns a Coldwell Banker office with about 24 workers, wasn't obligated to pay anything toward the hip surgery. But he sees his employees as family, and if they're too hurt or sick to work, no one benefits.

"I've invested so much money in them," he said by telephone. "All she's got to do is make one transaction for us, and we've got our money back."

But even with the growing momentum, big questions must be asked by anyone considering treatment abroad.

Despite the five-star facades of some hospitals — fountains, white marble floors, even a Starbucks and McDonald's inside Bumrungrad's lobby — the comfort of having a major surgery near home with family at the bedside is a far cry from the experience in the developing world, where culture shock alone can be stressful.

Pollution, poverty and insane traffic are all part of the experience when visiting hospitals like the Indian-owned Max Healthcare facilities in New Delhi, where it's not uncommon to see people urinating along roadsides. Jet lag, traveler's diarrhea and strange foods also can be coupled with the unpredictable, such as September's bloodless military coup in Thailand, which ultimately had little impact on daily life.

Language and cultural barriers also can make communication with doctors and nurses frustrating for some Americans, who are used to being direct with their physicians, often peppering them with tough questions and expecting straightforward answers.

Some Asian cultures also rely more on hints and subtleties to communicate, and doctors in some countries are regarded as authority figures who often aren't questioned. Follow-up care back in the U.S. also can be an issue for some patients.

"There are a lot of risks," said Rick Wade, a senior vice president at the American Hospital Association. "What happens if something goes wrong?"

In countries like Thailand and India, medical malpractice claims are rare and multimillion dollar awards are nonexistent.

"If there's a mistake, we fix it," said Curtis Schroeder, an American who is group CEO of Bumrungrad hospital, which requires all doctors to carry malpractice insurance. "But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the U.S."

In February, Joshua Goldberg, a 23-year-old American who was traveling in Thailand, died at Bumrungrad after seeking care for a leg injury. His father, James Goldberg, has set up a Web site alleging the hospital administered a deadly drug cocktail to a patient with a history of substance abuse.

Bumrungrad insists the care given was appropriate. Thai authorities are investigating the case, as is standard with all unexpected hospital deaths. No conclusions have been reached.

"What I'm dedicated to doing is to try to alert people to at least do their homework and consider very carefully what they're getting into. Why is this such a good deal?" Goldberg said by telephone. "You might not walk away. That's what happened to my son."

It's ultimately up to patients themselves to investigate hospitals and physicians before considering surgery abroad. The Internet is loaded with resources that range from doctor bios to patient blogs, detailing the positives and negatives.

As the phenomenon grows, more countries are trying to get in on the action. The Philippines began a campaign this year aimed at attracting Filipinos living abroad and Asians within the region. Packages offering city tours, day spas and even golf have been combined with health checkups and cosmetic surgery.

Some experts predict greater access to options like these will eventually drive more people to take control of their own health care.

Medical tourism facilitators like California-based PlanetHospital are banking on it, already working to make the journey less stressful for patients traveling abroad by arranging everything from visas and airport pickup to sightseeing.

Many doctors working in facilities catering to medical tourists are trained abroad, often in the U.S. or Europe. About 100 foreign hospitals have been approved by the international arm of the Chicago-based Joint Commission on Accreditation of Healthcare Organizations, which also accredits American hospitals.

Six countries in Asia have accredited facilities, including Bangkok's Bumrungrad; five in India, with three belonging to the Apollo Hospital group; and 11 in Singapore.

The Max Super Speciality Hospital where Gilmore had her surgery on Oct. 10, is working to become accredited, but she said she felt comfortable from the very beginning. Even if her boss had refused to pay for the surgery, she said she likely would have made the two-day flight on her own because her insurance would never have paid to fix the pre-existing condition.

"It's either that, or do it in the States for $28,000 to $40,000," she said. In the U.S. do you not sign forms? They're not responsible. The risk of it didn't really weigh on me."

In addition to saving thousands — the three-week trip totaled about $12,000, including the surgery, travel and lodging for two and a tour of the Taj Mahal — she also underwent a new technique just approved this year in the U.S.

Instead of total hip replacement, which limits mobility and requires the top of the femur to be cut off and a long shaft inserted, hip resurfacing uses only a small ball-and-socket device that enables patients to maintain their flexibility for activities like yoga, praying or even racing horses.

Gilmore's Indian physician, Dr. S.K.S. Marya, chief surgeon at the Max Institute of Orthopedics & Joint Replacement, has performed some 150 hip resurfacing operations over the past two years. About one American comes to him for the surgery each week, and Gilmore is just the latest in a growing number of satisfied patients who plan to keep their passports renewed.

"Every day I feel better. I can get around on one crutch now," said Gilmore, who plans to be back in the saddle within six months and out selling ranches soon after returning home. "I don't have near the pain. I can already move my leg a lot more than I could before. I can actually go up the stairs without pain, that's something I couldn't do before."

U.S. health care industry has been largely immune to overseas competition — just one reason behind soaring costs.

So inability to send American jobs to India raises costs? What a childish understanding of economics! Just try to do that with child labor or slavery for that matter. Try out of control tort lawyers/judges and oppressive regulation?

Actually, I suspect full government health care will only accelerate this kind of thing.

The 60+ patient who goes to India for surgery today to save money will go to India for surgery tomorrow because the government will refuse to treat them -- under the rationing of care that will be a part of any government-run system.

does the government force medicare patients to go to India for surgery today?

the "rationing" boogeyman is only going to go so far - if employer provided health plans starting forcing workers to go to India for surgery, those people are going to turn around and vote for politicians who provide a national health care plan that avoids that.

If employer provided health plans starting forcing workers to go to India for surgery . . .

Who said anything about "forcing" them to do anything?

I know a guy in New York City who was going in for open-heart surgery a couple of years ago. His insurance company called him up and extended an offer to him. Instead of going somewhere like Columbia Presbyterian or another NYC hospital, they offered to fly him down to the DeBakey Institute in Texas (probably the top cardiovascular center in the U.S.) for the surgery.

They covered his entire stay, and even put his wife up in a hotel down there for the entire duration of his recuperation period.

It actually cost the insurance company less that way! -- and he was thrilled to do it.

Now THAT is a free market approach to health care that works.

There is NO JOB that cannot be done as well, and far cheaper by a foreigner.

Remember that.

Whatever YOU are doing right now, no matter WHAT it is, someone can do as well at half the price.

Completely free trade does indeed mean lower prices.

Going full circle, what it means is that whatever your job is, no matter what it is, a foreigner will do it cheaper, and if we have wide open unregulated trade in all sectors, that foreigner WILL do it cheaper.

Then you will be out of a job unless you are willing to work for the wages the foreigner will work for.

Unfettered free trade will reduce you to a serf, in time.

It's more likely the employers will demand a universal insurance scheme than the emloyees, since they pay most of the cost.

For a 50K per year employee, the employer's share of the health insurane plus social security, medicare, workmans comp, unemployment insurance, etc., plus any other state taxes must be approaching the 'Eurosclerotic' level of 40%-50% of wages.

I wouldn't be surprised to see mandatory national health insurance in 5-10 years.

that is true, there is also a push from employers for everything to go national.

I know my employer has stated it plainly - they are drifting towards a 50/50 split on health insurance costs between the employer, and the employee (through deductibles, co-pays, monthly paycheck contributions, etc). so I look at is this way:

- I have to pay taxes so medicaid persons can get free health care (including illegals)
- I have to pay taxes so senior citizens can be on medicare
- I have to pay taxes so municipal workers and government employees, public school employees, can get good medical plans, even into retirement
- then, I have to pay 50% of my own employer provided health insurance

at some point, don't I say "the hell with it" - I'm better off with medicare extended to everyone, with some broad based consumption tax funding it all? at least the groups identified above, who now "underpay" or pay nothing at all for their health care, will pay into the system through a consumption tax.

Yes, you ARE better off with universal Medicare.

That is the way to go too.
It's expensive, but it retains the independence of doctors, and leaves the "gap" insurance niche to private insurers.

It's far better than the Canadian alternative of essentially communizing the doctors, and it's better than Hillary's "Insurance Groups", which still doesn't end up being really universal.

National Medicare, from pre-natal to death, is the cheapest way to provide coverage to everybody, in the end. It's what France has, and they pay about half of what we do, per capita, for about the same standard of care.

It's better than the alternatives, including the current system, which is going to bankrupt private business, or force working age people into uninsured status.

Whatever YOU are doing right now, no matter WHAT it is, someone can do as well at half the price.

Yes, and in many cases, for far less than half.

I believe that if you are paying as much as half of an American salary for outsourcing, then you are likely paying a middleman a very generous amount of money.

"But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the U.S."

If we don't do something about the law suits, there will be no effective healh care industry left in the US.

What we should be looking for is all of the rules and regulations that restrain trade and run the prices up. Repealing them and fostering competition would benefit us all most.

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