Businesses may move health care overseas

Go to India and get that brain jack, on your company health plan, that is illegal to implant in the U.S. 

Link

Businesses may move health care overseas

By MALCOLM FOSTER and MARGIE MASON, Associated Press Writers

Thu Nov 2, 12:11 PM ET

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.”

____

AP Business Writer Malcolm Foster reported from Bangkok, and AP Medical
Writer Margie Mason reported from New Delhi. AP writers Tom Breen in
Charleston, W.Va., and Teresa Cerojano in Manila contributed to this
report.

____

On the Net:

http://medicaltourism.com/

http://www.jointcommissioninternational.com/

http://www.planethospital.com/

http://www.bumrungrad.com/

http://www.maxhealthcare.in/corporate/index.asp