HONG KONG – The long-awaited United States healthcare reform package became law last week. Asian hospitals treating American medical travelers will have to wait longer to see whether the bill will have a significant impact on their businesses, but US insurers will feel the reforms’ impact more quickly, and that could lead them to look more closely at international options.

“Greater coverage for more Americans presumably would mean fewer Americans would need to travel abroad for care,” Bangkok Hospital international marketing manager, Judy Mitchell, said.

The only problem with this is that real benefits don’t kick in until 2014. So those with medical needs that aren’t able to take advantage of the sweeping legislation will still seek the care they need. With top-quality, low-cost care available around the world, the industry may be just fine for a while.

The medical tourism industry should be looking at the long-term. If a former Congressional Budget Office Director Douglas Holtz-Eakin is correct, the new legislation increases the US federal budget deficit by half a trillion. From the New York Times on March 20th, 2010, Holtz-Eakin writes:

“In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion.”

If this is true, then they are going to have to lower the amount of payout to service providers and increase taxes on business and individuals to make up for the shortfall. With those decreases in payouts will come shortages of healthcare workers. The only option left to those in need of actual doctors will be medical tourism.

Let’s say Holtz-Eakin is wrong and the legislation actually saves money over the next decade. That $138 billion pales in comparison to the deficits that the CBO is projecting today for each of the next 10 years totaling $9.7 Trillion.

From a common sense economics point of view this will be a long-term boon for the medical tourism industry around the world.

That brings me to the topic of this post: choosing a Medical Tourism Advocate.  You’ll want to know first if medical travel is even practical or advisable . That is a decision you should make based on the recommendations of your doctor. Other factors may include cost, and availability of the treatment you need. As you probably already know, if you’ve looked in to Medical Tourism at all, costs are anywhere from 1/2 to 1/3, and in some cases 1/10, of the costs for the same procedures here in the US. In many cases that will include travel and lodging costs for you and a companion. On the availability side of the equation there are some treatments which are not available in the US, such as stem cell therapy. If you are at the end of your treatment rope at home, you aren’t limited by the border lines of your home country.

Once your and your doctor have talked it over and you’ve, at the very least, decided you’re going to look into Medical Tourism, where are you going to get reliable information? That’s where a Medical Tourism Advocate comes in. These companies have spent many years developing relationships with the best people and top-notch doctors that work in the most advanced hospitals around the world. They’ve sifted through a mountainous amount of information to discover who does what type of treatment the best. Apart form the fact that they can arrange all of the travel and see to that you get the best doctor for your particular need, good Medical Tourism Advocates will ensure that you have the continuity of care you deserve.

How will you know the Medical Travel Advocate (or facilitator, as they are more commonly known) is reliable? Here are some guidelines.

A reputable advocate should:

1. Work only with Joint Commission International accredited hospitals. In the case of stem cells, services are provided in clinics but a good advocacy will have pre-screened potential service providers to assure reputability.
2. Provide a list of services providers and the destinations in which they operate
3. Have a list of prescreened accommodations that will meet your pre and post operative needs and assure they are met.
4. Create a communication plan for you and your loved ones and your attending physician and your service providers abroad. This should include a prepaid cellular phone that is able to call back to your home country.
5. Provide a list of payment options that suit your needs
6. Negotiate with your insurance company at your request to see if your insurance provider will waive deductibles and co-pays due to the savings they will experience.*
7. Provide for translation services if needed
8. Provide you with a list of people who have used their service so you can talk with them.
9. Assist with leisure plans for touring if you so desire

This is a short list, but these few basic guidelines are essential to choosing the right Medical Travel Advocacy Company. Your comfort is the most important part of any experience in the world of healthcare. Going under the knife can be a worrisome and fearful experience. You’ll want to make sure that you feel comfortable with the people and services you decide to accept. If you aren’t, get a second or even third opinion. After all, it’s your health we’re talking about.

Paradise Island (Borocay), Philipines. Clean teeth, clean heart and mind.

Recently a friend of mine returned from the Philippines where he and his wife had dental work, including a cleaning, and eye exams. After the dentist, optometrist and re-wedding, he spent another couple of weeks on Baracay Island. He said the trip was just what the doctor ordered. He is a firm believer in the three week vacation. He said it allows him to forget about everything for a while, but the main benefit is clearing out all the stuff that tends to get built up in his head. He said he returned with a much more focused and clearer vision of work and where he wanted to take his many business ideas and concerns.

I look back on the vacations I’ve taken, short though they may have been, and I really value what those times away from it all did for my mind and soul. There were times at the end of the trip where I just wanted to get back so I could take care of business I had lined up before I left. And of course there were times when I didn’t want to go back. The idea that I could have that ever-annoying teeth cleaning and eye exam with a vacation tacked on the end seems like a good way to go, especially since those medical type procedures would cost less than an extra night’s stay.

More invasive procedures can weigh heavily on one’s mind. Spending time on a beach in some of the most beautiful places our little blue marble has to offer might be a good way to clear the cob webs and relax afterwards. It’s been proven that a positive mental attitude is one of the keys to recovery. Who could argue that two weeks in paradise being waited on hand and foot wouldn’t do anyone a world of good. You’re sure to return with a little more spring in your step, or at least a brighter smile.

Facilitator comes from the latin root “facilis” meaning easy. But world health travelers don’t want just easy. Certainly, having surgery isn’t going to be easy for you. Going to Costa Rica for dentistry or Korea for a discectomy, I would want someone to be my voice in the fine details. Notice the root of “advocate.” It’s “vocare” meaning to call to ones aid, which is derived from a more basic root “vox,” or “voc” meaning voice. An advocate will make all the arrangements for the trip and the procedure as well as be your principle agent when dealing with the insurance company, and search for the best doctor for your particular health need. An advocate would be there to answer your questions, and help my medical travel companion find something to do other than sit in the waiting room and worry.

Advocates ensure that there is “continuity of care.” This is probably the most important part of going beyond borders for treatment. Contact between your surgeons and your home doctor is essential from initial decision through to any physical therapy and recovery. An advocate will not just hand your records off, but be a conduit through which information between doctors and hospitals can communicate. An advocate will give 100%, where as a facilitator may not be so inclined to give you that extra special treatment and service you deserve.

I really prefer the term Medical Travel Advocate. Who would you rather have on your side, a facilitator or an advocate? So far the only company I’ve found that uses Medical Travel Advocates is Patients Without Borders. The distinction is small, but the difference is huge.

Stem cells are amazing little critters. What sets them apart from regular cells, like those in your liver or big toe, is that they don’t have any specialized characteristics, and can be grown through cellular division outside the body for long periods of time. They do this naturally inside the body, but with a little coaxing they can do it in the laboratory as well. The most interesting part is that they are employed as the repair crew for the many different kinds of specialized cells. Without stem cells we wouldn’t be here because these cells create all the specialty cells that make up the rest of our bodies in the first few days after conception. 3 to 5 days after sperm meets egg these cells start to build every organ in the body. Stems cells were derived from the embryos of mice in 1981  and then in 1998, a method for deriving stem cells from human embryos in the lab was discovered and used for research into human reproduction. Embryonic stem cells do not come from eggs fertilized in a woman’s body, but from eggs that have been removed from a woman and fertilized with sperm for use in in-vitro fertilization. Fertilized eggs that aren’t used for in-vitro fertilization were donated for stem cell research with, of course, informed consent of the donors. 2006 brought another discovery. Researchers discovered a way to genetically manipulate adult cells to take on the characteristics of embryonic stem cells(source). The difference is that embryonic stem cells can specialize into more types of cells than adult stem cells, but carry the risk of causing tumors in the recipient.

Stem cells have been in play for quite a while. The first successful Bone Marrow Transplant was done by Dr. Robert A. Good at the University of Minnesota on a 5 month-old boy suffering from profound immunodeficiency. The boy grew to be a healthy adult (source).  Those with leukemia are treated with high doses of chemotherapy and radiation to kill off the cancerous blood cells. Peripheral Blood Stem Cells(PBSCs) are used to replace those cells that are destroyed by the chemo and radiation to help the patient fight infection and renew their own blood supply. This is done in a number of ways. Patients can have their own PBSCs removed and then put back in their blood stream in a procedure called Autologous Transplant. PBSCs can also come from a relative or a matching donor (Allogenic Transplant) or from an identical twin (Syngeneic Transplant).  There are other sources which include from the bone marrow of a donor, umbilical cord blood, or from adipose tissue (i.e. fat).

Stem cells are being used to treat a wide variety of conditions; the most common are diseases of the blood, like cancer. Doctors in other countries (India, Panama, Germany, Ukraine, China, Thailand, etc.) are using them to treat nasty conditions like Multiple Sclerosis, Cerebral Palsy, Rheumatoid Arthritis, and damage to the heart. Suzanne Hart of Patients Without Borders just returned form Panama where she visited Cell Medicine. Doctors there are using stem cells extracted from adipose tissue (fat) to treat a host of ailments. I asked her if there was anything folks should know about the process. She told me that stem cell therapy is not for everyone. People hoping to use stem cells must go through a rigorous screening process before they will be accepted for treatment. She also said that while we humans are just beginning to use stem cells for treatment, one aspect has become increasingly clear; that the risk of side effect was virtually zero with the use of autologous stem cells. There is no matching because it is the person’s own tissue that is being used. The biggest risk as that no improvement would occur.

People who have had stem cell therapy are reporting improved quality of life, and are seeing improvements in function. Here is one story, and another, and another and another. These are just a few, but some searching will pull up many stories. I’m not trying to make any political statement with these links, but I do want to emphasis that successes are occurring.

If you are looking to take advantage of this emerging technology, please make sure that you learn everything you can before you make a decision. Patients Without Borders is committed to providing in depth answers to your questions and seeing to it that you are well informed. Also, understand that this blog in no way recommends any medical treatment. It is for informational purposes only. It’s your life and you alone are responsible for the decisions you make. We here at World Health Traveler wish you the best in your pursuit of good health.

Here’s to your good health and safe travel,

Meditrekker

I can tell you this and you might believe it’s true. But let me share with you some statistics from the a few of the hospitals around the world that are doing fantastic work.

In South Korea, Wooridul Hospitals performs many different types of surgery. With 40 peer reviewed articles in various health related journals Wooridul is making a name for itself. According to their 2008 annual report, they treated 1017 patients from 56 different foreign countries with a majority coming from the United States (318). The total number of spinal surgeries for the year is an astounding 22,964. They also performed another 57,531 non surgical treatments which include the use of the 4th generation of Cyberknife.

The first JCI accredited hospital in Turkey, Acibadem International caters to patients in many areas of health care including oncology,  neurosurgery, in-vitro fertilization, thoracic surgery, plastic and reconstructive surgery, general surgery and many others. Acıbadem operates with over 8.000 employees of which 1,580 are physicians, in 9 General Hospitals, 8 medical centers, 1 laboratory and genetic diagnostic center.

Hospital Clinica Biblica, located in San Jose, Costa Rica, is a short flight (3-6 hours from the US) away. With a knee replacement package of under $12,000.00 it may make sense to look to this tropical paradise. Costa Rica offers so much more on the tourism side as well. It is one of the most biologically diverse areas on the planet; 1500 species of butterfly alone. But the hospital has 200 skilled physicians offering a wide variety of services, including lap band surgery that costs approximately $7,100 as apposed to the $25,000 you might pay in the US.

Your medical options might seem limited when faced with putting your financial health at risk in the US. Health care abroad is providing another option. If you’d like more information, contact our sponsor. Patients Without Borders can answer any questions and help you make an informed decision.

The expected outlay for hip replacement and knee replacement is expected to grow by nearly 12% per year. In 2008, hips and knees were generating a market size of 6.7 billion dollars. That’s going to more than double by 2015 to $14.7 billion. That’s a lot of joints!

Unfortunately the entire report is too pricey for this blogger ($3,500US), however if you are in the knee and hip biz, and have the means, I highly recommend it. It will give you insight into trends in the market as well as many other useful tidbits. Stuff like treatment flow analysis, and where the restraints of the market are likely to slow its growth.

One aspect of the market I didn’t see in the table of contents was the impact medical tourism will have on market growth here in the US. Judging by the investments being made in Asia in healthcare and their plans to grab a share of the American patient market at significantly lower costs it won’t be long before Americans are flocking to India, South Korea, China, Malaysia and Turkey to trade for newer models.

Another aspect to consider in this is the early adoption of treatment by a younger set of patients. It seems to reason that the younger you are the less money you have, so traveling to get a hip resurface at one tenth to one third the cost of the US makes economic sense. Plus a trip to the Great Wall, or Istanbul is a great way to break in the new hardware (if your doctor says that’s okay, of course).

This report lists the Medical Tourism Association’s guidelines for those considering travel abroad for medical treatment.

They are:

• Medical care outside the US should be voluntary.
• Financial incentives to go outside the US for care should not inappropriately limit diagnostic and theraputic alternatives, or restrict treatment referral options.
• Financial incentives should be used only for care at institutions accredited by recognized international accrediting bodies
• Local follow-up care should be coordinated and financing arranged to ensure continuity of care.
• Coverage for travel outside the US for care must include the costs of follow-up care upon return.
• Patients should be informed of rights and legal recourse before traveling outside the US for care.
• Patients should have access to physician licensing and outcomes data, as well as facility accreditation and outcomes data.
• Transfer of patients’ medical records should be consistant with HIPAA guidelines.
• Patients should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities.

If your medical facilitator ensures that standards on each of these points is high, then you have chosen a good facilitator. But there is much more to this equation.

Surgery and health treatment are serious matters. After all, it’s your life we’re talking about. That’s why it is so important to have someone you trust helping you through the process. Of course this begs the question: How do you know who to trust?

The answer can sometimes be difficult. Consider the following:

• Ask a lot of questions - You may not know all the right questions to ask. That is why it is important to ask many. If you don’t understand something your doctor of facilitator is telling you, keep asking questions until you do. This is your life, your body, and your money, so being able to make informed decisions will help ensure a favorable outcome.

• For information, go straight to the source – It is very important that you check out information related to the facility you’ll go to, and the doctor who will be handling your case. Pretend you are a private eye and that no one is trustworthy. Look for corroborating  evidence from other independent parties (like JCI or The Medical Tourism Association). Your best move is to be proactive in your own care.

• Find others who have traveled for treatment – Connecting with people today is very easy. With all of the social networking sites available, you should be able to make contact with others who have traveled for surgery or other treatment. Thousands every year travel for a myriad of health care needs. Don’t just rely on the referrals given to you by your facilitator, find your own sources of information.

• The Human Touch – Most of us make decisions about people very shortly after we meet them. What does your gut tell you? If you are planning to travel halfway around the world to have surgery, your instincts should never be discounted, so trust yourself. If you don’t feel your “sixth sense” about people is very strong, invite someone you trust as a good judge of character to meet your facilitator with you.

• Always compare what is said with what is done – If your facilitator says they are going to do something and it doesn’t get done to your satisfaction, or if it was done in a way that doesn’t line up with what they said they were going to do, find another facilitator.

Here are some sources of information to get you started:

Medical Tourism Association

Joint Commission International

Medical Travel City

International Medical Travel Journal

You can also order a book called “Patients Beyond Borders.” It is a comprehensive look at at the basics of medical tourism.