Outsourcing surgery can mean vacation, too

Medical tourists find savings, sights abroad

By peter korn

The Portland Tribune, Nov 30, 2007, Updated Oct 30, 2009 (11 Reader comments)

Wendy Greening, who had no health insurance when she dislocated her hip and needed surgery, found that it was cheaper to fly to India for the procedure than to have it done in Portland.

SARAH TOOR / TRIBUNE PHOTO

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Wendy Greening can remember the day two years ago when she took the fall that led her, in a roundabout way, to India.

The North Portland resident was walking her sister’s German shepherd when a cat dashed by. The dog’s leash wound around her, and before she knew it, Greening said, “I was bouncing on the pavement.”

Greening didn’t think of the accident much until a year later, when she found she couldn’t lift anything heavy. Soon after that she found she couldn’t walk without leaning to one side, and wearing shoes of any kind made walking nearly impossible. And there was near constant pain.

Greening, 55, saw a chiropractor and then a radiologist who told her that she had dislocated her hip and that the hip’s cartilage had degenerated. The radiologist said she needed hip replacement surgery.

Greening was familiar with the procedure; her sister had the surgery on both hips in Colorado after falling from a horse. That had cost $80,000, Greening said.

But Greening, whose husband, Marti, runs his own cleaning business, faced a problem her sister never had to confront – she had no health insurance. And she didn’t have enough cash to pay for the procedure.

Eventually Greening discovered a United Kingdom-based company called the Taj Medical Group, which specializes in the burgeoning field of medical tourism. The company helped Greening travel to Mumbai (formerly Bombay), have her operation, tour the subcontinent a bit and return home for just a fraction of what the surgery would have cost in Portland.

These days, Greening’s trip can hardly be considered unusual. Experts estimate that, in a phenomenon practically unheard-of a decade ago, tens of thousands of Americans are now leaving the country each year for medical care, much of it major surgery.

Brazil is noted as a center for plastic surgery. India, Thailand and Singapore are drawing increasing numbers of patients for heart, hip and knee surgeries.

In 2006 more than 1.2 million medical tourists visited Thailand, with another 600,000 heading to India for their medical care, according to Charles Runckel, a Portland biologist and director of research at Delphi Health Services, which helps promote medical tourism. Prices in India, Runckel said, average a fifth of those in the United States.

Runckel said large medical centers in Asian cities are building facilities with the latest high-tech equipment specifically to service medical tourists.

“The average American hospital can’t hold a candle to these centers,” Runckel said.

Robert Martindale, chief of general surgery at Oregon Health & Science University, said he couldn’t agree with that statement. But, he said, many of the claims being made by the companies touting medical tourism are valid.

“I think for the right patients, if you know the right doctors, it’s fantastic,” Martindale said. “This is a world market now.”

U.S. loses big-ticket patients

Unfortunately, Martindale said, that world market comes at a cost for American hospitals.

“What they’re doing is skimming the cream of the crop, the high-money (procedures),” Martindale said, mentioning gastric bypass and hip and knee replacement surgery as primary targets. “They’re not doing the bread-and-butter difficult things that are not high-income producers.”

Martindale said that medical tourists need to do their research and take precautions. Some Web sites touting care in foreign hospitals don’t reflect the actual care that will be received, he said. Patients should make sure they know which doctor will be performing their surgery rather than traveling to a clinic that will make decisions for their care, he said.

In particular, Martindale said, OHSU has seen a number of patients who went to Tijuana, Mexico, for budget gastric bypass surgery and returned with complications that were “near life-threatening.” Care after surgery, Martindale said, can become a problem once a patient has flown home.

But Martindale said most of the surgeons he has met in other countries are excellent. “Most of them are U.S.-trained,” he said.

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