Patients With Passports

When Roger Wertanen sought relief from back pain by way of a medical device from Fridley, Minn.-based Medtronic, the southeast Minnesota resident flew to India to get it.

That's because the device is an artificial disk that isn't approved for use in the U.S., but it is available in India, Germany and some other countries.

Wertanen, 67, said he has no regrets about the trip he took in February for the treatment, although India wasn't his first choice.

"I would have gone to Germany if I could have afforded the $40,000," said Wertanen, a retired registered nurse who lives in Peterson, Minn. "In India, the total for the surgery -- all hospital costs including tests, meals and the room -- was just under $15,000. Altogether, the trip for me and my wife was about $18,000 for the two weeks or so."

Medical tourism is alive and well, experts say, with health care consumers scanning the globe for the best deals in everything from back surgery to angioplasty.

Cost is the primary motive for many Americans who travel abroad for care, usually because they lack health insurance coverage for their chosen procedure. Wertanen belongs to a subset of medical travelers who are motivated both by cost and by gaining earlier access to technology.

"Access to technology is a strong secondary motivator," said Josef Woodman, a North Carolina writer who this spring published "Patients Beyond Borders," a how-to guide for medical travelers. "But the main reason folks are heading overseas -- and the trend is growing -- is cost."

Woodman estimates about 150,000 Americans each year travel abroad for medical care. Most go for cosmetic surgery or dental work. About 70,000 people travel each year for everything from orthopedic work to major heart surgery.

One measure of the trend, Woodman said, is the growing number of overseas hospitals accredited by the Joint Commission International, a branch of the organization that accredits U.S. hospitals. International medical centers can charge less, he said, because of dramatically lower costs of labor, malpractice insurance and overhead related to health insurance paperwork.

Bumrungrad Hospital in Thailand, a leading destination for medical tourists, says its volume of patients from the U.S. has grown by 18 percent over the past three years, although the hospital's numbers include care for Americans living in the region.

How Big Are the Savings?
A coronary artery bypass graft surgery that can cost health plans between $54,000 and $79,000 in the U.S. can cost $10,000 to $20,000 overseas, said David Boucher, an assistant vice president for health care services for Blue Cross Blue Shield of South Carolina.

This year, Boucher's company launched a program to help arrange for overseas care. No patients covered by the South Carolina insurer have yet used the service, but Boucher predicted there will be more interest when large employers with "self-funded" health plans create incentives for the overseas care.

An employee with a $2,000 deductible who needs a knee replacement, for example, would have the option of going to Thailand for the procedure, Boucher said. The deductible would be waived, and the employer would pay for transportation, he said, while the company health plan would save more than $20,000 on the overseas medical bills.

As insurance companies develop their own medical tourism programs, patients are finding their way abroad on their own.

Leslie Harstad, 38, of Eden Prairie, Minn., traveled for medical care in June because she didn't meet her health plan's coverage criteria for weight-loss surgery. To get the procedure paid for, "you had to be bigger than I was," said Harstad, a vice president at ThreeWire, a medical marketing firm.

Faced with the prospect of paying for surgery out-of-pocket, Harstad started shopping around and found that hospitals in Minnesota would charge her between $24,000 and $30,000. That contrasted with a price quote of $8,300 from a hospital in Tijuana, Mexico, where Harstad was operated on by a surgeon who had a good deal of experience with the weight-loss surgery technology she sought.

"The actual experience far surpassed my expectations," she said.

Doug Stoda, 53, of Tomah, Wis., lacked health insurance when he flew to India for a hip resurfacing procedure in January, 2006. At the time, the procedure was not approved for use in the U.S., but it struck Stoda as a better option than hip replacements that were available here.

What's more, whereas a hip replacement here would have cost between $65,000 and $75,000, Stoda said, he and his wife spent a total of $11,500 on a three-week trip to India for the hip resurfacing.

The package price covered not just the hospital care, but also the plane tickets and the cost of recuperating at a "gorgeous" resort on the Indian Ocean, Stoda said.

"I had a severe case of bone arthritis in my hip," he said. "Seven weeks after surgery, I returned to full-time work."

Wertanen of Peterson, Minn., sought two artificial discs to treat his case of degenerative disk disease because he feared that a fusion surgery -- which would have been covered by Medicare -- would limit his mobility and involve a longer recovery.

Wertanen had to give up running -- what he calls his "way of life" -- about three years ago because of back pain, and the symptoms limited his ability to do construction work in his retirement. The surgery alleviated the pain, and Wertanen just recently began a slow return to jogging.

One of the artificial disks that Wertanen received has "migrated a bit," he said, and he now experiences a different -- but more manageable and intermittent -- type of back discomfort. But Wertanen, who arranged his trip through a California firm called Planet Hospital, said he's not sure if he'll need to go abroad again for follow-up care.

"I'm better off than I was in terms of back pain," Wertanen said.

Questions about the quality of overseas health care is part of what gives Dr. Andrew Schmidt, an orthopedic surgeon at the University of Minnesota, pause about the medical tourism trend.

Use of artificial disks has been "very, very controversial," said Schmidt, a past president of Minnesota Orthopedic Society. He added that orthopedic surgeons disagree about the long-term outcomes with the hip resurfacing procedure that Stoda of Tomah, Wis. underwent.

While hip resurfacing ultimately was approved for use in the U.S. during 2006 by the U.S. Food and Drug Administration, Schmidt said of patients receiving unapproved technology overseas: "The fact that it is FDA approved is worth something."

Beyond concerns about particular procedures, Schmidt said he questioned how well patients could assess the quality of surgeons overseas.

Neither the Minnesota Medical Association nor the Minnesota Hospital Association has a formal policy on whether patients should go abroad for care. But Amy Harris, a spokeswoman for the hospital association, notes that with the Mayo Clinic in Rochester, Minnesotans are more accustomed to hearing about tourists coming here for medical care.

"There's a lot of things to take into account besides cost," Harris said.

Christopher Snowbeck can be reached at csnowbeck@pioneerpress.com or 651-228-5479.

Source: Pioneer Press , St. Paul, Minn. Distributed by McClatchy-Tribune Information Services. Powered by YellowBrix.