Medical tourism: Maine man one of many patients heading overseas for cheaper surgery

Jeff Wheeler would like to use his boat to haul lobster traps with a recreational license, but his bum shoulder prevents it. Next week, he's traveling to Thailand for surgery to fix it.
Troy R. Bennett | BDN
Jeff Wheeler would like to use his boat to haul lobster traps with a recreational license, but his bum shoulder prevents it. Next week, he's traveling to Thailand for surgery to fix it. Buy Photo
By Jackie Farwell, BDN Staff
Posted July 25, 2013, at 3:12 p.m.

Jeff Wheeler has always wanted to travel to Southeast Asia. He also happens to need shoulder surgery.

Next week, he’ll cross both items of his to-do list with a trip to Thailand. His itinerary concludes with a stint in a Bangkok hospital.

Wheeler, who lives on Westport Island, a small Lincoln County community in Sheepscot Bay, will pay roughly $9,000 for his shoulder replacement overseas, about 80 percent less than he would shell out in the United States.

He’ll also get to take in the sights after a preliminary CT scan in Bangkok, traveling to Vietnam to explore Hanoi, Da Nang and the tunnels of Cu Chi, an immense network of underground tunnels in Ho Chi Minh City, before heading to the Cambodian temple Angkor Wat.

After his travels, he’ll return to Thailand to have his left shoulder replaced. A work injury and wear and tear have left his shoulder painful, he said.

“Might as well have a look around while I’m there, I like to travel,” Wheeler said.

Wheeler is among a few hundred thousand Americans expected to travel overseas this year in search of affordable medical care, from nose jobs to root canals to joint replacements. Fueled by rising health care costs in the U.S., “medical tourism” can open the door to high-quality treatments at steep discounts, often a fraction of the cost at home.

The growing industry caters primarily to the uninsured and people with insufficient insurance, or plans that don’t cover certain elective procedures or carry painfully high deductibles.

Wheeler, a 59-year-old retired boilermaker, has some health insurance, but still expects to pay far less out of pocket for his surgery by traveling overseas. One Massachusetts hospital quoted him about $130,000 for the procedure, he said.

Big corporations move their “operations” of a different sort overseas, so why not individuals, Wheeler figures.

“It’s a global market,” he said. “I think a lot of people in the U.S. are a little bit xenophobic or they have some fears about going [overseas]. But I think eventually these fears will fade as they know more and more and they hear about savings.”

Wheeler booked his three-week trip through a Calabasas, Calif., company called Planet Hospital that vetted his doctors and the hospital along with assisting with his travel arrangements. Since its founding in 2002, the company has served 6,000 clients, most of them uninsured, said Geoff Moss, Planet Hospital’s vice president of corporate affairs and business development.

“If they need that life-changing procedure and they can’t afford to do it in the United States, they contact us,” he said.

Many of the doctors the company works with were trained and board certified in the U.S., later lured back to their home countries by the promise of tax incentives, Moss said.

“Just because you’re traveling completely across the world doesn’t mean that you’re sacrificing the quality of medical care that you’re receiving,” he said.

Certain countries have become known as destinations for specific treatments. Mexico is popular for cosmetic and dental surgery, Korea and Japan offer high-quality cancer care, while India is known for top-notch orthopedic procedures, Moss said. Thailand was one of the first countries to promote itself as a medical tourism locale, he said.

“The hospitals are really designed to cater to foreign patients,” he said. “They have American menus, they have Wi-Fi, they have American TV stations, the staff speaks perfect English.”

The trend also has caught on in the business world among self-insured companies, Moss said, which cover their employees’ health care costs directly rather than paying an insurer to handle claims. Larger businesses offer to waive workers’ co-pays and deductibles if the employee opts to have an expensive procedure performed abroad at a far lower cost, he said.

Several years ago, the Hannaford supermarket chain set up a partnership with a reputable hospital in Singapore that would have allowed employees to receive less expensive knee and hip replacements. But none of Hannaford’s employees took advantage of the arrangement and the company discontinued the program in 2011, according to a Hannaford spokesman.

Wheeler, a former Army medic, said some people may fear going under the knife abroad, but it all comes down to whether patients trust their doctor. That’s true whether you’re on the operating table at your local hospital or thousands of miles away, he said.

“How far do most people actually go to check out the physician anyway?” Wheeler said.

Planet Hospital provides clients with background information on their physician, including how many of the chosen procedure the doctor has performed. The company also reviews hospitals’ nurse-to-patient ratios, English language proficiency, and infection rates, among other criteria, Moss said.

The foreign doctors review patients’ medical records and imaging scans such as MRIs and CAT scans before arranging surgery, he said. Many are willing to communicate directly with patients beforehand, he said.

Planet Hospital does not accept clients in critical health because of the physical demands of travel, Moss said.

Medical tourism carries some risk. As with medical procedures performed in the U.S., complications can arise. Planet Hospital encourages clients to travel with a friend or loved one to help ease the sometimes long recovery periods.

Wheeler is traveling alone. His wife doesn’t like hot weather, he said.

In 2009, the American College of Surgeons issued a statement warning consumers about the risks of undergoing medical treatment abroad, including variability in medical professionals’ training, differences in the standards to which medical institutions are held, potential stress from being away from family and friends, and little recourse if an injury occurs.

Patients typically sign contracts before departing the U.S.

Some elements of medical tourism have also fueled safety and ethical concerns. “Transplant tourism,” in which patients travel overseas to avoid long waiting lists for organs in the U.S., has raised worries about exploitation of poorer nations and unhealthy donors.

Some medical tourism companies, including Planet Hospital, offer controversial surrogacy services that pair prospective Western parents with not only egg and sperm donors but also surrogate mothers from poorer countries. “The surrogate acts as a rented womb” and has helped Planet Hospital to assist more than 800 “would-be parents to realize their dreams,” according to the company’s website.

The American Medical Association has issued guidelines for medical tourism that urge patients to coordinate follow-up care in the U.S. in advance and use only accredited medical centers.

“Our only concern would be that they do this with their eyes wide open,” said Gordon Smith of the Maine Medical Association.

While foreign doctors are often capable and highly trained, many countries lack the medical liability insurance system in place in the U.S. that compensates patients in cases of malpractice, he said.

Smith said he believes the number of people willing to travel overseas for medical care is “infinitesimally small.”

If all goes well for Wheeler, he may return to Thailand for surgery on his other shoulder, which also hurts, he said. He wants to enjoy his golden years and remain as active as possible, cutting wood, canoeing, boating, and traveling into old age, he said.

“I want to go places and do the things I always imagined doing when I was around a dirty, rotten boiler,” Wheeler said. “The things that you look forward to.”

The Bangor Daily News will check back in with Wheeler when he returns to Maine in mid-August.

http://bangordailynews.com/2013/07/25/health/medical-tourism-maine-man-one-of-many-patients-heading-overseas-for-cheaper-surgery/ printed on September 18, 2014