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Archive for Medical Tourism

Singapore medical tourism diaries

by David Williams

I finally completed my diary from my medical tourism research trip to Singapore. Now I’m working on posts about some of the individual hospitals I visited. If you’d like to read the entries on MedTripInfo, see:

Medical tourism in Singapore

by David Williams

I’ve wrapped up my medical tourism research trip to Singapore and am at the airport for my return journey. I’ve made several posts on MedTripInfo and will continue to churn out more thoughts over the next several days. Here’s what’s there so far:

Interviews and speeches (audio recordings)

Travel log

Interview with medical tourism author Jeff Schult

by David Williams

Jeff Schult,  author of medical tourism book Beauty from Afar: A Medical Tourist’s Guide to Affordable and Quality Cosmetic Care Outside the U.S., began writing the book when he journeyed to Costa Rica for major dental work. What started out as a magazine article turned into a full length book once he got to Costa Rica and learned the extent of the medical travel phenomenon. As the name implies, Beauty from Afar focuses mainly on cosmetic and dental procedures. However, he does delve into some of the more “serious” treatments as well. The afterword of the book is written by Curtis Schroeder, CEO of Bumrungrad International in Thailand.

You can listen to the interview at MedTripInfo.

Going deep: Patients Beyond Borders Singapore edition

by David Williams

Medical tourism author Josef Woodman is following up with a Singapore edition of Patients Beyond Borders,  just four months after the release of the original, groundbreaking book. (Listen to or read the transcript of my interview with Joe for more on the first book.)

According to the press release:

The 336-page guidebook features an in-depth overview of Singapore’s hospitals and clinics serving international patients, including detailed coverage of Centers of Excellence, specialties and super-specialties, patient liaison services, accommodation options, travel destinations and more.

The new book will be launched in Singapore in late July during the World Conference of Family Doctors. SingaporeMedicine and Mr. Woodman will hold a joint press conference on the 23rd of July, followed by a media tour of some of Singapore’s finest hospitals.

Singapore sets the gold standard for international medical travel, with at least 11 JCI-accredited hospitals, high standards of medical care and excellent patient service. Prices tend to be higher than other places in Asia, but much lower than the in the US.

At the 4th WHCC in Washington, I met Dr. Jason Yap, Director of Healthcare Services of the Singapore Tourism Board. He laid out Singapore’s medical tourism strategy, which I found to be particularly clever. The logic goes something like this:

  • Singapore aspires to have world-class health care for its citizens
  • With a population of under 5 million, the country lacks the minimum efficient scale required to support the various sub-specialties
  • By orienting itself to serve the global market, Singapore can achieve sufficient patient volumes to support sub-specialists, and can make it attractive for Sinagporean and other world-class physicians to work there
  • The strategy is supported by Singapore’s overall positioning as a modern, efficient, clean, technologically-advanced, orderly place with high customer service levels

I can’t wait to read the book, and I’m also hoping to join the media tour in Singapore next month. If I make it, I’ll have a lot more to write about.

Medical travel meets the mainstream

by David Williams

The Providence Journal has a good article on travel abroad for medical care, sometimes called medical tourism. I comment on it at MedTripInfo, a new site I am developing. (I’ll explain more about MedTripInfo when I officially launch the site in a couple of weeks.)

Long wait times in the US

by David Williams

An article in today’s Business Week (The Doc’s In, but It’ll Be a While) examines the issue of waiting times for health care in the US.

One of the most repeated truisms about the U.S. health-care system is that, for all its other problems, American patients at least don’t have to endure the long waits for medical care that are considered endemic under single-payer systems… But… waiting times in the U.S. are often as bad or worse as those in other industrialized nations… In addition, 48 million people without insurance do not have ready access to the system.

The article’s author, Cathy Arnst, interviewed me for the story. She’d seen a commentary I’d written about a well-insured patient who had to wait for care, and I let her know about some data sources to back up the anecdotes.

Changing demographics are only worsening the problem. Patients are getting older and sicker and requiring more care. But a new generation of doctors, half or more of them women, is no longer interested in working long, grueling hours. Low insurance reimbursements and heavy paperwork loads also limit physicians’ willingness to see any patient any time. And tightening immigration rules have limited the number of foreign-born doctors entering the U.S. “There are restrictions on the supply side and growing demand, so longer waits are going to be inevitable,” says David Williams, a consultant with MedPharma Partners in Boston.

There are a couple of key takeaways for me:

  1. Americans may have more in common than we think with Europeans and Canadians who go overseas to avoid waiting times
  2. It reinforces my conviction that Americans shouldn’t look down their noses at health care provided elsewhere. We know we spend more in the US. The evidence on what we get for that extra spending is pretty thin

Podcast interview with Rudy Rupak, Founder and President of Planet Hospital (transcript)

by David Williams

This is a transcript of my recent podcast interview with Rudy Rupak, founder and president of Planet Hospital. You can listen to the audio version here.

David Williams: This is David Williams of Medpharma Partners and the Health Business Blog. I spoke earlier today with Rudy Rupak, Founder and President of Planet Hospital, a company that arranges medical travel to fourteen international destinations. Listen in to hear Rudy and me talk about the ins and out of medical travel; what patients can expect when they leave the country for care; how insurance carriers are thinking about coverage, and what happens to patients when they return to the US. Rudy, thanks for joining me today.

Rudy Rupak: Hello David. Thanks for having me.

David: Rudy, tell me a little bit about how Planet Hospital works. What sort of services do you offer?

Rudy: We are in the business of saving our clients lives. We do this by helping them find the best possible care in any of our fourteen different destinations for their health care needs as well as for their financial and time needs. We do this by finding the most appropriate surgeons from one of our destinations and we are able to bring hard-to-find treatments for people who need it the most.

David: Now what sort of destinations are you talking about? Are these all outside the US?

Rudy: These are all outside the US. However, we have been bringing some patients into the US as of late, especially from the Middle East.

David: How would you distinguish what you do from what others do; from what other agencies that are involved in international medical travel do, or from people just arranging these trips on their own?

Rudy: We didn’t focus so much on price when we first started the company, and we still don’t. We focused on quality and in doing so we basically choose the absolute best surgeons we could find around the world, including in the US, and made them part of our network. Usually, with very rare exceptions a good surgeon works at a great hospital in an international location. The hospital benefits by being associated with great surgeons and the destination is an afterthought.

If a good surgeon happens to be in the JCI hospital in India then that is where we would recommend our patients to go to. But we don’t just provide them with a choice of one surgeon, we provide them with multiple choices…

David: How do you identify these good surgeons in the first place?

Rudy: Well we review things like medical journals. For… oncology, who’s out there that’s doing a lot of research and is recognized by their peers in their field? Who is Western Board certified and / or Western educated? What have their success rates been? What is their bedside manner like?

I will meet them, I will interview them, and I will do some background research on them. I will also look at their teams. If we have a great surgeon but he happens to work with a local, nondescript anesthesiologist it’s a cause for concern for me. If, on the other hand, he’s got an outstanding anesthesiologist, an outstanding scrub nurse and an outstanding OR assistant then I know that this is somebody that I would put my life into their hands and I can comfortably feel that the patients can do so as well.

David: You mentioned JCI facilities. Can you tell me what JCI is and what that means for a patient who might be looking for medical travel?

Rudy: JCI is the International body for JCAHO, which is the Joint Commission on Accreditation of Healthcare Organizations, and this is the body that accredits the quality of a hospital in the US. In fact, any hospital in America must be JCAHO in order to receive work with an insurance company. To work with doctors and Medicare they must be JCAHO. Now, a lot of international hospitals are not JCAHO yet but a lot of the good hospitals are getting there.

David: So, if somebody has JCI accreditations is that the same as a JCAHO accreditation or are there some differences in what they are required to do?

Rudy: Standards of measurement may be the same but the standards of scrutiny unfortunately are not, and that’s where JCI lags. Hospitals here live in absolute dread that a JCAHO inspector will just show up, unannounced. The hospitals overseas at least have the comfort of knowing that that’s not going to happen - currently. But we’re not worried about that because they are trying to maintain great standards. They have to if they’re going to be in the business of international guests.

David: Now what specific services would you provide to a patient who is considering traveling overseas for medical care? What would they get if they worked with you compared to just making arrangements on their own?

Rudy: Well, patients are kind of divided between what we call “wants” and “needs.” A “wants” patient is typically somebody who wants a cosmetic dentistry or cosmetic surgery, IVF or surrogate pregnancy. The needs patients happen to be people who need more elective care such as orthopedics, cardiology, neurology, cancer surgeries and other general surgery.

David: And what sort of services would you provide for those different types of patients?

Rudy: We offer a complete wraparound service for anybody who wants Medical Tourism. That means when they first contact us they speak to a doctor or a nurse within our company. These doctors and nurses do a pre-consult with the patients. They then recommend the various surgeons that would be appropriate for the care that they are looking for. Ultimately, of course, the patients choose that. We then book the surgery date; we then book their flights, their hotels and even take care of their passports and visas. Then we have staff that meets the patients in the destination country where the procedure will take place and we take care of them from the moment they land to the moment they leave.

David: That sounds like a pretty comprehensive kind of a service. Does that tend to erode the savings?

Rudy: We charge exactly what the hospitals charge. We don’t mark-up the cost of the care so when they’re getting all these services it’s a ‘value add’ by working with us versus doing it themselves. We’ve done the research for them already. They’re getting the benefit of our research and then the benefit of our ’strength in numbers’ when dealing with the hospitals to get good savings and good care. Optionally the patients could pay $395 for the concierge service.

David: And what do they get in addition if they want to have the concierge service?

Rudy: First of all we would book the airfare for them and [if] they need to change their return trip there’s no penalty charge; that’s the first benefit. The second benefit is that somebody meets them at the airport when they land, gives them a mobile phone and escorts them to their hotel or the hospital, is with them on the day of the surgery, is with them on the day of they’re discharged, takes them to the hotel, arranges any special request that they need. If something should go wrong, there’s somebody within our company there to take care of them. Not that we would do that if they didn’t pay the concierge, of course we would. At least you know that there’s somebody on your side in a foreign country,

David: Right.

Rudy: It makes a huge difference and for $395 most people don’t argue the point. I mean heck; they save more than that if they’re changing their flights alone.

A lot of people need to change their flights because… they need to stay longer.

David: Now are the airlines seeing this as a market for them and are they making any accommodations for patients who at least have some sort of disability when they’re going over and then still maybe recuperating on their way back?

Rudy: Some are exploring it; one airline and I have just recently partnered together on creating cosmetic surgery packages to Costa Rica and Panama.

David: I notice when you talk about your destinations, you have some destinations that are in the Western hemisphere and then some that are over in Asia and my understanding is that typically more of the serious sort of orthopedic or cardiovascular surgeries are typically done in Asia. Are you also seeing the ability to do those in the Western hemisphere?

Rudy: Well, if you define Belgium as Western hemisphere then yes. A lot of our orthopedics clients are going to Malta and Belgium right now. They’re giving India a good run for their money since the costs –when you’re include the air and the hotel– the cost between India and Belgium, the gap narrows very significantly.

David: Can you tell me a little bit about the typical customer? You talked about your “wants” customers and your “needs” customers but can you personalize that or just give me an example of what a typical customer might be like?

Rudy: Sure, on the “wants” side they are typically female, 40 plus [years old], whether it’s cosmetic surgery or whether it’s dental or IVF. In the “needs,” I describe them as too wealthy for Medicaid and too young for Medicare. And I often describe them as the rude awakening clients, who have Medicare, but they just learned for the first time that Medicare doesn’t cover everything they thought it did.

David: So they would be typically someone in their 60s or 70s that’s experiencing what looks like it’s going to be a costly procedure and they find out that Medicare doesn’t cover it and they look for alternatives?

Rudy: Right, well Medicare won’t give them what they want. Medicare will give them medications but not surgery.

David: What happens for patients that have a commercial insurance? Do you have patients whose commercial insurance would pay for them to go overseas? Or do you also find this similar sort of a gap like you described with the Medicare patient where someone may find that something is not covered and they go abroad even though they’re insured in the U.S.?

Rudy: We believe the future of our business lies in insurance. And to date we’ve managed to convince the insurance companies to pay for five of our client’s surgeries so far. We’re working with insurance companies to help them wrap their heads around this. We feel that insurance is definitely a market; I think we’re going to get there. This industry will definitely change when insurance companies start to adopt it more and more. We’re definitely leading the charge in that area.

We’ve got five different opportunities; I’d say two low hanging fruit opportunities and about three opportunities that would be like a one year’s adoption cycle. And I’m going to do an analogy, for a moment, to another form of outsourcing that we are familiar with. Healthcare outsourcing is what we do.

12 years ago, [software] outsourcing didn’t even exist as an industry. It was a niche beyond a niche and companies that adopted it originally were very small businesses. I think they had some data worked on that they couldn’t do cost effectively themselves. Then 12 years later, there’s 30 companies in the outsourcing industry that have a market capitalization of over a billion. And seven years ago, overseas call centers entered the field. Year one most people that used them were some marketing outfits and specialty agencies or again, data entry and suddenly there’s over eight companies in that field that are a billion dollar market cap.

So, the industry has a good future, but how to get there, it can’t be consumer driven only. The institutions will have to adopt it.

David: What do you see as some of the drivers of that? Obviously there’s the high healthcare cost but are there particular issues or barriers that an employer or health plan would have to get over before they could see this as a mainstream sort of outsourcing opportunity?

Rudy: What I typically tell a lot of insurers is that America does have the best healthcare in the world. There’s no argument about that. But! Only if you can afford it; and healthcare is becoming more and more expensive… Companies get into a crisis over promises made relating to healthcare; whether it’s retiree benefits, whether it’s employee benefits or union contract. It’s starting to hurt a lot and not just in the private sector but in the public sector as well.

What we do… drives down the cost, but the quality [is] driven up as well. You [can] get the equivalent of a high-end hospital in America for a lot less, and that’s good value. I can get you a surgeon for cheap. The quality barrier we have managed to address very well. They ought to and meet and review the type of surgeons we’re talking to.

The next barrier is obviously malpractice and there have not been any instances, knock wood, of situations like this.

David: What kind of reaction do people get these days when they say they’re heading overseas for a medical procedure? I can imagine if you’re talking about a Medicare population, these are people who maybe have not traveled internationally before and all of a sudden, they’re getting on a plane to go over to Thailand or India. What sort of reaction do they get from their friends and their family?

Rudy: We’ve had patients who’ve never even left Georgia or Iowa and are now getting on a plane to go to India. So I think it’s a huge culture shock! Usually, there is a bit of fear in the patient and then it’s exacerbated by friends and neighbors telling them, “Don’t do it,” and, “You’re going to wake up missing a kidney,” or some strange story like that. But they come back with amazing stories and they turn skeptics into believers.

So what happens is that I hear the word “dignity” used a lot. “I was treated with dignity at this hospital.” That I hear, over and over again, because they are so tired of that mistreatment that they seem to receive in American hospitals.

David: Now do you think that there is going to be any impact on the US healthcare system from competition, if you will, overseas and in terms of improvement of customer service, the sorts of things that you are talking about for dignity or even on the price side?

Rudy: I hope so. I mean, healthcare is one of the few companies, industries in America that has no competition. Hey, competition is healthy –if you would pardon the pun. I remember my mother describing a hospital in Connecticut where it was like going into the Shangri-La hotel. It was bright, it was beautiful and she was a private payer. They took such great pampering and care of her. Now the same hospital no longer does that. They have been cowed by malpractice and cowed by cost control just to provide the most basic of services and doctors are practicing defensive medicine, you know, because they are hearing of lawsuits and so a lot of their cost has been because of a litigious society more than anything else.

David: Do you see any changes already underway? I am thinking, for example, in the area of cosmetic surgery, which has been self-pay for long time and which has been popular for overseas travel. Do you see any impact on the US cosmetic surgeons?

Rudy: No, not really. US surgeons are still busy. They are still making millions and they are still doing well because there’s a certain population that just will not go overseas for that kind of care and they believe that American doctors are the best. And I agree with them, they are the best.

The changes I am seeing are certain American plastic surgeons are now working with us to travel overseas to do certain cases as well.

David: You are actually finding that you got US physicians coming with you overseas in order to enhance their reputations?

Rudy: We have got this program called “Best of Both the Worlds,” which is one of the low hanging fruits I was talking about in the insurance world, where an American physician travels to a foreign destination and takes care of American patients, …and then the follow-up care is back in the US. Only the geography of the surgery changes. That change has significant impact on the cost.

You could have your executive health checkup overseas. We are now doing this program: colonoscopy, cardio test, lab test, EKG, and 64-slide CT scan, all for $1995 with air, hotel, and meals included.

David: Now Rudy, tell me about how you got into the field because you are obviously one of the trailblazers and you had Planet Hospital for a bit. How did it all start for you?

Rudy: We started the company in 2002 when my fiancee and I were traveling overseas in Bangkok. I describe her as a professional patient and she got ill while we were in Bangkok and refused to go to a third-world hospital. She had visions of…you know, tents instead of buildings. And I tell her, at least get a shot of painkillers and come back to the hotel room or something. Now we go there and this hospital was just truly amazing. And, she had her own private nurse, a doctor who saw her within 20 minutes of her arrival, took ownership of the problem, and a chef to take care of her meal requirements based on the doctor’s orders. After three days stay with her medications, tests, etc., her bill was a staggering 411 dollars. And that’s when I thought there is a business here.

David: What if someone travels all the way to India for a hip operation and then they find out when they are there that the surgeon thinks that it’s actually a different diagnosis? Does that happen and how do you deal with it, if and when it does?

Rudy: Let me give you a bittersweet story. We have a client who needed tour help… we sent her to Singapore ultimately for her breast cancer and follow up on her radiation. She was also told that she was going to get cataract surgery done [in the US], but she decides to put it off, and get the breast surgery done instead. And since she was going to stay there for six weeks and get radio, we thought why not get the cataract surgery done there, too. Now the surgeon in Singapore did some tests and said that you don’t have cataracts. I don’t know why your American doctors told you have cataracts; you do not have a cataract problem. The problem seems to be behind the eye. So we did a diagnosis and discovered that she had cancer [in her optical nerves]. So here’s a patient from America who was ready to get cataract surgery even though it would have done nothing for her and she learned, you know, that she had a different condition now. It’s a good thing that happened there because it obviously got caught there and it is going to cost her a lot less to get it fixed there. While she is there now she is taking care of this issue as well.

David: How about coordination between the US and overseas? Some of these patients, I imagine, don’t have a good primary care relationships, but what happens when the patient inevitably needs some sort of follow-up even if there is not a complication from the procedure? Do there tend to be tensions between the US physician and the fact that the patient was treated overseas? How do people handle that?

Rudy: Not really. I mean, because they don’t have insurance, they are used to being cash-paying patients and so we have a network: it’s small now, but it is growing. A network of physicians, primary care practitioners, and specialists throughout the US that we recommend…

David: These are people within the US who are…

Rudy: …willing to see my patients after they come back.

David: OK, so you have a real international network that’s both here and abroad.

Rudy: Correct.

David: How do you expect the field to evolve? What do you think we will see if we look back five years from now? What will we see?

Rudy: I think we will see a lot of insurance companies adopting the concept of medical tourism. I think it will become a more common, acceptable practice with, on one side baby boomers going to exotic locations to get plastic surgery done where they can lose a decade in a day, to retirees and employees of companies being given the option of getting healthcare carried out in the US or abroad.

David: I have been speaking today with Rudy Rupak, Founder and President of Planet Hospital. Rudy, thanks for very much for your insights today, I really appreciate it.

Rudy: It was a pleasure, thank you again for having me.

Podcast interview with Rudy Rupak, Founder and President of Planet Hospital

by David Williams

I spoke yesterday with Rudy Rupak, Founder and President of Planet Hospital, a company that arranges medical travel (aka medical tourism) to 14 international destinations. Listen in to hear Rudy and me talk about the ins and outs of medical travel: what patients can expect when they leave the country for care, how insurance carriers are thinking about coverage, and what happens to patients when thy return to the US.

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Interview with Josef Woodman, author of Patients Beyond Borders (transcript)

by David Williams

Here’s the transcript of my recent podcast interview.

David Williams: This is David Williams, cofounder of MedPharma Partners and author of the Health Business blog. Medical care in the US costs a fortune. In the past few years uninsured and underinsured Americans have been venturing to places as far away as India and Singapore for surgery and other treatments. The care’s often excellent, prices are low, and even surgeons are customer service oriented. I spoke earlier today with Josef Woodman, author of Patients Beyond Borders: Everybody’s Guide To Affordable World Class Medical Tourism. Listen in and hear what he has to say.

Joe, tell me how you got interested in international medical travel.
Josef Woodman: Three and a half years ago my father suddenly announced that he was heading to Mexico to get a mouthful of teeth restored. He was 72 at the time. I had a visceral reaction. I was concerned about treatment in a shoddy clinic with rusty instruments and an untrained doctor, so I followed him out there and found exactly the opposite to be true. He had located a very clean clinic with a board certified physician, a dentist, really a quality staff, state of the art instrumentation. In fact I think the first panoramic Xray I’d ever seen in a dentist’s office was there.He saved $11, 000. That includes the cost of the trip and a month there. I came back home and found friends with the same reaction when I would tell them the story where I had gone, what I was doing. These friends had the same reaction I had when I let them know what the real story was. They would follow me out the door looking for his email address. So the publisher part of me just couldn’t resist the notion of a book on the subject. That started a three-year project which resulted in Patients Beyond Borders.
David: Interesting. So it’s interesting that you were involved more in the health care and publishing space than your father seemed to be, the trailblazer. How did he find out about the idea of going, not necessarily overseas, but going to another country to have dental work done?
Josef: He is a very practical person, and when he was quoted some price, it just dropped his jaw. I think he was quoted something like $24, 000 for this restorative dentistry. He just simply couldn’t afford it. He had been in Mexico and seen some of these clinics, and he was curious about them. Three and a half years ago he was something of a pioneer, but there were enough websites in English that he could get through.
David: Now, I sometimes hear this term medical tourism, which you use a little bit in your book but not so much. I’m wondering where that notion of medical tourists came from, and also if you have a preferred term other than that?
Josef: Well, actually the term grew out of India when the Indian government was trying to court medical travelers. That is a fairly recent term. The term medical tourism is probably not more than two years old. In fact it grew out of India after we started our research. On the one hand we were happy to see it labeled. On the other we considered it a misnomer, which is why you don’t see it much in the book. We actually mentioned the term in the book as a misnomer.We prefer international medical travel. The reason we feel it’s a misnomer is because it implies tourism and leisure time and recreational time. We feel they’re separate issues. We don’t recommend that anyone takes a vacation we think it’s best for people to take care of their bodies, take care of their health, not think of it in terms of tourism any more than a business traveler is thought of as a business tourist. You never hear the term business tourist. People have a goal. They meet their goal. They come on home, and then maybe if they saved some money, which they usually do, they can salt that away and when it’s time to a nice trip, they and their companion can go on a nice trip together. It’s separate issues.
David: Did you have a prototypical patient in mind when you wrote the book?
Josef: There are two types of medical tourists. One is the cosmetic surgery crowd and the Beverly Hills, Chevy Chase crowd. They head down to Brazil. They’ve got their own network. They spend probably twice and three times the amount they’d spend in America and come back home and brag about it. That’s a relatively low number. That’s not the crowd that we addressed.The crowd that we saw repeatedly in these hospitals were part of the 46 million uninsured and another 30 million under or partially insured. These are folks that are aging into expensive medical procedures, and they find themselves financially challenged. They’re in the middle class. They’re in the upper working class. They don’t want to have to sell their home or sell their small business just to pay for an expensive procedure.
David: So when you talk about underinsured patients, that sounds like patients that have some kind of insurance, and they’re still finding it worthwhile to go overseas?
Josef: Oh yeah. Underinsured can involve a number of circumstances. Technically anyone with a dental plan is underinsured, and there’s a 120 million Americans without dental insurance. For those who have dental insurance, they’re technically underinsured because, especially aging patients, your flesh is going to outlive your teeth. Almost no dental plan covers any of the major noncritical procedures, such as restorative surgery. So technically you’ve got so many exclusions with a dental plan that you’re underinsured.Same thing is true with, let’s say, a hip replacement, an orthopedic procedure. Unless a physician defines that as being critical care, you get to pay for that yourself even if you have insurance. It’s excluded. Also a lot of people have preexisting conditions, and that gets excluded.
David: Now, what about patients who aren’t underinsured but who are well insured? Are there any insurance companies that are actually looking to overseas providers as a way to reduce costs or to increase quality or convenience?
Josef: Well, our research shows us that so far there’s just a couple or three insurance companies with very specific plans, but look for big changes within the next year.
David: What are some of the common misconceptions that people have about international medical travel?
Josef: Well, as far as the misconceptions, there are three misconceptions that I’ve seen and that we’ve struggled with as the industry matures.One is that it’s somehow a gimmick, that you can’t get something for nothing, or for a 30%80% discount. There must be something. Either the customer care isn’t as good or you’re actually going to get your surgery in a mud hut. So that’s a fairly common misconception, which is born of typical American xenophobia shall we say. People just aren’t familiar with other cultures, and can’t believe that the healthcare would be on par in other countries.

Another common misconception is one we alluded to, which is what I call sort of the fun and sun misconception. When we first started our research the web was filled with all kinds of promotion from countries, from health travel brokers. “Get your cosmetic surgery and lie on the beach for ten days and then come on home.”

So the whole notion of medical tourism as being somehow having surgery and going on a vacation was much more popular. You don’t really see much talk about it now as the media grows up, and begins to address some of the more important aspects of international medical travel.

And the third misconception is outsourcing. And people feel that somehow medical travel is all about outsourcing. And what they need to know is most of the hospitals that were built to attract the international medical traveler in Thailand, in Singapore, the hospital that’s just being built in Dubaihuge complex of hospitals therethey don’t even have the medical traveler in mind. Most of the international medical travelers are from Europe, they’re from the Middle East, they’re from Africa, and Eastern Europe.

And so it’s really not about outsourcing. Doctors aren’t leaving this country to go practice elsewhere. And huge industries aren’t cropping up that match the traditional definition of outsourcing.
David: What are some of the mistakes that people make when they’re planning treatment overseas?
Josef: Well, that’s a good question. We sometimes refer to our book as the result of a thousand mistakes that patients have made. Fortunately, very few of those mistakes are life threatening.The main mistake a patient makes is being uninformed or being illinformed. And so to the extend that a patient is informed, they’re going to have a successful medical trip if they take the time to look into, for example, the accreditation of a particular hospital, success rates, and the number of surgeries performed, which questions to ask your physician, how to handle discomforts and complications after you get home.

Make sure that you inform your physician before you leave, and make sure you leave your destination after your precedence with all of your medical records. And we’ve got a dos and don’ts chapter that covers most of the common mistakes that people can make.
David: Now, you have a whole section of the book that talks about the most traveled health destinations. And with the various countries, you list some of the key clinics there with their information, about them, and prices that they charge, and so on and I’m wondering how were you able to compile that information?
Josef: Well, we put a team together, an editorial and a research team, and we spent almost two and a half years compiling and writing the book. Naively we started with around 50 countries. And then we began to wonder, how in the world do we assess these countries?And long story short we began to look at the accreditation within a giving country. We discovered JCI (Joint Commission International), which is an arm of JCAHO that accredits hospitals overseas. There’s now 117 hospitals accredited abroad through an American agency. Out of say, around 1, 000 hospitals that we looked at, we vetted those hospitals in terms of in country accreditation, in terms of the cultural transparency, and the kind of experience that especially an American traveler would accept.

And then when we pared the list down, we sent surveys out to those hospitals, and depending on their answers to those surveys, if they answered them at all, we then narrowed the list down to hospitals that you see featured in the book. All of them had to have an international patients’ center where there was English spoken, they all had to at least respond to the survey, and they all had to have reliable accreditation.
David: Now, do you have a favorite destination of all these countries? I’m sure it would depend on the particular treatment that you needed, but are there any ones that stand out that you particularly like?
Josef: In general treatments for dentistry and cosmetic surgery can be handled on the Western Hemisphere, either in Mexico, or Costa Rica, or Brazil. And we recommend for people who are looking for procedures involving cardiovascular, orthopedic it may be best to endure that 24 hour, 30 hour trip to Singapore, or Thailand, or India, or Malaysia for those more invasive surgeries.
David: Now I noticed in thumbing through the list of the different countries and the different centers that it seems like some governments have been much more proactive than others in trying to attract the international medical travelers. And in particular, I noticed the contrast between Brazil and Singapore. Could you talk a little bit about that?
Josef: A lot of the success of international medical travel does have to do to the extent the governments, the accreditation agencies, and frankly the tourism bureaus want to attract that international traveler. So in Singapore, for example, the government oversees all four of the main health care networks including two of the private networks, Parkway and Raffles. These are huge medical institutions that usually don’t answer to government. Singapore’s done a great job of corralling that and bringing a lot of standardization to international medical travel.Brazil, on the other hand, the government for a number of reasons eschews medical travel, especially for the main reason people go down there which is cosmetic surgery. There’s not a lot of cultural transparency. If you don’t speak Portuguese, chances are you’re going to be out of luck, unless you go to one of the very few hospitals that cater to the international traveler.

India, for example, is a huge proponent of medical travel. In Thailand they saw it as one of the solutions to the falling baht in the late ’90s, and they identified medical travel as a big revenue source and targeted the many expatriates in Thailand and in Bangkok to come to Bumrungrad. That’s how Bumrungrad got it’s start, was through marketing to the expatriate crowd. Then they discovered lots of Europeans and Middle Easterners coming over. After 2001 when folks in the Middle East weren’t welcomed in the United States, Bumrungrad was flooded with those folks. Now they’re marketing to a more Western audience including America.
David: Well, one of the things that really struck me in reading the book was the way that physicians overseas, even some of these surgeons, are quite accessible. It mentioned something that was a real shock to me, which was that they would typically want to communicate by cell phone with a patient even when the patient was first in the country and then after the surgery and to follow up on them. Can you talk a little bit about what somebody might expect in terms of how they work with an overseas physician compared to what they’re used to in the US?
Josef: Yeah, I have to tell you if I hadn’t seen this with my own eyes and actually hadn’t been a medical traveler myself, I just wouldn’t have believed it. My first experience was when I traveled to India. There was a couple from Wisconsin that I interviewed and followed for months after they returned home. They were consulting regularly with one of the top surgeons in Asia, a man named Vijay Bose in the Apollo Network in Chennai in India.I actually thought that this man was almost a charade for what he perceived as a reporter when I was there. I found out later that he spends probably 25 percent of his time talking to his patients directly on the telephone, preprocedure and postprocedure. These guys just live with their cell phones in their hands, with text messaging and voice. They have a very close tie with their patient. In addition, most of them are more than willing to talk with a US physician should there be any discomforts or concerns or, God forbid, complications upon a patient’s return.
David: Now one question I was going to ask that you made me think about was how does physicians in the US feel about their patients going overseas? It sounds like the overseas physicians are willing to follow up with the US physicians. Is the patient likely to get written off by their US doctor if they go overseas for treatment?
Josef: I feel bad for physicians. I feel like they’ve got a raw deal in the US. They now find themselves unable to compete in a way that they would probably like to. They find themselves rushed and forced into a lot of decisions outside of their control by their hospitals, by the insurance bureaucracy. It’s a tough place to be. So many physicians are either uninformed about health care overseas and just the quality of the health care and the quality of customer service, or they’re competitive and intimidated, or both.So a patient who queries his or her physician or specialist is not likely to get a lot of support, and that’s understandable.
David: Now, other than reading your book, are there some other resources that you recommend for patients who are considering international medical travel?
Josef: If I were a patient, I would certainly start with JCI and get familiar with some of the better hospitals. JCI has a listing of hospitals throughout the world that have received their seal of approval, their JCI accreditation. There are some good websites. They won’t give you alpha to omega information, but you can piece it together. There’s a site called medicaltourism.com. There’s Medical Nomad. It’s medicalnomad.com. Those folks have compiled information for the medical traveler. No doubt there’ll be more books after this one broke its ground, after “Patients Beyond Borders.”
David: Now, Joe, what’s going to be next for you after writing this book and getting highly involved in the whole international medical travel area? Is there a “Patients Beyond Borders II”? Are you moving on to something else? What do you think?
Josef: Well, certainly there’s a second edition. We had to get the book out, and we culled the information down to 22 destinations in 14 countries, which gives people a really good start for the common procedures. However, there are specialty hospitals. There are centers of excellence within the hospitals that we featured that we’re learning about.So in the second edition, which we expect to be at least 50 percent bigger than the first edition, we want to go deeper. People don’t need more hospitals. They need better information about these centers of excellence. So if they had a certain type of cancer, they know which two or three hospitals have the very best cancer centers. We want to dig deeper into research. And of course there are more hospitals emerging.
David: I’m been speaking today with Josef Woodman, author of “Patients Beyond Borders: Everybody’s Guide To Affordable, WorldClass Medical Tourism” published by Healthy Travel Media. Joe, thanks very much for speaking with me today.
Josef: Oh, thank you. It was good to be here.

Podcast interview with Josef Woodman, author of Patients Beyond Borders

by David Williams

Medical care in the US costs a fortune. In the past few years uninsured and under-insured Americans have been venturing to places as far away as India and Singapore for surgery and other treatments. The care is often excellent, prices are low, and even surgeons are customer-service oriented. There was an excellent session on this topic at the recent World Health Care Congress in Washington, DC. I expect we’ll be hearing more about this topic.

I spoke yesterday with Josef Woodman, author of Patients Beyond Borders, Everybody’s Guide to Affordable, World-Class Medical Tourism. Listen in and hear what he has to say.

You can buy the book at Amazon and other retailers.

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