Why the Logic of Free Trade In Medicine Is Becoming Harder To Resist

"If domestic hospitals actually had to compete with international hospitals the way American car companies have to compete with Toyota and Honda, they might be forced to become more efficient."  ~New Yorker Magazine

This year, a few hundred thousand Americans will head to places like Costa Rica, Mexico, India and Thailand  and not for the views of the Mayan ruins or ancient Buddhist temples, but rather for affordable medical care.

Yesterday's New Yorker features the story Club Med on James Surowiecki's Financial Page, discussing the increasingly commonplace practice of destination health care, in which US patients travel abroad for treatments as varied as root canals, metabolic surgery (for type 2 diabetes) and hip replacements.

Surowiecki opines that if costs for US healthcare continue to rise, and Obama care is overturned in the Supreme Court, this practice will become more and more common. 

Destination health care is nothing new - Mayo Clinic is one of the earliest practitioners, attracting  more than 80,000 medical travelers, or medical tourists, per year.

Now, international hospitals such as Bumrungrad Hospital in Bangkok and Angeles hospitals in Mexico are also major hubs for destination healthcare, treating hundreds of thousands of medical tourists every year.

Who Said It? 

“Ten years from now, we’ll all get on planes and fly somewhere to get treated.”  ~NY Times

Other countries reporting  annual medical travelers to their private hospitals numbering in the hundreds of thousands include the Philippines, Malaysia, India, Korea, and China; dental travel is common in Mexico and eastern Europe. 

The attractions of destination healthcare are many:  most significant, of course, is the value, i.e. medical care is much cheaper abroad, often less than half the out of pocket costs to insured patients in the US health system.

But cheap is perhaps not the best word, since the private hospitals catering to American medical travelers are often quite luxurious by US health care standards, with very low nurse:patient ratios, all private rooms, and the latest medical technology.

And as Surowiecki notes, the challenges to medical travel have virtually disappeared with the advent of destination health care facilitation services, including:

• employers providing destination health care options in employee benefits
• physican-founded organizations like Orbicare specializing in taking US stem cell, IVF and metabolic surgery  patients to Latin AMerican destinations such as Spain, Argentina
• technology companies like Health Travel Guides providing patients with a global network of health are options and a free, full complement of concierge services to make the process easy
• medical device companies are choosing to bypass the FDA approval process and offering their products abroad, where Americans must follow for the latest technology

In short order, the market for destination health care could expand by as much as forty million (the number of Americans who are uninsured) if Obamacare is overturned.

Cuts in  Medicaid and Medicare  might make the cost of US health care cost prohibitive to America's silver citizens, adding further to the growing ranks of medical travelers.

Health care has, to date, been insulated from the impact of globalization, but medical tourism might spell the end of that.  Benefits of the practice go beyond savings to the patient, according to Surowiecki; more medical tourism increases free trade in medical services.

The US of course has a long history of breaking down barriers to free trade in manufacturing and service, exposing these  industries to foreign competition and resulting in lower prices and higher quality goods and services to American consumers.  The same, Surowiecki argues, would hold true for competition in health care.

Despite the technology explosion and social interfacing of the information age, medicine has stubbornly remained an anachronism - local and somewhat unconnected business.  That would quickly change if patients could easily engage in domestic medical tourism (i.e. journeying to lower cost hospitals within the US), or if Medicare and Medicaid covered treatment in  foreign hospitals, and/or if insurers decide to cut consumers in on the savings from treatment abroad. 

Ironically, bringing the US health care system's costs into line might only be possible as the result of more Americans outsourcing their health care.

What Else We're Reading and Listening To

• Why 1 in 3 US Hospitals Is On Life Support
• The State of American Health Care: Some States More Equal Than Others
• How Many Hospitals Should Serve McDonald's? 
• Regretful Former Insurance Exec Calls Obamacare a Boon To Greedy Insurance Industry 
• From the Patient's Mouth: US Nurse Goes Abroad for Metabolic Procedure 
  
  

Oh My Aching Back: CEO Has Revolutionary LDS Surgery for L4L5 Pain

My guest blogger today is Paulo Yberri (pictured at left), who lives in San Ysidro California, and is the CEO of a large private hospital on the Baja Penninsula in Tijuana, just south of San Diego. His story is a lot like my husband's - ongoing back pain at the L4L5 that finally drove him to surgery.

My husband was cured of his pain, but only after FOUR surgeries in eight months. We have insurance, but the insurance company dropped us like a hot potato when the second surgery was required, citing a 'pre-existing condition' (meaning, the error the surgeon made in the first surgery).  The total bill: $165,000.  Yes, you read that right. Believe it or not, he never spent the night at the hospital.


By comparison, Paulo was in and out of the hospital in 24 hours, with a bill of $14,000, because he was lucky enough to work at a place where one of the world's leading back specialists, Dr. Juan Dipp, has written the global protocol for a new lumbar surgery made possible by US medical device manufacturer PercuDyn - a fairly common practice:

Medical Device Companies Look Abroad
Free Medical Webcast: Noninvasive LDS for L4L5: Free Your Back From Pain for Life

So without further ado, meet Paulo:  an active 37-year-old male: in addition to being a CEO of a large company, he practices martial arts and is a biker and skier, and the father of two young children.

"My first back injury occurred when I was in my late teens. I was never able to pinpoint one cause or event –I was very active at the time, and the injury was probably the result of a number of things, for example, at the time I was practicing jujitsu, being slammed into a mat all day long.

Being young , I didn’t pay much attention to the pain at first. I just figured it was a cramp, nothing I couldn’t handle. I have a fairly high tolerance for pain, and this exacerbated the problem. My back began to get very painful, but only sporadically. If I laid down or stretched, it would feel better. The pain didn’t disappear, but it was manageable, so I kept on ignoring it.

Soon I was living with and managing the pain on a daily basis. I became aware that I was almost never pain free. I didn’t want to face the reality that something could be wrong with my back in a permanent way. But after awhile, the pain went from uncomfortable to totally unbearable. In the last two years it was a constant drag on my life: the pain was always there, and I was always aware of it.

You’d think that as a hospital director I of all people would understand that untreated pain does not go away by itself. But like many men, I though I could stand it ….that is, until the pain finally became so bad that I could not move easily, or get out of my chair like normal. My activities were limited by the pain; I could no longer work out with any intensity.

"At age 35 I was about to become a dad for the first time..but I was moving like a granddad."

 
The breaking point was when I had to start taking shots and medication on a regular basis, just to deal with the pain. I finally faced the fact that my back was not only not going to fix itself, it was degenerating, and I began to search for options.

Because I am a hospital director I was able to get access to many physicians to discuss treatments. I discussed spinal fusion with a very prominent surgeon in California, and while I am sure he would have done a great job, but I didn’t think it was a good option. Spinal fusion is an expensive surgery, a two-level fusion that results in a loss of mobility, a long recuperation time, and there is only a 70% chance of being pain free afterward. To me, the cost benefit analysis simply did not bear out.

When Dr. Dipp told me he was setting up protocols for a new spinal procedure that he was very optimistic about called Lumbar Dynamic Stabilization, I became very interested. I liked that it was low invasive, ambulatory and reversible…in short, very low risk with a very high likelihood of success. I would not require general anesthesia and there would be no risk of loss of mobility. I particularly liked that recovery time for LDS is lower than any other alternative out there, and that the procedure is reversible.

“The cost benefit analysis of spinal fusion, with its long recuperation and only a 70% success rate, did not bear out.”

In the ER, they sedated me but not full anesthesia. The surgery took 32 minutes. I woke up in recovery, went to my room, and was able to walk to the bed on my own. My only pain was a slight soreness from the incision. The next day I was walking around with no need for medication.

Today my life is exactly as it was before the back pain entered. Everything is normal –my sex life, my athletic life, everything is as it should be for a healthy 35 year old man. In the end, I suffered too much pain by not dealing with the problem, but I was very very lucky that when I was ready to deal with it, I did not have to take a risky and expensive measure like spinal fusion, that this innovative LDS procedure was available to me.

I’m proud that a surgeon on our hospital staff is working with PercuDyn (the American manufacturer of the implant device) to develop the worldwide protocol for this procedure –meaning, he is training surgeons around the globe in LDS. The LDS procedure is only available in Mexico and Europe, it is still in the clinical trial stage in the U.S.

Of course, we work with medical travelers every day at Hospital Angeles Tijuana –everything from coronary bypass to cataract surgery. Any US patient who is like me -unhappy with the high price tag, long recovery and 70% confidence of spinal fusion (especially in the US) can come to Hospital Angeles Tijuana to have the procedure with Dr. Dipp. We’re just a few minutes away from San Diego and we handle everything for the patient, including their travel itinerary.

Thanks for Paulo for sharing his story! If you are interested in learning more about the LDS procedure, contact a Health Travel Guide toll free at 866.978.2573 or go online to chat.