All the World’s an Operating Room

When Josef Woodman’s father decided to hop a flight to Mexico for a few months to have some restorative dentistry work done, his son was horrified — and took the trip with him out of fear for his dad’s well-being, as well as to satisfy his own curiosity.

What he found was not an unsafe, unregulated medical environment rife with peril, but rather a professional health care environment offering a number of procedures that are common in the U.S., at a fraction of the cost. What’s more, many of the patients were American, in search of the same savings as Woodman’s intrepid father.

Upon their return, the elder Woodman had a new smile, and his son had a new direction in which to take his career as a writer — covering the phenomenon of medical travel, also known as medical tourism and global health care.

It’s a burgeoning field that is receiving increased attention of late, as more types of procedures become available, often at lower costs than can be found stateside, and as a greater number of accrediting, advisory, and regulatory entities enter the picture.

Three years after first being exposed to medical travel, Woodman is now the author of a best-selling book titled Patients Beyond Borders: Everybody’s Guide to Affordable, World-class Medical Tourism, and an internationally-recognized proponent of the practice.

He’s also a convert himself, having recently saved about $1,100 on a root canal by traveling to Costa Rica for the procedure. In this issue of BusinessWest, Woodman answers some of our most pressing questions about this health care phenomenon, and how it fits into the medical landscape at home and abroad.

BW: You first learned about medical travel through your father’s experience. What went through your mind when he told you about his trip?

JW: When he told me he was heading to Mexico for a medical procedure, I thought, “Oh, God, here we go again. Another wacky idea from dear old dad.” But he’d used the Web to do his research, and he said, “If you’re so concerned, why don’t you join me?” I did, but I was still expecting to see rusty instruments and untrained surgeons practicing in a decrepit building.

BW: And is that what you found?

JW: Not at all. My dad had isolated three clinics in the area of Puerto Vallarta that performed the procedure he needed, and had eliminated two of those rather quickly. At the third, a board-trained dentist performed work that, here in the States, would have cost about $24,000, for $11,000 including accommodations and traveling costs for a month. When I came back home and began to get my arms around what he’d done, I told my friends about it, and they were horrified and shocked. But by that time, as a publisher by trade, I was starting to see the beginnings of a book.

BW: How new was medical tourism when you began your research for Patients Beyond Borders?

JW: At first, my agent thought there was nothing to it when I pitched the idea for a book. This was only four years ago, and it was about six months after that when I first saw the term ‘medical tourism’ appear on the Web — it was being used by India to explain what they do in this field, and I think that’s where it started.

But medical tourism itself is thousands of years old. People from all over the world have traveled distances for their medical care as long as it’s been an option, and most recently, the Hollywood crowd popularized trips to Europe and elsewhere, where they will often pay three times as much for a procedure than they would in the U.S.

Contemporary medical travel is much more cost-effective, though; procedures generally range from 30% to 90% less than U.S. costs, and the industry is driven by quality. The JCI [Joint Commission International, a U.S.-based accrediting body that evaluates medical facilities overseas with a particular focus on state-of-the-art technology] has been accrediting hospitals overseas for about 10 years, and in 2002 there were less than 40 accredited hospitals. Now, there are more than 130.

BW: How did you go about collecting information in such a fast-evolving industry?

JW: When I first began looking into it, I thought I was writing a travel book. I began to travel to many of the countries that offer medical procedures for travelers, and visiting a number of facilities.

Soon, though, I saw it was really a medical book; it was important to get things right. There are a lot of ways to ensure a successful trip of this kind, but there are also a lot of ways to slip up and get in trouble. For example, a lot of the promotion around this has a ‘fun in the sun’ connotation, so I don’t even like the term ‘medical tourism’ and try to downplay it. Surgeries, wound management, physical therapy … this is not the stuff of vacations.

I learned quickly that as consumers, we must ask the right questions. I made some mistakes along the way — none of them fatal — and in addition, there are the mistakes of a thousand patients in this book, as well as answers to what they’ve done, what could have been better, and what they’d do differently.

BW: What has the reception been to your book since it was published?

JW: It has hit a nerve within the health care community, and it’s emerging around the world. The book has a Taiwan edition and a Singapore edition as well [each offer an in-depth overview of the countries’ international hospitals and clinics, selected health travel agents, nearby recovery and guest accommodations, and area travel information]. Both are in English, but Singapore alone receives 400,000 visitors a year as part of medical tourism, and most speak English — so this book is becoming a resource.

BW: What types of procedures are being sought out by medical travelers, particularly those from the U.S.?

JW: Here, we have excellent health care infrastructures, but we have priced ourselves out of the market. In terms of who are sometimes called the ‘working poor,’ the lower middle class, some people are one expensive procedure away from disaster. Choices have evolved, and they’re valid.

That said, the more expensive the procedure, the more attractive because of the big cost savings. Orthopedics, for example, is huge — an estimated 7 million Americans suffer from chronic pain related to orthopedic maladies, and surgeries to correct these problems are largely elective in the U.S. So if a person is uninsured or underinsured, there are not a lot of doors open to them.

Medical travel has opened huge doors, though, largely due to the fact that health care has improved globally to the point at which traveling for surgery is an option. Cardiac procedures are also huge, for example, ranging from the insertion of stents to angioplasties. Transplants are sensationalized somewhat in this sector. However, cosmetic surgery remains huge, and dentistry is huge among the aging Baby Boomers, who are essentially outliving their teeth.

BW: Is it safe to say that people from all walks of life are looking into medical travel as an option?

JW: There are some specific cautions to heed before you travel and prepare for a trip and for surgery — you need to find the right hospital, and to match the treatment to the hospital by making sure the hospital has done a number of those procedures.

But medical travel is no longer seen as frivolous, and it’s not only for the upper-crust. It isn’t for everyone, but the JCI especially gives Americans a new measure of comfort. I’ve traveled for my own procedure — a $4,000 root canal that, in Costa Rica, cost about 25% less. There were many Americans in the waiting room when I was there, and upon returning home, I had my dentist check the work. Reluctantly, he said the dentist had done a good job.

BW: Which countries are most prevalent in the global medical travel scene?

JW: I would say if had to look at four major destinations, they’d be India, Thailand, Singapore, and Malaysia. Singapore is unquestionably the gold standard for medical travel, but it’s more pricey.

India, Malaysia, and Thailand are also granddaddies of medical travel, and offer huge cost savings, but there is often a lot more to deal with as far as cultural opacity goes, meaning language and cultural barriers. As for dental and cosmetic surgery, Mexico, Costa Rica, and Panama are among the frontrunners.

BW: Do residents of countries other than the U.S. travel for medical reasons more or less frequently?

JW: The U.K. has a longer history with this than the U.S. — as a matter of fact, BUPA [the British United Provident Assoc., the UK’s leading provider of private health care insurance and health care services] has quietly begun sending people to India for care. Canada has a rising market: 300,000 Canadians traveled for health care last year, compared to about 200,000 U.S. citizens.

In addition, 200,000 Indonesians routinely travel to Singapore each year because the former has no health care infrastructure, but does have a rising middle class. These people can use discretionary dollars in Singapore, which is a stone’s throw away, for their medical care.

BW: So what’s next for medical travel?

JW: It’s going to continue to grow. Insurance companies are now formulating strategies for sending people, and this is being watched very closely.

If the drivers stay in place — an aging and affluent population, quality, lower costs abroad, and a lot of people coming back happy if not downright evangelistic, referrals will continue to mushroom. Right now, we’re seeing from 15% to 25% growth annually.

The main point is that we have a choice that didn’t exist 20 years ago.

Read more about medical travel and Woodman’s book atpatientsbeyondborders.com