ST. PETERSBURG — Still scarred from a vehicle accident in the 1980s, Paul VeHorn faced a $40,000 bill to have facial surgery in the United States.
He chose to go to Thailand instead. His cost? About $16,000, which included airfare, accommodations for three weeks and medical care at a hospital that he says resembled a five-star hotel.
"One-hundred percent satisfied," VeHorn, of St. Petersburg, said of his 2007 trip. He returned to Thailand in 2008 for dental work, again at sizable savings.
Once reserved for the uninsured or very wealthy, medical tourism is increasing in popularity and broadening in scope. More than 648,000 U.S. residents traveled abroad for care last year, and that is expected to increase to 1.6 million by 2012, according to the Deloitte Center for Health Solutions, a consulting firm that tracks medical tourism trends.
And while many medical tourists travel for cosmetic procedures such as facelifts and tummy tucks, an increasing number are going abroad for hip and knee replacements, cardiac procedures and major dental work.
A number of factors are fueling the growth:
• Medical procedures abroad are drastically cheaper, by as much as 80 percent. That has long been important to patients seeking a procedure such as cosmetic work that isn't covered by insurance. Now, with health costs soaring ever higher, it's luring those who have no insurance or whose policies require them to pay a larger share of their health costs.
• More international hospitals are earning accreditation by the Joint Commission, the same body that reviews U.S. hospitals.
• U.S. employers who provide health insurance to their workers are starting to include coverage for care abroad.
"It's dangerous to say you can save a lot of money, because it sounds too good to be true. But the care is state-of-the-art," said Gary Ruehle, a former St. Petersburg resident who two years ago started the A New You, which helps coordinate medical tourism trips to Thailand, where he lives.
Traveling for health care does come with risks. When an American Medical Association panel sought to establish medical tourism guidelines in 2007, it noted potential hazards: less-rigorous quality standards, difficulty assessing physician credentials, and possible complications during the flight home after surgery.
Patients going abroad also need to consider how they'll get followup care at home. And, if their surgery goes wrong, what their legal options will be.
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Larry Turpen of St. Petersburg said there was no way he could afford the $15,000 to $20,000 it would have cost to have weight loss surgery here. His insurance would not cover the procedure.
So in January, he traveled to Tijuana, Mexico, where he stayed for three days while undergoing a Lap-Band procedure.
His cost? $6,000, plus about $250 for airfare to San Diego.
"I was happy with it," said Turpen, 44, who has lost 45 pounds and has seen his diabetes and high blood pressure improve.
Savings can be substantial. A heart valve replacement that is $177,000 in the United States could cost less than $20,000 in Thailand, according to Companion Global Healthcare, a Blue Cross Blue Shield of South Carolina company that coordinates medical tourism with insurers, employers and individuals.
Why are prices so much lower abroad? Chalk it up to lower costs for, among other things, labor, equipment, hospital construction and malpractice insurance.
Ruehle says a heart bypass, which can cost $130,000 here, is $25,000 in Thailand.
"That puts it in the realm of being affordable for people who don't have insurance," he said. "Plus, you can have the surgery, and a week of exotic vacation."
But as the AMA notes in its guidelines for medical tourism, you should be fully informed that you may not be up to an action-packed holiday after surgery.
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Increasingly, there's a lot consumers can do to investigate facilities before they sign up.
The Joint Commission, the U.S. accrediting body, has put its stamp of approval on more than 250 international hospitals.
Bumrungrad International Hospital in Bangkok was the first in Asia to receive the Joint Commission's seal. It also has more than 200 physicians who are trained or board-certified in the United States, or both, said David Boucher, president of Companion Global Healthcare.
Some accredited facilities abroad are even built to U.S. standards and many have the same state-of-the-art equipment.
A number of major U.S. medical centers have also forged international partnerships. Harvard Medical, for example, has partnerships with facilities in 40 countries. Other academic medical centers with partners abroad include the Cornell, Duke and Columbia medical schools.
Another indicator of quality is patient outcomes, which data show are as good as or better than U.S. hospitals, said Jay Wolfson, an expert on health policy at the University of South Florida.
Quality of care abroad is "far less an issue now than it was even three years ago," he said.
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But not everyone who travels for care goes to an accredited facility. It's also not as easy to check a physician's qualifications or discipline record as it is in the United States. And if you are the victim of malpractice, you are subject to the laws of another country.
Assuming you can't spend a great deal of time at your destination, you'll need followup care when you get home. Many doctors aren't eager to take on post-surgical patients they haven't treated before. Turpen said it was a challenge to find a local doctor to care for him after his Lap-Band surgery in Mexico.
News reports of botched procedures abroad are rare, but there have been a few. A 2007 story in the Los Angeles Times told of the experience of a Texas resident, Maggie Terry, who developed an infection after a $4,500 tummy tuck at a small hospital in Mexico.
And in 2006, the Providence Journal in Rhode Island reported that a Rhode Island woman, Jude Jarvis, died of a blood clot four days after having a tummy tuck and breast reduction in India. Her sister, however, called it a "freak accident,'' and said the hospital was not at fault.
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Most medical tourists pay the costs themselves, but insurers are getting into the act, too.
More than 200 employers in 21 states now cover treatment abroad for their employees through Companion Global Healthcare, though Florida is not among them, Boucher said.
Most of the employers who offer medical tourism benefits are self-insured, so less-expensive care abroad saves money for both them and the employee.
But it usually takes additional incentives to get patients to leave the country for care they could get at home. One California business pays 100 percent of the costs, including airfare for two — and still saves significantly, he said.
But Boucher said employer coverage for medical tourism can be a touchy subject, particularly when unions are involved. Boucher declined to give the St. Petersburg Times a list of Companion Global's clients.
Several years ago, he explained, Blue Ridge Paper Products in North Carolina was going to send an employee to India for medical care. The union protested and Blue Ridge abandoned the plan.
Wolfson said insurance is key to medical tourism's growth.
"If you have an insurance company behind it, that creates a new dynamic," he said. "You would have a guarantee of coverage, followup care, protection against malpractice."
Despite the potential savings for patients, employers and insurance, Boucher doubts people will be forced to travel abroad for care — at least for now.
"But 10 to 15 years from now? Who knows?''
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330