How you can save on healthcare abroad

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Anne Kates Smith

Last year, more than a half-million U.S. residents got medical care abroad, according to Patients Beyond Borders, a consumer advisory service. That number is likely to grow at a 25 to 35 percent annual rate.

Some procedures lend themselves to international travel. The five most-popular overseas procedures are cosmetic surgery, dentistry, orthopedics, weight-loss surgery, and in vitro fertilization and other reproductive services.

Complex procedures that require lengthy recuperation (think bone-marrow transplants) are problematic. Cancer is a gray area, with travel dictated less often by potential cost savings and more often by the desire to undergo treatment close to friends and family.

Even with lower-stakes procedures, costs can add up. It makes more sense to travel for four dental implants than for two because you have to make a second trip to get crowns on the implants. A good rule of thumb, according to experts, is that cost savings should be at least $5,000 to $6,000 to make a trip worthwhile.

Medical care overseas is cheaper in many places because the cost of living is lower than in the U.S. Efficiencies are often greater overseas as well. In Singapore, you’ll find few general hospitals, for instance. Most medical procedures are performed in specialized centers.

World-class hospitals

Many hospitals abroad are world-class facilities that roll out the red carpet for medical tourists. Bumrungrad International Hospital, in Bangkok, Thailand, is one of the biggest, boasting more than 400,000 international patient visits per year.

Many of its 900 doctors completed fellowships or residencies in the U.S.; some 200 are U.S. board-certified, and nearly all speak English. The hospital’s International Medical Coordination Office will schedule procedures, attend to family logistics and coordinate follow-up care. Bumrungrad will even send someone to pick you up at the airport.

Facilities don’t have to be huge to be attractive. The Barbados Fertility Centre is the smallest hospital to receive accreditations by the Joint Commission International, the global arm of the Joint Commission, the major hospital accrediting body in the U.S.

The appeal of medical travel is obvious for the uninsured and under-insured. Travel is also appealing to workers with high-deductible health plans.

Not only might they save a bundle abroad, but they can use tax-free dollars from a health savings account to pay for care (and some of the travel), provided the procedures meet Internal Revenue Service criteria for qualified medical expenses. (To see what the IRS permits, visit www.irs.gov/publications/p502.)

Or you can always deduct the cost of qualified procedures that exceed 7.5 percent of your adjusted gross income. It’s rare that U.S. insurance is accepted by overseas care providers.

How to book a trip

If you’re considering medical travel, your first stop should be the book Patients Beyond Borders by Josef Woodman, a comprehensive guide to medical travel with information about the best international hospitals and clinics. A newly revised edition is due out in March (about $16 on Amazon.com).

The organization (www.patientsbeyondborders.com) also offers one-on-one advice in free 15-minute consultations or more in-depth advice for $250.

Some medical tourists prefer to arrange a trip with the help of facilitators, or brokers. Many work with networks of hospitals, doctors and clinics with which they’ve negotiated discounted rates.

But be careful. The industry is unregulated, and anyone can hang out a shingle. Look for a long track record and satisfied customers, an affiliation with major insurers or employers, or safeguards against bias in recommendations.

Brokers should thoroughly inspect the facilities they recommend. For example, David Boucher, the CEO of Companion Global Healthcare (www.companionglobalhealthcare.com), said that Companion physically visits every hospital in its network and that his company does not accept referral fees from hospitals. Instead, patients pay a $700 case-management fee, in addition to the cost of travel and medical care.

Planet Hospital (www.planethospital.info) typically recommends three or four hospitals for you to choose from, and although the company is paid by the hospitals in its network, staffers have no incentive to recommend one over another. Most patients pay for concierge service that costs $100 per day for the first three days and $75 a day thereafter.

Be aware that in some countries, doctors may use products that are of lower quality than ones required in the U.S., such as certain types of silicone implants and cosmetic injections. Infection is a leading cause of complications — as it is in U.S. hospitals.

Do your homework

Whether you travel for care on your own or with help, insist on a few things. Accreditation by the Joint Commission International is a must. (More than 400 public and private healthcare organizations in 39 countries are accredited or certified by JCI.) Look for English-speaking patient representatives.

And ask your doctor the same questions you’d ask a doctor anywhere: Where were you trained? How many of these procedures have you done? Who makes the implants you’ll use?

Ask if you can contact the doctor before, during and after care. Before you go, arrange for the transfer of medical records and for after-care in the U.S.

Insurers, facilitators, and clinics and hospitals may try to reduce or eliminate their liability in case of malpractice, so read the paperwork carefully. Foreign medical arbitration systems often drag out the process, and if you do get compensation, don’t be surprised if it’s much less than what you’d expect in the U.S.

Anne Kates Smith is a senior editor at Kiplinger’s Personal Finance magazine. Send your questions and comments to moneypower@kiplinger.com.
© 2012 Kiplinger’s Personal Finance