Circa 2007
In his new book, Patients Beyond Borders: Everybody’s Guide to Affordable, World Class Tourism, author Josef Woodman offers a comprehensive manual for how you can see the world and get many of your surgical needs met—all at a cost that may be cheaper than having the procedure done at your local hospital. But that doesn’t mean you should start packing now. Preparing for surgery overseas requires lots of homework. In this excerpt, Woodman tells you how to get organized.
When my father was 72, he traveled to Mexico for extensive dental work. When I first heard his plans, I felt a mixture of bewilderment and fear. But I knew that despite my protestations, he was going anyway. Dad and his wife, Alinda, selected a U.S. trained dentist in Puerto Vallarta and paid around $11,000, which included two weeks of noodling around the Pacific Coast. They returned tanned and smiling, Dad with new pearly whites and Alinda with an impromptu skin resurfacing. In the States, Dad’s procedure would have cost him $24,000—double what it cost south of the border.
My dad was a health travel pioneer. In his day, finding quality care abroad was a far more arduous task than it is now. In a few short years, big government investment, corporate partnerships and increased media attention have spawned a new industry—medical tourism—which is bringing with it a host of encouraging new choices for patients. Individuals can now choose from a smorgasbord of safe, reliable options for diagnosis and treatment, ranging from dental care and cosmetic surgery to some of the more dramatic and expensive procedures, such as hip replacement or heart valve surgery.
AN IMPARTIAL PERSPECTIVE
International health travel has received a good deal of attention of late. While one newspaper or blog giddily touts the fun ‘n’ sun travel side of treatment abroad, another issues dire, Code Blue warnings about filthy hospitals, shady treatment practices and procedures gone bad. My research has convinced me that with diligence, perseverance and good information, patients considering traveling abroad for treatment have safe choices, not to mention an opportunity to save thousands of dollars over the same procedure here in the U.S. Hundreds of patients who have returned from successful treatment overseas provide overwhelmingly positive feedback. They convinced me that I should write this guide to becoming a savvy, informed international patient. I designed it to help readers reach their own conclusions about whether and when to seek treatment abroad.
Last year, more than 150,000 Americans, Canadians and Europeans packed their bags and headed overseas for nearly every imaginable type of treatment: tummy tucks in Brazil, heart valve replacement in Thailand, hip resurfacing surgery in India, addiction recovery in Antigua, fertility diagnoses and treatments in South Africa, thalassotherapy in Hungary or restorative oral dentistry in Mexico.
Currently, at least 28 countries on four continents cater to the international health traveler, with more than a million patients visiting hospitals and clinics each year in countries other than their own. The roster of treatments is nearly as varied as the travelers.
As baby boomers become senior boomers, they’ve begun to find that their health care and prescription costs devour nearly 30 percent of their retirement and pre retirement incomes. But with the word out about top quality treatments at deep discounts overseas, informed patients are finding they have an alternative. Uninsured and underinsured patients, as well as those seeking elective care, can realize 15-85 percent savings over the cost of treatment in the U.S., depending upon the country and type of treatment. Or, as one successful health traveler put it, “I took out my credit card instead of a second mortgage on my home.”
A patient from Santa Ana, California, whom I’ll call Margaret, was quoted $6,600 for a tooth extraction, two implants and two crowns. One of the 120 million Americans without dental insurance, she had heard of less expensive dental care abroad. Through a friend, she learned about Escazu, Costa Rica, known for its excellent dental and cosmetic surgery clinics. Margaret got the same treatment in Costa Rica for $2,600. Her dentist was a U.S. trained oral surgeon, who used state of the art instrumentation and top quality materials. Add in airfare, lodging, meals, and other travel costs, and this savvy global patient still came out way ahead.
Then there’s a man I’ll call Doug S., a small business owner from Wisconsin, who journeyed with his wife, Anne, to Chennai, India, for a double hip resurfacing procedure that would have cost more than $55,000 in the U.S. The total bill, including travel for him and his wife, lodging, meals and two week recuperation in a five star beach hotel was $14,000. “We were treated like royalty,” said Doug, “and I’m riding a bicycle for the first time in six years. We could not have afforded this operation in the U.S.”
The above costs are for surgery, including hospital stay. Airfare and lodging costs are governed by individual preferences. To compute a ballpark estimate of total costs, add $5,000 for you and a companion, figuring coach airfare and hotel rooms averaging $150 per night. For example, a hip replacement in Bangkok, Thailand, would cost about $17,000, for an estimated savings of $26,000 over treatment in the U.S
The estimates above are for treatments alone. Airfare, hospital stay (if any) and lodging vary considerably. Savings on dentistry becomes more dramatic when “big mouth work” is required, involving several teeth or full restorations. Savings of $15,000 or more are common.
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BETTER QUALITY CARE
Veteran health travelers know that facilities, instrumentation and customer service in treatment centers abroad often equal or exceed those found in the U.S. In fact, governments of countries like India and Thailand have poured billions of dollars into improving their health care systems, which are now aggressively catering to the international health traveler. VIP waiting lounges, deluxe hospital suites, and staffed recuperation resorts are common amenities, along with free transportation to and from airports, low cost meal plans for companions and discounted hotels affiliated with the hospital.
Moreover, physicians and staff in treatment centers abroad are often far more accessible than their U.S. counterparts. “My surgeon gave me his cell phone number, and I spoke directly with him at least a dozen times during my stay,” said David P., who traveled to Bangkok for a heart valve replacement procedure.
Even the most robust health insurance plans exclude a variety of conditions and treatments. You, the policyholder, must pay these expenses out of pocket. Although health insurance policies vary according to the underwriter and individual, your plan probably excludes such treatments as cosmetic surgeries, dental care, vision treatments, reproductive/infertility procedures, certain non emergency cardiovascular and orthopedic surgeries, weight loss and substance abuse rehabilitation programs as well as prosthetics. In addition, many policies place restrictions on prescriptions, which can be quite expensive, as well as post operative care, congenital disorders and pre-existing conditions.
Facing increasingly expensive costs at home, nearly 40 percent of American health travelers hit the road for elective treatments. In countries such as Costa Rica, Singapore, Dubai, and Thailand, this trend has spawned entire industries, offering excellent treatment and ancillary facilities at costs far lower than U.S. prices.
SPECIALTY TREATMENTS
Some procedures and prescriptions are simply not allowed in this country. Either Congress or the FDA has specifically disallowed a certain procedure, or perhaps it’s still in the testing and clinical trials stage or was only recently approved. Such treatments are often offered abroad. One example is an orthopedic procedure known as hip resurfacing. For many patients, this represents a far superior, longer lasting and less expensive alternative to the traditional hip replacement still practiced in the U.S. While this procedure has been performed for more than a decade throughout Europe and Asia, it was only recently approved in the U.S., and the procedure’s availability here remains spotty and unproven. Hundreds of forward thinking Americans, many having suffered years of chronic pain, have found relief in India, where hip resurfacing techniques, materials and instrumentation have been perfected into a routine procedure.
Although traveling abroad for medical care can often be challenging, many patients welcome the chance to blaze a new trail and find the creature comforts offered abroad a welcome relief from the sterile, impersonal hospital environments of many U.S. treatment facilities. For others, simply being in a new and interesting culture lends distraction to an otherwise worrisome, tedious process. Getting away from the myriad obligations of home and professional life can yield healthful effects at a stressful time. What’s more travel—and particularly international travel—can be a life changing experience. You might be humbled by the limousine ride from Indira Gandhi International Airport to a hotel in central New Delhi, struck by the simple, elegant graciousness of professionals and ordinary people in a foreign land or wowed by the sheer beauty of the mountain range outside a dental office window. As one veteran medical traveler put it, “I brought back far more from this trip than a new set of teeth.”
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PLANNING YOUR JOURNEY
If you decide that a medical trip is right for you, research several physicians, clinics or hospitals that offer the treatment you need. Don’t snap up the first option you find. Plan as far in advance as you can as well. Three months lead time is good. Six months is great. But one month is generally not sufficient time.
Here’s why:
• The best overseas physicians are also the busiest. That’s true everywhere. Just as in the U.S., doctors, surgeons and specialists abroad work 24/7, and their schedules are often established a month or more in advance. If you want the most qualified doctor and the best care that your global patient money can buy, give the doctors and treatment centers you select plenty of time to work you into their calendars.
• The lowest international airfares go to those who book early. As veteran international travelers know, out of country prices rise savagely as the departure date draws closer. Last minute fares, reserved for family tragedies, rich jetsetters, and busy corporate executives, are the most punishing of all. Book treatment at least 60 days ahead to avoid this.
If you plan to redeem frequent flyer miles, try to book at least 90 days in advance—even if you’re not 100 percent certain of your treatment date. At this writing, many airlines don’t charge for schedule changes on frequent flyer fares, and you’re better off reserving a date—then changing it later—than being stuck without a reservation at all.
Similarly, for paid fares, it’s usually better to reserve your trip as far in advance as you can, giving your best guess at a schedule. Then, budget in the $100 penalty in the event you need to change your flight itinerary. Before you can book that flight or reserve your hotel room, you must first confirm your treatment appointment. Before you do that, you’ll need to decide which country you want to visit, which physician(s) suit your needs, and more. An organized approach will save you time and money in the end.
THE TWELVEFOLD PATH TO ENLIGHTENED HEALTH TRAVEL PLANNING
The following is culled from hundreds of interviews with patients and treatment center staff members around the world. Follow the steps and advice outlined here and you’ll streamline your planning, select the best physician(s), communicate effectively with staff and agents, save money and pack your bags with confidence.
STEP 1: CONFIRM YOUR TREATMENT OPTIONS
Doctors often recommend a range of choices for a given condition and then leave the choice up to patients and their families. That’s wise, because your body is your own, and no one except you can or should make such vital decisions. Most physicians respect their patient’s autonomy. That’s why they usually stop short of advising you on a specific course of treatment.
If you have doubts about your diagnosis or feel dissatisfaction with your relationship with your physician or specialist, don’t be timid about seeking a second—or even third—opinion. At the very least, a second opinion expands your knowledge base about your condition. The more you and your hometown health team learn about— and discuss—your condition, diagnosis, and treatment options, the more precisely and confidently you’ll communicate with your overseas practitioners.
As you sort through treatment options and consider courses of action, learn as much as you can about your condition. You’ll get better care from your overseas practitioners if you are a knowledgeable and responsive patient. Request copies of all local consultations and recommendations in writing, along with cost estimates for treatment. Then begin a file for all paperwork related to your treatment and travel.
Note: To become the best possible patient—both at home and abroad—we highly recommend you buy, beg, or borrow and read—cover to cover—You: The Smart Patient: An Insider’s Handbook for Getting the Best Treatment by Michael F. Roizen and Mehmet C. Oz. These two physicians have written a witty, often irreverent, and highly useful guide to becoming an informed patient, whether in your doctor’s office or dentist’s chair, on the surgeon’s table or in an emergency room. This 400 page consumer bible is packed with information on patients’ rights, surgical precautions, second and third opinions, health insurance plans, health records and precautionary advice.
STEP 2: NARROW YOUR DESTINATIONS
Once you’ve determined the treatment you’re seeking, locate the destinations that offer it. (See chart below) Your search will likely produce a dozen or so places that offer, for example, excellent dental care. Great! Choice is good.You will now want to narrow your search based on your circumstance and personal preferences. For example, if you have a choice in travel times, you may prefer a cooler climate in Eastern Europe over the coastal humidity of Cape Town, South Africa. Or perhaps you speak a little Spanish and are more comfortable conversing with Costa Ricans than Croatians. For sheer travel convenience, a patient living in California or Oregon may prefer Mexico as a destination for dental treatment, while Costa Rica makes more sense to a Florida or Georgia resident.
The point is to narrow your options based on your travel preferences, geography, budget, time requirements and other relevant variables. To help you narrow your options, ask yourself these questions:
• When do I want—or need—to travel?
• If I’m taking a companion, when can he or she travel?
• Can I sit through a 10 hour flight? An 18 hour flight?
• Do I have a preference for a hotter or cooler climate?
• If I’m planning on leisure activities while abroad, what types most interest me? Hiking? Museum hopping? Shopping? Beaches? Night Life?
• How much cultural diversity can I tolerate?
FOR BIG SURGERIES, THINK BIG
If you’re heading abroad for a liposuction or tooth whitening, you can skip this. However, if you’re going under the knife for
• open heart surgery
• any type of transplant
• invasive cancer treatment
• orthopedic surgery (including knee or hip replacement)
• spinal surgery
you want to be certain you’re getting the best.Your life is at stake. For big surgeries, you should head to the big hospitals that have performed large numbers of exactly your kind of procedure, with the accreditation numbers and success ratios to prove it. A Joint Commission International [JCI] accredited hospital—such as Apollo in Chennai or Bumrungrad in Bangkok—carries the necessary staff, medical talent, administrative infrastructure, expensive instrumentation and institutional follow up needed to pull off a complex, larger surgery. They make it look easy. They’ve done thousands of operations like yours. It’s almost routine. You want that.
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THE WHAT AND WHY OF JCI
When you walk into a hospital or clinic in the U.S., chances are good it’s “accredited,” meaning that it’s in compliance with standards and “good practices” set by an independent accreditation agency. In the U.S., by far the largest and most respected accreditation agency is JCAHO, the Joint Commission on Accreditation of Healthcare Organizations.
The commission casts a wide net of approval for hospitals, clinics, home health care, ambulatory services and a host of other healthcare facilities and services throughout this country. Responding to a global demand for accreditation standards, the Joint Commission launched its international affiliate accreditation agency in 1999, the Joint Commission International. In order to be accredited, an international healthcare provider must meet the same set of rigorous standards set forth in the U.S. by JCAHO. At this writing, nearly 100 hospitals outside the U.S. have been JCI approved, with more coming on board each month. JCI’s website carries far more information than you’ll ever want to explore on accreditation standards and procedures.
A note about ISO: When researching hospitals and clinics abroad, you’ll often come across the phrase “ISO accredited.” Based in Geneva, Switzerland, the International Organization for Standardization is a 157 country network of national standards institutes that approves and accredits a wide range of product and service sectors worldwide, including hospitals and clinics. ISO mostly oversees facilities and administration, not healthcare procedures, practices, and methods. Thus, while ISO accreditation is good to see, it’s of limited value in terms of your treatment.
Be sure to ask about success and morbidity rates for your particular procedure; find out how they compare with those in the U.S. Finally, ask your surgeon how many surgeries of exactly your procedure he or she has performed in the past two years. While there are no set standards, fewer than ten is not so good. More than 50 is much better.
STEP 3: ENGAGE A GREAT HEALTH TRAVEL AGENT
Good news: If you don’t want to do all the planning, research and travel arrangements yourself, you can secure the services of a health travel planner. A qualified agent is usually a specialist in a given region or treatment, with the best doctors, accommodations, and in country contacts at their fingertips.
Once you’ve settled on your health travel destination, it pays to seek out the services of that locale’s best health travel agent. Agents usually pay for themselves and are well worth the relatively modest fees they typically charge. The better health travel agents do all the work of a traditional travel agent and more, including some or all of the following:
Match you with the appropriate clinic and physician(s): In addition to weeding out bad apples, the best agents have years of experience with treatment centers, physicians and staffs, and are in a position to find the best fit among a variety of choices. Because the agency’s success depends on references from satisfied customers, top agents work hard to make the physician patient relationship a good match from the start.
Arrange and confirm appointments. Once you’ve selected or approved a physician, the agent can handle the details of making appointments for consultations, tests and treatment. Agents know all the assistants and aides; they can push the right buttons to fast track your arrangements.
Expedite the transfer of your medical information. Your agent can work with you and your physicians at home and abroad to relay medical data, including history, xrays, test results, recommendations and other documentation. Agents can help you get data into the right format for emailing or help you determine the best way to ship documents.
Book air travel. Agents sometimes have arrangements with airlines for good deals on airfares, and booking international flights is usually a standard part of an agent’s service offering.
Obtain visas. For a relatively modest fee, a health travel agent can help you avoid the hassles of purchasing a visa (if required), update your passport, procure tourist cards and hound the appropriate embassy for service.
Reserve lodging and other accommodations. These folks can work with your budget and lifestyle preferences to put you in touch with hotels closest to your treatment center; they’ll often book reservations and arrange amenities such as private nursing care. Many agents have forged partnerships with hotels for discounted rates.
Arrange in country transportation. Most agencies either provide transportation from the airport to your hotel or treatment center, or they work directly with the hotel or hospital to arrange transport. If transport is required between your hotel and treatment center, they’ll also help with arrangements.
Help manage post treatment procedures. Agents can be hugely helpful at the point of discharge from your treatment center, ensuring that your exit paperwork and other documentation are in order. Help with recovery and recuperation. Little publicized and often overlooked are the recovery resorts, surgical retreats and recuperation hotels that can make a week or two of post treatment more bearable—sometimes even enjoyable. Agents know all about facilities in their area and work in close partnership with the better ones. The international travel services coordinator at your hospital can also help on this front.
Help with leisure activity planning. If you and your companion are up for a pre or post treatment trip, most agents offer assistance with side trips, car rentals, hotels, restaurants, and other travel amenities.
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STEP 4: CHOOSE A RELIABLE, CAPABLE— AND FUN!—COMPANION
Folks who journey to far flung places for medical treatment fare much better with a companion than if they go solo. Whether a mate or friend or family member, the right companion can provide great help and support before, during and after treatment. Together, you two may also add in some fun and adventure when your health permits.
Most health travelers choose either a good friend or spouse as companion. If you have the luxury of choice, make sure you’re not packing a lot of emotional baggage for the trip. The successful medical journey requires large and prolonged doses of support. In an ideal world, you should get on fabulously with your capable, reliable and fun companion. He or she should have good organizational skills and remind you to bug the travel agency for your passport renewal application, help you organize and email your medical documentation, keep track of your in country appointments, monitor your post treatment prescription regimen, encourage you to follow your doctor’s orders, and assist with myriad other tasks that call for sustained bouts of left brain activity. Remember to be as supportive and complimentary of your companion as you can possibly be. Your companion is a treasure. Cherish the relationship.
If you’ve already found a willing and able companion, you are blessed. Be sure to involve him or her in the early planning stages. That’s the best way to cement the relationship and to learn at the outset if you’ll be compatible. Ask your companion to accompany you to the doctor, help with second opinions and make initial international inquiries. You’ll begin to work as a team. If you don’t feel comfortable at the early stages, find a cordial, diplomatic way to part company
STEP 5: FIND DR. RIGHT
For most folks considering a medical trip abroad, this step is the most challenging—and perhaps the most emotionally charged. Yet if you follow a few basics and caveats, you’ll find the process far less mysterious and daunting. Remember, the final choice in selecting a physician—like the decision whether to travel at all— remains in your hands.
Here are some tips to aid you in your search: Insist on English. While this advice may sound provincial and harshly xenophobic, if English is your only tongue, then insist that the parties you’re working with speak only English. Your health is too important to risk important information getting lost in translation.
Don’t settle for poor English. Do your best to listen and understand, but if you find yourself constantly asking people to repeat themselves, don’t blame yourself. Hospitals, clinics, and agents who cater to an international clientele will have English speaking staff. If not, then apologize graciously for your lack of language skills and move on.
Seek Dr. Right, not Dr. Personality. OK, if a practitioner candidate is downright rude to you, then move on, but otherwise, give your physician some “personality latitude” at least initially. Focus on skill sets, credentials, and accreditations, not charm.
Even in this country, many of the finest medical practitioners are technicians. While they may love what they do and be quite good at their chosen specialty, their personal presentation skills may be lacking. This is doubly true where language and culture create additional social awkwardness.
Use your judgment and give the charm factor—or lack of it—the benefit of the doubt. If credentials and other criteria check out, and if you’re otherwise comfortable with your choice, then charm and personality can probably take a back seat.
Expect good service. Although patience is often required when corresponding with international healthcare providers, rudeness should never be excused, and no culture condones it. If anything, you’re likely to encounter greater courtesy and graciousness abroad than here. If parties on the other end appear rude or indifferent, move on.
In corresponding with hospitals and clinics overseas, you will often find yourself directly in contact with your physician or surgeon. The good news is that you’re engaged in a real dialogue with the professional who will be treating you. The downside is that he or she is probably very busy. Expect delays—sometimes two or three days—between email exchanges. If longer, then politely, but firmly, request a response.
Ten “Must Ask” Questions for Your Physician Candidate
Make the following initial inquiries, either of your health travel agent or the physician(s) you’re interviewing. Note that for some of these questions, there’s no right or wrong answer. Your initial round of inquiry will help establish a dialogue. If the doctor is evasive, hurried, or frequently interrupted, or if you can’t understand his or her English, then either dig deeper or move on.
1) What are your credentials? Where did you receive your medical degree? Where was your internship? What types of continuing education workshops have you attended recently? The right international physician either has credentials posted on the Web or will be happy to email you a complete CV.
2) How many patients do you see each month? Hopefully, more than 50 and less than 500. The physician who says, “I don’t know,” should make you suspicious. Doctors should be in touch with their customer base and have such information readily available.
3) To what associations do you belong? Any worthwhile physician or surgeon is a member of at least one medical association. Particularly in areas where formal accreditation is weak, your practitioner should be keeping good company with others in the field. For example, if you’re seeking cosmetic surgery in Mexico, your surgeon should be a member of the Mexican Association of Plastic, Reconstructive and Aesthetic Surgery. It’s also a plus to see physicians who are members of, or affiliated with, American medical or dental associations.
4) How many patients have you treated who have had my condition? There’s safety in numbers, and you’ll want to know them. Find out how many general procedures your hospital has performed. Ask how many of your specific treatments for your specific condition your doctor has personally conducted. While numbers vary according to procedure, five cases is not enough. Somewhere between 50 and 200 is more like it.
5) What are the fees for your initial consultation? Answers will vary, and you should compare prices with other physicians you interview. Some consultations are free; some are deducted from the bill, should you choose to be treated by that physician; some are a straight nonrefundable fee. In any event, it pays to have this information in advance.
6) May I call you on your cell phone before, during and after treatment? Direct and personal access to your doctor is foreign to the American experience. Yet most international physicians stay in close, direct contact with their patients, and cell phones are their tools of choice. When physicians aren’t treating patients, you’ll find cells or headsets glued to their ears.
7) What medical and personal health records do you need to assess my condition and treatment? Most physicians require such basics as: recent notes and recommendations from consultations with your local physician or specialists, x-rays directly related to your condition, patient history and other health records. Be wary of the physician who requires no personal paperwork.
8) Do you practice alone or with others in a clinic or hospital? “Safety in numbers” is a good bet on this front. Look for a physician who practices among a group of certified professionals with a broad range of related skills. For example, your initial consultation might reveal that you need a dental implant instead of bridgework, and it just so happens that Dr. Guerrero down the hall is one of the country’s leading implantologists. Or, on a return visit, your regular doctor is on vacation, but Dr. Cho who’s available in the clinic can access your history and records, check your progress and help you determine your next steps.
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Prior to surgery:
9) Who’s holding the knife during my procedure? Do you do the surgery yourself, or do you have assistants do the surgery? This is one area where delegation isn’t desirable. You want specific assurances that all the trouble you went through to find the right surgeon isn’t wasted because the procedure is actually being performed by your practitioner’s able protégé.
10) Are you the physician who oversees my entire treatment, including pre-surgery, surgery, prescriptions, physical therapy recommendations, and post surgery checkups? For larger surgical procedures, you want the designated team captain. While that’s usually the surgeon, check to make sure.
STEP 6: GET TO KNOW YOUR HOSPITAL OR CLINIC
Before you start booking air travel and accommodations or planning the more relaxing parts of the trip, do some sleuthing, beginning with your treatment center. Although detail driven, this investigation is not as daunting as it sounds, and most of your research involves simple fact checking. Here’s what to do and how:
Check hospital accreditation. If you’re looking into a treatment that requires hospital care, check to see whether the center is JCI accredited. While JCI accreditation is not essential, it’s an important new benchmark and the only official American seal of approval. Learning that your treatment center is JCI approved lends a comfort to the process, and the remainder of your searching and checking need not be as rigorous. That said, many excellent hospitals abroad, while not JCI approved, have received local accreditation at the same levels as American approved treatment centers.
Check for affiliations and partnerships. Did you know that many of the best overseas hospitals enjoy close partnerships with universities and U.S. medical centers? For example, Gleneagles Hospital in Singapore has a working partnership and information exchange program with Johns Hopkins Hospital in Baltimore. Similarly, Malaysia’s Pantai Medical Center has forged working partnerships with Duke University Medical Center and the Cleveland Clinic.
Learn about success rates. Although smaller clinics don’t offer such information, the larger and more established hospitals freely publish their “success rates” or “morbidity rates.” These are usually calculated as a ratio of successful operations achieved to overall number of operations performed.
For larger surgeries (such as cardiovascular and orthopedic), success rates of 98 plus percent are on par with those found in the U.S. For the more common surgeries, you should further investigate any rates under 98 percent.
Learn about number of surgeries. Most large hospitals will happily furnish information on numbers of surgeries performed. Generally, the more the better, for there’s safety in numbers on this front. For example, the Manipal Heart Hospital in Bangalore, India, has performed more than 14,000 cardiac surgeries in the past five years, with a success rate of 98.8 percent. You will rest easier on your outbound flight knowing that your destination hospital has performed large numbers of procedures with high success rates.
STEP 7: FOLLOW UP WITH CREDENTIALS
Once you’ve located one or two competent physicians, be sure to obtain their resumes. Many physicians post such data on the Web. If yours don’t, then request that your doctors or your health travel agent send you full background information, including education, degrees, areas of specialty, number of years in practice, number of patients served, and association memberships.
Get references, recommendations, and referrals. If possible, speak with some of the doctor’s former patients to get their feedback. Understandably, many former patients wish their privacy respected, and international law protects us all in that regard. Thus, it’s often difficult for a physician to put you in direct contact with a former patient.
If you’re unable to talk with former patients, ask your physician to provide you with testimonials, newspaper or magazine articles, and letters of recommendation—in short, anything credible that will help assess this individual’s expertise. If you’re using the services of a health travel agency, ask your representative to check credentials and background of physicians to help you narrow your search.
Specifically, here’s what you’re looking for: Education. Universities, medical schools attended, degrees held and when awarded. Any special achievement awards or honors.
Certification. Exactly what is this physician licensed to practice? If you’re having implants done, then you want a certified implantologist’s fingers in your mouth.
Professional history. How long has he or she been practicing, and where? If a surgeon, how many surgeries have been performed, and what types of procedures? Information on presentations, publications, honors, and awards gained along the career path will help you evaluate a doctor’s talent, performance, and commitment to his trade.
Affiliations. With what medical and related associations are your physician affiliated? Information about community involvement is useful as well.
Continuing education. Mandatory in many countries, continuing education helps a physician stay abreast of new trends in his or her field. Most good physicians travel at least once a year to accredited conferences and workshops. Find out where your doctor goes and how often.
Patient references and letters of recommendation. Nearly as useful as professional histories are reference letters or letters of recommendation from patients, colleagues, or other credible sources.
If you’ve not engaged the services of a health travel agent, ask your physician or medical staff to email you a copy of your doctor’s resume or CV. If you want to take your search a step further, contact the universities, associations, and references listed in the resume to verify authenticity.
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STEP 8: GATHER YOUR MEDICAL RECORDS AND CONSULTATION DATA
Once you’ve established a relationship or scheduled a consultation with one or more overseas physicians, they’ll probably ask to see supporting information. Such data usually include the following:
• reports or written recommendations made by your local specialist related to your condition
• x-rays or imaging reports from your specialist’s office or your radiology lab
• test results from your specialist’s office or third party laboratories
Depending upon your treatment, some physicians may ask for additional data, including your general medical history, health record, or pathology reports from previous treatments.
Some patients are timid about requesting health information from their doctors. If you’re one of those people, it’s important for you to know that as of April 2003, any physician, surgeon, specialist, hospital, or laboratory you visit is required by law to provide you copies of any and all medical information they’ve compiled about you. These data include consent forms, consultation records, lab reports, test results, x-rays, immunization history, and any other information compiled as a result of your visits. Although most won’t, your doctor or laboratory has the right to charge you a nominal fee for making copies.
These days, more and more medical information is going digital, particularly all important x-rays and other imaging data. When you request your medical records, ask staff to email you the data in digital form and to provide you with a hard copy as well. If you can obtain only hard copy documents, then have them scanned. If you’re uncomfortable with technology and computers, perhaps your companion or friend or family member can tweak the paperwork into computer files into the form of an electronic file (scanning is not time consuming for those who know how to do it). A full service copy shop or office supply center can convert hard copy paperwork to digital files for a nominal fee, and you’ll save real money over international courier rates if you transmit via email. Overseas physicians generally prefer digital records, particularly x-rays, which are easier to study and manipulate.
STEP 9: PLAN YOUR RECUPERATION AND RECOVERY
For patients abroad, the days or weeks you spend post treatment can be particularly difficult. Perhaps you’ve been on the road vacationing prior to treatment, and you’re ready to head home. Or seemingly urgent work challenges are piling up back at the office. Or you’re just feeling far away and becoming homesick. Any surgeon, dentist, or other medical specialist can tell you that if complications are to develop, they’re most likely to occur in the first few days following treatment.
That’s the time when your body is doing everything it can to compensate for the stress and trauma of your treatment. Rest and a healthful lifestyle are essential during recovery, but in these busy, overworked times, many people don’t take recuperation as seriously as they should. At the first glimmer of normalcy, we’re off and running again.
Do yourself and your loved ones a big favor: follow your doctor’s post treatment orders, allowing your body and spirit time to return to health. It’s not that much more time out of your life. For extensive dental work, recovery is usually a matter of a few days. Even the more invasive surgeries have you back to something approaching normalcy within a couple of weeks.
You might be surprised—and encouraged—to learn that many international health travelers enjoy recovery and recuperation accommodations not available in the US. Recovery resorts, surgical retreats, hospital residences, and a host of other options are available in many of the destinations featured in this book. Services offered include:
• on-site medical staff to assist with bathing, getting in and out of bed, physical therapy, medication, & more
• gyms and other accommodations for physical therapy and daily exercise
• room service for meals and laundry
• Internet access
• liaison with hospital
Another big plus for recovery accommodations is the company you keep. The guests are people like you who have recently undergone treatment. There’s comfort in sharing experiences, and dinner table conversations with fellow patients can yield a wealth of medical tips and travel advice. If recovery retreats are not offered in your region of choice, ask your health travel planner or hospital for recommendations on hotels or apartments nearby.
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STEP 10: CREATE YOUR HEALTH TRAVEL VACATION
For most health travelers, vacations take a back seat to treatment and recovery. Many simply don’t have the time or the motivation to tack a vacation onto an already time consuming health travel trip. Some patients require more invasive procedures with longer recovery and the planning alone (not to mention the usual discomforts of recuperation) knock a beached whale Riviera jaunt clean out of the picture.
Medical travelers planning for less demanding treatments, such as light cosmetic surgery or nonsurgical dentistry, should take a brief inventory of their treatment schedule and time requirements. Ask the following questions:
• How many appointments does my treatment require?
• How long is my expected recuperation period?
• How long need I remain near my treatment center during my stay?
Unexpected tests, appointment reshuffles, and travel delays can eat up leisure time. As a rule, the treatment part of your trip will probably be three or four days longer than your appointment schedule indicates.
Whether you can work in a vacation or not, the most important consideration is your health. Focus on your treatment and try not to bite off too much. Remember that you can always take that vacation later, happily spending the money you saved by being treated abroad.
STEP 11. BE TRUE TO YOUR BUDGET
Be sure also to give your health travel representative a good idea of your budget. You might be surprised to learn that hotel rooms in developing countries can cost as much as the best accommodations in New York. Confirm rates and amenities before pulling out your credit card.
The same holds true for airfares. First-class and business-class fares are usually quite punishing; they’re reserved for jetsetters, corporate executives, and frequent flyers. If you don’t mind traveling coach or economy class, you’ll save a bundle.
If you’re making your travel plans on your own, ask your physician to recommend some hotels nearby. Some of the larger hospitals have partnerships with hotels at discounted rates. Such information is often posted on their Web sites.
Just Ask
When it comes to asking for special assistance from the airlines, many travelers believe they must be severely handicapped to request a wheelchair or some other service. And some folks are just shy about asking for help or embarrassed to be wheeled around airport corridors and jetways.
Get over it! If you’re heading to India for hip surgery and you’ve been in chronic pain for three years, there’s no shame in requesting a wheelchair, and every airline company we contacted ministers happily to medical travelers. In the same vein, if you’re still feeling the effects of surgery on the return trip, it’s perfectly reasonable to request wheelchair assistance.
Airlines ask that you or your companion request a wheelchair 48 hours prior to the trip. Then, when you arrive at the airport, check in with the skycap at curbside, where a wheelchair is usually nearby. Remember to tip folks who assist you a few dollars; they’ll appreciate the gesture and remember you the next time your paths cross.
STEP 12: TRIPLE CHECK DETAILS AND DOCUMENTS
In addition to ensuring that the kids, dog, and other loved ones are looked after in your absence, it’s crucial on a medical trip to remember to take everything that you and your companion will need. Unlike forgetting your favorite tie or blouse, leaving important documents behind can create unnecessary hassles on the other side of the world. Make sure you have all your paperwork in order, including travel itinerary, airline tickets or etickets, passports, visa, immunization records, and plenty of cash for airport taxes and other unexpected expenses. Be sure to pack all medical records, consultation notes, agreements, and hard copies of email correspondence. Also remember to take the telephone numbers, fax numbers, and email addresses of all your contacts, at home as well as in country.
Pack Smart
You’ve likely heard the cardinal rule of international travel: pack light. Less to carry, less to lose. Don’t worry if you leave behind some basic item like shampoo or a comb. Once abroad you can always buy essential items you may have forgotten, and picking up socks or toothpaste is a great excuse for you or your companion to hit the local market.
That said, below are several items you absolutely, positively shouldn’t forget:
• Passport
• Visa (if required)
• ATM card or travelers’ checks, plus enough cash to handle unexpected expenses
• Prescriptions you’re taking
• Hard to find over the counter drugs you’re taking
• Alcohol based hand sanitizing gel (for cleaning hands while traveling)
• Your medical records, current x-rays, consultations, and notes
• Phone numbers, postal addresses, and email addresses of people you need or want to contact at home or in country
