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HEALTH SENSE

Bon voyage, and get well!

More and more Americans are traveling to foreign countries for surgeries, drawn by lower prices, and side trips to tourist sights. Experts advise patients to do their homework before they go.

Eileen Clemenzi , a 56-year-old hairdresser from Vero Beach, Fla., had a great time in Malaysia this summer. She loved the malls, the beaches, and the attentive service she got from hotel staff, including one sweet bellboy who sent her a jade Buddha after she got back home.

But the best part of her overseas adventure was getting a new hip at Gleneagles Medical Centre in Penang -- a surgical procedure that, with no health insurance and an annual income of $30,000 a year, Clemenzi could never have afforded at home.

``It was a great experience. Oh, my God, the care was great. I could never have gotten a hip any other way," said Clemenzi, who had been in severe pain for two years.

Like Clemenzi, more and more Americans are embracing medical tourism: flying to India, Thailand, Malaysia, Turkey, Brazil, Singapore, and other places for treatment in attractive, sometimes world-class foreign hospitals, often with a resort vacation afterward.

No one knows how many Americans are outsourcing their medical care. And no one, apparently, has kept good data on how well those patients have fared.

The trend began among Americans who are native to those countries, and for people wanting procedures not covered by insurance, such as a facelift. Now, people with inadequate or no insurance are going for more complicated procedures. And insurance companies and employers are beginning to consider the practice as a way to save money.

``The big news," said Robert K. Crone, president of Harvard Medical International, is the fact that Americans are now confident enough in the quality of care to get hip and knee replacements and cardiac surgery thousands of miles from home. ``And the motivation there is clearly financial."

In Clemenzi's case, the whole shebang -- airfare, two weeks in a hotel, plus an $8,000 bill at Gleneagles -- cost about $14,000. Hip replacement surgery in the United States would have run more than $35,000, largely because of higher labor costs.

Her trip was organized by MedRetreat, one of several companies that connect American patients with foreign hospitals and doctors. MedRetreat, of Illinois and Maryland, has worked with about 320 American patients since it opened in 2003. Consumers pay for their airfare and hotel; they also pay 20 percent of the medical bill up front, which goes to MedRetreat, then pay the remaining 80 percent to the hospital and doctors after treatment.

Dr. Naresh Trehan, chief of cardiac surgery at the Escorts Heart Institute in New Delhi, said he can offer cardiac surgery of the same quality he offered for 20 years at New York University for roughly one-fifth of the price. He said his clinic does 4,500 to 5,000 heart procedures a year, including a few dozen operations on Americans who lack health insurance. It's not much different, he said, than when rich Indians used to come to him for surgery in New York -- except now the motivation is economic instead of technological.

David Frazzini , a senior healthcare consultant for Mercer Health & Benefits, a consulting firm, said Mercer is currently ``having conversations with a handful of big employers" including ``at least a few Fortune 500 companies," about the idea of sending employees overseas for care. Frazzini added that ``there is already very strong evidence of large financial reasons to be looking at outsourcing healthcare, and a lot of the other pieces are coming together, too, like international quality accreditation for facilities."

But US Senator Gordon H. Smith, an Oregon Republican, said medical tourism is a sad commentary on the healthcare system.

``Americans should not have to travel overseas to obtain affordable healthcare," Smith said in a statement released at a hearing he held this summer on the issue. Citing Medicare and Medicaid data, Smith noted that the average charge for heart valve surgery in the United States is $115,221, while at Apollo Hospital in Chennai, India, it's $7,000. ``The $108,221 difference is staggering," he noted.

Organized labor worries that workers will be forced to go abroad for medical care and that the practice will eventually cost American jobs.

Not long ago, Stan Johnson , assistant director in District 9 of the United Steelworkers, got wind of the fact that a union member, Carl Garrett , 60, who works as a technician at Blue Ridge Paper Products Inc. in Canton, N.C., was going to go to India for gall bladder and rotator cuff surgery. Worse yet, in Johnson's view, Blue Ridge was providing incentives for him to do it.

``I would have had no co-pay," said Garrett, adding he would also have received 25 percent of the savings the company would realize from sending him abroad for treatment. He was thrilled, as was his fiancée. ``We had gotten our shots, visas, passports, we were packing, buying things to take. Our friends even threw us a beautiful party."

But after the union protested, the company backed down and scratched the trip. Garrett was ``devastated" and said he fears that he alienated his local doctors by planning to go abroad and will now ``have to start all over again at a different hospital with new doctors."

So, should you consider going abroad for an expensive surgical procedure?

The most important thing for anyone thinking about traveling internationally for medical treatment is to check out the prospective hospital and doctors as much as possible by phone or e-mail and look for hospitals -- and surgeons -- that do a high volume of the operation you are considering.

One good way to check out foreign hospitals is to visit the website of the international arm of the Joint Commission on Accreditation of Healthcare Organizations (www.jointcommissioninternational.org). The standards used to rate foreign hospitals are ``as rigorous as here," said Char Hill , a spokeswoman for the group.

Harvard's Crone said accreditation is more of a baseline than a stamp of approval, but he personally vouched for a number of foreign hospitals where he has spent time and is confident that the care is world-class, including the Wockhardt hospitals in Mumbai, Kolkata, and Bangalore, India; the Acibadem hospitals in Istanbul; and Samsung Medical Center, Yonsei University Medical Center, and Seoul National University Hospital in Seoul .

If you're the litigious type, though, don't go abroad for care. Filing a malpractice suit in a country halfway around the world could be a nightmare.

Personally, I was skeptical about the idea of medical tourism until I talked with Dr. Jerome Kassirer, former editor of The New England Journal of Medicine and a man with, presumably, the best medical contacts in Boston.

Kassirer recently had knee replacement surgery that has cost his insurance company about $40,000 so far, he said. If he hadn't had the insurance, he said ``I would have seriously looked at the possibility of having it done [abroad]."

Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com.

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