Going Overseas for Major Surgery — Frugal, Cheap, or…?

I’m pretty familiar with the concept of outsourcing or offshoring—long practiced in business and perhaps increasingly practiced by individuals for personal needs. The World is Flat and all.

But it’s one thing to move your call center abroad. Or to have a virtual assistant abroad answering your e-mails, scheduling vendors to take care of your household chores, or arranging airline or event tickets for you.

It’s another to move your kidney surgery abroad.

So I read with curiosity an SFGate article I found yesterday titled, “More who need major surgery are leaving U.S.”

No official statistics are kept on how many Americans travel overseas for medical care, but one estimate places the number at 150,000 in 2006… [¶] Other trends are more clear-cut. Many Americans are uninsured - nearly 47 million at last count - and others have health insurance that does not adequately cover procedures they desperately want or need.

And the price differentials are quite astounding. The article describes one individual who had dropped his health insurance—right before getting hit by an uninsured driver. The bill for his hip replacement surgery was going to run $30,000. He had the surgery done instead at a hospital in Bangalore. The hospital bill of $8,880, combined with his $1,300 airfare, was still about a third of what the cost would have been in the U.S.!

Here’s a summary of other cost differences outlined in the article, contrasting U.S. prices with prices in India, Thailand, Singapore, and Costa Rica.

Surgery Cost Comparisons
Procedure	U.S.	Outside U.S.
Coronary bypass	$130,000	$6,650-$24,000
Spinal fusion	$62,000	$4,500-$25,000
Angioplasty	$57,000	$5,000-$13,000
Hip replacement	$43,000	$5,800-$12,000
Knee replacement	$40,000	$6,200-$11,000

According to the article, “more patients seem willing to accept that quality of care in some foreign hospitals may be the same or higher as that found on U.S. soil...”

Is that true though?

Well, it could be that Americans were already be losing some confidence in U.S. hospitals in the first place. SmartMoney’s 2006 article, “10 Things Your Hospital Won’t Tell You” outlines several problems with U.S. hospitals, with a few highlights summarized here:

• Errors in treatment are a serious problem in U.S. hospitals, with one report stating 1.5 million patients each year given the wrong drugs.
• Exposure to other infections are also a serious problem in U.S. hospitals, with one report stating about 2 million people each year contract an infection at the hospital (with 90,000 dying).
• Getting the attention of the right person—or the person in charge—can be difficult at U.S. hospitals.
• Even within a U.S. hospital, you could run into problems with your bill. Your insurance may not cover everything or some of the doctors at the hospital may not be in your network, including many important specialists such as anesthesiologists, pathologists, and radiologists. The article also reports that clerical errors in bills to you can and do occur.
• The care at U.S. hospitals varies—both generally and specifically in regards to a particular type of surgery or procedure. The article also recommends staying clear of hospitals in July, “when medical students become interns, interns become residents, and residents become fellows and full-fledged doctors.” Apparently, the “adjusted mortality rate rises 4% in July and August for the average major teaching hospital, according to the National Bureau of Economic Research.”

But the SFGate article notes that American physicians warn that people may underestimate the risks of taking their complex surgery overseas:

"Everything is made in China now. It doesn't have to be that way for health care," said Dr. Robert Klapper, chief of orthopedic surgery at Cedars-Sinai Medical Center in Los Angeles and spokesman for the American Academy of Orthopaedic Surgeons. "You take major risks when you go elsewhere."

Klapper admitted he typically ends up seeing only those who run into trouble but said that such complications happen and that puts local surgeons at a disadvantage because they lack information about the procedure.

I’m not in any position to assess whether the quality of care in some of the countries mentioned is as good as or better than the U.S. It wouldn’t surprise me if it is. But I’d be worried about how well I would be able to communicate with the people giving the care and to where I’d be able to turn if anything went wrong.

Of course, right now, we are able to afford and we buy health insurance—and we’ve never had an issue with needing or wanting a treatment for which there wasn’t sufficient coverage. And even at the reduced prices overseas, it seems to me that many will be higher than your out-of-pocket here, if you are insured. So in the here and now, I can’t imagine making a decision to drop our insurance as a money-saving measure.

But what would we do if we couldn’t afford health insurance—or buying it was stretching us too far? What would you do?