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Ticket to treatment

Foreign countries offer Americans a growing menu of sophisticated and relatively cheap medical care

November 02, 2008|Marla Dickerson | Dickerson is a Times staff writer.

Monterrey, Mexico — When Andy Dijak injured his right knee playing tennis, he wasn't surprised that he needed surgery. "It swelled up like a balloon," said the 50-year-old West Lake resident.

The real shocker was the price tag: $12,000 to $15,000 to repair tattered cartilage. Dijak, a creative director for an entertainment company, has no health insurance, so he started shopping for a deal.

He found it in the northern Mexico city of Monterrey at Christus Muguerza High Specialty Hospital, owned by Dallas-based Christus Health. Here, the staff treated him more like a big shot than a bargain hunter. An English-speaking employee picked him up at the airport. Dijak recuperated in a private hospital room with a flat-screen television and a view of the peaks of the Sierra Madre. His surgeon recorded the operation on video and gave Dijak a DVD copy for his peace of mind.

Total cost, including airfare: $4,500.

"I got better care there than I would have in the United States, unless I were a billionaire," he said.

Americans have long been willing to leave the country for bargain face-lifts and cut-rate dentistry. But now the availability of top-notch medical services at low cost is enticing a growing number of U.S. patients to developing nations for more sophisticated procedures. Most, like Dijak, are obtaining elective surgeries for ailments that aren't life-threatening. Increasingly, they are seeking treatment for more serious conditions, including heart maladies and cancer.

Last year, 750,000 Americans traveled abroad for care, according to estimates by the Deloitte Center for Health Solutions, a Washington-based research center that's part of the consulting firm Deloitte & Touche. Other analysts say the numbers are lower. But hardly anyone disputes that medical care, once a highly local business, is going global like never before. By 2010, Deloitte projects, 6 million consumers a year will venture outside the United States for medical treatment.

The idea of jetting off to India for heart surgery might strike some as a radical way to save money. But proponents say it's a logical outgrowth of the globalization that's reshaping the industry.

Already, offshore firms handle Americans' medical records and read their X-rays. Top U.S. hospitals such as Johns Hopkins have established outposts abroad. Rising prosperity in many parts of the developing world is luring foreign-born, U.S.-educated doctors home to practice in modern hospitals catering to increasingly affluent consumers.

Nearly 200 institutions outside the U.S. have been certified by the Joint Commission International, an affiliate of the organization that accredits U.S. hospitals. Medical travel companies are springing up to link American patients with foreign providers eager to boost their profits.

Add a rapidly aging U.S. population and a shrinking medical safety net, and the notion of Americans looking elsewhere for treatment no longer seems such a stretch.

"This is going to be one of those things that starts slow and becomes pretty routine 15 years out," said Arnold Milstein, chief physician for Mercer Human Resource Consulting.

The fact that 1 in 6 U.S. residents, nearly 46 million people, lack health insurance is well known. But soaring deductibles and increasing restrictions on coverage are driving even insured consumers to seek alternatives.

Mark Sawko's insurer balked at paying to replace a bum knee the 50-year-old Arizonan injured back in high school. So he called a Tempe, Ariz.-based medical travel company called MedToGo. The firm arranged for him to have surgery last year in Puerto Vallarta, Mexico, where he spent $13,500 instead of the $50,000 quoted by a local orthopedic surgeon.

The owner of a company that makes industrial parts, Sawko competes every day with foreign manufacturers. He sees the same thing happening in medical care.

"I think we're going to lose a lot of business to these other countries," said Sawko, who has returned to playing golf without pain. "I'm American, so I'd like to keep things here. But no one was going to make it affordable for me."

At present, the vast majority of U.S. medical travelers are cash-paying patients such as Sawko. But analysts say that's changing fast as insurance companies and employers add foreign providers to their networks to slow runaway costs.

In Southern California, insurers Aetna, Blue Shield of California, HealthNet and PacifiCare have developed cross-border programs that allow members to seek treatment in Mexico. That means cheaper premiums for employers and smaller co-pays and other out-of-pocket expenses for members.

"A lot of small employers have been priced out of traditional coverage," said Jim Arriola, president of Sekure Healthcare Inc., a Chula Vista, Calif.-based company whose plans cap services at a fixed dollar amount. "That same $1,000 benefit goes a lot further south of the border than it would in the U.S."

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