07 Aug (N Y TIMES) – As health care costs in the United States rise, an increasing number of Americans are going overseas for elective procedures, or are at least considering that possibility. In response to an article in The New York Times on Sunday about an American who went to Belgium to have his hip replaced because his insurer in the United States would not cover the procedure, hundreds of readers said they would be willing to follow that path.
Michael Shopenn’s surgery in 2007 would have cost close to $100,000 in the United States. But it cost just $13,660 — including all medicine, doctors’ fees and round-trip airfare — at a private hospital in Torhout, Belgium. The Belgian government regulates medical fees, though most doctors’ offices and hospitals are privately run.
“In the past few years, Americans are definitely more willing to go overseas and now appreciate that there is quality there, whereas seven years ago they didn’t have that perception,” said Jonathan Edelheit, the chief executive of the Medical Tourism Association, an industry group that supports and facilitates such travel.
The growing numbers of American medical tourists tend to be people who do not have insurance or whose insurance does not adequately cover the procedure they need. Their destination often depends on their cultural ties, Mr. Edelheit said. Spanish-speaking patients might favor Latin America, for example, he said.
While five years ago most American patients who went abroad for cheaper care went to countries like India and Thailand and over the border to Mexico, many are now going to Europe, where care at top hospitals frequently costs a fraction of what is charged in the United States. There are private facilitators who help make the arrangements, pairing patients with doctors and hospitals and arranging travel plans.
In the last few years, governments and hospitals in Europe have entered the field and are now promoting their services.
“The idea is to make it easier for patients from overseas — whether from North America, Russia or the Middle East — to see Europe as a solution because of its high quality and reasonable prices,” said Balazs Stumpf-Biro, the executive director of the European Medical Travel Alliance, an industry group.
People from the East Coast tend to head to Europe, while many from the West Coast go to Asian countries like South Korea or Thailand, Mr. Stumpf-Biro said. “The numbers are really growing because of the costs in the U.S.,” he added, “but the main driving factor is quality and a common background.”
Dr. Fabrice Gaudot, an orthopedist with a private practice in Paris, said that his clinic treated a lot of foreigners and that the total price for a hip replacement was about $13,000, which he called expensive by French standards. Implant prices are about one-fifth as much in France as in the United States, he said. The patient and the doctor settle on a price and by law must sign a contract before surgery.
Hospitals in English-speaking countries offer an obvious advantage for Americans. A consortium of hospitals and health care providers in Northern Ireland is exploring setting up a program to attract and treat foreign patients.
But before readers start booking tickets to Europe, they should know that several programs are in the works to lower the cost of joint replacement surgery in the United States. With a huge increase in demand for joint replacements as baby boomers age, holding down costs is important to companies as well as patients.
The average price of a hip replacement rose from about $35,000 in 2001 to about $65,000 in 2011, according to Truven Health Analytics. The number of such procedures each year for patients under 65, paid for by commercial insurers, rose to about 90,000 from less than 30,000.
The California Public Employees’ Retirement System set a so-called reference price of $30,000 for joint replacement surgery for those it covers. If patients choose a hospital that charges more, they must pay the difference.
A study by James C. Robinson, a health economist at the University of California, Berkeley, that was published on Monday in the journal Health Affairs found that the program was a two-pronged success: a majority of patients chose hospitals that met the price. More important, many hospitals reduced their price so patients would be more likely to choose them. In two years, the program saved California $6 million and saved patients $600,000 in costs and co-pays, Dr. Robinson said.
Medical tourism, it turns out, does not have to be international. (Medicare does not currently cover joint replacements outside the United States.) Some economists point out that health plans in New York City, a relatively expensive market, could save money by sending their patients to Buffalo in limousines.
Services like MediBid allow patients to shop online for lower-priced medical care, whether local or in another state. Ralph Weber, the chief executive of MediBid, said the service recently sent a patient to Glendale, Calif., for a hip replacement for $14,450 and another to San Antonio for $19,000 — comparable to European rates.
“When companies make a large purchase of machines, they ask for a few bids, but that doesn’t normally happen in medicine,” Mr. Weber said. “When providers have to compete with transparency, the rates come in lower.”