The Pros and Cons of "Off-Shore” Medicine

In years past, "medical tourism" referred mainly to the practice of bringing people from foreign countries to the US for high-quality medical care. In recent years, the term has assumed a new definition, as US citizens leave the country for more affordable surgery and other treatments. Hundreds of thousands of Americans are seeking foreign medical care each year, and this trend is expected to grow as US insurance companies consider covering "off-shore" medicine. But before you jump on a plane, here are some important points to consider…

Is it safe? Americans have long assumed that foreign medical care is more dangerous than that offered here at home. But high-quality medical care can be found in many places throughout the world. The Joint Commission on the Accreditation of Healthcare Organizations, the private group that accredits hospitals in the US, has an international branch (www. jointcommissioninternational.org) that accredits foreign hospitals. If you are thinking about going abroad for medical care, make sure that the facility you are considering has been accredited by the joint commission. Also, check on the training of the doctors who would be caring for you. Look for physicians who were educated at US medical schools and completed a residency in their area of specialty at a US hospital. This is not a guarantee that you will receive high-quality care, but it does give you some reassurance because it is easier to check the reputation of medical schools and residency programs in the US.
Will I really save money? Med Solution (www.medsolution.com), a Canadian medical tourism firm, recently released these comparisons of costs…
Hip replacement-$40,000 in North America, $15,000 in France and $5,800 in India…
Coronary angioplasty-$35,000 in North America, $18,-100 in France and $3,700 in India.

Many people going abroad for face-lifts and other cosmetic procedures are paying 30% to 50% of US prices.

Do I have all the facts? It's usually best to use a medical-tourism firm. To find one, search the term "medical tourism" on the Internet and/or consult the informational Web site www.medicaltourismguide.org The firm you select will ask for your medical records to review, and you will then be matched with a doctor and hospital. These firms handle all the details, including travel and hotel arrangements. But make sure you get references for the firm (check for complaints with the Better Business Bureau or the attorney general's office in the firm's home state) as well as the hospital and doctors they recommend to you ask the firm for contact information for patients treated at these medical facilities).

Buyer beware: If something goes wrong with your overseas medical care, emergency treatment will be provided (your insurance probably won't cover the cost, though). Also, you have no legal recourse in the US against the overseas provider. Each country has its own malpractice laws. Most are not as protective as those in the US. Very few foreign hospitals or doctors will be of much help to you once you return to the US. Make sure that you have a doctor here who is ready to provide follow-up care.

Six Ways to Survive Your Hospital Stay

I recently had to put all my years of experience as a medical-consumer advocate to the test when I found myself in the hospital recuperating from surgery for an enlarged prostate gland. My surgery was a success—in part because I chose a surgeon who had done the procedure, a transurethral resection of the prostate (TURP), more than 1,000 times. But my hospital stay went without major incident also because I knew what to do to avoid problems. Here's what you—or a loved one-can do to have an equally successful hospital stay…

Bring a list of your medications. I always advise people to bring a list of all their medications and the dosages—when they go to the doctor, but the same applies if you're headed to the hospital. Coming prepared with your medication list is one of the best steps you can take to protect yourself against medication errors. I brought my medication list and kept it on the adjustable table by my bedside. One nurse thanked me and used it to be sure that her records were correct.
Hang signs. The 84-year-old man in the bed next to mine was nearly deaf and couldn't understand the questions that the doctors and nurses asked him. He would just nod and say "yes" to everything. When I realized this was happening, I made a sign with bold print that read, "You have to speak directly into my ear!" and hung it on the wall above his head. It worked. Once my roommate was able to hear the staff, they got real answers. You can make a sign for a variety of messages, such as "Contact my son/daughter and give phone number) for any medical permissions."
Use the phone. One night, I needed the nurse but was getting no response when I pushed the call button. I waited 20 minutes and finally picked up the phone, dialed "0" and asked for the nurses' station on my unit. A nurse answered on the first ring. I asked her to come to my room, and she showed up about 10 seconds later. I never had a problem again when I pushed the call button.
Bring earplugs. Hospitals are noisy places. Knowing this, I brought earplugs with me and slept peacefully. A portable music player with earphones or noise-canceling headphones can provide the same escape.
Call home. Twice during my three-day hospitalization, my doctor visited when no one from my family was around. So when my doctor entered the room, I got on the phone, called my wife and had the doctor talk to her at the same time he was talking to me. This is the best way to keep your family informed, and it is especially helpful if you are not feeling well or need someone to ask questions for you.
Check the bill. I received a bill from the hospital that said I owed $2,600. I knew this was wrong. By going over the itemized bill (which I had requested at my discharge), I discovered that I had been inadvertently charged for services received by another patient. Because I was diligent and made a lot of calls, the insurer found the error. Since an estimated 85% of all hospital bills have errors in them, it's buyer beware!