Turn the clock back 15 years and listen to what the experts — healthcare professionals, medical insurers, governments, the media and the travel industry — were saying. Who among them was predicting an imminent international healthcare revolution?

As with most revolutions, ordinary people were the catalyst, catching the establishment off guard. From modest, word-of-mouth beginnings, the medical tourism phenomenon is transforming healthcare in America and across the globe.

In the early 1990s, few Americans contemplated going abroad for medical treatment. But with about 15 percent of the population uninsured and healthcare costs spiraling, the demand for cost-effective alternatives was not being met at home. The Internet enabled individuals to look for treatment worldwide, and a new trend was born. By 2006, about 150,000 Americans opted for cross-border medical treatment; it is estimated that the figure doubled in 2007.

With increasing numbers of overseas hospitals gaining accreditation from the Joint Commission International (the international division of the JCAHO, which scrutinizes U.S. hospitals) and medical insurance companies beginning to cover foreign healthcare, the medical tourism boom is only just beginning. The industry is predicted to reach $40 billion worldwide by 2010.

In his book, Patients Beyond Borders, Josef Woodman writes, “As employers, insurers, hospitals and large third-party players become more involved in global healthcare, the idea of heading abroad for medical care is becoming as ordinary as owning a German or Japanese automobile.”

Few countries have been more proactive in encouraging medical tourists than India, which has introduced a system of medical visas to streamline the entry process. Last year 272,000 foreign nationals took advantage of the visas, a number that is expected to rise by 30 percent each year. India predicts medical tourism earnings of $2.3 billion annually by 2012.

Already about 12 percent of patients in Mumbai’s top private hospitals are foreigners. For Canadians and Britons, who are already served by national healthcare systems, India offers the opportunity to circumvent long waiting times for certain treatments. For Americans, the benefits are largely financial.

A full hip replacement that costs $39,000 in the United States is just $3,000 in India. Gall bladder surgery, usually around $60,000, is $7,500. And a heart bypass operation, $130,000 in the United States, costs $10,000 in India.

Not everyone is in favor of outsourcing complex medical procedures to developing countries. Writing in the London Daily Telegraph, Dr. Richard Dawood, medical director of the Fleet Street Travel Clinic, worries about the risk. “It is not enough that a surgeon, or hospital facility, is adequate for the operation being contemplated; they must be proficient enough to cope with worst-case complications as well, and to be able to offer swift access to state-of-the-art intensive care as and when required.”

Dr. Naresh Trehan, former personal surgeon to the president of India and more recently the chief cardiovascular surgeon at Delhi’s Escorts Hospital, contends that standards in India’s premier hospitals are world-class. “The death rate for coronary bypass patients at Escorts is 0.8 percent and the infection rate is 0.3 percent. This is well below the First World averages of 1.2 percent for death and 1 percent for infections.”

Other concerns include the risk of contracting infections such as hepatitis, HIV or malaria from contaminated blood, the difficulties of recuperation in an alien environment away from friends and family, and the threat of deep-vein thrombosis on the long-haul flight home after major surgery.

Despite the potential problems, the demand appears to be insatiable, and many countries have followed India’s lead, tailoring national healthcare strategies to accommodate foreign patients.

In Malaysia, where 35 private hospitals are geared to accept international clientele, the number of medical tourists tripled between 2001 and 2006 and will soon exceed 500,000 each year. Neighboring Singapore also boasts premium facilities and recently entered into partnership with Blue Cross Blue Shield to treat U.S. citizens at prenegotiated rates.

For all the advantages, cultural differences are a concern for many patients. Recovery can be traumatic enough without the added burden of coping with unfamiliar customs, language and food. English-speaking countries are much less daunting and are among the most popular medical destinations for Americans.

New Zealand has rapidly established itself as a leading option for non-acute operations and procedures. In June 2008, Pinnacle Health of Massachusetts partnered with Auckland-based Medtral New Zealand. With 9,824 miles of coastline and 245 days of sunshine each year, New Zealand is an ideal environment for recuperation, and Medtral’s all-inclusive packages offer several post-surgery options. Combining a major operation with a vacation makes sense both practically and financially. Even taking into account airfare, accommodations and other expenses, a heart bypass operation in New Zealand costs $70,000 less than in the United States.

In South Africa, several companies integrate medical treatment with traditional tourism itineraries. Surgical Attractions, a cosmetic surgery specialist with facilities in Cape Town and Johannesburg, offers a full menu of procedures, including breast enlargement or reduction, liposuction and facial augmentation.

Surgery is typically followed by what the company calls a “rejuvenation holiday” — two or three weeks in luxury accommodations with the option of a few days on safari. The total cost is around half the price of the equivalent surgery alone in the United States, and adds the benefit of complete discretion — patients can attribute their healthy new look to their South African vacation.

Perhaps understandably, the American Society of Plastic Surgeons does not entirely welcome the advent of cheaper competition overseas, cautioning that “it may be difficult to assess the training and credentials of surgeons outside the United States” and that procedures may be performed in “non-accredited surgical facilities.”

The ASPS also advises that patients avoid many common vacation activities in the days following surgery, including sunbathing, drinking alcohol, exercise and extensive walking or bus tours.

Their most persuasive argument concerns follow-up care at home. If complications set in, “local doctors may not know what surgical techniques the physician used in the initial operation, making treatment difficult or nearly impossible.”

Complications are a very real risk, and medical malpractice laws in countries outside the United States can be a legal minefield.

For peace of mind, increasing numbers of patients arrange their overseas treatment through U.S. companies such as Health Travel Guides, founded in 2006 by Herb Stephens and Alex Marxer.

Stephens established the company after suffering a serious back injury in a skiing accident. “The entire experience with healthcare providers and insurance companies was a nightmare. My initial surgery cost $20,000. For the same procedure in Thailand or India I would have paid between $2,500 and $5,000. Those numbers are very hard to ignore.”

Health Travel Guides’ comprehensive package includes finding the most suitable venue for the treatment, booking flights and accommodations, and providing a bilingual local guide in the destination country.

“I do not like the term ‘medical tourism,’” said Stephens. “It lessens the seriousness. I prefer ‘health travel,’ as it suggests that one is traveling for the sake of health as opposed to sightseeing or some other adventure. Going away for a medical procedure has many benefits, including the reduction of one of the greatest factors contributing to poor health: stress. By getting away from the daily stresses of life back home, one can recover in peace and privacy.”

California resident Nathan Murray recently traveled to Guadalajara, Mexico, for laser treatment to correct his vision. “I considered having the treatment in the United States, but when I found out that I could save 60 percent of the cost by having it done in Mexico, the decision was a no-brainer.”

Murray flew to Guadalajara the evening before his surgery, consulted with the ophthalmologist the following morning, was operated on in the afternoon and had a 30-minute follow-up examination the next morning prior to flying home. He was in Guadalajara for less than 48 hours.

“I opened my eyes to a crystal-clear picture,” Murray said. “For the first time in my life I had 20/20 vision. Guadalajara looked beautiful! I wish I had spent another day there.”

But there are concerns about the long-term impact on public healthcare in the host countries. With only so many qualified doctors and nurses in countries such as Mexico, and the influx of foreign patients triggering a rapid expansion of the private sector, there is a real danger that expertise and resources will be drained from public hospitals.

Herb Stephens hopes not. “My personal observation is that it has, on balance, had a positive impact. The majority of international healthcare providers are private, for-profit practitioners. Increased revenue for these practices improves the local economies and, far from taking away from the public healthcare system, generates resources and brings back successful doctors to support it.”

India faces little danger of losing doctors available to the local populace — its education system produces up to 30,000 new doctors every year. India’s politicians view medical tourism as an unexpected economic opportunity.

As with many revolutions, it will take time for the full impact to become clear. Meanwhile, hundreds of thousands of Americans are taking advantage of affordable healthcare in parts of the world that many would not otherwise have considered visiting.

It has long been asserted that travel broadens the mind. Now it can improve your health and your bank balance as well.

To Your Health

India
Escorts Hospital, Delhi
http://www.ehirc.com

Malaysia
Association of Private Hospitals of Malaysia
http://www.hospitals-malaysia.org

New Zealand
Medtral New Zealand
http://www.medtral.com

Singapore
Singapore Medicine
http://www.singaporemedicine.com

South Africa
Surgical Attractions
http://www.surgicalattractions.com

United States
Health Travel Guides
http://www.healthtravelguides.com

Pinnacle Health
http://www.pinnaclehealth.com