Affordable Health Care in Thailand and Costa Rica : The New Yorker

This year, a few hundred thousand intrepid American travellers will head to places like Thailand and Costa Rica, in search of something that they can’t find in the United States. They won’t be looking for Mayan ruins or ancient Buddhist temples, but something a bit more practical: affordable medical care. These medical tourists will be getting root canals, knee surgeries, and hip replacements at foreign hospitals. If health-care costs in the U.S. keep rising—and especially if Obamacare is overturned by the Supreme Court—more of us may soon be joining them.

For decades, wealthy people from developing countries have come here for care, but these days medical tourists travel all over the world. And while it’s hard to disentangle the stats from the hype—a number of countries portray themselves as favored destinations—it’s clear that millions of people are now doing this. The Bumrungrad hospital, in Bangkok, treats four hundred thousand foreign patients annually. Malaysia had almost six hundred thousand medical tourists last year. And South Korea had more than a hundred thousand, nearly a third of them American.

For Americans, the attraction is obvious: medical care is a lot cheaper abroad. At CIMA Hospital, in Costa Rica, for instance, hip-replacement surgery costs around fifteen thousand dollars, roughly a sixth of the average here. So far, though, various factors have kept a lid on demand. Logistics can be challenging, and insurance companies have been leery about reimbursements for care overseas: they already get big discounts with U.S. hospitals, and they risk a public-relations disaster anytime something goes wrong abroad. Above all, patients have been wary. We trust the quality of foreign-made televisions and cars, but we haven’t taken that leap when it comes to foreign doctors. People worry about the lack of legal recourse, and the sheer unfamiliarity of medical tourism makes people hesitant to try it. A few years ago, the grocery-store chain Hannaford set up a partnership for the benefit of its employees with a well-accredited Singaporean hospital. Singapore is one of the most prosperous countries in the world, but medical care there is still significantly cheaper than in the U.S., so the arrangement looked like a model for how medical tourism might work. But none of Hannaford’s workers were interested in going to Singapore.

There are a host of forces that could change this. The quality of medical facilities in developing countries has risen dramatically, and the private hospitals that cater to tourists often feature technologies similar to those in American hospitals. (This has its problematic side: many of these high-end hospitals are in countries where citizens struggle to get basic care.) Furthermore, new companies are making treatment abroad easier and more attractive. Blue Cross/Blue Shield has started a company called Companion Global Healthcare, which connects patients with hospitals around the world. Political events could also quickly make medical tourism considerably more attractive. If Obamacare is overturned, forty million Americans without insurance will stay that way. If Medicaid and Medicare are cut sharply, the cost of American health care will eventually become prohibitive to many senior citizens. And if health-care costs keep soaring fewer employers will offer health insurance. That doesn’t mean that Americans are soon going to jet halfway around the world for an ingrown toenail, but it’s easy to envisage regional systems becoming common, with Americans heading to places like Costa Rica and Mexico, and Western Europeans going to places like Hungary and Turkey.

CONTINUA.

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