A Nose Job in Costa Rica, Root Canal in Mexico


U.S.–ACCREDITED hospitals in countries, such as Mexico and Costa Rica, offer medical care at much lower prices than at home.

If the total cost of getting medical care plus travel abroad can be lower than that of the same treatment alone in the U.S., why not take a vacation?

“Medical tourism” from the U.S.—Americans seeking medical care in foreign countries—doubled between 2007 and 2017 and may grow as much as 25% every year for the next decade, write University of Arizona physicians James Dalen and Joseph Alpert. The reason: comparably lower price tags on almost all medical treatment outside of the U.S.

Incoming medical tourism continues to exceed income lost by outgoing U.S. medical tourism, according to Dalen and Alpert, but at least one economist has warned about the comparison to Japanese carmakers’ effect on the American market as their products developed reputations for value and reliability.

Beginning in 1998, the Joint Commission that evaluates, inspects and accredits U.S. hospitals had by 2017 accredited 800 foreign hospitals—and expects to increase that number by 20% each year.  Physicians and other health professionals, trained in the U.S., staff many of these hospitals.

While Brazil has long been the go-to country for cosmetic and plastic surgery, both Mexico and Costa Rica have gained reputations for these—and Mexico has seven Joint Commission-accredited hospitals—while Taiwan and South Korea specialize in orthopedic and cardiac conditions.

Surgery in India using “cutting edge technology” saves patients between 65% and 90% compared to costs in the U.S. Some hospitals offer health care packages for foreign patients that include private chefs; and one Indian hospital has 200 U.S. trained board-certified surgeons.

Dental surgery, most often not covered at all by U.S. insurance, can cost half as much in Mexico. Towns along the U.S.-Mexican border have intense concentrations of dentists due to the “dental crisis in the United States.”

Taiwan also offers low-cost dental procedures.  And dental care lures many to Costa Rica, where the CheTica Ranch in San Jose provides “exotic recovery retreats.”

The Netherlands, “constantly ranked as one of the best health care systems in the world by advanced metrics,” spends a quarter of the cost to American insurers for hip and knee replacements. And a CT scan costing $140 in Holland can cost $1,000 in the U.S. —or, depending on the U.S. location, anywhere from $250 to $1,500.

While there may be good arguments for some higher prices in the U.S.—for example, paying more for drugs in the U.S. to cover pharmaceutical companies’ expenses for bringing new drugs to market—for exams like CT scans, the only explanation for both higher costs and costs that vary by region is the lack of price regulation.

Prescription medications, especially those essential to protect from life-threatening conditions, are notoriously expensive in the U.S. compared to foreign countries.  Factor VIII, the clotting agent on which hemophiliacs with the most common form and in the most severe cases cannot live, costs half the U.S. price or less in “every single country.”

Another drug, Humira—offering incomparable relief from the pain and inflammation associated with autoimmune diseases, notably rheumatoid arthritis—can cost less than half of the U.S. price if bought elsewhere.  And for Harvoni, one of the new breakthrough cures for hepatitis C, the most common 12-week regimen costs $94,500 in the U.S. and less than one-fifth that price in South Africa.

For medical tourists who might worry about the quality of care in foreign countries, a good option is U.S. medical centers— including Harvard, Boston University, Johns Hopkins and the Cleveland Clinic—that work directly with hospitals and clinics outside of the U.S.

Among its “global collaborations,” Johns Hopkins works with hospitals in Brazil, China and Columbia.  Johns Hopkins also provides a “special concierge” to individuals wishing to arrange medical treatment abroad.

If choosing foreign facilities on your own, the most common advice is to look for accreditation by Joint Commission International, the division of the U.S. organization that certifies hospitals outside of the U.S.

While U.S.-based health care brokers can help arrange travel, accommodations and access to various hospitals and physicians around the world, warnings abound to watch out for the hard sell and for those selling packages that include a holiday, according to the Scottish National Health service.

Among general warnings for medical tourists, communication is number one. “Receiving treatment in a facility where you do not speak the language fluently may increase the risk of misunderstandings about your care,” as the Scottish site puts it.

Related warnings advise speaking directly with the healthcare provider and/or having a consultation before treatment. Before leaving home, a written agreement with the health care facility should list what treatments, supplies and care are covered by the costs of the trip.

Blood products can be an issue because many countries don’t screen as carefully as the U.S. for infections. And the third big concern is the risk of flying within the week after surgery, which can increase the risk of blood clots.

Other advice includes consulting your doctor or dentist and arranging for follow-up care before you leave; taking with you copies of all medical records and a list of all current medications; and making sure to get copies of all medical records in the foreign facility before returning home.

But there’s always a worst-case scenario, such as an accidental nick during surgery that results in infection that’s difficult to control with antibiotics and then requires additional surgery to repair the error —care that is covered in U.S. hospitals but foreign facilities may not have the capability to deal with, and the fees already paid may not cover.

For expensive dental surgery like a root canal —with a local price tag of $3,000 to $5,000 paid out of pocket on the first visit— a Mexican vacation sounds tempting.  On the other hand, the need is often sudden and immediate following a scan; the root canal is best done in several visits at least several days apart; and there is the risk of needing repairs or a re-do down the line, all of which increase the challenges of getting the procedure in Mexico.

Mary Carpenter

Every Tuesday, count on well-being editor Mary Carpenter to deliver health news you can use.


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