In a recent NY Times article, a very brave 60 year old man discusses his decision to go to a foreign country for hip replacement surgery. It sounds like he got a great deal, $13,660, all costs included. The article suggests that the US estimate would have been closer to $78,000 but as I’ve discussed in a previous article, published US numbers are historically inaccurate and NEVER what the insurance company or even an uninsured patient would ever pay.
Before I go on, I want to clarify that what the gentleman in the article did was very shrewd. At the time of his surgery, he was 60 and had a pre-existing hip condition, and as such, his insurance would not cover his hip replacement. So he did his research and found a respectable hospital in Belgium that had a program for foreign patients wishing to pay cash, ie medical tourism. Very smart. Very well thought out. I have no criticism for his decisions. I’m glad it all worked out for him. But to suggest that medical tourism will ever be the norm is an overstatement…and here’s why.
Let’s take his specific situation and expand from there. He was 60 at the time so he was not yet covered by Medicare. If he was 65 or older, and therefore had Medicare, the pre-exisiting condition would not have precluded him from receiving a hip replacement. Medicare does not preauthorize or deny patients before any operation. Surgeons and hospitals treat Medicare patients without knowing whether either of them will get paid afterwards. It’s a good faith decision that they will get paid, and they typically do get paid, albeit at a much lower rate than what was billed. Medicare has no pre-authorization hotline, unlike most other insurance companies. This keeps Medicare costs down by having less employees to handle these administrative roles.
But let’s address those patients that might be less than 65 and not covered under Medicare. With the soon-to-be implemented Obamacare, pre-exisiting conditions will cease to be a reason for denial of care. So if you’re covered after 65 by Medicare and the Affordable Care Act requires that you be covered under 65, and covered by your parents under the age of 26, everyone will have access to medical care, even if that access is only through an emergency room. Thus, you won’t have to fly to Belgium for your hip replacement or your breast reconstruction (Gent, Belgium has a world-class breast reconstruction program, although their website is not world-class!).
Medical tourism is also a hot topic in the world of cosmetic surgery. But I think this will take care of itself. There are so many horror stories of patients having cosmetic surgery outside of the US, only to return with a complication and more expenses when they need a US plastic surgeon to correct their complications. Unfortunately, most consumers don’t realize how affordable cosmetic surgery is in the US, especially when performed by a board certified plastic surgeon. BuildMyBod is a website that allows consumers to find pricing on plastic surgery from real plastic surgeons before going in for a consultation. And I would argue that even if cosmetic surgery in the US is more expensive that flying to Mexico for surgery from a doctor whose credentials are not certain, it’s probably not a great deal more expensive. And feel free to attribute any extra cost to the increased “peace of mind” you’ll have with surgery here at home!
Lastly, let’s not forget the principal of supply and demand, and Capitalism in general. If anyone in the medical community in Belgium reads the same NY Times article, they’ll realize that they should be charging more than $13,600 for hip replacement surgery since they will now recognize that the market can bear it. My feeling is that the most positive consequence of medical tourism will be increased competition here at home, which may help bring prices down in the US to such an extent that patients will no longer see the benefit in venturing out of the country – much to the detriment of businesses that are banking on it.