Apart from the cost one of the major differences between the majority of US healthcare and medical tourism destinations appears to be the personalized service one receives.

For example, the private healthcare offered in places such as New Zealand is the boutique option. You can choose your hospital, doctor and the day of treatment but you have to pay. In contrast, the public healthcare system in New Zealand is government funded and hence there is no charge for its use by individuals. Indeed the same doctors work in both systems. The real difference is in the waiting time, and choice of doctors.

Contrasting this with the US health system where a recent article cites an example of the same medical clinic having two entrances: one for the insured clients and one for the self- pay. The self pay got the boutique service; to see a doctor and the higher charge. The insured patient got the diagnostic test but very little more and their insurance paid (a reduced rate).

It appears more and more Americans are walking away from insurance and wanting to make their own decisions with added benefits that feel to them that they are receiving fair value for their own non-insured, self pay health dollar. In this environment of consumer driven healthcare, medical travel must be an option.

Americans now have a boutique option of medical care in their own country where increasingly the customer not the insurer pays. Since the customer can not negotiate substantial discounts, (like the insurers) they pay … a lot.

Hence to travel overseas for easy access to the same level of service, a single invoice (if not more personalized), for 25% the cost of the boutique service in the US, with no bureaucratic minefield or unexpected bills starts to sound attractive.

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1. Defensive Medicine – Why Americans Pay More

A few tips for those heading abroad for Hip Replacement surgery (THJR). These are a combination of what I tell our clients coming to New Zealand for surgery, what they tell me, and what our surgeons and physical therapists advise.

1. Choosing accommodation

If you are not using a medical travel facilitator to book your accommodation (or even if you are in some cases) make sure that your accommodation is suitable for someone who is having hip replacement surgery. You need to make sure that you don’t have to navigate flights of stairs on crutches or that you don’t have to step into a bathtub to have a shower. Also bear in mind that low seating is not appropriate for people with recent hip replacements – especially if you are tall.

2. Airports

Ask your facilitator or travel agent to request wheelchair transfers for you in transit. While you may not think you need a wheelchair, sometimes it is a long walk between terminals and you may need some assistance with luggage etc.

3. Bring a knapsack

It makes life on crutches so much easier.

4. Bring slip on shoes

Unless you have a very patient traveling companion, you may struggle with laces.

5. Bring Skirts or loose fitting trousers

It will make life easier and be more comfortable than tight fitting clothing after surgery.

6. Talk to your surgeon

Arrange a telephone call before traveling to your destination. Find out what you can expect afterward in terms of recovery and mobility. Find out how long before you can get your wound wet (different surgeons have different perspectives on this). Then plan any additional travel with this in mind.

7. In flight DVT prevention.

This is important both before and after surgery. Drink plenty of water, avoid alcohol, make sure to get up and walk regularly on the flight. Talk to your surgeon about preventative measures for the flight home.

8. Recuperative Care.

This is VERY important. For our New Zealand clients we provide exercise equipment in the hotel rooms so that our physical therapists can work out a regime that gives you optimum results for your surgery and recovery. Be concerned if your overseas provider makes no mention of it.

9. Don’t skimp on the pain medication.

While you don’t want to overdo it either, being in pain can interfere with your post operative recuperation and physical therapy regime. Make sure your doctor explains clearly when and how you should take any prescribed pain medication.

10. Find out what sort of implant.

Will be used in your surgery. Implants can vary greatly in both price and quality. The general rule is you get what you pay for. Make sure you are comfortable and confident that you are getting a reputable brand of implant and that it is appropriate to your needs. Talk to your surgeon about the different types and what is best for you.

Note that these are suggestions only and should not replace any advice given to you by your health professional

Have you had or are you considering having hip replacement surgery either at home or abroad?

How do you decide on a hospital or surgeon?

Do you have any questions?

Do you have any tips for others?

Please leave a comment below. I’d love to hear from you.

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1. Medical travel food for thought.

Is access to safe blood transfusions a consideration for you when selecting a medical tourism destination? Information from the WHO suggests it should be…

“Evidence-based strategies for blood safety and availability have been successfully implemented in most developed countries and some transitional and developing nations. However, despite the proven effectiveness of these strategies, many countries are making slow progress towards their implementation.”

Infection is a risk with any blood transfusion. Diseases such as HIV, Hepatitis B & C, Malaria and Syphilis can be acquired through receiving contaminated blood products. This fact has lead to strict regulation and screening of blood products in developed countries.

The WHO Aide-Memoir for national blood programmes indicate that the risk of infection through blood product transfusion can be substantially reduced through the following measures:

• Establishment of a nationally-coordinated blood transfusion service
• Collection of blood only from voluntary non-remunerated blood donors from low-risk populations
• Testing of all donated blood, including screening for transfusion transmissible infections, blood grouping and compatibility testingReduction in unnecessary transfusions through the effective clinical use of blood, including the use of simple alternatives to transfusion (crystalloids and colloids), wherever possible.

But wait, before you unpack your suitcase and sell the house to have your surgery at home, there are many Medical Tourism destinations with equally as safe, or even safer, blood supplies than the USA’s. For example New Zealand has one of the safest blood supplies in the world with no reported cases of HIV transmission from blood transfusion since they began screening for it in 1985 (NZBS).

You should be able to obtain reliable information on screening and outcomes from the hospital or facilitator you choose. An example of such information is the New Zealand Blood Services Hemovigilance Report.

While giving blood prior to your surgery (Autologous Transfusion) is an option it is usually not appropriate for Medical Tourists for the following reasons:

• Most reputable blood organizations will only take around 4 units of blood. In the case of an emergency this may not be sufficient and you may still require donor blood as a ‘top up’.
• Ideally you should allow around 1 week between donations. With the final donation a bare minimum of 48 hours prior to your surgery. This leads to a long visit to your chosen destination!
• There is a cost involved in the collection and storage process.
• Not all people or procedures are suitable for autologous donations eg. Cardiac surgery.

All it takes is a little research to find out which destinations are safe. Any facilitator worth their salt should be able to provide you with some statistics on your preferred destinations. Failing that a simple Google search with “blood transfusions [country]” should give you an abundance of information.

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1. The Great Unknown – Is leaving home for healthcare really that scary?

As traveling overseas is becoming a more widely accepted way of receiving medical treatment, here are a few key questions to tick off your list when considering an overseas destination.

How far do I need to travel?, Is it a direct flight or multiple stop overs?

Where possible try to book direct international flights rather than flights with 1 or 2 stopovers. You might not notice it so much traveling to the destination, but returning home after surgery could prove to be far more taxing than it needs to be with lengthy stopovers included in your travel plans.

How easy is communication with the doctors and nursing staff of the destination Hospital?

When dealing with issues about your health it’s vital that you are not in the position of not being understood, or not understanding what the doctors and nurses are saying. For example if you are an English speaker, consider countries where English is spoken as the primary language first.

What is the total cost of the package

Most destinations advertise medical procedure costs only and compare them to similar US based medical procedure costs. This is meaningless as you need to factor in the cost of travel, accommodation, aftercare and transport costs within the destination country. Always compare the total package cost of the destination to the procedure cost in the US for a true savings comparison.

What are the Potential hidden costs in the packages?

You don’t want any surprise costs when you travel to the destination country. Never assume, always confirm what additional out of pocket expenses you can expect.

What happens after discharge from Hospital, does the destination country provide comprehensive aftercare?

This plays a critical part in aiding your recovery after a medical procedure. Some destinations provide daily physical therapy, excercise routines and nursing programs in your Hotel to aid in getting you back to full health as quickly as possible. Some destinations also provide domiciliary aids to help with shopping and even dressing if required. Not having comprehensive aftercare can impact on the success of your procedure and recovery time. Make sure you fully understand what you will be receiving in the way of aftercare post surgery.

How transparent is the medical destination?

Will the destination hospital share surgical outcome data concerning their hospital and the procedure that you are traveling for? How many operations has the surgeon you are seeing performed and what training has the surgeon undergone? Can you talk your procedure over with the surgeon prior to leaving home? Can you talk to other patients that have already been there? All important points to help build both your understanding and confidence in the overall process.

What happens when things go wrong?

In the majority of western hospitals, the risk of complications is minimal but never zero. Adverse events happen even to healthy people. Find out what contingencies the destination hospital has in place to ensure you are looked after if you have a complication, and what it will cost. Some Destinations include contingency insurance to protect you against additional costs incurred as a result of an adverse event. It’s an important point to check before you agree to travel.

Will you feel safe and comfortable traveling to the destination?

Traveling and having a medial procedure will make you feel considerably more vulnerable than usual, so you must feel you can trust the destination you have chosen to make you feel comfortable and safe. Complete culture shock can be avoided by selecting a safe and culturally similar destination to your own, consider destinations that are safe, friendly and conducive to aiding your recovery.

What is the main purpose of my travel?

While beautiful beaches and scenery might sound enticing, they shouldn’t outweigh the quality of care factor when deciding on the destination. The time you spend at the destination may involve some must see tourist sites and experiences before the operation. However, after the operation you are more likely to be solely interested in getting better and getting home, so plan carefully.

These are just a few things to consider when traveling for medical treatment. A professional well focused medical destination will have anticipated many of these issues and questions, making the process of traveling there is as simple and risk free as possible.