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Q & A

How far would you go for surgery?

The need for serious — and expensive — dental work forced freelance writer Jeff Schult to get creative. Research led him to a clinic in Costa Rica, which opened Schult to the burgeoning world of medical tourism. Two years ago he published Beauty from Afar: A Medical Tourist’s Guide to Affordable and Quality Cosmetic Care Outside the U.S. Schult describes how this international market is changing healthcare.

Q: How did you get involved in medical tourism?

I needed dental work that I couldn’t afford. Most major dental work isn’t covered by insurance. I looked into it with my dentist here in the United States and determined it was going to cost upwards of $15,000, which was just out of the question. I decided not to do anything about it at that point, but later on in an online discussion I ran into the concept of medical tourism. Somebody on a mailing list had a friend who had work done in Thailand. I remember reading that post and thinking, “Gee, I wonder if I can get dental work done that way.” I was on a mission at that point. I started researching and ultimately found a dentist in Costa Rica. I got substantial dental work done for about a third of what I would have been charged in the United States. Being a journalist, I decided to write about it. A magazine article led to an agent and a book deal on medical tourism worldwide. Since the book came out, I’ve kept involved in the industry. I consult for medical tourism companies around the world.

Q: What exactly did you have done?

I had my upper teeth redone. We’re not certain but we think it was the result of grinding. If you lose the enamel on your teeth they wear away pretty quickly. I had 14 crowns on my upper teeth. I also needed six root canals.

Q: Were you at all concerned about getting medical treatment in a developing country?

This was 2004 and the idea of going to a place such as Costa Rica for medical treatment was seen by a lot of people as totally insane. I did extensive research before settling on a dentist, until I was satisfied in his ability. I was still nervous going down there, until I walked into his office and saw how modern it was. Also, the waiting room was packed with Americans. My dentist had done probably more procedures like the one I needed than anyone in the world. Costa Rica in particular got an early start in medical tourism, focusing on plastic and dental surgery going back to the ’70s and ’80s. They’re on the second generation of doctors with international clienteles and have built up an infrastructure around them.

Q: We hear a lot about hospitals in places such as India, Thailand, and now in the Middle East, where Harvard Medical School is involved in something called Healthcare City in Dubai. What is the future of medical tourism?

It depends on who you’re talking about. People hear of Americans going to India or Thailand for procedures but those are mostly expatriates. There are three factors to medical tourism: quality, cost, and proximity. Don’t discount proximity. Few people want to travel around the world for major medical procedures. This is a big reason Costa Rica has become so popular. But the fact is that much of medical tourism for Americans takes place within a few miles of the Mexican border. You don’t fly someplace exotic; you drive to Tijuana, or another border town. In San Diego, you can buy cross-border health insurance.

Q: Tijuana?

I toured a hospital down there. It was brand new, and was one of the nicest, best laid-out hospitals I’d ever been in. This is big business. A company in Texas called the International Hospital Corporation owns about 10 hospitals in Mexico and throughout Latin America. It’s becoming so big I actually did a consulting project where I went to Costa Rica with representatives of Blue Cross Blue Shield in South Carolina. They announced a program last fall that helps members get inexpensive dental care in Costa Rica. In the UK, where there are waiting lists for certain procedures, there’s a movement to essentially outsource parts of its health system to other countries in Europe and India. Even within Europe medical tourism is booming. Spain and Portugal are looking to the richer countries to provide patients. There’s a joke that there are no dentists in Germany anymore because all Germans now go to Hungary for dental work. Cost will continue to play a huge role in the globalization of medicine. The only thing that might slow it down in the near term, at least for Americans, is the falling dollar. Especially for lower-end procedures, the cost-differential is shrinking and might be less attractive to people.

Q: If it’s all about cost, why don’t insurance companies — or in the case of most developed nations — governments require that patients seek out the cheapest procedures, even if that means going out of country?

It’ll be interesting if you see the more wealthy nations, particularly in the European Union, shifting some of their public healthcare burden to poorer countries. You hear people talking about it, but no one is going to require that you go to Bangkok for your surgery. Of course, this can be done on a case-by-case basis, rather than by mandate. They’re going to present it as an option and if nobody goes, they’re going to look at the cost differential and they’re going to perhaps incentivize people to go. You get more time off; perhaps they can pay patients to go. If you go to Asia, we’ll give you an extra week off and we’ll pay you $2,000. There’s actually a World Bank report that estimated that by outsourcing 10% of 15 major procedures that don’t have significant aftercare issues, the U.S. economy could save $2 billion annually. And they suggested that the way to do that was to incentivize the patients financially. You know how economists are. If you say there is a fear, they want to assign a cost to it — there’s got to be a price on it. Give them a couple thousand dollars and people will overcome their fear.

Q: We’ve talked about the medical aspect of the issue. What about the tourism part? I imagine some of these trips, surgery aside, can be really lovely.

Certainly a place like Costa Rica is beautiful. But the first night I got there, they did all six root canals. The second day, I was in the chair all day as they made my upper teeth into posts. Still, I had a wonderful time. My father ended up going to my dentist for two crowns and a root canal. He was quoted $3,000 in the United States, and he saved only a couple hundred dollars by going to Costa Rica. But he went anyway, because he got to take my mother to Costa Rica for two weeks, get the work done, and have a great vacation.

Interviewed by John Zebrowski

Department: Q & A