We’re done with procedures and pricing. That’s all I’ve got, for now, anyway.
Chapter 4 Page 7 | What Else is Out There?
I liked finishing the chapter with the comments of the Indian M.D. who was elected president of the International Society of Minimally Invasive Cardiothoracic Surgery in 2005. Dr. Naresh Trehan has been a controversial figure at times in India, but I do not believe anyone would dispute his accomplishments. He said he would build MediCity, and he has:
Chapter 4 Page 7 | What Else is Out There?
Non-Cosmetic Procedures
Except for perhaps the very cutting-edge care techniques, for which the United States maintains a still-visible edge on the rest of the world, most surgical procedures are available elsewhere from qualified and reputable doctors, in state-of-the art facilities, and at prices sharply below those in the United States. The primary examples, for now, are the private, international hospitals of the Far East, most notably but not exclusively, those in Thailand, India and Malaysia.
International private hospitals advertise a variety of procedures and services, including but not limited to:
They claim to be world-class, which United States residents can take to mean equivalent to or better than what they may have access to at home. There is strong evidence that the international hospitals are, in fact, that good. They represent an option that the uninsured and underinsured in the United States should not ignore, if facing unaffordable and unavoidable medical expenses.
As Good, or Even Better
The prestigious International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) is an organization dominated by United States and European doctors, so it is no surprise that when Naresh Trehan, M.D., of India, was elected president in 2005, it made big news. In an interview with the India Post he made the following points:
“Having lived in the United State for 20 years, ‘I know, to get equal recognition, we [foreign doctors] have to be 150 percent better than our counterparts in America.’
“There is huge inward flow [of patients to India] from the rest of the world.”
“I’m building MediCity, which will be like the Johns Hopkins or the Mayo Clinic of the East.”
“I am not in favor of advertising, but the information should be out to people that it is possible to access treatment [and get] good outcomes and affordable costs in India; and that the experience can be very positive if one chooses the right place.”
Can anyone really doubt that quality medical care is available globally? In the United States and elsewhere, however, it is increasingly the responsibility of the patient to evaluate medical options and make choices. Fortunately, the research tools are widely available, and people can learn to master them.
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I have not exactly breezed through Chapter 4, but it will be wrapped up with the next post. Today, we brush against: hair implants, ear pinning, weight loss surgery and dental procedures. This concludes Beauty from Afar’s summary of cosmetic procedures that people frequently seek outside of their own country.
Chapter 4 Page 6 | Other Cosmetic Procedures
In the conclusion of Chapter 4, I touch briefly on what is generally called complex medicine — no disrespect to cosmetic surgeons intended. This has to do more with treatment of disease, life-saving surgery, etc. And, of course, medical travel includes such care as well … though to date, at least for those who travel out of the United States, dentistry and cosmetic surgery remains the largest part of medical tourism.
Chapter 4 Page 6 | Other Cosmetic Procedures
Hair Implants
Hair implants involves the transplantation of thousands of tiny patches of hair-bearing scalp tissue to the balding areas of the head. Results vary from patient to patient and are by no means guaranteed. Though Costa Rica’s Dr. Cohen mentioned that he does not see as many hair transplant patients as he once did because transplantation has become less expensive in the United States, research indicates that there is still a substantial “overseas discount” of 25 percent to 50 percent. Hair transplant prices are generally based on the number of hair/skin grafts done. U.S. prices range upwards from about $3,000, depending on the extent of the work.
Ear Pinning (Otoplasty)
Prior to research, I’d had no idea that fixing protruding ears was a popular cosmetic procedure. Otoplasty is the general term for cosmetically enhancing the appearance of the ears. Roughly 25,000 U.S. residents underwent some sort of cosmetic surgery of the ear in 2004, according to ASPS statistics. Prices in the United States range from $2,500 to $4,000; prices abroad range from $800 to $1,500.
Weight Loss Surgery (Bariatric Surgery)
Bariatric surgery that is designed to cause significant weight loss is increasingly popular in the United States. The surgery alters the digestive process, either restricting the amount of food the stomach can hold or causing food not to be absorbed. There are several different procedures and techniques with more continuing to evolve. The intestinal bypass was the first and is still the most common in the United States.
There are eight recognized types of bariatric surgery including laproscopic bariatric surgery, bariatric bypass surgery, and vertical banded gastroplasty (VBG). Bariatric surgery is considered a drastic lifesaving solution for a major health problem. In this instance, it is covered by some medical insurance plans and prospective patients in the United States who have health insurance are generally well-advised to explore the option with their insurer. However, many patients do go abroad to afford the surgery. For those interested in bariatric surgery and wondering where to start, I recommend without qualification the Obesity Help website (www.obesity-help.com), an online support group that boasts more than 200,000 members.
Dental Procedures and Appliances
My personal experience with going abroad for costmetic surgery is limited to dental work. It is ironic, perhaps, I did far less research prior to going to Costa Rica for full-mouth reconstruction than I now recommend that others do before making a decision. Readers interested in the extensive details of my own experience should visit my Web site Beauty from Afar (www.beautyfromafar.com). Since having my work done in 2004, I have recommended at least dozens of patients to Drs. Cordero and Rubinstein at Prisma Dental in Costa Rica. Invariably, however, I point out that there are other excellent dentists in Costa Rica and around the world, and I urge prospective dental patients to thoroughly explore their options at home and abroad before making a decision.
Dental insurance in the United States rarely covers the full cost of extensive cosmetic work. There is certainly little reason to go abroad for routine dental work. However, when the prospective out-of-pocket expense for wanted or needed dental work climbs into the thousands of dollars, going overseas can become the pragmatic option.
Generally, dental patients do not require extended convalescence abroad, or significant immediate after-care and support, as do medical surgery patients. Costs range widely based on various dental proceedures, but my general statement that patients can expect to save from 40 to 75 percent on medical services abroad holds true for dental work. Many cosmetic surgery patients abroad opt to get at least minor cosmetic dental work, such as teeth whitening, done on the same trip.
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We commence today with Chapter 4 of Beauty from Afar, for which I half apologized in advance. I really needn’t have, now that I look at it again. Immodestly, I don’t mind saying that I like the way it starts out, and I have Joseph Cohen, M.D., of the Rosenstock-Lieberman Center for Cosmetic Plastic Surgery in San Jose, Costa Rica, to thank for that.
Chapter 4 Page 1 | You’re Going Abroad for…What !?
Dr. Cohen’s candor made him a terrific person to interview on the subject of what surgical procedures people go overseas for, and why; that he, a prominent cosmetic surgeon in Costa Rica, would consider going to the U.S. (hypothetically) for his own care, under certain circumstances, I think makes for a nice balance in a book that is mostly about people going in the other direction. And it gives him credibility.
We’ve now covered 76 pages of the original text of Beauty from Afar, which has worked out to 37 web pages. That seems about right to me … and it means I’m about a third done, which feels substantial.
I’ve mostly resisted the journalistic urge to step too far outside the boundaries of the book, but anyone interested in the business of medical tourism ought to go read Brendan Borrell’s Reuters story, published today:
Controversial couple dominates U.S. medical tourism
I don’t see how this has any real impact on patients, mind you, or I’d be more concerned. As a nascent “industry,” though, medical tourism has not traveled all that far since I first wrote about it in 2004-2005. The squabbles are a little bigger.
It was really in 2004 and 2005 when the U.S. media “discovered” Medical Tourism … about the same time I did. (Maybe just a little after I did. 
) And it was discovered because the media noticed that people were going overseas for serious, life-saving procedures, not just cosmetic surgery and dentistry.
Chapter 3 Page 5 | The Media Imprimatur
Medical tourism and travel has been episodically in the news in the U.S. ever since and remains a story in parallel with the dominant narrative about healthcare reform in the U.S. that arose in 2008 — 2009. I’ve often been asked if real healthcare reform in the United States would be the end of medical tourism, and the answer is no. Medical tourism and international medical care will remain less costly alternatives and U.S. patients and insurers will continue to explore and integrate the travel-for-care options that are available.
We’ve hit the end of Chapter 3. Chapter 4 will look at what surgeries and procedures that patients choose to have done overseas — specifically, it is mostly a list of cosmetic procedures and average prices and savings in 2004 — 2005. As I go through it, I’ll try to put forth any updates of which I am aware. Chapters 4 and 5 (which is a tutorial on doing Internet research) are, to me, the driest parts of the book but I’ve encountered readers who thanked me for them. So … off we go. Tomorrow, probably.
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