Going Abroad for Medical Care

Puerto Rico and Maryland are exempt from readmission penalties, and are still covered by Medicare. Links for Puerto Rico are below. Over a million US residents go abroad for health care each year, mostly to Mexico.

Foreign hospitals and doctors have their own payment systems for their residents, but still have prices for US travelers. They are not covered by Medicare, so hospital stays abroad do not incur readmission penalties, and do not count as costs in Accountable Care Organizations. Some US and international private insurance pays for foreign care. In any case costs are often much less than in the US, and specialized hospitals can give better care. Some of the best offer luxury as well as ordinary care.

Kiplinger (2017) says the book Patients beyond Borders, and its website have reviews of hospitals. I have not seen the book, but the website shows the size of each hospital, and often the total patients treated, though not the number of times doctors do any particular procedure, nor other measures of quality. You may have to ask.

Lists

• One list of top 10 hospitals, 2014 (bones, cancer, children, hearts, hernias). Best is in Maryland. 7 are abroad:
  Asklepios Klinik Barmbek, Germany: Drugs, Equipment, Laboratory, Heart surgery, Cancer
  Great Ormond Street Hospital, UK:  Children, Children's heart or brain surgery, Children with cancer
  Wooridul Spine Hospital, South Korea: Spine, Joints
  Shouldice Hospital, Canada: Abdominal hernia
  Bumrungrad International Hospital, Thailand: Most specialties
  Anadolu Medical Center, Turkey: Cancer, Bone Marrow Transplant Center, Preventive medicine
  Gleneagles Hospital, Singapore: Orthopedics, Cardiology, Cancer, Obstetrics, Gynecology

• Deloitte estimated in 2008 that 750,000 US residents went abroad for treatment in 2007, and about 400,000 foreigners came to the US for treatment. 28% of Medicare recipients would consider elective surgery abroad, with higher rates among Asians and Hispanics. Their 2016 report says Thailand and Mexico are the top destinations, and they expect growth in Cuba now (p.15; their footnotes are in a separate file). The 2008 report lists top foreign hospitals with their specialties as
   Bumrungrad, Thailand: Orthopedics, Neurology, Plastic surgery, Dental, Cardiovascular, Cancer, Fertility/sex reassignment
  CIMA, Costa Rica: Orthopedics, Neurology, Plastic surgery, Dental, Cardiovascular, Cancer
  St. Luke's, Philippines: Orthopedics, Neurology, Plastic surgery, Dental, Cardiovascular, Cancer
  Apollo, India: Orthopedics, Neurology, Plastic surgery, Cardiovascular, Cancer
  American, UAE: Orthopedics, Weight loss, Cardiovascular, Cancer, Fertility/sex reassignment
  National Cancer Center, Singapore: Cancer
  Ivo Pitanguy Clinic, Brazil: Plastic Surgery 
• Awards, 2015 were based only on written applications by the hospitals and €150 fee from each contestant

Referrals

• International Association for Medical Assistance to Travelers (designed for people who get sick abroad) has a directory (for a small donation) of English-speaking doctors in most countries who will see you for an initial consult of $100. These provide a chance for checking the local reputation of a surgeon you are considering, or treatment of follow-up complications. "majority has received post-graduate training in North America or Europe... IAMAT health care providers will refer you to a specialist in any field, including dentists... Our doctors and mental health practitioners will advocate on your behalf and help you with any issues that may arise during your experience with the health system of your destination country."

• Subsidiary of Blue Cross (surgery and dental), includes the Costa Rican, Indian, Thai, and Turkish hospitals listed above. See their cost data below.
• Joint Commission International accredits hospitals abroad, also at worldhospitalsearch.org/. Founded by Joint Commission in US, which is a separate organization.
• WhatClinic.com has a few reviews worldwide, for example 16 reviews of knee replacements, and 8 of hernia repair (none from any hospital listed above). Reviews can be found with a specific term, like knee replacement, but clinics describe themselves with broad terms like orthopedics, so search both ways. It probably needs to partner with local review sites to get more reviews. Reviews are mostly accepted from people who had previously contacted the clinic through the site. They do not mention a policy on removing reviews. Clinics can list themselves free, or advertise.
• Medigo.com lists many hospitals and clinics for many conditions in many countries. Among the hospitals recommended above, Medigo only includes Apollo in India. The lists are easy to search and often give prices. They do not rank clinics on quality, and do not describe their criteria for listing clinics. They do not visit all the clinics, and they say when they do. The few patient ratings only appear on each clinic's page, so comparing ratings is a slow process. Terms of use forbid "disparagement" (8.2), and they do not say whether they include all reviews. They charge 0-9% to arrange treatment, depending on country, and various other fees. You can search with their free lists and contact the clinics directly if you don't want Medigo's services, but you'll need to find other measures of quality. They cite news stories, which cover medical tourism, not Medigo. Terms of Use limit their liability, and section 9.6 makes you pay their costs for some lawsuits. They are based in Germany, and the founders are Polish. Suits against them must be in Berlin.
• Dental Departures (dental referrals and travel agency) visits nearly all their dentists, has questionnaire on sterilization, includes patient reviews, and has dropped 8 dentists for poor quality from its list of 2,500 dentists in 29 countries.
• Medical Tourism Association (industry association) See their cost data below.
  

Medical Travel Agencies (listing does not mean recommendation, and you may find others)

• Patients beyond Borders, lists other articles and questions to ask your doctor
• Planet Hospital, lists other articles
• Pilgrimed See their cost data below
• Healthbase
• MedRepublic
• MedRetreat
• Companion Global Health Care phone number forwards to MMT Global Health Care, which says it is a different company.
  

Advice

• Organization for Safety, Asepsis, & Prevention suggests phone questions to ask foreign doctors; has members abroad
• Aerospace Medical Association, risks of air travel with some medical conditions

• Centers for Disease Control (advice) says some countries have poor quality drugs, more resistant bacteria, and paid blood donors, without saying which; links to other organizations
• American Medical Association, 2008 recommendations on foreign care. They say patients should get "physician ... outcome data" (p.6 line 48), which is only sometimes available in US
• International Society of Aesthetic Plastic Surgery advice; has members abroad

Articles

• Buzzfeed, 2017, on hundreds of dentists in Mexico near Yuma, and using RV community for referrals
• US News+World Report, 2012
• AARP, and US News+World Report, 2014, by same author
• Economist, 2014
• Guardian, 2014, on Poland
  

Other

• While abroad for treatment, complications or other illness one may need medical or evacuation insurance.
• While traveling on commercial airlines, the plane's medical kit is minimal (except on ANA-All Nippon Airways  and Lufthansa), so people with medical issues need to bring what they might need. Also, the plane can call a doctor on the ground who handles plane emergencies every day, as well as whatever doctor may be on the flight. Flight attendants are certified in CPR and AED.
• Puerto Rico 2013, updates: 2014, 2015, 2016, covered by Medicare, exempt from readmission penalties
• Maryland, covered by Medicare, exempt from readmission penalties, working toward new limits by 2019
  

MTA Cost Comparisons 2015 have US and 13 foreign countries.  (2011 had 10 foreign countries and an African average)
25% Average: Foreign as % of US
12% Heart Valve Replacement 
15% Heart Bypass 
12% Spinal Fusion 
33% Hip Replacement 
34% Knee Replacement 
30% Angioplasty 
46% Hip Resurfacing 
50% Gastric Bypass 
35% Cornea
64% Gastric Sleeve 
41% Hysterectomy 
66% Lap Band 
49% IVF Treatment 
39% Face Lift 
59% Tummy Tuck 
9% Rhinoplasty 
63% Breast Implants 
47% Liposuction 
63% Lasik 
61% Cataract surgery
51% Dental Implant 

Blue Cross Cost comparisons for:

DaVinci Prostatectomy
Dental Crown
Dental Implant
Dental Veneer
Heart Bypass
Heart Valve Replacement
Hip Replacement
Hysterectomy
Knee Replacement
Root Canal
Spinal Fusion

Pilgrimed Cost comparisons for:

Angioplasty
Breast Implants
Dental Implant
Heart Bypass
Heart Valve Replacement
Hip Replacement
Hip Resurfacing
Hysterectomy
Knee Replacement
Lap Band / Bariatric
Rhinoplasty
Spinal Fusion

NA=US Average not available to calculate percent. See link for costs abroad