By January, Jane Schaeffer could barely manage a walk around the block, which was no surprise: She needed a new hip.
Schaeffer, who is 64 and a yoga teacher in Bennington, didn't like that prognosis. So, she consulted the oracle of Hippocrates - the Internet - and concluded that what she wanted was a Birmingham Hip-Resurfacing, or BHR, a less-invasive procedure developed in England and approved in the U.S. in 2006.
Unfortunately, Schaeffer's insurance company, Blue Cross Blue Shield of Vermont, saw her case differently and insisted that, at her age, she should have her hip replaced. That left Schaeffer, if she wanted to get better, with a choice: Get a new hip on BCBSVT, or pull together $8000 and have the joint "resurfaced" in India.
For Schaeffer, it was no choice at all. On April 18, she underwent a BHR at Apollo Hospital in New Delhi. Two weeks later, she was home, preparing to return to work. "With full hip replacement, I would never have full range of motion in my hip," she said. "I would never be able to teach properly again."
Americans have been going abroad for health care for years. Retirement communities in Arizona routinely bus fixed-income residents over the Mexican border, where the prescription drugs and dental care are cheaper. For those with radically different needs, and a certain disposable income, Brazil and Argentina are famous for skilled, cut-rate plastic surgery; a $10,000 tummy tuck in L.A. or Houston might cost a third as much at Plenitas, a boutique clinic in Buenos Aires.
In the last few years, hospitals in exotic locales such as India, Singapore and Thailand have aggressively marketed major surgical procedures - heart bypasses and coronary valve replacements, for instance - at drastically lower prices than are available in the United States. And more and more Americans are taking advantage of it. A 2007 study by the National Center for Policy Analysis in Dallas estimated that about 500,000 U.S. residents traveled abroad for care in 2005. According to the management consultant McKinsey & Company, the worldwide "medical tourism" industry was worth $60 billion in 2006, and is expected to reach $100 billion by 2012.
Whether or not this is a good thing is still being debated. The American Medical Association called medical tourism "an emerging development," but said it's too early to know whether the risks outweigh the advantages. Others are more certain that they don't.
"I think it's the market at work, and that's a good thing," said John McClaughry, president of the Ethan Allen Institute, a free-market public policy think tank in Concord.
Jeanne Keller, a health-care consultant in Burlington, disagrees. "Granny Overshoe in East Calais, on Medicare or Medicaid, is not going to be helped at all by this," Keller said. "And it's not going to reduce costs here in America."
Why it's cheaper to have surgery in say, Bangalore, rather than Baltimore is not complicated. The cost of labor is lower for physicians and health-care workers; so is the cost of medical devices and other products. There is also less cost shifting, whereas the American health-care system depends on spreading the expense of caring for the poor and uninsured among those who can afford it.
Keller said medical tourism could end up hurting the U.S. health-care system. "We're still going to have to carry the cost of maintaining the facilities for people who can't afford to go to India," she said.
Concerns about the quality of care abroad have all but disappeared, thanks to improved standards of care that are monitored by accreditation bodies, such as Joint Commission International and the International Society for Quality in Health Care. Studies have shown that mortality rates at hospitals that specialize in medical tourism are as low as, or lower than, those at U.S. hospitals.
Jane Schaeffer said Apollo Hospital in New Delhi "was really a whole different universe.
"The whole situation there is set up for people who have hip resurfacing," she said. "I had [physical therapy] twice a day, the surgeon came in twice a day to visit . . . I can't recommend it highly enough."
Schaeffer made her own travel arrangements to New Delhi but relied on an online broker, Healthbase, to find a doctor and hospital for the operation. Saroja Mohanasundaram, Healthbase's chief executive officer, said her company has formed "partnerships" with major hospitals in 11 countries. Her staff handles everything from digitizing and transferring patient medical records, to arranging airport transfers and hotel accommodations.
"The medical part is the main thing," Mohanasundaram said. "Once they like the facility and the doctor, then we try to help them with the logistics."
Schaeffer said she arranged any needed follow-up care with an orthopedic surgeon in Bennington prior to her trip - a practice the AMA lists among its guidelines for those considering traveling abroad for health care. But, since her return from New Delhi on April 30, she has been walking without crutches and has full range of motion in her hip.
Her next step is to ask Blue Cross Blue Shield, which declined to authorize the Birmingham Hip Resurfacing, to reimburse her for the surgery.
"I'm going to appeal it, based on: I saved a lot of money, I can still continue with my work, and they were wrong," she said. "We'll see what happens."