Finally, an upside to off-shoring

["Dave Farber" <dave () farber net>]

------- Original message -------
From: Ralph Sierra  <ralph.sierra () erols com>
Sent: 26/4/'05,  10:19

Dave Farber,

This could turn out to be one of the most important stories 60 Minutes has
ever produced.  First because it addresses one of the most critical issues
in America - rising healthcare cost (combined with the uninsured), and
second because the show's audience are the prime consumers of these
services: the aging baby-boomers.

While I can see that it might take a few years for flying to Asia for major
surgery to catch on, I predict that insurance companies will eventually find
a way to use these options to force U.S. healthcare providers to lower their
prices.  (Of course, then the battles in congress will start...)

http://www.cbsnews.com/stories/2005/04/21/60minutes/main689998.shtml

 Vacation, Adventure And Surgery?
April 24, 2005

Summertime. It's almost upon us. Millions will be heading out to foreign
lands for vacation, adventure, tourism, or just a beautiful beach. But how
about hip surgery or a multiple bypass or a facelift?

A growing number of tourists are doing just that: combining holidays with
health care. And that's because a growing number of countries are offering
first-rate medical care at third-world prices.

Many of these medical tourists can't afford health care at home; the 40
million uninsured Americans, for example. Others are going for procedures
not covered by their insurance: cosmetic surgery, infertility treatment.

And the hospitals in these faraway countries are glad to have these medical
tourists. In fact, they are courting their business, trying to get more
people to outsource their own health care. Correspondent Bob Simon reports.
--------------------------------------------------------------------------------
Thailand is an exotic vacation spot known for its Buddhas, its beaches, its
brothels, and the bustle of Bangkok.

But for people needing medical care, it's known increasingly for Bumrungrad
Hospital, a luxurious place that claims to have more foreign patients than
any other hospital in the world. It's like a United Nations of patients
here, and they're cared for by more than 500 doctors, most with
international training.

The hospital has state-of-the-art technology, and here's the clincher: the
price. Treatment here costs about one-eighth what it does in the United
States. It's the No. 1 international hospital in the world.

"It's sort of Ground Zero. I haven't heard anybody yet who's told us that
they take more than 350,000 international patients a year," says Curt
Schroeder, CEO of Bumrungrad.One patient is Byron Bonnewell, who lives
12,000 miles away in Shreveport, La., where he owns and runs a campground
for RVs. A year and a half ago, he had a heart attack, and his doctor told
him he really needed bypass surgery.

"They told me I was gonna die," says Bonnewell, who didn't have insurance.

He estimates he would have had to pay over $100,000 out of his own pocket
for the operation he needed, a complicated quintuple bypass. And he says he
actually decided not to do it: "I guess I figured I'd rather die with a
little bit of money in my pocket than live poor."

But Bonnewell says his health was deteriorating quickly, when he read about
Bumrungrad Hospital: "I was in my doctor's office one day having some tests
done, and there was a copy of Business Week magazine there. And there was an
article in Business Week magazine about Bumrungrad Hospital. And I came home
and went on the Internet and made an appointment, and away I went to
Thailand."

He made that appointment after he learned that the bypass would cost him
about $12,000. He chose his cardiologist, Dr. Chad Wanishawad, after reading
on the hospital's Web site that he used to practice at the National
Institutes of Health in Maryland.

"Every doctor that I saw there has practiced in the United States," says
Bonnewell.

But three days after walking into the hospital, he was on the operating
table. Two weeks later, he was home.

How does he feel? "Wonderful. I wish I'd found them sooner," says Bonnewell.
"Because I went through a year - I was in bad shape. I couldn't walk across
the room."

How was the nursing? How was the treatment?

"I found it so strange in Thailand, because they were all registered nurses.
Being in a hospital in the United States, we see all kinds of orderlies, all
kinds of aides, maybe one RN on duty on the whole floor of the hospital,"
says Bonnewell. "In Thailand, I bet I had eight RNs just on my section of
the floor alone. First-class care."

That's what the hospital prides itself on: its first-class medical care,
which it can offer so cheaply because everything is cheaper here,
particularly labor and malpractice insurance. You can get just about any
kind of treatment, from chemotherapy to plastic surgery.
Kim Atwater from Bend, Ore., was on vacation in Thailand when she decided to
combine sightseeing with a bit of an eyelift.

Was she nervous about having an operation done in Thailand?

"Yes, yes, I was somewhat hesitant about having any type of operation in a
foreign country, and it turned out to be, I mean, it was beyond my
expectations," says Atwater.

And it was not beyond her budget: $1,500, and that included a private room.

How would she describe the difference between this place and an American
hospital? "It's much nicer than any that I've ever stayed in the United
States," says Atwater.

The rooms look more like hotel rooms than hospital rooms, and that's no
accident. The idea was to make the whole hospital look like a hotel and a
five-star hotel at that. There are boutiques and restaurants to suit every
taste and nationality

"Part of the concept was to create an environment when people came in they
didn't feel like they're in a hospital," says Schroeder. "Because nobody
really wants to go to a hospital."

Bonnewell says he's going back this fall for another checkup. He'll have to
take a 22-hour flight, but there's even an upside to that.

"We do have a very unique relationship with Thai Airways," says Schroeder.
"So you can buy a ticket. You can use frequent flier mileage to get your
checkup."

Whatever it takes to get your business.

"And this is not the only hospital trying to outsource healthcare, is it?"
asks Simon.

"My goodness, no. I, we certainly have not gone unnoticed," says Schroeder.
"There are hospitals throughout Asia. There are hospitals throughout Asia,
throughout India." India wants to become the world leader in medical
tourism, and it might just make it. Alongside the familiar images of the
country (teeming, dusty streets, and poverty) you can add gleaming new,
private hospitals.

The hospital boom in India was fueled by India's growing middle-class who
demanded access to quality health care. Now, the country known for exporting
doctors is trying hard to import patients.

The most important player is the Apollo Group, the largest hospital group in
India, and the third largest in the world.

Why is it so important to get foreign patients here?

"It makes sense to establish India as sort of a world destination for health
care," says Anjali Kapoor Bissell, director of Apollo's International
Patient Office.

But why should foreigners come here? Well, it's even cheaper than Thailand
for most procedures, with prices about 10 percent what they would be in the
United States.

Anne Bell works at the British High Commission in New Delhi. She just had a
baby and says she's glad she was here, and not in England: "There's been no
pressure to go home after the delivery. We've been welcomed to stay as long
as we want. They're looking after the baby. They're looking after me, giving
me enough time to get settled and get confident enough to go back home.
Often in the UK, you might be out of the hospital within five hours if
you've
had a normal delivery."

And in the UK, she wouldn't have had a private room and a private bath. Not
to mention massages, and yoga, too. And the doctors? Indian doctors are
known worldwide, they speak English, and they're often the very same doctors
you may have had in Europe or America, where many of them practiced before
returning to India.

"Do you find that many Indian doctors are coming back now because of
hospitals such as this one?" asks Simon.

"Yes, a large number are coming back," says Bissell. "Because they have
something to come back to."

Dr. Praveen Khilnani, a pediatric intensive care specialist, worked at
several American Hospitals, including Mass General. Dr. Vikas Kohli is a
pediatric cardiologist who worked at hospitals in New York and Miami.

Both need sophisticated equipment to care for their patients, something
India didn't have before the birth of private hospitals like Apollo. They
both wanted to come back to India despite the fact that medical care costs
much less here, partly because doctors make much less.

"How much less do you make here than in the United States?" asks Simon.

"Maybe a tenth or a twentieth of what we were making the U.S.," says
Khilnani.

They wanted to come back, they say, because they felt their expertise was
needed here in India much more than in America.

"There are probably 1,500 to 2,000 pediatric cardiologists in the U.S. I
would be one of them," says Kohli. "In India, there were just four of us. I
was very passionate about working for Indian kids."

Since there are so many Indians who require the kind of care that only they
can offer, why is there such a strong drive to attract foreign patients?

"Who doesn't mind extra money flowing in?" says Kohli.

Stephanie Sedlmayr didn't want to spend the tens of thousands of dollars it
would take to get the hip surgery she needed. And she didn't have insurance,
either. So with her daughter by her side, she flew from Vero Beach, Fla., to
the Apollo Hospital in Chennai. She'd never been to India before, but she
already knew quite a bit about Indian doctors

"My doctor, actually, in Vero Beach, she's an Indian doctor. So, why not go
where they come from?" asks Sedlmayr, who says her friends questioned her
decision. "Hardly anybody said, 'Oh, great idea.'"

But she didn't just come here to save money; she came for an operation she
couldn't get at home. It's called hip resurfacing, and it has changed
people's
lives.

It hasn't been approved yet by the FDA, but in India, Dr. Vijay Bose has
performed over 300 of them. He showed 60 Minutes the difference between a
hip resurfacing and hip replacement, which is the standard operation
performed in the United States. He says his patients usually recover faster
because his procedure is far less radical and doesn't involve cutting the
thighbone.

Instead, Bose fits a metal cap over the end, which fits into a metal socket
in the hip. The result, he says, is that patients end up with enough
mobility to do virtually anything.

"So my patients, you know, play football, basketball, whatever you want. Not
a problem," says Bose.

Until the FDA approves it, the only way to have this operation in the United
States is by getting into a clinical trial. But be warned: It isn't cheap.

How much does it cost in the States?

"I believe it costs something from $28,000 to $32,000 U.S. dollars," says
Bose.

And in India, Sedlmayr says it costs $5,800: "Private nurse after surgery.
And, feeling always that they were just totally attentive. If you rang the
bell next to your bed, whoop, somebody was there immediately."

Sound too good to be true? Don't forget: It's at least a 20-hour trip, there
is malaria in parts of India, patients have complained of intestinal
disorders -- and if something goes wrong, you could end up suing for
malpractice in an Indian court.

And one could only wish you the best of luck. But Sedlmayr feels she's
already had more luck than she had any right to expect. By the time 60
Minutes left India, she was into the tourism part of her treatment,
convalescing at a seaside resort an hour's drive from the hospital.

"Is this standard, that when somebody gets surgery at the hospital to come
to a resort like this afterwards?" asks Simon.

"Yeah, they suggest it. They recommend it," says Sedlmayr. "[It cost] $140
day for myself and my daughter, including an enormous fabulous breakfast
that they serve until 10:30."

"I think a lot of people seeing you sitting here and what's usually called
post op, and hearing your tales of what the operation was like, are going to
start thinking about India," says Simon.

"Yeah, and combining surgery and paradise," says Sedlmayr.




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