Thailand Medical Tourism and Travel Blog Finalist

Youth sees a through-line to immortality until age intervenes.  Occasionally, I felt a twinge in my right hip as far back as fifteen years ago.  I laughed and called it “sex hip”, as in, “Ow. I have sex hip”.  Other versions were bluer.  Until recently, a sore hip whispered, “fun weekend”.

Join me as I jump over hurdles to shopping for healthcare locally and globally after I discover that I need hip surgery. Two previews:  1) It takes about 8 times longer to get basic information from a U. S. hospital than from an international hospital.   2) In January of 2011, I was quoted retail prices between $16,000 and $19,000 per night for hospital rooms in Southern California vs. $166 per night at Thailand’s best hospital.

Prognosis: Middle Age

In the fall of 2010, the Tourism Authority of Thailand (TAT) announced a blogging contest to refresh the world’s awareness of Thailand’s leading role in cross-border healthcare.  I’m working on a book about Thailand so I was eager to inspect Thai health providers personally.  I entered the contest and became a finalist.

Thanksgiving week I arrive in Thailand at 6 AM to an enthusiastic TAT team and a daily 7AM to 10PM, forced-march schedule seeing hospitals, clinics and sites in Bangkok. After 17 hours flying in coach I’m beat, jetlagged and limping.  I didn’t realize how bad my hip had gotten.

Auspiciously, Bumrungrad International, which has a Center of Excellence in orthopedics and is one of the world’s top hospitals is on my itinerary.  Sometimes familiarization trips like the one I’m on include the offer of experiencing a service.   I ask if they will look at my hip and am whisked in to see an orthopedic surgeon for a range of motion evaluation.  Quick-as-an-X-ray, I’m diagnosed as needing Birmingham hip-resurfacing surgery, a more conservative version of total hip replacement.  Bumrungrad sends me off with the doctor’s preliminary diagnosis and a digital copy of hip X-rays.  I’m 51.  Sex hip just became middle-age hip.

Skin in the Game

Nothing like a little skin in the game to motivate a search for value. The Centers for Medicare and Medicaid Services (CMS) say healthcare accounts for 17.3% of the U.S. GDP in 2009.   Healthcare is 23 percent of the federal budget, 21 percent of individual state budgets, and 16 percent of discretionary spending in the average household.  It sounds like nonsense to say that Americans are not good consumers of healthcare (because we certainly consume enough of it).  But, we’re bad at it ― though, through little fault of our own.  There are legal, competitive, structural and social barriers to the availability of basic information that drives purchase decisions in non-healthcare industries.

To clarify, there is lots of data about healthcare.  Government publications, regulatory agencies, care providers and insurance companies all publish tons of information about the consumer or how to buy insurance.  However, in months of research, I cannot find any information on how to go about buying a surgical treatment service in the U. S. (other than plastic surgeries) or how much frequently performed surgeries should cost.   Why aren’t prices for medical services as  easy to find as say,  pricing an airline ticket?  I was about to find out.

If you’re a medical professional you’re probably saying that I just don’t understand the constraints you operate under.  You’re right.  I don’t…not completely anyway.  However, the utter lack of information makes me wonder what you don’t seem to want me to know.  I’m not asking for the recipe to Coke Classic.  This isn’t national defense.  Why the secrecy? The absence of easy-to-find consumer information on U. S. healthcare and pricing is all the more surprising because healthcare is a mature, highly regulated industry.

Three years ago I started researching Health Travel, (which is the notion of applying consumer behaviors we use in every day life shopping for food, clothing, electronics, entertainment and durable goods), to healthcare.  This sounds simple but it gets confounded by a U. S. healthcare system that brims with distortions that decouple costs from results.

Artificial market distortions, which Economists call asymmetric information, obstruct a normal consumer search for value.  My experience shopping for surgery in the U. S. was  so difficult and unsatisfying that it is damning.  I defy anyone to shop for a specific health treatment service and then tell me with a straight face that, “The U. S. has the best healthcare in the world.”  Here’s why.

Good Patients.  Lousy Consumers.

It is easy to compare features and pricing when shopping for cars or electronics.  In contrast, do you know how much the doctor marks-up the lab tests you just took?  Any idea how much your insurance company was charged for your last colonoscopy?  Do you ask the price of specialist consultations before you go?  Offhand, do you know which nearby hospital has the best value in emergency room services or how much a hospital room costs per night?  Do you consult any objective measures of how good your personal doctor is?  Probably not.  If you’re insured you probably leave details to the insurance company and just follow a path set out by your doctors.  Good patients are lousy consumers.

Shopping for Healthcare in Southern California

I decide to use my requirement as a reason to put myself in the shoes (on the crutches?) of a regular patient and go shopping for hip surgery.  I start my search where I live in California before going global.  For now, I set aside the issue of insurance and shop as a cash (not insured) patient because it reveals the consumer process more clearly.

If you know anything about U. S. healthcare, you might flag “cash patient” as a canard because some hospitals quote higher prices to cash patients; while others quote their highest prices to insurance companies and offer lower pricing to cash patients.  My point exactly.  Situational distortions like these frustrate consumer behavior because value becomes so difficult to identify.  Fluid pricing results in adverse selection, asymmetric pricing and general confusion…all of which are bad for consumers.

The Challenge of Getting Basic Information

Cash Pricing at UCLA - 4 Hours and 6 Touch Points

*Cash Pricing on basic information collected, January, 2011.

1) I start by contacting the 3 Southern California hospitals that top the U. S. News & World Report’s Best Hospitals in Orthopedics list.  You’re probably thinking, can’t you just go on a hospital website to view room prices and procedure estimates?  Nope.  Can you call a hospital and find out enough general information to decide whether you might want to become a patient there?  Not really.

2) Getting price estimates is a multi-step, multi-source process that took 3 to 4 hours of active time for each U. S. hospital, (over several days).  The data above are from 6 different phone calls to 6 different sources.  Seems to me getting cash pricing requires more sophistication and persistence than it should.

For example, the hospitals I contacted required that I provide them with the accurate insurance code for my procedure before the hospital could tell me what an in-patient room costs.  The insurance codes are called CPT codes, and I was able to get them for Birmingham Hip Resurfacing / Total Hip Replacement from an Internet resource.  But sheesh!  Really?  I have to become expert enough to figure out the insurance code (for a cash procedure) or you can’t tell me anything?

At the apex of frustration, USC, asked for the CPT codes too but then would not provide any information about services or pricing without a written request from one of their own, internal doctors.  To restate, USC would not tell me pricing under any circumstances, even though they have a website tab for International Patients.  I presume that International Patients don’t have Blue Cross-Anthem…so they must be paying cash.  I wonder if they have to know CPT codes, too.  Maybe I’ll fake a French accent and call that line next time.

3) I was up-front with the hospitals about shopping for value.  Two hospitals (UCLA and Cedars-Sinai) eventually quoted verbal estimates for the hospital room, the operating room and the cost of the implant.  Keep in mind this is a healthcare need I can schedule.  If the need were urgent there would not be any hope of searching for value.

4) Originally, I hoped for written estimates…something as simple as the UCLA graphic above.  However, the only estimates I could get were verbal.

5) There is no “all-in-one” source for information.  Each hospital department is specialized and will not provide any information about another department…more than an accurate telephone number.  I understand that medicine is highly specialized but all I wanted were general guidelines, like, “How many weeks of physical therapy do most patients need?”.

6) Hospitals don’t seem to use much outgoing email.  Seems email can be construed as creating a contract with the hospital so most information is offered verbally without email confirmation.  There may be some HIPAA requirements for information provison by email, but seriously…even Obama uses email and his job is pricklier than hospital billing.

Sly Costs and Other Barriers

Hospitals like USC which require a doctor be involved as a pre-requisite to getting general information and pricing are effectively saying that patients need to pay for the privilege of knowing how much something costs.

I point to this because getting a doctor to make an internal request requires payment of the doctor consultation fee ($900) labs fee ($350) and imaging fee ($300), or approximately $1400-$1500 for the privilege of knowing general information.  Why is basic info treated like a state secret?  Why does it feel like I’m being penalized for asking questions?  My personal feeling is that silly requirements like this add to the healthcare costs we all pay…and who wants that?

Alternatively, I am told, if I go to the emergency room as a patient that I might be able to get better information.  No kidding.  I asked one of the UCLA doctor referral operators how I could find out what a surgeon charges in professional fees for hip replacement surgery and she suggested the emergency room as a resource for general and pricing information that was otherwise unavailable.  So, I should go to the emergency room to get surgical pricing?  Should I put “Confusion” down as the reason for the visit?  No disrespect to the referral operator…but I have a few questions for the hospital’s policy group about why the emergency room is a better work-around than posting general guidelines on the hospital’s website.

Is the prestige of healthcare so high that it is entitled to function above other types of commerce?  Shouldn’t there be some sort of consumer protections?  Finance majors would call these sunk costs and they are pretty good examples of the kinds of distortions that exist in current U. S. healthcare.  I’ll editorialize for a moment to say that U. S. healthcare reform is supposed to empower the kind of consumer shopping I’m doing here but the barriers to information seem so extreme…I’m not hopeful about how quickly the walls will come down.  I believe these nutty extremes are one way healthcare providers discourage value shoppers like me, (and consumer behavior in you).  But, to what end?

I got the impression that to date surgeons get very few calls asking how much they charge for professional services.  One reason is the normal policy of many surgeons to not price an operation until after it is over.  Offshore hospitals and top practices like the Cleveland Clinic and the Mayo Clinic offer pricing for complete surgical packages but the Southern California hospitals I contacted did not.  You’ll see on the graph here that the Mayo Clinic in Scottsdale offers package prices for much less than Southern California hospitals.

As long as I’m already replaying every “Open the Kimono” joke I have ever heard and attributing causation for each hospital’s Waiting for Godot logic and Soviet-era-communication-styles, I’ll add a few notes.  In fairness, doctors have a duty-of-inquiry as part of their requirements for informed consent and referral, but I don’t see how these legal concerns extend to basic pricing questions.  It seems each hospital’s and doctor’s customer service people with whom I spoke are afraid of being understood as offering medical advice or conveying information that could be construed as creating a hospital’s commitment to me.

The forces against transparency seem so extreme that I imagine most patients give up before they get basic info.  I sure thought about it.

Domestic Health Travel

There is growing interest in domestic Health Travel.  Lowe’s Companies, Inc., the home goods retailer is trying to control its healthcare costs and improve the value it offers employees.  Lowe’s offers employees who need major heart surgeries, the option of going to the Cleveland Clinic which is one of the world’s best heart hospitals.

Lowe’s pre-negotiates rates with the Cleveland Clinic, saving the company tens of thousands per surgery.  Top healthcare can be counter-intuitive; the Cleveland Clinic has superior medical outcomes and lower prices than many other hospitals.  Lowe’s shares those wins with employees by forgoing employee deductibles and paying the travel costs of those who opt-in to the program.

I contacted the Mayo Clinic as my domestic Health Travel touch point and it would be my U. S. preference for the simple reason that they seem to work on the basis of less of the crazy.

Shopping for Surgery  Globally

I researched real global prices for hip surgeries in January 2011.  The most vivid differences are between the retail price for hip surgery at Cedars-Sinai hospital in Los Angeles and Bumrungrad International in Thailand.  The retail price of hip surgery at Cedars-Sinai is $120,731.  Some discounts may apply. See here for more detail. Bumrungrad charges $18,300 (or 15.1% of what Cedars charges) for the same surgery.   The comparison is important because it should ignite the urge in all of us to become better consumers of healthcare.  I’ll mention that high healthcare costs are a downward driver of the general competitiveness of American businesses.

Shopping for healthcare internationally is a dream compared to hoop-jumping in California. It is easy to get general and pricing information from offshore hospitals in part, because they’re more used to global patients.  It took approximately 30 minutes of active time (over a few days) to get basic information from the hospitals on this graph.  I write books on Health Travel and can say with authority that these international hospitals are equivalent to UCLA, USC and Cedars-Sinai in orthopedics.

Contacting Global Healthcare Providers

Offshore hospitals are not a perfect shopping experience either; they make patients work a little too hard for details but at least they provide general information readily and without any of the crazy distortions or blocks.  It is so much simpler and faster to get basic information globally that it makes me all the more red-faced about my experiences with U. S. hospitals.

Its easy.  Just call, fax or email the International Patient’s desk of Health Travel hospitals you want to know more about.  I sent a digital X-ray together with the initial diagnosis and got back basic information about procedures and pricing within a few days.  Chances are high you’ll soon be communicating directly with a doctor who specializes in the type of medicine you need.  If you’re the type who frustrates easily, you can default to using an International Medical Travel Facilitator to make your arrangements.

The Rat-King

U. S. healthcare is made up of impossibly complex iron triangles of entrenched interests.  I describe it more colorfully as a Rat-King; German folk stories about a swarm of rats with tails that become entwined, even as the rats grow.  The rats pull individually but cannot move except in cooperation.  The Rat-King of insurance companies, pharma companies, hospitals and even doctors and the government prevent the creative destruction the PPACA will have to cause if it is to be successful in empowering normal consumer behaviors.

No wonder drug and insurance companies are freaked out and supporting healthcare repeal.  Industries don’t voluntarily lower the barriers-to-entry that support  industry structure, competitive advantage and associated profits.  Doing the right thing for individual patients and national strength would be bad for business and shareholder value.   And, by the way…the end of spending on the cold war created a “peace dividend”….when are we going to start talking about the “health dividend” which will surely come?

Consumer Affairs

If I buy a car in California where I live, I’m protected by a Consumer Affairs Bill of Rights that guarantees the seller will show me itemized prices before I buy anything.  Shouldn’t healthcare have at least that much transparency?   Shouldn’t buying medical services be at least as easy as buying a car?

One of the expressed goals of The Patient Protection and Affordable Care Act, (PPACA) is to make us all better healthcare consumers, create transparency and reward those who shop for better healthcare value.  I’ll light a candle.

Opportunity

The nuisance factor of shopping for healthcare in the U. S., alone, may be reason to look offshore.  In my case, reliable information was so hard to come by that the “If you can’t measure it you can’t manage it” adage comes to mind.  I’ll predict that any company which empowers consumer choice by lowering the freakishly high customer burden to getting information could find big market success.

As for me, the way forward is undefined.  All I know for sure is this is the year my hip gets its mojo back.

Piyavete Hospital's Tria Entry

Recently, I toured Piyavete Hospital’s Oncology and Gene Therapy Center.  The center is led by Dr. Thongbliew Prempree who is both a PH. D in Molecular Biology (from John-Hopkins in Baltimore) and a Medical Doctor from Mahidol University in Bangkok). Dr. Prempree practices Radiation Oncology in the emerging field of Gene Therapy.  A few years ago, he returned home to Thailand, and brought his U. S. molecular biology lab along with him.  We ask him to talk about Targeted Cancer Therapies which offer 65% to 70% (high) cancer treatment success rates.

How Targeted Therapy Works

Targeted Therapies are today’s most promising developments for cancer treatments.  The 4-5 years of patient results are so good that many expect Targeted Therapies to replace traditional chemotherapy in short order.  Gene therapies are just now moving from research centers into broader hospital practice.  In the U. S., many of the most promising therapies are only available through phase trials, (which are closed to many patients).  And, it may be years before new therapies are reimbursed by U. S. insurance.  Piyavate is one of the few hospitals in Thailand to make Targeted Therapies available to cancer patients.

Each person’s cancer is as unique as they are and Gene Therapy holds real promise for cancer remission and cure.  Dr. Prempree is able to claim higher cure rates because he studies each patient’s unique tumor genes from which he identifies proper targets for treatment. Therapies start with two steps: 1) Analyze the unique protein produced by the cancer gene, then 2) Analyze Deoxyribonucleic Acid, or DNA, to identify the unique characteristics and mutation because such mutation significantly affects the cure.

One approach uses Ex-Vivo Assay (EVA) to analyze the cancer cells and match them with FDA approved drugs (chemotherapeutic agents) or combination therapies that should be most effective in treating this type of cancer in this unique individual.

Dr. Prempree says, “In my view, the best hope for cancer cures lies in this path.  I believe the study of patient’s tumor genes and development of customized treatments yield the best results.  We already see it here at the Oncology and Gene Therapy Center.”  The three top reasons patients come here are higher cure rates, higher cure rates, and higher cure rates.”

He continues, “Thailand has some advantages in cancer treatment over the U. S. because we have the freedom to use Anti-gene or Targeted Therapy based on what we find in the mutated genes of the patient’s cancer tissues.  I estimated that we can identify tumor genes and host genes for about half of U. S. costs and that is a big advantage because it means many more people will be able to come.”

The advantage of individualized cancer medicine is that by using the patient’s own tumor cells, the reaction to a chemotherapeutic drug or combination of drugs can be analyzed, resulting in a cancer treatment that is tailored to each patient’s unique profile.  This means targeted chemotherapy only kills that cancer cells and cancer causing cells leaving healthy cells to support recovery.  Patients are much more comfortable and recover from treatments much more quickly.

Piyavete Hospital

Piyavate Hospital Public Company Limited.
998 Rimklongsamsen Road, Bangkapi,
Huay Kwang, Bangkok, Thailand 10310
Phone: (66) (2) 625-6500 Fax: (66) (2) 246-9253

The Holistic Medical Centre Lobby in Central Bangkok

Holistic Medical Centre (HMC) is an innovative medical center in central Bangkok that puts a convenient, friendly, all-in-one-place face on alternative wellness.  Integrative Medicine is a branch of holistic medical therapies that treat the causes (rather than symptoms) of disease.

Holistic Medical Centre uses a variety of western and holistic methods of diagnosis to detect abnormalities at the energetic level.  HMC’s assessments seem miraculous to me.  In my case two simple, comfortable holistic tests (a pin-prick of blood and a device that sent an electrical current through my nervous system), picked-up medical problems that I later confirmed through western medicine lab tests .

I wonder aloud why Integrative Medicine is so highly developed in Thailand?  Dr. Vergel Jay Bautista, M.D is HMC’s Medical Manager.  He says:

“Buddhism and Alternative Medicine are closely related in Thailand because Buddhist philosophy underpins the practice of medicine in general.  Specifically, Buddhism is the foundation of our understanding of health and illness.  The Four Noble Truths address the cause of suffering and as a doctor, I look for the cause of the illness.  It is hard to say this to a sick person, but we believe the manifestation of disease is a form of illusion.”

He continues, “We look at the whole person’s body-mind-spirit.  Practically, we believe it is necessary to root-out negative emotions and treat the patient with medicine, diet, and physical therapies. This makes our therapies very Buddhist and also very Thai.”

Many of the services Holistic Medical Centre offers exist near my home in Los Angeles, but similarities end there.  In L. A. you usually get only one or two holistic services in each location before you traipse to the next place for one or two more services.  Not very convenient or relaxing.  Another difference is that medical doctors administer or monitor every HMC service.

There are many facets to Holistic Medical Centre’s offerings but tent-pole services include:

MRIT (Molecular Resonance Imaging Technology) – This device detects electrical changes from a standard score to reveal the tendency to develop certain diseases.

Live Blood Analysis (LBA) – A tiny drop of blood screens for excess protein, fat and heavy metal residues.   

ALCAT Test- Tests your sensitivity to 150 foods and 20 additives.

Hormone Test- Imbalances cause sexual dysfunction, osteoporosis, menopausal syndrome and other age related problems.

Treatment Modalities Include:

• Detoxification: Chelation & Colon Hydro therapy
• Haematogenous Oxygen Therapy
• Hyperthermia
• Vitamin C Infusion
• Nutri-medicine

If you are reading my other posts, you know I need to have hip replacement surgery.  My personal fantasy for surgical preparation would be to arrive in Bangkok four or five days before I scheduled surgery.  I would go to an Integrative Wellness clinic like HMC to get my body as strong as possible before going under anesthesia and the knife.

Holistic Medical Centre
20^th Floor, 253 Building, Asoke-Sukhumvit 21 Road
Klongtoey-Nua, Wattana
Bangkok 10110

Tel: 02-640-8090

www.hmcthai.com

The Atrium of Bumrungrad Hospital's Out Patient Center

Recently, my right hip became painful. I know the situation is headed on a bad trajectory but still think like a younger man: “It will get better.” I say to myself.

On the first morning of the Thailand Med Blog Contest, I draw the best itinerary of cultural sites for my bucket list and top hospitals for my work.  Score.  That night is a press party and I’m jet lagged to a fare-thee-well.  I can already see that the itinerary will be a forced march to get everything in.

At the party, I’m trying to be charming and learn everything I can.  This is a press event and I don’t really like attention, (being on stage is torture).  All of this is to say, I’m exhausted and a little miserable when I meet the Bumrungrad team.  They notice I’m limping and offer to help.

If you’re keeping up with the MedBlog contest blogs, you’ve noticed that most tours involve taking some kind of treatment: a massage, a screening…something real clients request.  The Bumrungrad team offered to switch the cardio stress test they had planned for something I might find more useful.  I ask them to diagnose my hip.

Intake

Bumrungrad is a wonder.  It is a tour de force of business process design; improving patient safety, medical outcomes and costs while simultaneously improving the patient experience.  If Apple® designed hospitals, I imagine they would be a lot like Bumrungrad.

The experience starts as you walk into the soaring, sun washed lobby of Bumrungrad’s new Out Patient Center which has super-sophisticated modernist detailing, rich colors and nice materials.  The Out Patient Center sees 3,000 patients per day, of whom 300 patients are new.  Patient intake is genius.  You answer a few questions and you’re in the doctor queue.

If you listen, you’ll hear subtle ways the hospital begins mitigating mistakes and practicing skillful medicine.  A nurse does intake which allows her to ask a few simple questions that provide basic information but also indicate whether I’m experiencing a medical crisis.   I’m sure the checklist went something like:  Responsiveness? Obvious warning signs of medical crisis?  Is there shock…heart attack…flu…bleeding…stroke…mental break…broken bones, etc.  All this happens at the same time they’re double checking name spelling and other details that avoid duplicate patient records and other data points that can cause trouble down the road. Total genius.

Extra Genius Points accrue for how Bumrungrad uses design to wrap the business process and information technology into an aesthetic response.  Everything whispers sophistication, confidence and authority.  See pricing comparisons here.

Seeing a Doctor

I understand that long waits to see a Bumrungrad doctor are rare.  I am at the hospital early so I don’t even get to finish my tea before Dr. Winyou Ratanachai invites me in.  He asks a few questions and examines my hip’s range of motion then gives me a knowing look and, “Let’s confirm this with an X-ray”.  Digital X-rays follow and Dr. Winyou tells me I need hip resurfacing.

I’m only 51 and need surgery?  #*@F! Ouch. The good news is that hip resurfacing is a stable surgery that works well for younger candidates.  It allows a wider range of motion and conserves bone material in the (likely) event, I’ll need a total hip replacement on down the road.

Bumrungrad Hospital Out Patient Center Lobby

Bumrungrad International Hospital
33 Sukhumvit 3 (Soi Nana Nua), Wattana
Bangkok, 10110 Thailand

Telephone: +662 667 1000
Facsimile: +662 667 2525
E-mail: info@bumrungrad.com
http://www.bumrungrad.com/

If You Go

Bumrungrad in Thailand offers one of the best values in international Health Travel.  Thailand pioneered global health travel and now has over 13 western accredited, JCI hospitals, (www.jointcommissioninternational.org).  This graph shows how Bumrungrad stacks up to global hospital pricing.

Tourism is Thailand’s largest industry so the country has more “connective tissue” conveniences and services than some other destinations have.  The country also has a strong tradition of Integrative Wellness centers and feel-good holistic services that have great wellness appeal.

Costs

Here is a graph of actual costs for Birmingham Hip Resurfacing surgery from personal research I conducted in January 2011.  Note: Your prices will vary.  It is challenging and complex to get cash prices for surgeries in the U. S. but this is a detailed, good faith effort to compare “apples to apples” costs in these countries.   I grouped data for both hip resurfacing and total hip replacement surgeries because not every hospital I contacted performs hip resurfacing and the costs for each surgery are similar.

Bumrungrad Room Prices

At Bumrungrad, a 2-patient room is $166 per day; a single room is $268 per day and deluxe rooms / suites are available from $315 per day.  The “retail” prices of 2-patient hospital rooms in Southern California are approximately $16,000 (UCLA) per night and $19,000 (Cedars-Sinai) per night.    Discounts may apply.

Bumrungrad International Hospital
33 Sukhumvit 3 (Soi Nana Nua), Wattana
Bangkok, 10110 Thailand

Telephone: +662 667 1000
Facsimile: +662 667 2525
E-mail: info@bumrungrad.com
http://www.bumrungrad.com/

Read more about my visit to Bumrungrad here.

So, you have done your research and you’re seriously considering becoming a medical tourist.  Here are some fine points to consider.

Hospital Care

Hospital care in a top Thai Hospital means something different than it does in a western one.  In the west, care means:

• Dispensing the proper medicine in the right dosage at proper intervals.
• Insuring oxygen, IVs and monitoring equipment are functioning.
• Basic patient safety, security and comfort.
• Following accepted treatment guidelines, (protocols).
• Dealing with changes and emergencies.

In Thailand, care means the above but adds feel-good components, “Would you like some tea? What can the chef make you for lunch? Are you comfortable?”

Time to Heal

Most western patients are happy with the “medicine” part of medical care in the U. S. but are dissatisfied with the “care” component.  Costs are the reason.

We all hear stories of patients being rushed out of hospitals by noon to avoid thousands of dollars in room charges that insurance may not cover.  If the average U. S. hospital room rate is $3,750 and the high end is $23,000, no wonder insurance companies limit in-patient hospital care.  Lower overall costs in Thailand create the space for real recovery.

The Convenience Factor

The surgeries that work best for Health Travel are singular, like cosmetic procedures, that don’t require frequent doctor contact after surgery.  Health Travel requires more planning than just driving across town so small procedures in isolation don’t have the economic payback.   However, it is convenient to condense the every-day medical services you will need for the year into one chunk of time in a destination country.  If you get all the deferred dentistry you have been putting off, new eyeglass lenses and the general maintenance care most people need, you start to think medical travel is pretty convenient after all.

Risks

A small portion, about 3%, of all medical patients (domestic and cross-border) would not repeat a medical procedure. Surgical success rates are over 98-99% in most hospitals. So, why is there a 2% disparity between surgical success and patient satisfaction?  Overly hopeful expectations, age related disappointments in outcomes and anesthesia reactions account for most. This 3% risk applies to you too, so get smart on risk factors and realistic outcomes to avoid being on the wrong end of this statistic.

What About Complications?

Any surgery has a small risk of complications.  If you develop complications when you’re still in-country, your doctor will re-admit and re-treat you, usually at no additional cost.

Complications that arise when you are back in the USA can be problematic.  Affordability aside, you may have trouble finding a specialist who will treat complications because the doctor fears being sued for a medical problem s/he did not create.  Keep in mind that patients who go offshore for care are already controversial with U. S. doctors who are not eager for low cost competition.

Ask yourself whether you have the resources to fix complications when you’re back at home.  If not, the best ways to protect yourself is to buy Medical Travel Insurance and plan extra recovery time in the treatment country.  Even if you’re watching nickles, get insurance.

Malpractice

The majority of medical malpractice claims in the U. S. are from mistaken diagnoses and medication errors, which you’ll be able to ameliorate by getting second or third opinions before your procedure in Thailand (they’re a great low-cost way to eliminate a source of malpractice risk).  Going to an accredited Hospital is another great hedge against the kinds of mistakes that create malpractice claims

In the unlikely event something bad happens and you feel you have a claim for malpractice, there are ways to recover money for medical procedures performed in another country.  However, the chances of receiving a large award for pain and suffering are remote.   Malpractice awards in other countries are small and there is the tendency to favor fellow nationals.  These realities are also part of the reason healthcare in Thailand is cheaper.

The best single step to manage malpractice risk is to buy Medical Travel Insurance before you go. These policies do not offer large cash awards.  However, they will cover costs associated with making you better.

Here are other practical ways to manage malpractice risk:

• Choose a doctor who does a large number of your specific procedure, prestige medical research and who cares about reputation.
• Choose a hospital that does a large number of your specific procedure, is engaged in prestige medical research and that cares about reputation.
• Get second and third opinions on your diagnosis.
• Pay with a credit card in case you need to reverse charges later on.
• Find out about the hospital and doctor “fix it” policy and get it in writing.
• Plan for extra days of hospital in-patient care.
• Allow extra recovery time in the treatment country.  More days = lower general risk, lower malpractice risk and improved well-being.
• Buy Medical Travel Insurance.

Medical accreditations are assurances by meticulous, technically focused third-parties, that a care provider meets minimum requirements of infection control, medication safety, facility safety, standards compliance and overall quality.  “Minimum requirements” makes this sound easy but these measures are closer to zero (or a few occurrences per thousand) than the way “minimum” sounds.  There are other types of accreditations and quality marks that warrant non-medical aspects of hospital reliability.

Affiliations signal academic aspirations and resources while partnerships signal a hospital’s standing in the local business community.

Medical accreditations can be confusing, but you’ll understand most of what you need to know by focusing on two names:  ISQua and JCI.  The general idea is that health and safety procedures in an accredited hospital in Chicago will be very similar to the health and safety procedures of a similarly accredited hospital in Bangkok.  JCI gets singled-out because it is a USA-based accreditation and has the highest media visibility.

Accreditations are very expensive to get and maintain because of the costs of high standards and oversight.  Often, only top offshore hospitals go to the trouble.

The Joint Commission (formerly JCAHO) and the Joint Commission International, (JCI)

The Joint Commission is an independent U. S. based non-profit corporation that offers medical accreditation programs to subscribers; including over 17,000 U. S. hospitals and care organizations.  U. S. hospitals need Joint Commission accreditation for many insurance reimbursements.

The Joint Commission International (JCI)

JCI is the international accreditation arm of the Joint Commission.  JCI is the most popularly recognized marker and brand of international quality and the ISQua licensed accreditation for over 300 international hospitals and programs.  JCI claims higher standards than other ISQua grantors.

The International Society for Quality in Health Care (ISQua)

ISQua is an official partner of the World Health Organization and the non-profit umbrella organization for the gold-standard international medical accreditations.   ISQua creates the standards that guide 16 accreditation granting bodies.  Accreditations are awarded by ISQua partners and not by ISQua directly.

ISQua Accreditation Organizations

Accreditations are the mark of an expert warrant.  Medical quality is way too complex for most to understand on our own and we need an expert to tell us which hospitals meet the highest, pickiest standards.  Accreditations do that.

Any ISQua accreditation is very, very good and indicates that hospitals with these accreditations will have similarly high standards, procedures and quality.

• Accreditation Canada.
• The Australian Council on Healthcare Standard – ACHS.
• Australian General Practice Accreditation Limited / Quality in Practice – QIP/AGPAL.
• Healthcare Accreditation Quality Unit, UK – CHKS-HAQU.
• Council for Health Service Accreditation of Southern Africa – COHSASA.
• Health Accreditation System of Instituto Colombiano de Normas Tecnicas y Certificacion, Co – ICONTEC.
• The Irish Health Service Accreditation Board – IHSAB.
• Joint Commission International, USA – JCI.
• Malaysian Society for Quality in Health – MSQH.
• Netherlands Institute for Accreditation in Healthcare – NIAZ.
• Quality Improvement Council and the QIC Accreditation Program, Australia – QIC.
• Taiwan Joint Commission on Healthcare Accreditation – TJCHA.
• Health and Disability Auditing New Zealand – HDANZ.
• Global-Mark Pty Ltd, Healthcare Certification Programme.
• Health Care Accreditation Council of Jordan – HCAC.

National and Regional Accreditations

There are very good regional and national medical accreditations like NIAHO, NABL, NABH, Hospital Accreditation of Thailand and others, which deserve respect too.

International Organization for Standardization, (ISO)

ISO is a family of standards for a hospital’s quality processes.  Although ISO marks are not medical accreditations, they warrant that a hospital does important things, like keeping records well.  Often, ISO accreditation is present together with medical accreditation.

Private Sector Accreditations

There are a private sector accreditations like HAS (Haute Autorité de Santé) from France and QHA Trent Accreditation from the UK that are alternatives to ISQua.

Social (Non-Medical) Accreditations

Groups with progressive social goals award accreditations in-line with that group’s mission.  For example, Planetree promotes patient-centered care.

Operational Quality Marks

Measurement: Some quality marks center on measurement, calibration, environment and other operations management issues.  TUV is a leader.

Distance Medicine: TEMOS verifies distance medicine capabilities.

Samitivej Hospital has a unique customer focus and fantastic patient experience which the hospital calls “High-tech with High touch”.  The experience really is different than other healthcare providers.   Western hospitals are mine fields of nuisance but Samitivej seems to specialize in making things easy on patients. The hospital backs up marketing claims with a multi-lingual work force, immigration services, high-level care and convenience.

The word samitivej means medical gathering or place where doctors meet. The Samitivej Sukhumvit Hospital (one of three Samitivej Hospitals) is a 270 bed tertiary hospital located in central Bangkok.  The hospital is managed by the august Bangkok Dusit Medical Services and has the most exclusive accreditations, (JCI), and affiliations.  It is preferred for the following reasons:

Women
The hospital has a strong, specialized team of female physicians & surgeons to care for other women.  The name cracks me up, but ask about the Lady Bible which tracks how woman’s medicine differs from men’s medicine.

Babies
Samitivivej’s birth unit differs from many Thai birthing centers (where C-sections are common).  The birthing center includes water births and tools for natural and traditional deliveries.

Big in Japan
More than 20% of the hospital’s patients are notoriously quality conscious Japanese and Samitivej is the #1 Japanese hospital outside of Japan.

Sports & Orthopedic Center
Samitivej has the first center in Thailand to focus on: 1) sports performance, 2) sports injury and 3) sports recovery.

Locals and Expats
Locals always know the real deal and Samitivej programs respect and cultural sensitivity into the quality it offers.  In-the-know expats prefer Samitivej.

Here is a primer of concepts, advice, information and tools you need to book a medical procedure in Thailand with confidence.  The Quickstart Guide is just that, high level topics you’ll need to address for successful Health Travel.  There are two sections of tools: Search (for finding your solution) and Management (for managing your care plan).  Both sections have the right questions and resources to find the best hospital, doctor and recovery experience…especially if you don’t use a Medical Facilitator. If you like this, please share it with friends. Follow article links back to details.

Don’t be daunted.  Health Travel takes some time but is easy to organize if you’re persistent and understand the basics. Questions are designed to clarify your preferences, project manage the process and elicit information to guide your choices:

Resources Search

These topics are arranged, more or less sequentially, in the order you’ll use them.

Find a Great Thai Hospital-Identify the characteristics of top hospitals.

International Patient Coordinator-How the patient coordinator can help you.

Doctor Contact-How to prepare for all doctor touch points.

Find a Great Thai Doctor-How to identify top doctors who are the most qualified in your procedure.

Doctor Consultations and Evaluations-What to ask during your Evaluations / Consultations.

Health Journal & Medical Status-A contents list of the medical records you’ll need for offshore care.

Resources Management

Pricing Checklist-What and when to ask for details on pricing.

Packing Checklist-Trip essentials and more.

Surgery, Recovery, Relaxation, Release & Home Checklist-Tips to keep you safe and comfortable in these phases of your trip.

Step One-Research

Begin your research, as most do, online.  Try to understand the general healthcare landscape within three or four hours of unstructured search, then, shift into purposeful search for expert sources.

Read popular magazines and daily news for general information then progress to expert sources with strong medical points-of-view.  The National Institute of Health is a great place to start expert research: http://www.nih.gov/.

Step Two-Solution First. Then Hospital. Then Doctor.

Answer the question, “What is my ultimate medical solution?”.  Then get smart on the science, medicine, equipment and procedures of that solution.  Make a list of success factors, differences in treatment approaches and special equipment to guide your answer.

Step Three-Practical Matters

Immunizations can take 4 to 6 weeks for efficacy. Get shots now.

• Thailand requires entry Visas for some nations. Find Visa requirements now.
• Check that your passport is good for 180 days after you would arrive in the destination country. Otherwise, get it renewed.
• Create a complete record of your health.
• Identify whether you have a family doctor or specialist who will help support you through an offshore procedure.
• Identify a travel companion, if necessary.

Step Four-Identify One or Two Destination Countries

Have a look at the World Factbook for up-to-date country information on travel risks to your destination country, https://www.cia.gov/library/publications/the-world-factbook/rankorder/rankorderguide.html.  Thailand consistently ranks as a top contender for country development, health resources, political stability and quality of care.

Use Scorecards to rank the factors most important to you.

Step Four-Then Hospital.  Then Doctor.

• Get smart on identifying a great hospital and doctor.
• Get smart on accreditations, affiliations, type of enhanced skills, size, category, location, equipment and procedures.
• A smart strategy is to balance accreditation, price-level, location, enhanced skill level, procedure, affiliation and capital equipment.
• Start to look for “fit”.  Could you see yourself here?
• Start interviewing doctors.
• Book and pay for two formal Evaluations / Consultations.
• Compare diagnoses from the evaluations and adjust for the results.

Step Five-Get Detailed Pricing

Make a checklist of pricing questions.

Step Six-Do You Know Enough to Go?

Make sure you understand your procedure, pricing and expected result in detail.

If you are comfortable with the skills, accreditations, qualifications and price of your providers, you probably know enough to finalize plans and book your procedure.  If you still don’t feel comfortable booking care, listen to your intuition.

Disclaimer: If you have extreme pain, a spiking fever, fainting, symptoms from a dangerous chronic condition, or symptoms that persist over a long period of time…you may be in the midst of a medical emergency and need to see a local doctor.  If so, now may not be the time to begin research on Health Travel.

Excerpted from The Well Report © 2010.

The information in this post will help you stay comfortable, well and safe after your medical travel surgery.  Use the tips below as a blueprint to get through surgery and on your way to recovery. If you like this please share it.  Find a Quickstart Guide to Health Travel here.

The Day Before Your Procedure

The day before the procedure, you’ll want to make sure that the International Patient Coordinator (IPC) has contact e-mail addresses and phone numbers for your friends and family back home. Ask the IPC to send a surgery update to your list when you are in the recovery room

The Day of the Procedure

Tell the International Patient Coordinator what comforts, conveniences you would like nearby (your phone, iPod, earplugs, lighting levels…whatever).

Post Surgery Expectations

Normal recovery reactions include…

• Bruising and headaches.
• Pain, swelling, puffiness, vomiting and light fever.
• Swings in hunger.
• Trouble urinating.

Symptoms of complications include…

• Infection.
• Intense chest pain, headache or pain at the procedure site.
• Intense urination pain.
• Shortness of breath.
• Spiking fever or chills.

The Hospital Room

• Keep a bottle of hand sanitizer nearby and insist everyone have freshly washed hands or use the sanitizer.
• Ask the nurse to clean the television remote with alcohol.
• Ask anyone with a stethoscope to clean it with alcohol before they touch you.
• Ask the nurse for whatever you need. Make the room dark? More morphine? You want to sleep?
• The first night is bound to be uncomfortable. If you feel any rapid change in your well-being let the nurse know right away. If you feel really bad, insist that the doctor be called and told about your symptoms.
• Try to be a little mobile. This can be as simple as walking to the bathroom rather than using a bedpan.

The Day Before Hospital Release

• As a practical matter, shop for English language books from the hospital bookstore and make sure you have enough cash for the first few days at the recovery accommodation.
• Ask the IPC to arrange for things you would like to have in your recovery facility to be there when you arrive. Newspaper? Bottled water? Filled prescriptions? Internet access? If you need one, ask for an attendant to ride with you and get you settled into the recovery accommodation.
• Ask the IPC to coordinate and reconfirm your transfers to the recovery facility.

Review Charges

Make an appointment with the IPC to review your proforma hospital charges and discharge tools.  You want a copy of everything that is in the doctor’s file). If you are not feeling like yourself yet, hand-off this task to a friend on Team You back home, including:

• Lab and imaging diagnostic tests from before and after the procedure.
• Three photo angles of the procedure site.
• Prescribed medications with labels and written instructions.
• Receipts for procedures.
• Insurance claim forms.
• Physical therapy prescription.
• Written postoperative instructions.
• X-rays in hard and or digital format.
• Final payment will be due at checkout. Ask for a discharge report and copies of all the investigations during your stay.
• NB: Large amounts of filled prescriptions may be confiscated at the airport.

At the Recovery Accommodation

• Almost anything you need can be gotten for the price of the goods plus a tip.
• Ask the whereabouts of the nearest pharmacy and convenience store.
• Put the do-not-disturb sign on your door when you do not want to be disturbed.
• Take the phone off the hook when you choose.
• Tell the front desk that you have had surgery recently. Ask about room service, meals, where to call for errands, how many times you want someone to come by your room to bring meals or check in on you. Laundry, etc.
• Ask to have doorknobs, the television remote and bathroom levers in your room cleaned with alcohol (or do it yourself).

Surgical Follow-Up

A few days after surgery your doctor will want to see you again. S/He will ask about how you’re feeling and whether you have any major discomfort. This is the time to change any medications or make requests for additional pain medicine.

You want to stay close to your doctor for the first few days. If anything bad is going to happen, it usually happens within the first three or four days after surgery. If you feel well enough, then banish cabin fever and have some bite-sized adventures.  Even if you head off on an adventure now, you’ll need to see the doctor at least once more before returning home to be released from care.

Release From Care

• Ten or so days after your surgery (varies) you’ll have a last appointment with your doctor.
• Make sure you understand your after-care.
• Gather everything necessary for follow-up care back home.  Make the after-care appointment.
• Get a fitness-to-fly release from care signed by the doctor (just in case the airline requires it).

Excerpted from The Well Report © 2010.