If you live in a country where health care is expensive–like the US–you may have heard about the growing popularity of going overseas for medical or dental procedures, or in some cases for nursing home care.


Even with good insurance, the cost of care in the US is, for lack of a better term, unbelievable. You may survive the operation, but will you survive the bill? Not only that, but care in the US is often not the best, depending on your circumstances. The World Health Organization ranks the US healthcare system number 37 in the world, behind almost every European country, Saudi Arabia, Columbia, Costa Rica, and Chile.

If you don’t live in the US, you may still have some interest in medical tourism–perhaps your domestic health care system doesn’t cover a procedure you want, or maybe the wait for the procedure is too long.

People shouldn’t have to export themselves to get decent, affordable medical care, but this is the world we live in.

Types of Medical Tourism

Probably the most straightforward type of medical tourism is going overseas for dental work.

The most highly developed center catering to overseas dental patients is Mexico. The primary business of some entire towns along the Mexican/US border is dental work.

Costa Rica is another popular place for dental procedures. The dental infrastructure and sheer number of dentists is much smaller, but it’s still a good destination for many procedures.

It’s possible to get quality dental work in many countries, but in Latin America these two countries probably have the most overseas dental patients.

Plastic surgery overseas has been popular for quite some time. Many of the plastic surgeons performing procedures overseas have training comparable to those in the US or Europe and many have even gone to medical schools in the US or Europe.

A fairly new form of medical tourism consists of going overseas for procedures which are just too expensive in one’s home country. In some cases, it may be possible to pay cash for a procedure overseas–say gall bladder surgery, or chemotherapy or even imaging like MRI or cat scans–and even with travel expenses included end up paying less than your deductible and co-pays would have been in the US, even for those with insurance.

For those without insurance, and with limited access to the health care system, it could be a life-or-death matter–for a few people, going overseas for a medical procedure could literally save your life. Some insurance companies are beginning to pay for medical procedures performed in other countries, since the savings are so great. Hospitals have opened up in India and Thailand, among other places, which cater solely to overseas patients.

Alternative therapies not available in one’s home country have been popular for a long time. For someone with prostate or other types of cancer in the US, there are treatments available in Germany and other places which aren’t available in the US.

Overseas nursing home care is a small but growing business.  This is something worth considering for those who will need nursing home care, particularly from the US.

US rules require that you be basically broke (have under $2500 in assets) before the government pays for your nursing home care. If you don’t have long-term care insurance, the charges of $3,000-5,000 per month for nursing home care will quickly eat up whatever savings you might have. Speaking from personal experience of my own mother’s 15 years in US nursing homes, it may be worth checking into care in Mexico, to compare with offerings in the US. For those who can speak some Spanish, have at least some mobility, are flexible, and don’t have children to look after them, it might be a good option.

Quality of Overseas Care

A very interesting web site, which anyone contemplating overseas health care should study closely, is www.planethospital.com/. Their web site provides a great deal of information on procedures in various countries. This company can also assist you in choosing a provider, and for a relatively small fee can help you in arranging all the details of your overseas care. I’m not endorsing this company one way or the other, but their approach seems to me to be impartial and helpful.

It would be worth asking whether a foreign hospital you plan to use has been accredited by the Joint Commission International, particularly if you are considering a complicated and/or invasive procedure.

To the best of my knowledge, no such accreditation exists for overseas dental care and nursing home care.

Cost alone is usually a very poor standard to go by, and should never be the primary factor in your decision as to which health care providers to use.

Regardless of which facilities or providers you may decide to use, it would probably be wise for you to do a walk-through of the facility or offices before any procedures are performed. It’s easy to produce glossy brochures and web sites, and to make all sorts of promises and assurances. At any rate a walk-through would give you an idea of the general standards of their facility.

Another option would be to ask for references of people from your own country who have been treated at a facility or by a provider. While it is possible that some people could be paid to lie about their treatment (or lack of treatment) it’s still worth a shot. If you are knowledgeable about the procedure that you plan to have, you can ask some pointed questions that only a person who has had the procedure (or a medical professional) would know the answers to.

Overseas Dental Care

As mentioned above, the best-developed center for foreign patients seeking dental care is Mexico.

Some border towns along the US/Mexico border seem to exist primarily to serve US dental patients. Most border towns will have a relatively large number of dental offices, so it isn’t always necessary to go to a town like Nuevo Progresso (just south of McAllen, Texas) which has perhaps several hundred dentists.
In terms of quality, it can vary quite a bit. It would be wise to know exactly what you need before you go to Mexico, so that you won’t be sold any unnecessary procedures. Of course it would be wise to also know what a procedure would cost in the US.

The internet has a number of advertisements for dentists in Mexican border towns. Dentists in the interior don’t tend to advertise much. Prices tend to be higher along the border, but it can also be more convenient since it isn’t necessary to travel further south, and with a concentration of dentists the lab work can be faster and better quality (but not always).

If you plan to have some dental work done on the border, it would be wise to get an estimate of cost and the time required before making a trip, and then allow at least an extra day or so, in case anything comes up or the lab has to re-do some of their work.

If you know someone who has had dental work done along the border, ask them for input on their experience.

If you travel to a town on the border before deciding on a particular dentist, walk around and take a look at some of the offices. You might want to speak with several dentists and look at their equipment to get a feel for their competence. A dirty office is never a good sign, nor is equipment that seems to date from before the revolution.

From my own personal experience, I’ve seen mostly very modern equipment in Mexican dental offices. The x-ray machines tend to be the newer type where you don’t need the lead apron. Mexico graduates a lot of dentists, and they seem to buy new equipment when they set up their offices.

If you go to a small dental office, the dentist may not have a receptionist or even an assistant. This isn’t necessarily a bad thing, as the dentist may still offer good quality care. Some dentists have an office in the front of their house. Again, this isn’t necessarily a bad thing, and does not necessarily detract from the quality of their care.

I’ve known people who have saved thousands, and in some cases tens of thousands, by getting dental care in Mexico.

If you do visit a border town for dental care, you can normally get cheaper lodging on the Mexican side, but standards are sometimes better on the US side. It’s also not a bad idea to park your car on the US side, and take taxis on the Mexican side.

Many (not all but most) dentists in border towns will speak some English. In the interior, it isn’t so common. Standards at the border seem to be more consistent, in the interior it seems to vary more.

If you are interested in dental care in a different country, a lot of my advice still holds. It’s mostly a matter of evaluating the cost, the dentist’s references, the cost and ease of your travel to their office, how long the procedures will take, and how comfortable you feel with their expertise.

Specialized TMJ procedures can increase circulation and cure sleep apnea. See what a San Diego TMJ dentist can do for you.

Plastic and General Surgery

One provider of overseas medical care can be found at:
http://overseasmedical.net/index.htm. This company is affiliated with Wockhardt International, a hospital group in India. The Wockhardt hospitals have been inspected and accredited by Joint Commission International. Their web site has a good breakdown of procedures and costs.

Dealing with a hospital that has been inspected and accredited by Joint Commission International does take some of the guesswork out of getting care overseas. As usual there are few guarantees, but you know that procedures, equipment, staff, and training are probably going to be adequate for your needs. When you locate a health provider from a web site and only have their glowing (self provided) references to go on, you may be taking a much bigger chance, since you have no idea of the adequacy of their care.

There are any number of web sites which offer plastic and general surgery in various countries, so do some checking. But don’t in any case make any sort of decision on any procedure based on what you saw on some web site. These sites are best used as a basis for further research, to check references and prices, and to get an idea of how the whole thing would work for you. For a given procedure, learn what the cost would be in the US–don’t get just one estimate in the US, get several. Some web sites will high-ball the US cost to make it look like their “discounted” prices are lower.

Another thing to consider, particularly for an elective procedure for which you have either no insurance or insufficient insurance to pay for the whole thing, is that you may be able to negotiate a discount on a procedure in the US, without even going overseas. Some surgeons and hospitals will give a break on some procedures, but of course few will advertise this. If you have a certain amount of money for a procedure, ask around–let them know you will pay the bill upon completion of the procedure. It’s certainly worth checking this option before going overseas.

For the downside of plastic surgery overseas, check this web site:
www.ebreastaug.com/breast-implant-news/overseas-plastic-surgery.html.

Concerning elective surgery overseas, my advice is buyer beware. Look for a hospital that is certified (see Joint Commission International, above). I wouldn’t necessarily believe all the horror stories (you mean no plastic surgery patients in the US ever had any problems and all overseas patients have problems?) nor would I believe the glowing reports the overseas providers give (you mean EVERY patient you ever had was perfectly satisfied?). Going under the knife is serious business, and don’t even think about it unless you have done extensive research on the surgery provider.

In response to US providers who posit that all care in other countries is dangerous, I would ask them why the World Health Organization rates the US system as #37, after Costa Rica, Columbia, Chile, and almost every European country? It’s possible to get excellent care overseas, provided you do your homework.

If you can find a provider who was trained in the US or Europe, so much the better. Don’t spend a dime until you see the facility and talk with the surgeons who will be performing any procedures. Where did they receive their training? What if you have problems after the surgery, how will they deal with that? What sort of insurance do they have if you have to sue them? Can you even sue them at all in another country? What sort of after-surgery follow-up procedures do they have?

Arrive a couple days early for a procedure, and tour the facility where you plan to have surgery. Talk to the surgeon. Do you feel comfortable with the facility and the surgeon? If not, think twice about going through with any procedure.

Before going overseas, ask for and check out any references you can get. Talk to anybody you might know who has had a similar procedure done, whether in the US or overseas. Don’t consider paying cash for a procedure, always pay by credit card. If your credit card limit isn’t high enough, try to work it out with the issuing company.

In my opinion, any reputable surgery provider should have lots of good references, should be willing and eager to answer any of your concerns to your satisfaction, should be willing to accept payment by credit card after the procedure is done and you are satisfied with the results, and their hospital of facility should be inspected and accredited by an independent accreditation body, like Joint Commission International.

It’s also worth Googling any overseas doctor, hospital, or clinic to see if anybody else has written anything about them, whether good, bad, or indifferent. Keep in mind that some positive references may have been written by those who have been paid to do so.

For those seeking medical care in Mexico, an excellent reference is the book, Mexico Health and Safety Travel Guide, by Robert H. Page, M.D. and Curtis R. Page, M.D. Phone 866-MedToGo, www.medtogo.com

Going Overseas For Imaging and Diagnostic Care

One of my cousins recently had an MRI. The cost? Five thousand dollars. He had good insurance (with a large employer) but he was still out a thousand dollars out of pocket. Five thousand dollars for a twenty minute procedure. At the rate of two MRI procedures an hour, this one machine would generate roughly twenty million dollars a year in revenue (eight hour day). Good work if you can get it.

In some cases it can make sense to go overseas for imaging and diagnosis of some conditions, especially under the following circumstances:

1) you lack funds or insurance to pay for imaging (particularly in the US) but have a condition where imaging would be very useful, and you do have enough money for overseas imaging

2) you have diagnosis and treatment options in your home country, but think you might have better alternatives in a country with different treatment regimes (for example going to Europe for prostate cancer treatment). Some treatments may be available overseas that aren’t available in your home country

3) you’ve had treatment of a condition and have had poor outcomes and would like a second opinion.4) you feel the quality of care you’ve received in your home country is poor or you have too much of a wait to receive it
You might be surprised to know that even now, some x-rays for some US hospitals are read by Radiologists in India. Of course, many health care providers in the US are foreign born, and received all or much of their training overseas.

Overseas Nursing Care

For older readers, nursing care is something to consider in their waning years. If you’re fortunate enough to live in a country with a good elder-care system, you may never need to consider leaving your country to find a decent place to grow old in once your health begins to limit your ability to provide your own care.

However, some readers will find it necessary to make some tough decisions. In the US, for example, before the government will pay for nursing home care, you have to spend all your money above $2500 before they begin to pay. This almost guarantees that nursing home residents can’t go back to live independently–they don’t have any money left, since they had to spend it all on their nursing home care.

Many people prefer assisted living care while they are still more ambulatory, but Medicare doesn’t pay for it.

I’ve been in quite a few nursing homes in the US, and I can say that I’ve only seen a couple that I liked at all. Only one that I would have considered living in myself.

Keep in mind that some of the complaints about nursing homes in Mexico also can apply to nursing homes in the states. Speaking from personal experience, my mother suffered from various forms of abuse, some of which was at the hands of nursing home employees, theft by nursing home workers of her possessions, and poor medical care. And this was while I kept a hawk’s eye on her care, all in a nursing home that was regularly inspected only a few miles from my home! I should also mention that one of the state nursing home inspectors locally was convicted of taking bribes from nursing home owners, and that the bookkeeper in my mother’s home was convicted of embezzling from patient’s accounts. You really can’t get much worse than that. Why not consider Mexico for a fraction of the cost?

One of the biggest complaints of nursing home residents in the US is that they are lonely, so that should come as no surprise that it would also be a complaint in Mexico. However, the attitude toward old people seems to be different in Mexico.

Many people would hesitate to move to Mexico because their family members are living nearby, and they assume they would come to visit them regularly, but would not do so if they moved to Mexico. On the other hand, many relatives basically stop visiting you once you move to a nursing home, particularly if you live more than an hour from them. Family visits can become rare once you live in a nursing home–with some people, their relatives would visit no more seldom if they lived in Mexico than if they lived in the US. It’s sad but true, and I’ve seen in many times.

Another option for living in Mexico is to live independently in a house or apartment, and hire a live-in caretaker. Wages will vary, but should be no more than $3-5 per hour. In many areas, $15 or $20 a day would be considered a very good wage for a caretaker.

When considering a nursing home in another country, it would be wise to choose one located not too far from your home country. Many people, when they get older, don’t tolerate cold weather, so choosing a warm climate can be a smart move as well.

I would suggest that anyone considering an overseas nursing home arrange to stay in a home for several weeks on a trial basis, before making the final move. Food, medical care, staff, cleanliness, freedom from stress, activities, and weather are some of factors that will influence your happiness in a nursing home. It’s likely that you won’t be as happy in any nursing home as you were in your own home, but if you can’t live independently any more, you have to live someplace where you can get assistance.

Alternative Care Overseas

Mexico has been known for a long time as a center for alternative cancer treatments. An introductory discussion can be found at:
www.alternative-cancer.net/mexican_hospitals.html

The Cancer Cure Foundation web site at www.cancure.org/directory_clinics_outside%20US.html contains information on cancer clinics using a wide variety of treatments in many different countries. The same web site also has their own listing of Mexican alternative care clinics.effective for curing your cancer. This is true whether you are in the US or overseas. Conventional treatment may be very effective in many cases, but it’s also true that many people die from conventional treatment. Unfortunately we don’t know how many. It’s difficult to say whether alternative treatment may be more effective in your own particular case, but it certainly is worth investigating.

What If You Already Have Great Insurance?

Many people confuse good insurance with good medical care. The difference is that insurance only guarantees payment, not the quality of the care. Even if you (or your insurance company) pays a fortune, the quality of your care is not guaranteed.

A lot of people also seem to have an inordinate, and often unearned, faith in their health care providers, and don’t realize that consumer protection and standards of service in some ways are inadequate in the medical business.

In some cases it may be possible to get better care overseas for less than the cost of your co-pays and deductibles in your home country, particularly if you are from the US. Most overseas providers aren’t in such a big hurry to process everybody. House calls and office visits that are extremely thorough and unhurried and can take an hour or longer (as much time as is necessary) are a thing of the past in the US, home of the five minute office visit.
So don’t let your “good” insurance get in the way of your care.

Purchasing Pharmaceuticals Overseas

Many people, particularly in the US, pay very high prices for pharmaceuticals.

As an aside, almost every European country has price controls on pharmaceuticals. The US does not. Many companies sell identical drugs in Europe for a fraction of what they cost in the US. In poorer countries, the prices are often even far lower than that.

Some pharmaceutical companies have campaigns to scare people into thinking that all drugs purchased overseas are dangerous, subject to counterfeiting and so on. Counterfeit drugs are to be found, but it’s probably not nearly so common as you might be led to believe. Many drug companies insinuated that drugs purchased in Canada were dangerous. To the best of my knowledge, oversight of pharmaceuticals in Canada is at least as good as it is in the US.

Counterfeiting might be a concern when purchasing drugs on the street in some African country, or perhaps in India, but otherwise it probably isn’t that common. India, by the way, has a huge generic drug industry, and large, reputable companies like Ranbaxy, Dr Reddy, etc, which export many pharmaceuticals to the US. Brazil and Thailand also have many large generic drug companies. In some places, purchasing pills in individual blister packs might be safer than purchasing pills which come in bulk, if you do have a concern.

For those living in the US, the most convenient place to purchase pharmaceuticals is Mexico. Many border towns have large pharmacies which cater extensively to US citizens crossing the border to save on their prescriptions. In Mexico it often isn’t necessary to have a prescription for most drugs, or if you do need one in some cases there will be a doctor in the pharmacy who will write a prescription for you on the spot.

If you happen to be traveling to another country and regularly take prescription drugs which are expensive, it’s worth visiting a local pharmacy to check the price of drugs locally. You might be able to stock up, and save hundreds of dollars.

If you are in Mexico, one of the best places to get pharmaceuticals is Farmacia Similares. They sell primarily generic drugs, and have better prices than I’ve seen elsewhere. Some of the large pharmacies in border towns are also competitive, but check around. Prices can vary drastically from one store to another, but Farmacia Similares seems to be a great bet.

If you do purchase a quantity of pharmaceuticals overseas (like in Mexico) and return to the US, you will sometimes be asked by the border personnel if you have purchased pharmaceuticals in Mexico, particularly if you walk across the border. Your response is a judgement call–good to be honest, but you did come to save some money, and if the US had price controls on pharmaceuticals the whole exercise wouldn’t have been necessary.

If you do plan to purchase some pharmaceuticals overseas, you should know the generic names of the drugs you plan to purchase, since they often go by different names in other countries, particularly if you’ve been purchasing the name-brand versions. You should also know the dosages appropriate for you, since different dosages are often available in other countries.
I’ve noticed that over-the-counter medicines are often more expensive in Mexico than in the US. The real savings are in prescription drugs.

Do Your Research

This article is meant to encourage you to do further research for your own particular needs. There are a few unscrupulous providers in other countries, but plenty of wonderful ones as well.

Supposedly we have great consumer protection in the US, but we’ve also had estrogen (prescribed for over 30 years, in some cases may create more problems than it solves), Phen-fen, Vioxx (greatly elevated heart attack risk), Celebrex (ditto), and many other products which were approved by regulatory authorities and prescribed by thousands of physicians.

It should be painfully clear by now that no country has a monopoly on consumer protection. Don’t trust any particular health care provider just because they are wearing a white coat and have “MD” after their name. Their treatment protocols may prove to be perfect for your situation, but that is to be determined by your own research, not by blind faith.

Best of luck in your search for good care, wherever you may find it.

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