Patients may soon be outsourced for their health care procedures

NEW DELHI, India — She’s a rodeo barrel-racing champion who runs a 180-acre ranch in Oklahoma when she’s not bouncing across back roads selling farms. Dodie Gilmore is a spry 60-year-old who loves the outdoors, but when she could no longer straddle her faithful horse, River, she knew it was time for a new hip.

But how could she afford it? As an independent contractor for a small Coldwell Banker real estate franchise in Durant, Okla., she knew her privately purchased health plan would never pay up to $40,000 for the operation.

So she asked her boss about traveling to India where hip resurfacing alone would cost just $7,000. He not only gave her his blessing but offered to foot the bill, minus travel and hotels — making Gilmore one of the very first Americans sent overseas for surgery by an employer.

“The doctors were wonderful,” Gilmore said days after being discharged, sipping coffee at a New Delhi roadside cafe with her sister, Carol, who was along for whole trip. “The overall care was pretty darn good.”

With an estimated 45 million uninsured Americans, some 500,000 trekked overseas last year for medical treatment, according to the National Coalition on Health Care. Asian hospitals in Thailand, India and Singapore have long been swarmed by medical tourists looking for tummy tucks and face lifts, but many glitzy, marble-floored facilities are now gaining reputations for big-ticket procedures including heart surgery, knee and back operations.

More and more patients like Gilmore — who had never held a passport or even tasted Indian food before her trip — are returning home and spreading the word about an alternative to America’s ailing health system. Businesses, insurance companies and even a state lawmaker are now also starting to eye the potential savings of outsourcing health from the world’s richest country to the developing world.

“It’s just one of the many ways in which our world is flattening,” said Arnold Milstein, chief physician at New York-based Mercer Health & Benefits, who’s researching the feasibility of outsourcing medical care for three Fortune 500 corporations. “Many companies see it as a natural extension of the competition they’ve faced in other aspects of their business.”

Some American hospitals already rely on places like India for X-ray readings and other diagnostics, while also importing foreign doctors and nurses. But the U.S. health care industry has been largely immune to overseas competition — just one reason behind soaring costs.

Premiums for employer-sponsored health coverage have surged 87 percent over the past six years, according to the Kaiser Family Foundation, putting a huge burden on both companies and employees. Family health coverage now runs about $11,500 annually, with workers themselves forking out nearly $3,000.

But just as shipping U.S. manufacturing to China and call centers to India initially created loud opposition, some critics are already preparing to fight any possible mass exodus of Americans packing their bags to go under the knife overseas.

In September, Canton, N.C.-based Blue Ridge Paper Products Inc., was set to send one of its employees to India for a gall bladder operation. Carl Garrett would have been the first U.S. employee sent abroad for medical care through an employer-sponsored pilot program, which would have allowed him to share the company’s savings.

Shortly before Garrett was set to leave, the United Steelworkers, America’s largest union, pulled the plug.

“We don’t want to expose our members to the risks associated with providing health care in the Third World,” said Stan Johnson, a union spokesman. “This is perceived to be voluntary, but voluntary programs tend to lead to mandatory programs.”

Blue Ridge ultimately scrapped its plan for union members, but several other U.S. businesses and insurance companies are starting to explore the option of exporting patients.

“I get the impression that they’re all waiting for someone else to take the first step,” said Jason Yap, director of health care service for the Tourism Board in Singapore, another major medical tourism destination. “They’re all interested in doing the homework now so they can move ahead when the time comes.”

But even with the growing momentum, big questions must be asked by anyone considering treatment abroad.

Despite the five-star facades of some hospitals — fountains, white marble floors, even a Starbucks and McDonald’s inside Bumrungrad’s lobby — the comfort of having a major surgery near home with family at the bedside is a far cry from the experience in the developing world, where culture shock alone can be stressful.

It’s ultimately up to patients themselves to investigate hospitals and physicians before considering surgery abroad. The Internet is loaded with resources that range from doctor bios to patient blogs, detailing the positives and negatives.

Some experts predict greater access to options like these will eventually drive more people to take control of their own health care.

Medical tourism facilitators like California-based PlanetHospital are banking on it, already working to make the journey less stressful for patients traveling abroad by arranging everything from visas and airport pickup to sightseeing.

Six countries in Asia have accredited facilities, including Bangkok’s Bumrungrad; five in India, with three belonging to the Apollo Hospital group; and 11 in Singapore.

The Max Super Speciality Hospital where Gilmore had her surgery on Oct. 10, is working to become accredited, but she said she felt comfortable from the very beginning. Even if her boss had refused to pay for the surgery, she said she likely would have made the two-day flight on her own because her insurance would never have paid to fix the pre-existing condition.

“It’s either that, or do it in the States for $28,000 to $40,000,” she said. In the U.S. do you not sign forms? They’re not responsible. The risk of it didn’t really weigh on me.”

In addition to saving thousands — the three-week trip totaled about $12,000, including the surgery, travel and lodging for two and a tour of the Taj Mahal — she also underwent a new technique just approved this year in the U.S.

Instead of total hip replacement, which limits mobility and requires the top of the femur to be cut off and a long shaft inserted, hip resurfacing uses only a small ball-and-socket device that enables patients to maintain their flexibility for activities like yoga, praying or even racing horses.

Gilmore’s Indian physician, Dr. S.K.S. Marya, chief surgeon at the Max Institute of Orthopedics & Joint Replacement, has performed some 150 hip resurfacing operations over the past two years. About one American comes to him for the surgery each week.