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Dental Tourism


Research Summary: Dental Tourism

Tuesday, August 08, 2006


The New York Times and two San Francisco Bay Area newspapers recently published articles on medical tourism. If your hometown paper has covered this story then you already know how people are traveling overseas to seek lower-cost alternatives to the more expensive treatment they require here in the United States. These stories usually spotlight a satisfied person who combined a trip to Thailand with a laser-eye surgery or someone who happily recovered from a face-lift whiling away the day beneath a cabana.

At the Blende Dental Group we recently saw a patient who took her oral health problems out of the country and now – four months later – her oral health problems have come back to find her. All of those crowns must be redone. Sadly that doctor's work has no assurance of quality nor does that country have a licensing board to advocate for her reimbursement. This patient returned to San Francisco and is now facing down the painful prospect of paying for work twice.

We understand that financial circumstances prevent many people from seeing a dentist. And we certainly understand that sometimes it makes sense to look for a 'deal'. Which is why we think it's important that patients call our office to discuss the wide variety of financial arrangements we offer.

We work with nearly every type of dental insurance and will file all of the paperwork on your behalf. We even support all of the follow-up communication with the insurer when greater detail is required to justify your claim or explain your treatment. We work with a company called Dental Fee Plan that provides low-cost financing to our patients who want to make gradual payments over time. More importantly, we make every effort to prioritize the work required in your mouth knowing that any sources of decay or infection or pain require immediate treatment. Dr Blende and the team will 'stage' your work showing you a variety of possible options for treatment. We speak openly and honestly about our own fees and charges so that we can partner with our patients to design affordable treatment plans that fit within your budget.

At the Blende Dental Group, we hope that your travel plans this summer are fun, and include long days at the beach or afternoon walks through a medieval village. And if you're going to travel anywhere to find your new smile- why not visit San Francisco? At the Blende Dental Group you can be assured of receiving our highest quality care with our commitment to delivering a great value for your travel dollar.

Click here for information and questions you should ask before traveling abroad for dental care.

What happens if something goes wrong during or after treatment? Is there a complaint process or a method for getting a refund if you are not satisfied? If you can't get a refund, is there meaningful recourse for dental treatment that is unsatisfactory or harmful? Will you have a right to sue? If so, can you do so cost effectively? Will you need to retain a foreign lawyer? Or return to the country where you received care to testify or appear at trial? Will you get a fair trial? All of these are important considerations before seeking care in other countries.

Click here to read the entire article in the Marin Independent Journal.


Medical tourism: Why Americans are traveling abroad for health care

Staff Report Marin Independent Journal

HOWARD ASCHWALD'S wife and mother had the same reaction earlier this year when he told them he was thinking of traveling to India to have laser eye surgery performed. "Their response was, 'You're going to India and having somebody work on your eyes. Oh my God!'" said Aschwald, a Belvedere investment manager. "I was concerned the way his mother was concerned," said his wife, Michelle Aschwald. "He had to call his mother after the surgery was over." Aschwald, 52, had the eye surgery performed in Mumbai, India, in March and a CT angiogram, a test to gauge the health of his heart, at a separate clinic there. Aschwald saved thousands of dollars on the procedures, and he and his wife realized a longtime dream: a vacation in India. "We've been studying India for a long time," Michelle Aschwald said. "We like yoga." Increasingly, United States residents are traveling abroad to have medical procedures performed, said John Knox, a spokesman for MedSolution, a new Vancouver, B.C.-based company that acts as a broker between American patients and foreign hospitals.

In the United States, the trend is being driven by the spiraling cost of medical care and the growing ranks of the uninsured, Knox said. In Canada, where medicine is socialized, long waits for surgeries are having the same effect, he said. Residents of Great Britain and other European countries with government-managed health care started the trend several years ago, Knox said.

The eye surgery Aschwald had performed is considered elective and would not have been covered by his Blue Shield insurance. He would have paid for the operation himself regardless. "I've got one of those wonderful $5,000 deductible policies," Aschwald said. A Santa Clara doctor quoted Aschwald a price of $4,895 for surgery to correct myopia. The cost in India was $1,250. The surgery was performed by an Indian doctor trained in London using laser equipment made in Germany – so new that it hasn't yet been licensed in the United States. Aschwald said he would have spent $2,000 in the United States for the CT angiogram that cost him $225 in India. It took the Aschwalds 25 hours to fly to India, not counting a six-hour layover in Singapore. They paid $1,450 apiece for airfare and $185 a night to stay at The Orchid, an ecology hotel in the exclusive Bollywood section of Mumbai where the eye clinic was located. They arrived on a Wednesday. Aschwald had his CT angiogram performed the next day. On Sunday, he had his eye surgery and on the next Tuesday the couple flew to another area in India and began touring. The temperatures during their 17-day visit were in the 80s. It rained only once.

Because Americans going abroad for medical treatment often combine business and pleasure, the trend is typically referred to as medical tourism. That may be a misnomer, however, said Peter Lindland, chief executive of Florida-based Medical Nomad, a Web site providing information for prospective medical tourists. That is because the people with the strongest motivation to seek medical treatment in countries outside the United States are those who face crippling medical expenses if they have the procedures performed here, Lindland said. "They have a choice between their health and their financial solvency," said Lindland, who became interested in the topic after saving more than $5,000 by traveling to Guatemala for dental work.

Guy Esberg, a San Anselmo marketing consultant, said he would have had to sell his house, and more, to pay for the surgeries and hospitalization he received in Ravensburg, Germany, in 1998 – had the procedures been performed in the United States. "It would have been devastating," Esberg said. Esberg required vascular surgery to repair a leg that he injured by walking through a plate glass window as a boy. Due to his previous injury and other medical problems, no private company will insure him. Esberg is covered by the state of California's Major Risk Medical Insurance Program. Esberg says his insurance would have covered just one night in the hospital and one morphine shot the next day before being sent home. As it turned out, there were complications. Esberg required additional procedures and spent three weeks in a German hospital. His entire bill came to slightly more than $50,000 – about the same amount he would have paid for one night in a U.S. hospital, Esberg said. Esberg may need additional surgeries on his leg, and he has already picked out the hospital in Thailand where he plans to have them done.

The Bumrungrad Hospital in Bangkok has been accredited by the Joint Commission International, a joint project of the commission that inspects hospitals in the United States and the World Health Organization. The International Organization for Standardization is another organization that accredits health-care providers worldwide. But unlike the JCI, which focuses on quality of care, the IOS rates the providers' business practices. "We are not the state-of-the-art country any more for a number of surgical and treatment areas," Esberg said. "You can get better stuff done overseas." But medical tourists need to carefully check out the facility in which they're going to be treated, said Dr. Kathryn Najafi-Tagol, a San Rafael eye surgeon. Najafi-Tagol came to the United States from Iran when she was 15 and has worked in hospitals in India. She said the quality of care varies from facility to facility in India and other Third World countries. "It's a very different medical environment than the U.S.," she said. "The standards are very different." Knox said, "You do hear nightmare stories in this industry about people who set up ad hoc surgical centers in their garage and they're not qualified to be performing surgeries. It does happen out there."

Najafi-Tagol said patients who are treated abroad also run a greater risk if there are complications. "The actual surgery is one thing but then the followup care is just as important. Often times complications happen down the line – a week, a month, six months later," Najafi-Tagol said. "If they haven't been treated locally then they don't have anyone to go to." Jeannine Walston of San Rafael, a freelance writer, will travel to Cologne, Germany, later this month to receive immunotherapy treatments that have not been approved by the Food and Drug Administration in the United States. One of the treatments, dendritic cell vaccine therapy, is in early stage clinical trials here, she said. Walston, 32, is seeking to boost her immune system to battle a cancerous tumor lodged in her brain. She estimates the six months of treatment will cost her $30,000 to $40,000. "Conventional cancer care in the U.S. does not address the underlying causes of disease," Walston said.

Surprisingly, many cardiac and orthopedic procedures are a third cheaper in France, Knox said. One reason may be that the French government underwrites the education of medical students, he said. The real bargain basement prices, however, are in the Third World, particularly India, Lindland said. "India is really gearing itself up, investing hundreds of millions of dollars in top-notch facilities," Lindland said. "It's the 800-pound gorilla in this industry." Other players include Argentina, Mexico, Costa Rica, Malaysia, Singapore, Thailand, the Philippines and Turkey, Lindland said. All the Turkish prices quoted on MedSolution's Web site include a vacation package. But one of the procedures offered, which allows a woman to choose the sex of her baby, cannot be done inside Turkey because it conflicts with Islamic beliefs, Knox said. After being examined in Istanbul, patients are flown to Cypress for the operation. Medical practices in Third World countries such as India can charge less because their overhead, including salaries, is much less, and they often have much lower litigation expenses, Lindland said. But while the fees they charge may seem minimal to U.S. residents, they are far too expensive for most of the people living in their own countries, Knox said. In most cases, the bulk of the population is dependent on the countries' substandard socialized systems, Knox said.

More Third World physicians are remaining in their counties of origin because of the growth in medical tourism, Lindland said. In the past, these counties have watched helplessly as their best and brightest medical students left for higher pay in the West. This trend threatens to exacerbate the shortage of doctors here, he said. But Peter Warren, a spokesman for the California Medical Association, doubts that medical tourism will ever become popular enough to make a substantial dent in California's medical system. "There will be a few people in the upper strata of society who will take advantage of it, but it's not going to deal with the 7 million uninsured in California, it's not going to bring down the price of premiums for health care, and it's not going to unclog the emergency rooms," Warren said. "It's not even a flea on the elephant," he said.

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