Oct 23

Chapter 3 Page 4 | Origins of  the term “Medical Tourism” (cont.)

Dr. Fournier claims he was the seventh cosmetic surgeon in the world to put up a Web site and I have no reason to doubt him; whether he was 7th or 17th, or 70th doesn’t matter much. U.S. cosmetic surgeons were quick to seize on the new medium of Internet marketing to spread information and awareness, but several of the Costa Ricans were right there with them, as were surgeons in other countries. Once reliant for marketing solely on word of mouth, occasional visits to the United States, and flight magazines, cosmetic surgeons around the world found they had a platform from which they could reach customers directly and at a minimal cost. As the demand for cosmetic surgery in the world’s No. 1 market, the United States, shifted into overdrive in the late 1990s, more surgeons abroad targeted the United States. Though their market share was tiny,  their growth rate likely was faster than that in the United States, and it remains so today. Business for foreign surgeons in 2005 was threefold, or fivefold (depending on who you ask) what it was in 1995, when things were already going well.

Around 1998, the phrase “medical tourism” finally began creeping into news accounts. The Washington Times noted in March of 1998 that medical tourism was one of the few bright spots in the economy of Castro’s Cuba. In April, officials in Miami, Florida were touting “the concept of medical tourism” in an Associated Press article. They were not talking about patients going abroad or even coming from abroad; the Miami Health Care Alliance simply thought maybe vacationers who were coming to Florida might like to visit a few doctors, seeing as how they were in town anyway. If you look in a big database of periodicals and magazines published prior to 2001, most of the references to medical tourism come from overseas. The New Straits Times of Malaysia ran a number of stories about the potential of medical tourism for that country, for India and for the rest of the Pacific Rim nations. The Jerusalem Post in 1999 referred to medical tourism as “a huge business.” But if it was a huge business, it was a remarkably unreported one in the United States in the late 1990s. For me, the earliest reference to medical tourism that bestowed proper global context to the term belonged to Prof. Sander Gilman, author of Making the Body Beautiful: A Cultural History of Aesthetic Surgery, published in January 2001.  He wrote:

The globalization of aesthetic surgery has spawned numerous centers that link surgery and tourism. North Americans have long gone to Mexico, the Dominican Republic, and Brazil; now the United Kingdom has started to offer “aesthetic surgery” tours for Americans as well. People in the United Kingdom flock to Marbella in Spain for discrete face-lifts, but Poland and Russia are now competing for this market. For medical tourists in the Middle East,  Israel has become the country of choice for many procedures, even for citizens of countries that do not have political ties to Israel;  Germans visit South Africa for breast reductions and penis enlargements as well as to see the Kruger National park;  South Korea and Singapore are important for the Asian market; and Beirut, Lebanon, is the place to go for quick, no-questions asked transgender surgery. Medical tourism has become big business, and aesthetic surgery, because of its elective nature, is a large part of the action. For every procedure recorded in one country, similar procedures are being undertaken on that country’s citizens elsewhere … Aesthetic surgery has become a worldwide phenomenon in the past few decades. (3)

(3) Sander L. Gilman, Making the Body Beautiful: A Cultural History of Aesthetic Surgery. (Princeton University Press, Jan 15, 2001), 8.

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Oct 15

Chapter 2 Page 9 | Prices in the United States and Abroad

Consumers who consider going abroad to save money for cosmetic surgery, dental work, or any other kind of medical care, will hear these bromides, either from voices in their heads or from well-meaning friends and relatives:

  • You get what you pay for.
  • If it sounds too good to be true, it probably is.
  • Quality doesn’t come cheap.

One does not have to have an intimate knowledge of international economics to understand why prices for high-quality cosmetic surgery can be far lower in less-developed countries than in the United States or Western Europe. A good surgeon is an artist, a psychologist, and modern-day wizard of sorts who transforms and restores; but he or she is also a businessperson. Cosmetic surgeons treat patients and are paid fees; cosmetic surgeons whose services are in demand can and do charge higher fees.

Simple, right? You get what you pay for, and quality doesn’t come cheap. However, among other things, geography matters a great deal. In your own town or city, you may find a range of prices from different cosmetic surgeons, as you might expect. Well-known surgeons with years of experience and hundreds or even thousands of satisfied customers will charge the most. A surgeon fresh from his or her residency, just starting out, trained but relatively inexperienced, will charge less. It is not unheard of for surgeons just starting out to offer reduced fees to clients who will agree to provide testimonials or referrals or otherwise participate in marketing the new business.

In your town, there will also be doctors and surgeons who may not be board certified in plastic surgery who nonetheless legally practice it, to an extent. The ASPS warns that such practitioners may be less-safe choices and, generally speaking, one would guess that they are right. Still, it goes on.

The average price of a typical facelift in the United States performed by a board-certified plastic surgeon in an accredited surgical facility, including surgeon’s fee, anesthesia fee, and operating facility fee, is in the $7,000 to $9,000 range, according to InfoPlasticSurgery.com (2005)

That might be the range in your town. But if you live in New York City, the range might be 50 percent higher. If you live in parts of the less-urban South or Midwest, the range might be a little lower. Geography matters, even within the United States. There is more demand for cosmetic and aesthetic surgery and procedures in urban areas and on the coasts; and the costs of living and of doing business are correspondingly higher. So how can board-certified, experienced surgeons working in modern facilities in Mexico, Brazil, Costa Rica, the Dominican Republic, Thailand, India, and other countries charge so much less? While a facelift abroad is more likely to cost between $3,500 and $6,000, including travel, meals, and accommodations, the costs of living and of doing business is correspondingly less in these countries. The top surgeons in the world, those with international reputations, can charge and get U.S. prices wherever they may be, but the many trained and qualified surgeons who aspire to be known as among the elite in the world must charge far less to draw patients from abroad, including the United States. And they can make a good living doing so.

Many think U.S. surgeons are greedy, but I do not think that is the case. They face significantly higher costs than do their counterparts and peers in other countries. In many ways, the reasons prices for cosmetic and other surgeries are lower in other countries than in the United States and western Europe are the same reasons why it is less expensive to produce DVD players or textiles abroad: They have less-expensive land, less-expensive construction costs, lower labor costs, lower taxes, and lower administrative costs. It is a mistake to single out any one thing as being responsible for the difference.

Malpractice insurance costs are also partly to blame. Though malpractice rates vary, depending on amounts of coverage, U.S. surgeons I interviewed said they each pay between $40,000 and $70,000 annually, compared to the less than $6,000 a year a Brazilian surgeon I know pays. This is a substantial difference, yet a small part of the overall equation. About the only business expense that is the same for surgeons regardless of where they live is medical equipment and medical supplies.

Price is relative from country to country, and a patient looking at the possibility of traveling abroad for care can responsibly factor that in. Some prices are so low that one can not help but be suspicious. Substantial inquiries are merited and references should be required. Cosmetic and elective surgery prices in the Far East are, for the most part, somewhat lower than those in South America, which are somewhat lower than those in Central America. I know that there are good surgeons in all those places.

Surgeons in the Far East, in fact, may be more likely to have trained in the United States and be fluent in English, though they have no monopoly on either of those things.

The cosmetic surgeon who charges the highest prices in your town may well be among the best and will almost certainly be among the most experienced. But paying the highest price does not guarantee the best outcome. Is a $10,000 face-lift in New York City better than a $7,000 one in Cincinnati? Is either better than a $3,000 one in Brazil? It depends.

I have talked to people who are unhappy with their expensive cosmetic work and people who are thrilled with the quality of their inexpensive results. For every anecdote, there is another one to give lie to the first. Beyond the borders of the United States, options abound for those willing to take the time to investigate, analyze, and choose.

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