Oct 28

We commence today with Chapter 4 of Beauty from Afar, for which I half apologized in advance. I really needn’t have, now that I look at it again. Immodestly, I don’t mind saying that I like the way it starts out, and I have Joseph Cohen, M.D., of the Rosenstock-Lieberman Center for Cosmetic Plastic Surgery in San Jose, Costa Rica, to thank for that.

Chapter 4 Page 1 | You’re Going Abroad for…What !?

Dr. Cohen’s candor made him a terrific person to interview on the subject of what surgical procedures people go overseas for, and why; that he, a prominent cosmetic surgeon in Costa Rica, would consider going to the U.S. (hypothetically) for his own care, under certain circumstances, I think makes for a nice balance in a book that is mostly about people going in the other direction. And it gives him credibility.

We’ve now covered 76 pages of the original text of Beauty from Afar, which has worked out to 37 web pages. That seems about right to me … and it means I’m about a third done, which feels substantial.

I’ve mostly resisted the journalistic urge to step too far outside the boundaries of the book, but anyone interested in the business of medical tourism ought to go read Brendan Borrell’s Reuters story, published today:

Controversial couple dominates U.S. medical tourism

I don’t see how this has any real impact on patients, mind you, or I’d be more concerned. As a nascent “industry,” though, medical tourism has not traveled all that far since I first wrote about it in 2004-2005. The squabbles are a little bigger.

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Oct 28

Chapter 4 Page 1 | You’re Going Abroad for…What!?

The most common cosmetic and other surgical procedures that lure people overseas

In more than a year of travel, interviewing, and reading, I have run across but one example of a medical procedure for which demand has declined overseas because prices in the United States became more competitive.

“We don’t do so many hair transplants as we used to,” commented Joseph Cohen, M.D., sitting in his office at the Rosenstock-Lieberman Center for Cosmetic Plastic Surgery in San Jose, Costa Rica. “The price came down in the States; there is not so much of a difference anymore. So people don’t come to us for that as much.”

Dr. Cohen, who did his undergraduate work in California and his residency in general surgery in Pennsylvania, also told me that if he needed heart surgery, he would prefer to be in one of the top hospitals in the United States. Not that there are not fine heart surgeons in Costa Rica; but he would have a preference for the United States: “They have the most experience and that’s what you want,” he said.

What procedures do people go overseas for, and why?

As of now, inexpensive cosmetic surgery and dentistry is the leading edge of medical tourism, at least as far as North Americans and Europeans are concerned. Weight loss surgery (WLS) of various kinds for the morbidly obese is also gaining in popularity, though some insurance plans in the United States provide coverage for that. Patients go abroad for every conceivable kind of medical care if the cost savings justifies the inconvenience and any perceived risk.

Of course, patients who are covered by insurance in the United States elect to have their surgeries and procedures done in the United States for the obvious reason that they will no longer be saving money by going outside of the country. However, there are exceptions. In some cases, patients prefer going out of the country because a foreign doctor or surgeon is renowned for his or her expertise in a particular procedure. Insurance companies, includings HMOs, have been known in certain cases to treat out-of-country care no differently than they treat out-of-network care in the United States. But this is something you need to check beforehand.

A more general exception is dental work. Most dental insurance plans in the United States effectively exclude major cosmetic work, either by way of defining what is covered, or effectively, by capping the amount of coverage annually or by procedure. Insured dental patients may have some minimal reimbursement difference to factor into their decision as to whether to go abroad or not, but in the case of major work —  implants or full-mouth reconstruction  — the savings for going overseas remains substantial and a compelling reason to consider it as an option.

In general, plastic surgeons in all countries perform a variety of procedures and services. Botox, facial “fillers” for wrinkles, lip augmentation, permanent makeup, and the like are all available around the world and are generally less expensive than in the United States. Many patients who go out of the country for more costly procedures will have additional procedures done on the trip as well, but it makes little sense to go to the expense of traveling if one is only seeking relatively low-cost, non-invasive procedures.

This chapter offers a rundown of some of the more common elective procedures for which people are willing to travel overseas to save money. Be forewarned that the prices cited are estimations and, depending on the surgeon, place, and time, can be more or even less than the ranges given. I attempted to be both cautious and reasonable in checking costs.

Prospective patients should remember that surgeons have varying prices for many reasons and that important among those reasons are experience and reputation for quality. Surgeons in less-developed countries generally have a lower price structure overall because their costs are substantially lower than those in the United States or Western Europe.

Another important consideration within the following summary is that not all surgeons define the same procedures exactly the same way. A facelift to one may be just the centerpiece of several procedures, each with a price that may be necessary to achieve the patient’s desired result (for example, facelift, plus facial liposuction, neck or chin lift and work), while another may include several procedures as part of “just a facelift.” Also, some surgeons will offer discounts for patients who undergo multiple procedures at the same time, as in so-called extreme makeovers.

When considering prices, prospective patients have to figure out and factor in all travel costs, which can also vary substantially.

For my own part, I did not choose the least-expensive dentists in the world, or even in Costa Rica. I first satisfied myself as to the quality of care I would receive from a particular dentist. I could have “shopped” more extensively but decided against it in the end. I knew that my savings would be substantial when measured against what I could expect to pay in the United States, and that was good enough for me. I saved at least $10,000, and perhaps I could have saved more; but I was comfortable with my choice.

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