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  CBS News, 60 Minutes, Apr. 25, 2005  


Vacation, Adventure And Surgery?

April 24, 2005


Summertime. Itís almost upon us. Millions will be heading out to foreign lands for vacation, adventure, tourism, or just a beautiful beach. But how about hip surgery or a multiple bypass or a facelift?


A growing number of tourists are doing just that: combining holidays with health care. And thatís because a growing number of countries are offering first-rate medical care at third-world prices.


Many of these medical tourists canít afford health care at home; the 40 million uninsured Americans, for example. Others are going for procedures not covered by their insurance: cosmetic surgery, infertility treatment.


And the hospitals in these faraway countries are glad to have these medical tourists. In fact, they are courting their business, trying to get more people to outsource their own health care. Correspondent Bob Simon reports.


Thailand is an exotic vacation spot known for its Buddhas, its beaches, its brothels, and the bustle of Bangkok.


But for people needing medical care, itís known increasingly for Bumrungrad Hospital, a luxurious place that claims to have more foreign patients than any other hospital in the world. Itís like a United Nations of patients here, and theyíre cared for by more than 500 doctors, most with international training.


The hospital has state-of-the-art technology, and hereís the clincher: the price. Treatment here costs about one-eighth what it does in the United States. It's the No. 1 international hospital in the world.


"Itís sort of Ground Zero. I havenít heard anybody yet whoís told us that they take more than 350,000 international patients a year," says Curt Schroeder, CEO of Bumrungrad.One patient is Byron Bonnewell, who lives 12,000 miles away in Shreveport, La., where he owns and runs a campground for RVs. A year and a half ago, he had a heart attack, and his doctor told him he really needed bypass surgery.


"They told me I was gonna die," says Bonnewell, who didn't have insurance.


He estimates he would have had to pay over $100,000 out of his own pocket for the operation he needed, a complicated quintuple bypass. And he says he actually decided not to do it: "I guess I figured I'd rather die with a little bit of money in my pocket than live poor."


But Bonnewell says his health was deteriorating quickly, when he read about Bumrungrad Hospital: "I was in my doctor's office one day having some tests done, and there was a copy of Business Week magazine there. And there was an article in Business Week magazine about Bumrungrad Hospital. And I came home and went on the Internet and made an appointment, and away I went to Thailand."


He made that appointment after he learned that the bypass would cost him about $12,000. He chose his cardiologist, Dr. Chad Wanishawad, after reading on the hospitalís Web site that he used to practice at the National Institutes of Health in Maryland.


"Every doctor that I saw there has practiced in the United States," says Bonnewell.


But three days after walking into the hospital, he was on the operating table. Two weeks later, he was home.


How does he feel? "Wonderful. I wish Iíd found them sooner," says Bonnewell. "Because I went through a year Ė I was in bad shape. I couldnít walk across the room."


How was the nursing? How was the treatment?


"I found it so strange in Thailand, because they were all registered nurses. Being in a hospital in the United States, we see all kinds of orderlies, all kinds of aides, maybe one RN on duty on the whole floor of the hospital," says Bonnewell. "In Thailand, I bet I had eight RNs just on my section of the floor alone. First-class care."


Thatís what the hospital prides itself on: its first-class medical care, which it can offer so cheaply because everything is cheaper here, particularly labor and malpractice insurance. You can get just about any kind of treatment, from chemotherapy to plastic surgery.

Kim Atwater from Bend, Ore., was on vacation in Thailand when she decided to combine sightseeing with a bit of an eyelift.


Was she nervous about having an operation done in Thailand?


"Yes, yes, I was somewhat hesitant about having any type of operation in a foreign country, and it turned out to be, I mean, it was beyond my expectations," says Atwater.


And it was not beyond her budget: $1,500, and that included a private room.


How would she describe the difference between this place and an American hospital? "It's much nicer than any that Iíve ever stayed in the United States," says Atwater.


The rooms look more like hotel rooms than hospital rooms, and thatís no accident. The idea was to make the whole hospital look like a hotel and a five-star hotel at that. There are boutiques and restaurants to suit every taste and nationality


"Part of the concept was to create an environment when people came in they didnít feel like theyíre in a hospital," says Schroeder. "Because nobody really wants to go to a hospital."


Bonnewell says he's going back this fall for another checkup. He'll have to take a 22-hour flight, but thereís even an upside to that.


"We do have a very unique relationship with Thai Airways," says Schroeder. "So you can buy a ticket. You can use frequent flier mileage to get your checkup."


Whatever it takes to get your business.


"And this is not the only hospital trying to outsource healthcare, is it?" asks Simon.


"My goodness, no. I, we certainly have not gone unnoticed," says Schroeder. "There are hospitals throughout Asia. There are hospitals throughout Asia, throughout India." India wants to become the world leader in medical tourism, and it might just make it. Alongside the familiar images of the country (teeming, dusty streets, and poverty) you can add gleaming new, private hospitals.


The hospital boom in India was fueled by Indiaís growing middle-class who demanded access to quality health care. Now, the country known for exporting doctors is trying hard to import patients.


The most important player is the Apollo Group, the largest hospital group in India, and the third largest in the world.


Why is it so important to get foreign patients here?


"It makes sense to establish India as sort of a world destination for health care," says Anjali Kapoor Bissell, director of Apolloís International Patient Office.


But why should foreigners come here? Well, itís even cheaper than Thailand for most procedures, with prices about 10 percent what they would be in the United States.


Anne Bell works at the British High Commission in New Delhi. She just had a baby and says sheís glad she was here, and not in England: "Thereís been no pressure to go home after the delivery. Weíve been welcomed to stay as long as we want. Theyíre looking after the baby. Theyíre looking after me, giving me enough time to get settled and get confident enough to go back home. Often in the UK, you might be out of the hospital within five hours if youíve had a normal delivery."


And in the UK, she wouldnít have had a private room and a private bath. Not to mention massages, and yoga, too. And the doctors? Indian doctors are known worldwide, they speak English, and theyíre often the very same doctors you may have had in Europe or America, where many of them practiced before returning to India.


"Do you find that many Indian doctors are coming back now because of hospitals such as this one?" asks Simon.


"Yes, a large number are coming back," says Bissell. "Because they have something to come back to."


Dr. Praveen Khilnani, a pediatric intensive care specialist, worked at several American Hospitals, including Mass General. Dr. Vikas Kohli is a pediatric cardiologist who worked at hospitals in New York and Miami.


Both need sophisticated equipment to care for their patients, something India didnít have before the birth of private hospitals like Apollo. They both wanted to come back to India despite the fact that medical care costs much less here, partly because doctors make much less.


"How much less do you make here than in the United States?" asks Simon.


"Maybe a tenth or a twentieth of what we were making the U.S.," says Khilnani.


They wanted to come back, they say, because they felt their expertise was needed here in India much more than in America.


"There are probably 1,500 to 2,000 pediatric cardiologists in the U.S. I would be one of them," says Kohli. "In India, there were just four of us. I was very passionate about working for Indian kids."


Since there are so many Indians who require the kind of care that only they can offer, why is there such a strong drive to attract foreign patients?


"Who doesnít mind extra money flowing in?" says Kohli.


Stephanie Sedlmayr didnít want to spend the tens of thousands of dollars it would take to get the hip surgery she needed. And she didnít have insurance, either. So with her daughter by her side, she flew from Vero Beach, Fla., to the Apollo Hospital in Chennai. Sheíd never been to India before, but she already knew quite a bit about Indian doctors


"My doctor, actually, in Vero Beach, she's an Indian doctor. So, why not go where they come from?" asks Sedlmayr, who says her friends questioned her decision. "Hardly anybody said, 'Oh, great idea.'"


But she didnít just come here to save money; she came for an operation she couldnít get at home. Itís called hip resurfacing, and it has changed peopleís lives.


It hasnít been approved yet by the FDA, but in India, Dr. Vijay Bose has performed over 300 of them. He showed 60 Minutes the difference between a hip resurfacing and hip replacement, which is the standard operation performed in the United States. He says his patients usually recover faster because his procedure is far less radical and doesnít involve cutting the thighbone.


Instead, Bose fits a metal cap over the end, which fits into a metal socket in the hip. The result, he says, is that patients end up with enough mobility to do virtually anything.


"So my patients, you know, play football, basketball, whatever you want. Not a problem," says Bose.


Until the FDA approves it, the only way to have this operation in the United States is by getting into a clinical trial. But be warned: It isnít cheap.


How much does it cost in the States?


"I believe it costs something from $28,000 to $32,000 U.S. dollars," says Bose.


And in India, Sedlmayr says it costs $5,800: "Private nurse after surgery. And, feeling always that they were just totally attentive. If you rang the bell next to your bed, whoop, somebody was there immediately."


Sound too good to be true? Don't forget: Itís at least a 20-hour trip, there is malaria in parts of India, patients have complained of intestinal disorders -- and if something goes wrong, you could end up suing for malpractice in an Indian court.


And one could only wish you the best of luck. But Sedlmayr feels sheís already had more luck than she had any right to expect. By the time 60 Minutes left India, she was into the tourism part of her treatment, convalescing at a seaside resort an hourís drive from the hospital.


"Is this standard, that when somebody gets surgery at the hospital to come to a resort like this afterwards?" asks Simon.


"Yeah, they suggest it. They recommend it," says Sedlmayr. "[It cost] $140 day for myself and my daughter, including an enormous fabulous breakfast that they serve until 10:30."


"I think a lot of people seeing you sitting here and what's usually called post op, and hearing your tales of what the operation was like, are going to start thinking about India," says Simon.


"Yeah, and combining surgery and paradise," says Sedlmayr.


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Selected Industry News Items | Home Page | Washington Post, Oct 21, 2004 | The Wall Street Journal, Apr. 26., 2004 | BusinessWeek, Feb. 16, 2004 | The Times of India, Feb. 14, 2004 | India Today, Nov. 24, 2003 | The New york Times, May 18, 2003 | Yahoo! News, Sep. 25, 2005 | TIME Magazine, May 29, 2006 | The State, Feb. 10, 2007 | Wall Street Journal, Mar. 8, 2007 | The Wall Street Journal, Feb. 19, 2008 | The Wall Street Journal, Feb. 26, 2008 | The New York Times, Mar. 10, 2008 | The Wall Street Journal, May 27, 2008

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