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Get Well Soon – Love, C.R.

Chuck Neudorf, from the U.S. city of Seattle, is combining his vacation to Costa Rica with a root canal.

Although he is insured in the United States, he has exhausted his dental benefits for the year.

“The cost of dental work seems to be around a third to a half of what I’d pay at home, and I feel perfectly comfortable working with medical professionals in Costa Rica,” he says.

Neudorf is part of a growing number of foreign visitors coming to Costa Rica not for its beaches, volcanoes or cloud forests, but for its hospitals.

Once a euphemism for cheap cosmetic surgery abroad, medical tourism is now a booming industry that is filling the gap between affordable health care and unaffordable health insurance.

“With the looming health care crisis in the U.S. (over 45 million uninsured) – and Costa Rica’s positive image, strong health care infrastructure and proximity – it was really no surprise that potential patients and companies would start taking an interest in Costa Rica,” says Bill Cook, international patient coordinator at Hospital Clínica Bíblica in San José.

According to the Cost a Rican Tourism Board, 95 percent of the estimated 5,000 medical tourists who come to Costa Rica each year are from the United States. The majority are uninsured or underinsured.

Medical treatment is not only less expensive here than in the U.S., but it is often less expensive than the deductible insured patients would pay for the same treatment at home.

“Labor costs are so different here. Health care prices are 30 to 40 percent lower than in the U.S.,” says Carole Veloso, director of the Hospital CIMA in Escazú, a western San José suburb.

While cosmetic surgery costs in the U.S. have adjusted to compete with cheaper alternatives overseas, the medical tourist today is more interested in a knee replacement or a gastric bypass than a facelift. Clínica Bíblica focuses on weight loss, orthopedic and minimally invasive procedures.

“A knee replacement in the U.S. might cost $30,000 to $40,000. Here at HCB, the price is $10,500, which includes airport pickups, personal assistance at the hospital and post discharge nursing care,” says Cook.

To facilitate visits abroad for medical care, a handful of companies have sprouted up in the United States as brokers. One is PreviMed, a recent Silicon Valley, California, start-up. Another is Healthbase, headquartered in the state of Massachusetts.

“Our North American clients find traveling to Costa Rica very convenient,” says Healthbase CEO Saroja Mohanasundaram. Healthbase began planning and arranging medical trips abroad three years ago.

Today, it sends its clients to health care facilities in 14 countries for medical care, including CIMA and Hospital Clínica Bíblica.

Cook says Clínica Bíblica has been attracting medical tourists since the mid-1990s, but the number of foreign patients has tripled in the last year to about 30 per month.

“About three years ago, we realized that medical tourism was getting really big,” says Veloso.

Hospital Católica in Guadalupe, east of San José, is putting the finishing touches on a new wing, called Hospital Hotel La Católica, to accommodate the growth in medical tourism.

To develop and promote medical tourism, Costa Rican hospitals, doctors and government agencies recently formed the Council of International Promotion of Costa Rica Medicine (PROMED), which will begin to operate officially in November.

Its president, Dr. Jorge Cortes, says PROMED also will organize and establish quality standards for the industry.

“This implies a great advance for Costa Rica,” Cortes says, “and makes us pioneers on an international level.”

In June, 21 doctors launched Costa Rica Medical Holding, the country’s first medical tourism consortium. The group will promote its services primarily in the United States, where it also hopes to cultivate working relationships with insurance companies.

“Over 750,000 Americans received medical care abroad last year,” says Hernán Campos, the consortium’s manager. “We estimate that in 2010, at least 40,000 of them will visit Costa Rica.”

Cook said Clínica Bíblica is starting to work with insurance companies and employers abroad.

“There is enormous potential ahead, as U.S. medical prices skyrocket and the economy worsens, for Costa Rica to be a huge player in providing medical care for companies that otherwise might not be able to offer insurance to their employees.”

Yet not everyone is willing to travel to an unknown foreign country to undergo health care procedures that are readily available much closer to home. “The people who come down here are not casual shoppers,” says Veloso. “They are either pushed to find health care or have traveled outside the country before.”

The American Medical Association is neutral on the medical tourism phenomenon.

“Medical tourism is a small but growing trend among American patients, and it’s unclear at this time whether the risks outweigh the benefits,» says Dr. James Rohack, an AMA board member.

The AMA recently published nine guiding principles on medical tourism. One advises medical tourists to coordinate local follow-up care prior to travel. Another warns prospective patients to inform themselves about the potential risks of combining surgical procedures with long flights and vacation activities.

Veloso identifies concern for proper preand post-op care as being the most pertinent critique that medical tourism faces. On average, the medical tourist stays in Costa Rica for about 10 days.

“We have had to turn patients away whose health needs would not fit safely into their time window,” she says. “But generally, health care here is a bit more aggressive than in the U.S. We get people up and about faster.”

For the ambitious medical tourist, that presents an added perk of seeking treatment in Costa Rica: time to take in the country’s beaches, volcanoes and cloud forests.



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