IDAHO FALLS, Idaho — Whether she likes it or not, Heather Cody is a snapshot of what's wrong with health care in this country: It's too expensive.

The 44-year-old counselor from Idaho Falls is planning a 19-day trip to New Zealand in July to have major surgery on her right hip. The trip - including plane tickets, surgery, anesthetic, two weeks in a hotel, pre- and post-operative care and a three- or four-day stay in the hospital - will cost less than half what she would pay for the operation alone in the United States. Cody's case is hardly unique. As health-care costs in this country rise, hospitals in places such as India, Hungary, Singapore and Colombia have improved the quality and reputation of their services, all while keeping costs down.

Meanwhile, thanks largely to the Internet, American health-care consumers are better informed than ever about opportunities, risks and the reliability of providers worldwide.

"(U.S.) residents are starting to accept that quality health care is available in other countries," said Jonathan Edelheit, president of the Medical Tourism Association.

In purely financial terms, some foreign countries are out-competing this country's health-care providers. They offer a comparable - sometimes superior - product that costs far less than the American version. A knee surgery that costs more than $10,000 in the United States, for example, might cost only $1,500 in Thailand or Singapore.

There's plenty of debate as to who's to blame for the high cost of medical treatment in the U.S. and what should be done about it, but almost no one disputes the claim that Americans are overpaying for health care.

U.S. residents like Cody are taking notice. But just how many are becoming "medical tourists" is unknown.

A 2008 report by the Deloitte Center for Health Solutions found that 750,000 Americans traveled outside their hometowns for health care in 2007, often to other countries. Deloitte expected that number to rise to 6 million by 2010. Its report anticipated the United States would lose $15.9 billion in domestic consumer spending to medical tourism in 2008 and nearly $68 billion by 2010.

Those are big numbers, and they're not lost on foreign countries, which are exploiting medical tourism as a profitable industry that ties into the broader tourism industry.

Yet it's difficult to pin down just how reliable Deloitte's estimates are. Howard Berliner, a professor of health policy and management at SUNY Downstate Medical Center in Brooklyn, N.Y., said he believes Deloitte's numbers aren't realistic.

For one thing, Berliner said, Deloitte's estimates don't take into account how many medical tourists were just regular tourists in other countries when their health took a turn for the worse. Another number that's not tracked is how many natives of foreign countries who reside in the United States returned home for medical procedures.

So just how common is medical tourism? The bottom line at this point, Berliner said, is that "no one knows."

Medical-tourism advocates hope to encourage greater competition among global health-care providers, leading to lower prices and better care, Edelheit said. Already, he said, some U.S. hospitals have taken notice of their global competitors and are working to cut prices.

That competition, coupled with the worldwide explosion in access to information about health care, could prompt consumers to become more medically savvy, Edelheit said.

"Medical tourism is the ultimate tool in consumer-driven care," he said.

Several factors, however, are likely to limit the growth of medical tourism in the foreseeable future. One is the ability to secure follow-up care once patients return to the United States. Some American doctors may not be eager to handle long-term outpatient care for procedures in which they were not involved.

Cody was lucky enough to find a local doctor who agreed to take on her follow-up treatment.

Another problem is patients' recourse in the event of malpractice.

"If anything were to go wrong during a procedure in a foreign country, the consumer has to work through the host country's legal system," Deloitte's report said. "This can be difficult and burdensome if the consumer lives far away from the place (he or she) received treatment."

The specter of "potential lawsuits linked to bad outcomes" has made some of the largest American insurance providers unwilling to cover procedures performed outside the United States, Deloitte's study found.

Ultimately, the death knell for medical tourism originating in the United States might be our own policies, Berliner said.

"If there is substantial health reform in the U.S., the market for medical tourism, at least from this country, is essentially gone," he said.

For Cody, the inadequacies of the American health-care system were a disappointment that led her to look overseas for treatment. She describes herself as not rich enough to afford a hip replacement that would cost $50,000 to $80,000 at home, but not poor enough to qualify for government assistance.

"I'm trying to pull my weight, but the access to health care is pretty poor for people in my situation," she said.

With help from her family, Cody has marshaled most of the $23,000 price tag on her summer trip to New Zealand. Not everyone is so fortunate, just as not every patient who hits the wall of health-care costs is a counselor trained to cope with the kind of stress that often leads to emotional instability. For too many people who experience physical hardship, depression and substance abuse are tragic outcomes, Cody said. A few months ago, she said, she had her own bout with mental and emotional sickness.

"I have more skills with that, just because of what I do, and I have a support system that I've been aware to make," she said. "Most people don't do that."

Source: Fort Mills Times