Six reasons for globalized health care

A woman who I know in Denver is a perfect example of why people travel to other countries for medical surgeries and procedures. She was involved in two car accidents causing damage to the intervertebral discs in her neck and leaving her with her spinal cord compression. Four spinal surgeons in the U.S. agreed she would need two levels of vertebrae to be fused. Fusion costs $125,000 for each level, and since she is on an 80/20 insurance plan, she would be responsible for $50,000 out-of-pocket.

Another top spine surgeon told her she wasn't a good candidate for the surgery since she was only in her 40s and an active athlete. Fusion causes stiffness in the neck, overworking adjacent discs in the spine when you are very active. She would be at high-risk for needing additional fusions every five to 10 years until her entire neck was fused. If you have seen people with multiple levels of fusion, you know they have to turn their body to look around.

Here is where western medicine can fail us.

Even though she was not a good candidate for this surgery, it was all that most doctors would offer because fusion is the gold standard for damaged disks, according to the American Medical Association. The only other option offered by a local doctor was artificial disc replacement using an outdated titanium ball-in-socket device that has proven to be just as problematic as fusion itself. And here is another interesting fact … while fusion is the gold standard in the U.S., it is often considered a last resort in Europe, where many other options exist. Her doctor suggested she do some research to see if there were other options overseas that looked better. While her doctor was unable to legally recommend any of these options, she was concerned enough to suggest that there were alternative, potentially better options out there. 

This patient is an avid researcher. She found several highly rated spine surgeons in Germany, Brazil and the United Kingdom that have had great success with an artificial disc that not only provides shock absorption between vertebrae, but also allows for constrained motion while twisting, mimicking a normal human disc. The disc is made in the U.S., but the company refused to go through the $100 million it would take to get FDA approval. Instead, the organization conducted a clinical trial with hundreds of patients in the European Union almost 10 years ago. The early results, along with follow-up tests two years thereafter, suggested this procedure was far superior to fusion and allowed most patients near full function and mobility of their spines with far less pain and complication rates in the long run.

She and her husband flew to Germany and stayed in a hotel for two and a half weeks for the artificial disc replacement surgery and follow up. The cost was $38,000 including everything except airfare. She ultimately saved $11,000. And instead of being in a neck brace for weeks and needing several months of physical therapy necessary after fusion, she never had a neck brace, was off pain killers in two weeks and returned to yoga and Pilates classes without restriction just one month post-surgery. She now enjoys full use of her neck and was back into more aggressive sports in just a few months. Follow-up care has been provided at no cost the last five years, where questions and period x-rays are sent to Germany to ensure ongoing success.

All of that is to say, here are the six common reasons people travel from the U.S. to other countries for medical treatment.

1. COST

This is evident with our spine patient mentioned above. Even with insurance picking up $200,000 of the $250,000 for fusion surgery locally, that left her $50,000 to be paid out-of-pocket. By having the surgery in Germany, she saved $11,000 after airfare, and received the advanced technology she needed, reducing the need for additional surgeries in the future, while preserving full mobility and function.

2. OPINION

Do you want a second opinion? Do you want to know if you really need a surgery that was recommended, or if a new technology like stem cell treatment might be better for you? For many spine patients, less invasive options might be better.

3. TECHNOLOGY

Some doctors are aware of new technologies offered in other countries that are not available in the U.S., largely due to FDA regulations. Often they are unable to recommend these procedures because the American Medical Association has not yet changed their standards, even after clinical trials have proven their value. Even within the U.S., there are additional options that are FDA-approved that can help people, but still some doctors will not recommend them, either because they are unfamiliar with them, or because the AMA has not approved them.

4. AVAILABILITY

If you have decided you need a procedure and you need to see a specialist, consider how many patients are ahead of you, waiting for the same treatment. If you have to wait three to six months, that's a long time when you are in pain. What is there is an internationally certified physician who specializes in that surgery and can take you in three to six weeks? Medical travel provides choices that may not otherwise be available. Many countries now have specialists that are at the top of their field internationally, outperforming standard medical care, but most people are unaware of how to find these specialists. 

5. QUALITY

For the lady above, she found that many people went to the clinic, largely outperforming fusion for her disc troubles, according to European research.

6. FACILITY

The woman above said when they were traveling to the doctor's clinic, she was shocked the hospital was in the midst of farmland, and when they pulled up to a small, old building with radiators in the rooms and only one floor for patients, she grew concerned. But such small and specialized facilites are common elsewhere in the world, in contrast to the extravagent complexes we are familiar with in major U.S. cities. German facilities seem to save their money for high-end technology in the surgical suites, and very competant staff. Fortunately, for this patient, when the nurses and doctors came in to explain how things would proceed, she realized the level of patient care at this facility far exceeded anything she has experienced, and the importance of the building disappeared. After the procedure, spine patients are kept in the hospital for one week with meticulous follow-up testing daily, before moving to a nearby hotel.

Needless to say, this patient has been extremely pleased with her outcome, and highly recommends that people look at a wide variety of options beyond what is first recommended by their local doctor. Better options might very well exist within reach, sometimes for less money, and with far better physical outcomes in the end.