Personal-finance columnist Charlotte Cowles asks the nosy, revealing, sometimes uncomfortable questions about money so you don’t have to.
Photo-Illustration: by The Cut; Photo: Getty Images
Erin Donahue, a photographer in her early 30s, grew up visiting her relatives in Taiwan during school breaks. But she never thought to make a doctor’s appointment there until she quit her corporate job a few years ago. Once she became self-employed, she got the cheapest health insurance she could find, but it was barely accepted anywhere. “Even when I did find a doctor who would take my plan, I’d have to wait months for an appointment,” she says.
Then she started seeing content on TikTok about people going abroad for medical testing or procedures. “That’s when I remembered that Taiwan’s health care is among the best in the world,” says Donahue. “I only used it once myself, as a kid, when I broke my jaw while we were there. My mom still talks about how it only cost $30 for emergency services.” During her next trip, she booked a full-body workup at a concierge clinic. She’s not a Taiwanese citizen, so she paid out of pocket: $425 for about 20 tests, including a comprehensive metabolic panel, a pap smear, ultrasounds of her organs, and vision and hearing assessments. “If I were to do that in the U.S., it would have required multiple appointments with different doctors, and it probably would have cost a lot more,” she says.
The medical facility was sleek, modern, and efficient; Donahue was in and out in a few hours. “It felt like being in a really nice hotel,” she says. “You could even order food at the end.” The experience was so positive that she booked another set of tests — a colonoscopy and an endoscopy — for the following year. The total bill was $525. “These are tests you can’t even get in the U.S. unless you’re over the age of 50 or have a specific risk,” she says. Her results came back normal, but if they hadn’t, she would have sought treatment locally rather than return to New York. “If I ever develop something chronic, I think I would need to leave the U.S. because the cost of health care here is so unsustainable,” she says.
Donahue is one of the countless Americans who, lured by a deluge of TikToks and reels about medical tourism, have traveled internationally for affordable medical care in recent years. (One popular destination in Mexico, Los Algodones — “Molar City” — receives more than a million Americans for dental work annually.) As health insurance and medical costs balloon in the U.S., even more Americans are exploring their options in Turkey, Korea, Mexico, India, Thailand, and other countries that are courting their business. Statistics on medical tourism are tough to track, but a recent report estimates that the market will grow, on average, around 16 percent each year in the next decade.
Popular videos about $14 bloodwork in Bali might seem too good to be true — and in some cases they probably are — but they also highlight the reality that medical pricing in the U.S. seems increasingly unrealistic. “Never seeing a doctor in the U.S. again” is a common refrain in medical-tourism content, along with “American health care is a scam” — hard to argue when medical bills are cited as the primary cause for the majority of personal bankruptcies in the U.S. Crossing the border for care has its barriers, too (plane tickets and accommodations are not exactly cheap), but patients can typically expect more transparency around pricing and savings of up to 30 to 80 percent.
“Most people who seek care outside of the U.S. do so because it can be less expensive, easier and quicker to get access, and just a qualitatively better experience,” says Dr. Kumar Dharmarajan, a licensed physician who worked as a cardiologist in New York for decades before he became the chief medical officer of World Class Health, a concierge network that helps patients find medical providers overseas. While services like this do exist, most Americans seek out private clinics that cater to international patients, often finding them through social media or at the recommendation of a friend or family member.
Why is health care so much cheaper elsewhere? “It’s complicated, but the biggest reason is that the U.S. health-care system has a lot more administrative waste — all these different entities, including the government, insurance companies, pharmacy-benefit managers, providers, and other groups are negotiating prices and taking a cut,” says Dharmarajan. “The way health care and medication is priced in the U.S. is very different from how it’s done almost everywhere else, and it’s much more opaque.” If you need surgery done in the U.S., it’s almost impossible to find out how much it will cost until after the fact, when your bills shuffle through the dark chambers of provider billing systems, insurance claims, and payment-assistance programs. In most other countries, there are fewer hands in the cookie jar, resulting in a simpler pricing model: You ask a provider how much something costs, you pay it, and — for the most part — it gets done.
Julie Theis, a 31-year-old actress and YouTuber from Montana, now only sees doctors when she’s traveling. “I used to think medical tourism was just for plastic surgery, but when I wanted LASIK, I decided to look up prices in Europe, because I had a trip planned to Croatia,” she says. “In the U.S., I was getting quoted $6,000 or more, because I had astigmatism. And then I found a doctor I really liked in Albania who was charging $1,200. That’s life-changing money to save.” On the same trip, she got a cavity filled for $30.
Theis was surprised by the criticism she got when she documented her LASIK surgery online. “People were very xenophobic,” she says. “I got messages like, ‘You’re going to lose an eye. They’re going to harvest your kidney. You’re so stupid for doing that.’ The assumption is that you’re getting back-alley medical care, when in reality, the doctor I saw was just as well-trained as anyone in the U.S., and the clinic was very clean and upscale.”
Procedures she’s gotten back at home do not compare favorably, Theis adds. “I got a root canal when I was living in Austin and it was horrible — very painful — and cost me $4,000,” she says. “The dentist in Albania told me she could have done it for $80.” She no longer has medical insurance in the U.S. and doesn’t plan to get it anytime soon. “When I used to have it, it cost all this money, but it didn’t seem to cover anything,” she says.
When Bryn Elise, a 31-year-old from Idaho, lost a filling on vacation in Thailand a few years ago, she became a medical tourist by accident. “I didn’t know what to do. I considered flying home to get it fixed, but that seemed ridiculous,” she says. “I ended up finding an international dental clinic in Bangkok and they were like, ‘Come in tomorrow.’” The check-in process was like going to a spa. “There was a big chandelier and these beautiful couches, and everyone working there spoke English perfectly,” she says. “They did X-rays before and after the procedure, so the dentist could show me what she fixed. It all cost me $38.”
She has since started a blog about the medical testing and procedures she’s tried in different countries. And like Theis, she doesn’t bother with insurance in the U.S. anymore. “If anything happens, I’ll just go deal with it abroad,” she says. “Sometimes I feel like I need catastrophic insurance just in case I get in a car accident, that kind of thing. But man, I don’t want to pay hundreds of dollars a month for that.” She’s currently trying to convince her mom to get a broken tooth fixed in Mexico. “She got a quote for like $10,000 here in the U.S., and I was like, ‘Mom, let’s just go to Tijuana and you can get it done for $1,500.’” A lot of the dentists there are American anyway, she says. “They live in San Diego and just come over to work because it’s easier. So it feels like you’re in California.”
Medical tourism does carry risks, of course. One of the many reasons why health care is so expensive in the U.S. is that providers pay hefty insurance fees in case of malpractice lawsuits; in other countries, malpractice laws aren’t always so stringent, so patients might have fewer options for recourse if something goes awry. Other countries also may have different regulations governing medical licensure and training, which leaves it up to the patient to research their provider’s qualifications beforehand.
When Dharmarajan is helping his clients find care overseas, he often looks for hospitals, clinics, and labs with JCI accreditation, which ensures that the facility meets a globally recognized set of standards. “Less than one percent of the world’s hospitals have JCI accreditation, so it’s a pretty high bar,” he says. He’ll also check an individual physician’s background, accolades, patient outcomes, complication rates, licensure, and fellowship training. “It can be a lot of legwork,” he admits.
Another downside to getting medical procedures overseas is that it can be hard to do proper follow-ups. What if your battery of tests turns up something worrisome? If you bring the results home, many U.S. doctors would reorder the same tests to double-check, says Dr. Paul Tallaj, a general surgeon affiliated with Somos Community Care, a nonprofit that helps underserved patients in New York. So you’d end up paying the same as what you would have paid if you never went abroad in the first place.
Other unforeseen costs can crop up, too. “I’ve worked in vulnerable communities, especially in the Bronx, where medical tourism is the only option people have to get a procedure they can afford,” Tallaj says. “There are common complications, though. Sometimes people would get prescribed a medication that has a different name here in the U.S., or they couldn’t get their insurance to cover it when they come back. Or there were communication issues resulting from language barriers or lack of paperwork.”
It also results in fragmented medical histories. “When I’m taking on a patient and they mention a prior surgery, I always ask, ‘Do you have the operative note of what was done?’” says Tallaj. “Most don’t, especially when that surgery was done in another country. It gives me an imperfect picture of a patient and puts me in a position where I might encounter something I don’t expect.”
Some patients underestimate the auxiliary costs of medical tourism, too. “They see that they can save 60 percent on a procedure, but they don’t take into account the travel expenses or the ongoing care that they need afterwards,” he says. “God forbid something goes wrong — are you going to fly back? Can you fly back?”
Still, he’s not against it, especially for certain procedures like dental work, hernia repairs, and some orthopedic surgeries. “You want to stick to elective procedures that are standardized and have a limited follow-up time that can be managed through telehealth,” he says. “As physicians, we need to understand that medical tourism is the only path that some patients have, and we should be there to guide them through it rather than try to talk them out of it.”
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