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My Two Cents<\/a><\/p>\n \n Personal-finance columnist Charlotte Cowles asks the nosy, revealing, sometimes uncomfortable questions about money so you don\u2019t have to.\n <\/p>\n \n Photo-Illustration: by The Cut; Photo: Getty Images\n <\/p>\n 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\u2019s 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. \u201cEven when I did find a doctor who would take my plan, I\u2019d have to wait months for an appointment,\u201d she says.<\/p>\n Then she started seeing content on TikTok about people going abroad for medical testing or procedures. \u201cThat\u2019s when I remembered that Taiwan\u2019s health care is among the best in the world,\u201d says Donahue. \u201cI 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.\u201d During her next trip, she booked a full-body workup at a concierge clinic. She\u2019s 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. \u201cIf 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,\u201d she says.<\/p>\n The medical facility was sleek, modern, and efficient;\u00a0Donahue was in and out in a few hours. \u201cIt felt like being in a really nice hotel,\u201d she says. \u201cYou could even order food at the end.\u201d The experience was so positive that she booked another set of tests \u2014\u00a0a colonoscopy and an endoscopy \u2014\u00a0for the following year. The total bill was $525. \u201cThese are tests you can\u2019t even get in the U.S. unless you\u2019re over the age of 50 or have a specific risk,\u201d she says. Her results came back normal, but if they hadn\u2019t, she would have sought treatment locally rather than return to New York. \u201cIf 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,\u201d she says.<\/p>\n 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 \u2014 \u201cMolar City\u201d \u2014 receives more than a million Americans<\/a> for dental work annually.) As health insurance and medical costs balloon in the U.S.<\/a>, 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<\/a> are tough to track, but a recent report estimates<\/a> that the market will grow, on average, around 16 percent each year in the next decade.<\/p>\n Popular videos about $14 bloodwork in Bali<\/a> might seem too good to be true \u2014 and in some cases they probably are \u2014 but they also highlight the reality that medical pricing in the U.S. seems increasingly unrealistic<\/a>. \u201cNever seeing a doctor in the U.S. again\u201d is a common refrain in medical-tourism content, along with \u201cAmerican health care is a scam\u201d \u2014\u00a0hard to argue when medical bills are cited as the primary cause for the majority of personal bankruptcies in the U.S.<\/a> Crossing the border for care has its barriers, too (plane tickets and accommodations are not exactly cheap),\u00a0but patients can typically expect more transparency around pricing and savings of up to 30 to 80 percent<\/a>.<\/p>\n \u201cMost 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,\u201d 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>, 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.<\/p>\n Why is health care so much cheaper elsewhere? \u201cIt\u2019s complicated, but the biggest reason is that the U.S. health-care system has a lot more administrative waste \u2014\u00a0all these different entities, including the government, insurance companies, pharmacy-benefit managers, providers, and other groups are negotiating prices and taking a cut,\u201d says Dharmarajan. \u201cThe way health care and medication is priced in the U.S. is very different from how it\u2019s done almost everywhere else, and it\u2019s much more opaque.\u201d If you need surgery done in the U.S., it\u2019s 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 \u2014 for the most part \u2014 it gets done.<\/p>\n Julie Theis<\/a>, a 31-year-old actress and YouTuber from Montana, now only sees doctors when she\u2019s traveling. \u201cI 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,\u201d she says. \u201cIn 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\u2019s life-changing money to save.\u201d On the same trip, she got a cavity filled for $30.<\/p>\n Theis was surprised by the criticism she got when she documented her LASIK surgery online. \u201cPeople were very xenophobic,\u201d she says. \u201cI got messages like, \u2018You\u2019re going to lose an eye. They\u2019re going to harvest your kidney. You\u2019re so stupid for doing that.\u2019 The assumption is that you\u2019re 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.\u201d 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. \u201cI didn\u2019t know what to do. I considered flying home to get it fixed, but that seemed ridiculous,\u201d she says. \u201cI ended up finding an international dental clinic in Bangkok and they were like, \u2018Come in tomorrow.\u2019\u201d The check-in process was like going to a spa. \u201cThere was a big chandelier and these beautiful couches, and everyone working there spoke English perfectly,\u201d she says. \u201cThey did X-rays before and after the procedure, so the dentist could show me what she fixed. It all cost me $38.\u201d<\/p>\n She has since started a blog<\/a> about the medical testing and procedures she\u2019s tried in different countries. And like Theis, she doesn\u2019t bother with insurance in the U.S. anymore. \u201cIf anything happens, I\u2019ll just go deal with it abroad,\u201d she says. \u201cSometimes I feel like I need catastrophic insurance just in case I get in a car accident, that kind of thing. But man, I don\u2019t want to pay hundreds of dollars a month for that.\u201d She\u2019s currently trying to convince her mom to get a broken tooth fixed in Mexico. \u201cShe got a quote for like $10,000 here in the U.S., and I was like, \u2018Mom, let\u2019s just go to Tijuana and you can get it done for $1,500.\u2019\u201d A lot of the dentists there are American anyway, she says. \u201cThey live in San Diego and just come over to work because it\u2019s easier. So it feels like you\u2019re in California.\u201d<\/p>\n Medical tourism does carry risks<\/a>, of course. One of the many reasons why health care is so expensive in the U.S. is that providers pay hefty insurance fees<\/a> in case of malpractice lawsuits; in other countries, malpractice laws aren\u2019t 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\u2019s qualifications beforehand.<\/p>\n When Dharmarajan is helping his clients find care overseas, he often looks for hospitals, clinics, and labs with JCI accreditation<\/a>, which ensures that the facility meets a globally recognized set of standards. \u201cLess than one percent of the world\u2019s hospitals have JCI accreditation, so it\u2019s a pretty high bar,\u201d he says. He\u2019ll also check an individual physician\u2019s background, accolades, patient outcomes, complication rates, licensure, and fellowship training. \u201cIt can be a lot of legwork,\u201d he admits.<\/p>\n 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>, a nonprofit that helps underserved patients in New York. So you\u2019d end up paying the same as what you would have paid if you never went abroad in the first place.<\/p>\n Other unforeseen costs can crop up, too. \u201cI\u2019ve worked in vulnerable communities, especially in the Bronx, where medical tourism is the only option people have to get a procedure they can afford,\u201d Tallaj says. \u201cThere are common complications, though. Sometimes people would get prescribed a medication that has a different name here in the U.S., or they couldn\u2019t get their insurance to cover it when they come back. Or there were communication issues resulting from language barriers or lack of paperwork.\u201d<\/p>\n It also results in fragmented medical histories. \u201cWhen I\u2019m taking on a patient and they mention a prior surgery, I always ask, \u2018Do you have the operative note of what was done?\u2019\u201d says Tallaj. \u201cMost don\u2019t, 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\u2019t expect.\u201d<\/p>\n Some patients underestimate the auxiliary costs of medical tourism, too. \u201cThey see that they can save 60 percent on a procedure, but they don\u2019t take into account the travel expenses or the ongoing care that they need afterwards,\u201d he says. \u201cGod forbid something goes wrong \u2014\u00a0are you going to fly back? Can you fly back?\u201d<\/p>\n Still, he\u2019s not against it, especially for certain procedures like dental work, hernia repairs, and some orthopedic surgeries. \u201cYou want to stick to elective procedures that are standardized and have a limited follow-up time that can be managed through telehealth,\u201d he says. \u201cAs 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.\u201d<\/p>\n Email your money conundrums to\u00a0mytwocents@nymag.com<\/a> (and read our submission terms here<\/a>).<\/p>\n
Procedures she\u2019s gotten back at home do not compare favorably, Theis adds. \u201cI got a root canal when I was living in Austin and it was horrible \u2014\u00a0very painful \u2014\u00a0and cost me $4,000,\u201d she says. \u201cThe dentist in Albania told me she could have done it for $80.\u201d She no longer has medical insurance in the U.S. and doesn\u2019t plan to get it anytime soon. \u201cWhen I used to have it, it cost all this money, but it didn\u2019t seem to cover anything,\u201d she says.<\/p>\n