Medical tourism
By Melanie Chambers • Bankrate.com

Gina Littley didn't get to see many sites in India on her last visit, but she came back with something more lasting: After a surgery that fused part of her vertebrae, the 69-year-old British Columbian returned home almost pain-free for the first time in over 20 years.

"(The surgery) has made it considerably better and I don't take any medication now," says Littley.

Littley is one of hundreds of Canadians going overseas for medical procedures that include hip and knee replacements, angioplasty and cosmetic surgery.

Currently the main reason for jetting across the ocean is to avoid long wait times for surgery in Canada. According to the Canadian Institute for Health Information, the need for angioplasty and bypass surgeries jumped 51 per cent between 1997 and 2003, while the number of knee and hip replacements surged by 30 per cent.

With an aging baby boomer population, it's predicted that the need for timely surgeries will only increase. If you're considering packing your bags, there are some things you should know first.

What is medical tourism?
After decades of restrictive pain in her neck, Littley took action. After a doctor in the US recommended surgery, she then sought a second opinion in Canada. But none of the neurosurgeons her GP contacted had time to see her.  

With increasing pain, and more medications that were making her feel groggy and out-of-touch, she serendipitously discovered a posting for Surgical Tourism Canada, a medical tourism agency, while surfing a website about arthritis.

Medical tourism agencies are middlemen who connect foreign patients to overseas hospitals. Depending on the agency, these companies can arrange the surgery as well as accommodations, meals, and airport pickup.

"We do the legwork for them, contacting people and asking for notarized documents (what procedures the hospital can perform, doctors' licenses)," says Alan Flowers, marketing and communications manager for Vancouver's MedSolution.

It took Littley two months of research and asking questions to decide she wanted to go ahead with the trip. But two things clenched her decision: First, she was impressed with how the company, Surgical Tourism Canada, treated her. "I really felt looked after." And second, she was encouraged after speaking with six North American patients who had had similar procedures overseas.

How it works
When it comes time to find an agency, make sure it has an official affiliation with the hospital where you'll have your procedure.

To start the process, Littley authorized her medical records, including MRIs, and X-rays, to be sent to the foreign surgeon. After the Indian surgeon reviewed her file, she received an assessment of her condition, a biography of her surgeon revealing all of his accreditations and a preliminary quote on how much her procedure would cost.

Packed and ready to go, Littley spent a full month in India, which included time spent recovering.

Cost considerations
Some agencies include airfare, meals and accommodations in their bills. Littley recommends that anyone considering medical tourism should have a complete breakdown of his or her bill, detailing what's included and what's not to avoid any surprises.

Clients are given an initial quote before surgery based on the physicians' initial assessments of their medical records. However, that price may change after the doctor has examined the patient. This happened to Littley. "He discovered it was a very simple surgery, but he expected a much more complicated surgery, so I got a refund."

With her husband along for support, the total price came to a little more than $21,000. That price included seven nights at a four-star hotel, 12 nights at a beach resort, telephone calls, meals and the company's service charge of 10 percent. 

But depending on where you go, prices may vary drastically. For example, a hip replacement will cost $6,826 in India, $15,889 in Costa Rica and $9,886 in Thailand, according to MedSolution. And in France, the country the World Health Organization considers as having the best overall health care in the world, a hip replacement will cost $22,538. Most companies require payment upfront.

In some cases, your provincial government may cover the cost of the out-of-country surgery. In Ontario, for example, the Ministry of Health will pay for out-of-country procedures if the surgery is already an insurable procedure in Canada and if waiting for a surgery in Canada will worsen your condition.

However, reimbursement isn't guaranteed, as Littley can attest. She, along with several patients in Alberta, New Brunswick and British Columbia, are appealing to their governments for reimbursement of their expenses.

Culture shock
But the money might not be the biggest obstacle. Despite the tropical breezes coming off the Bay of Bengal at her four-star beachfront resort, Littley was overcome by the poverty outside her sheltered paradise, children begging for money and men urinating in a nearby public beach. Emotionally, she felt drained.
 
To help with her recovery and culture shock, Littley was relieved to have her husband with her. Although bringing a loved one costs extra in airfare, some hospitals do offer free daybeds for a spouse.

Customer service
According to Littley, the biggest difference between Canada's health care system and India's was the personal service and attention.

"Almost every day the surgeon and his entourage came to visit me and asked: How are you doing? Here, (in Canada) you see the surgeon the day of surgery and maybe your family doctor comes in once. (In India), they do like to please you, but at the same time, they realize what a huge financial benefit this is to a country that is so poor."

In India alone, medical tourism is a $1-billion industry. And in Singapore, whose health care is rated sixth in the world by the WHO, patients can have very specialized surgeries, often using a minimally invasive robot that results in less recovery time. And depending on how much you want to spend, you can recuperate in swanky hospital rooms with plasma TVs and personal nurses at your beck and call.

Melanie Chambers is a freelance writer based in London, Ont.