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Medical Tourism, Jimmy Buffet, Hip Replacement and the Tropical Sun

By Walter Eisner

A few years ago, Dr. Edmundo Ford, AAOS member and past president of the Panamanian Society of Orthopedic Surgeons, along with his colleagues in Panama City, Panama, noticed that more and more calls where coming into their offices from North America and other Central American countries inquiring about medical services. The procedures that Dr. Ford uses call for U.S. protocols, which give patients confidence that the type of care they will receive in Panama will be as good as that they might receive in the United States. His devices of choice are manufactured by Biomet and Synthes.

Dr. Ford and colleagues recognized the opportunity to grow their practices and help Panama’s young medical infrastructure develop and advance. And so the seeds of medical tourism in Panama were sown.

Medical Tourism: History

Medical tourism is not a new phenomenon. Patients going to a different country for either urgent or elective medical procedures is well established and growing at rates that suggest it will soon be a worldwide, multibillion-dollar industry.

The reasons patients travel for treatments vary. Many medical tourists, especially those from the United States, travel to receive treatment at a quarter or sometimes even a tenth of the cost of the same treatments back home. Medical tourists from Canada, on the other hand, are often people who are frustrated by long wait times in the Canadian health care system. And, finally, for those arriving from Great Britain, the reason most often cited for seeking care thousands of miles from home is that the patient can't wait for treatment by the National Health Service but also can't afford to see a physician in private practice. And for all medical tourists, increasingly these decisions represent a chance to combine a tropical vacation with elective surgery.

A little Internet research will show that medical tourism is not new. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios, at Epidaurus. In Roman Britain, patients took the waters at a shrine at Bath, a practice that continued for 2,000 years. From the 18th century wealthy Europeans traveled to spas in Germany and the Nile. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate.

Countries including Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand have been leaders in the field. Other countries such as Belgium, Poland, Singapore and Panama are now entering the field. In South Africa you can visit the country for a safari and have a stopover for a nose job and see lions and elephants. For North American patients, Costa Rica is an increasingly popular destination for inexpensive, high-quality medical care without a trans-Pacific flight. Costa Rica is a Mecca for westerners seeking plastic surgery.


The New York Times recently published a story about the magnet that Panama has become for America's 77 million baby boomers on the brink of their "Third Age." The CIA lists Panama as the safest country in Central America and the American presence in the country is still seen by many Panamanians as being a boon for their country.

Panama City is a first-rate, first world city with restaurants, hotels, culture and services to match any tourist destination in the world. In short, American, Canadian and European tourists have replaced the economic stimulus that used to come from the U.S. military presence. Don Winner, publisher of the online publication Panama-Guide, says that there are almost 80,000 foreigners that are now living in Panama.

Medicare, Technology and Boomer Tourists

And Medicare? We all know that Medicare is reporting that it will go broke trying to keep the financial promises it has made to the boomers. In part to address this looming financial crisis, the Council on Foreign Relations recently issued a report that suggests that the U.S. government should allow Medicare benefits to be portable just like Social Security. Medicare beneficiaries would be allowed to use approved health care providers south of the border for their medical needs. We could call that "outsourcing seniors." Here's the benefit. The costs are much less and there is an ample supply of labor to take care of boomers in their third age, even as the long-term care industry in the U.S. reports a labor shortage. Presto ... Medicare saves a bundle of money and jobs get created at the source of labor.

The Internet, portable medical technologies and a long history of affiliations with American hospitals such as The Cleveland Clinic Foundation and Johns Hopkins have allowed patients to choose to receive procedures in first-class facilities staffed by physicians trained in the U.S. or Europe. In recent years, Panama has become the region’s aero hub, with daily direct flights to/from Miami, Los Angeles, Houston, New York and other cities. Getting to Panama is easy—just 2.5 hours from Miami and 4 from Houston—that is one reason why Panama’s tourism has grown by almost 20% every year for the last five years.

Panama Health Tourism

In the mix of these demographic, economic and technology tidal waves, Dr. Richard Ford (cousin of Dr. Edmundo Ford) decided to gather colleagues together and find the best physicians in the country of various specialties to offer their services to foreign patients. They formed an Internet-based organization called Pana-Health (www.pana-health.com) and recruited Enrique Pesantez of Pesantez Tours to manage the "tourist" part of the patient's visit.

Dr. Richard Ford obtained his degree of Odontology at Pontificia Universidad Javeriana, Bogota, Colombia, in 1984. After five years of general private practice in Panama City, Dr. Ford went to Louisiana State University School of Dentistry, where he received a degree of Specialist in Periodontics. Dr. Ford says that the association now has 22 specialists and expects to grow to 39 in the near future. The founding members require new physicians in the system to be trained at some point in the U.S. or Europe and one half of their physicians are board-certified.

He says that Pana-Health has seen a 250% increase in patients in the last year and that one out of every five consultations results in a new patient for one of their specialists. The association plans to start an advertising campaign in U.S. cities such as Miami, Atlanta and New York, where direct flights to Panama City originate.

Health Tourism Costs

The draw, of course, is cost.

For example, the Pana-Health website quotes the following cost comparisons between Panama and the U.S.

So here are the ingredients: First-class medical facilities, U.S.- or European-trained physicians, low-cost procedures, a tourist agency to handle all non-medical arrangements and an astoundingly beautiful country where you can recuperate from surgery.

Let's say you get a knee replacement. The airfare, one week of lodging, meals and transportation for first-class tourism might cost you a total of about $2,000-$3,000. Add the $12,000 for the medical bills and you've still got $5,000 left over. All the costs, including travel, are tax deductible. If you're aware of the risks and are comfortable with the track record of the practicing surgeons, this is a very tempting offer.

Happy Campers

What about that track record? What have patients said about their medical tourism experience in Panama? Again, from Pana-Health:

Diane Benson, Delco, North Carolina: "Your hospital, doctors, nurses and everyone else I came in contact with treated me with the utmost respect and was genuinely interested in me as an individual. I didn't feel like a number. The care I received there was excellent and I am totally satisfied with my experience and would not hesitate to come back for any other procedures I may need to have done. Not having to worry about finding a place to stay or finding a way from the airport was a huge plus. This was especially useful because of my not speaking the language."

Shirley Livingway, Pompano Beach, Florida: "Although initially hesitant, I traveled to Panama four years ago to have dental implants. I was at ease immediately because both staff and doctors speak perfect English and the entire procedure was explained to me with patience and precision. With the money I saved by having the procedure done in Panama, I had a wonderful vacation."

Too Good To Be True?

It almost sounds too good to be true. So there are some cautions.

Government and basic medical insurance (HMOs), and sometimes extended medical insurance, often do not pay for the medical procedure, meaning the patient has to pay cash. There may be little follow-up care. The patient usually is in the hospital for only a few days, and then goes on the vacation portion of the trip or returns home. Complications, side effects and post-operative care are then the responsibility of the medical care system in the patient’s home country. Many of the countries that offer medical tourism have weak malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.

There are growing accusations that profitable, private-sector medical tourism is drawing medical resources and personnel away from the local population (sounds just like the criticism directed toward American physician-owned specialty hospitals), although some medical organizations that market to outside tourists are taking steps to improve local service.

Message to American Physician Colleagues

Dr. Ford knows that surgeons in the U.S. are not going to rush to make referrals to specialists in Panama. But he cites many cases of making referrals back to U.S. surgeons. It's not for everyone and he wants to tell his colleagues in the U.S. that the Panamanian practices are good and their association uses U.S. protocols. Patients are treated with great personal care. He urges them to keep an open mind and find out for themselves by consulting with Panamanian physicians at Society meetings. To Wall Street, Dr. Ford says to keep an eye on what we are doing and consider the business opportunities for investments in the Panamanian medical infrastructure.

The Son of a Son of a Sailor

We can see it now. Jimmy Buffet clutching his walker and sailing down to visit his buddy, Ruben Blades, the Panamanian Minister of Tourism, to get him hooked up for his hip replacement. As Jimmy sings:

“Down to the banana republic,
Down to the tropical sun,
Come the expatriated Americans,
Hoping to have some fun.”

And now they can come for much more.

Source: Orthopedics This Week