How Medical Travel Can Save You Thousands on Surgery, IVF, and More

00:00:00.000 | Medical travel is gaining popularity as a huge way to save,

00:00:04.720 | but is it actually safe, cost-effective,

00:00:06.880 | and worth considering?

00:00:08.160 | Today I'm talking to Joseph Woodman,

00:00:10.200 | who literally wrote the book on the topic and says,

00:00:12.960 | - What people really don't know is that healthcare

00:00:15.680 | is as good or better overseas, cross borders,

00:00:19.400 | than they can get here in the United States.

00:00:21.160 | - So in this episode, we're gonna break down the facts,

00:00:23.600 | from cost savings up to 65%,

00:00:26.240 | to the best countries for different procedures,

00:00:28.600 | how to find the right doctors, avoid common pitfalls,

00:00:31.640 | and even leverage travel rewards

00:00:33.400 | to make medical travel more affordable.

00:00:35.440 | I'm Chris Hutchins, if you enjoy this episode,

00:00:37.400 | please share it with a friend or leave a comment or review.

00:00:40.200 | And if you wanna keep upgrading your life, money,

00:00:42.240 | and travel, click follow or subscribe.

00:00:44.560 | Joseph, what do you think are some of the most common myths

00:00:48.000 | about medical travel

00:00:49.280 | and how do they actually compare to reality?

00:00:51.560 | - Well, I think the main myth,

00:00:53.800 | especially for people who haven't traveled overseas,

00:00:57.160 | is a big misconception

00:00:59.320 | that US has the very best healthcare, and we do.

00:01:02.760 | But in order to take advantage of that healthcare,

00:01:05.680 | a significant number of people,

00:01:07.840 | mostly at the bottom of the pyramid

00:01:09.280 | or toward the middle of the pyramid economically,

00:01:12.120 | can't afford it.

00:01:12.960 | We've priced ourselves out of the market.

00:01:14.240 | So we don't universally have great healthcare.

00:01:16.920 | We're like everywhere else.

00:01:18.040 | What people really don't know is that healthcare

00:01:20.760 | is as good or better overseas, cross borders,

00:01:25.200 | than they can get here in the United States.

00:01:27.440 | And the conception there is

00:01:29.000 | anyone who hasn't traveled overseas

00:01:30.360 | can't imagine a Four Seasons or a Hilton

00:01:34.040 | or a Denny's or a J.Crew or a Costco.

00:01:36.880 | All of those exist in almost every city in the world now.

00:01:40.240 | And yet people who can't conceptualize that,

00:01:44.000 | who can't get their arms around that,

00:01:45.800 | are not gonna be able to get their arms around

00:01:47.880 | being on an operating table or a dental treatment chair

00:01:50.640 | in a mind-blowingly advanced hygienic environment.

00:01:55.640 | They just, they can't see that happening.

00:01:58.040 | What they see is a mud hut, rusty scalpels,

00:02:00.720 | and weird doctors that don't know English.

00:02:03.520 | - And let's talk about that last one.

00:02:04.840 | As I've been preparing for this,

00:02:06.080 | I've been talking about medical travel to people.

00:02:09.120 | And a lot of people have told me,

00:02:11.080 | "Gosh, but there's so much nuance in medical terminology.

00:02:14.920 | How are we gonna get past the language barrier?"

00:02:16.960 | Is that something anyone even needs to worry about?

00:02:19.120 | - That's a good question.

00:02:20.040 | 10 years ago, yes, when my father,

00:02:22.120 | who really was the inspiration for this book,

00:02:24.960 | some 23 years ago, traveled to Puerto Vallarta

00:02:27.440 | for a mouthful of dental care,

00:02:29.600 | very few of the sites in Mexico

00:02:31.600 | or anywhere in the world were in English.

00:02:34.000 | Very few clinics were actually consciously serving

00:02:37.160 | the international patient, all right?

00:02:39.480 | He was a pioneer, he always was.

00:02:42.760 | And when he mentioned it to me, I didn't know any better.

00:02:45.400 | And I said, "What are you doing again?"

00:02:48.000 | And he said, "Well, you wanna come join me?"

00:02:49.840 | And that's how this whole journey started.

00:02:51.960 | But at that time, none of those websites were in English.

00:02:56.440 | He had to go and find somebody and translate them.

00:02:58.880 | There are language barriers,

00:03:00.200 | that's part of the screening process.

00:03:01.760 | If someone refers you to a clinic

00:03:03.400 | or you find a clinic online and you contact them

00:03:06.800 | and their English isn't good, move on.

00:03:08.760 | The top clinics around the world

00:03:11.160 | that we've identified in our book,

00:03:13.000 | all of them speak English.

00:03:14.840 | That's a prerequisite because they serve

00:03:17.240 | an English speaking patient from the United States,

00:03:20.000 | from Canada, from the UK.

00:03:21.600 | Those are the three big markets.

00:03:24.480 | So if you have trouble with the language, move on.

00:03:27.520 | You'll find a clinic that caters

00:03:28.880 | to the international patient and it speaks good English

00:03:32.280 | or they have good translators.

00:03:33.400 | If you're in a foreign country like South Korea or Thailand,

00:03:37.760 | where English is a little more foreign

00:03:39.240 | than let's say in Mexico.

00:03:40.560 | - Backing up since not everyone listening is familiar

00:03:43.800 | with traveling for medical procedures or diagnostics,

00:03:47.360 | why should someone even be considering

00:03:50.160 | this over domestic options?

00:03:52.040 | - For U.S. outbound, and I'm assuming

00:03:53.880 | that's what we're mostly talking about,

00:03:56.160 | the main reason for traveling for care for U.S. is its cost.

00:04:01.160 | There's a lot of people that feel

00:04:03.080 | they have a false sense of security,

00:04:05.080 | that they're insured, they've got a skinny plan

00:04:07.920 | with zero premiums and then they get really sick

00:04:10.720 | and there's all these exclusions and deductibles

00:04:13.600 | and co-pays and gotchas, not to mention claims denials

00:04:17.840 | and prior authorization that they have to get through.

00:04:21.080 | And now it's wide open.

00:04:22.480 | The huge driver is cost.

00:04:25.480 | I have personally talked with people

00:04:28.200 | who were in for a simple colonoscopy

00:04:30.120 | and they were insured and they got charged

00:04:33.960 | by their insurance company, something like $2,300, $2,500.

00:04:38.960 | And they thought they were covered.

00:04:41.240 | They can get a colonoscopy down the road in Mexico,

00:04:44.840 | Costa Rica, almost anywhere, that's an easy one.

00:04:48.120 | And that's five, six, $600 with the latest technology,

00:04:52.440 | the latest machines, best doctors, best drugs,

00:04:56.640 | which come with colonoscopies.

00:04:58.440 | - That sounds like almost 75% savings.

00:05:02.200 | Is that kind of a rough average

00:05:04.680 | or how does that range compare?

00:05:07.160 | And are there certain things

00:05:08.320 | where the savings is better or worse?

00:05:10.280 | - The average savings that we tell patients they can expect,

00:05:13.400 | whether it's a complex dental procedure

00:05:16.360 | or an orthopedic procedure like a new knee or a new hip,

00:05:19.160 | which is very common, or IVF, is anywhere from 40 to 65%.

00:05:24.160 | So if you want to just figure roughly half,

00:05:27.680 | that's a good number.

00:05:29.400 | People who've been goaded by advertising or social media

00:05:34.920 | where they're advertising some cost that is 80, 85% savings,

00:05:38.840 | 90% savings, you really want to watch out for that.

00:05:41.920 | Cost shopping is one of the biggest mistakes

00:05:44.320 | that a medical traveler can make.

00:05:46.120 | Those are the people that get into trouble

00:05:48.920 | because the clinic's got to make money too.

00:05:51.200 | So they can't offer a knee procedure for $800.

00:05:55.640 | They got to pay their rent,

00:05:56.840 | they got to keep their equipment up,

00:05:58.260 | they got to feed their families.

00:05:59.880 | So if you aren't within that 50 to 70%,

00:06:03.080 | 40 to 60% cost range, you want to look out.

00:06:05.760 | If it's not enough of a savings

00:06:07.080 | by the time you add your travel, your accommodations,

00:06:10.280 | your dining and all that,

00:06:12.440 | unless you're tacking it on to your procedure,

00:06:15.400 | then you're probably not saving enough.

00:06:17.520 | - Where does that savings come from?

00:06:19.200 | How is it able to be so much cheaper?

00:06:21.240 | - That's interesting.

00:06:22.080 | The American Dental Association just released numbers

00:06:25.680 | on what a dental specialist makes as a salary.

00:06:28.440 | That's pretty staggering, 186, 240, $250,000 a year.

00:06:33.440 | And they deserve probably every penny they get,

00:06:36.420 | the cost of living in the United States is much higher.

00:06:38.760 | Cost of living in places like Mexico, Costa Rica,

00:06:42.400 | Thailand, even South Korea is much, much lower.

00:06:47.200 | There's not quite the emphasis on high pay.

00:06:51.920 | Doctors are perceived more as technicians

00:06:55.280 | rather than deities of some kind.

00:06:57.780 | And so the cost is lower.

00:07:00.320 | Another thing that people don't really talk about,

00:07:03.080 | not that big a deal, but it affects things,

00:07:06.240 | is that companies that produce

00:07:08.360 | a lot of that expensive equipment,

00:07:10.040 | like a cyber knife for cancer,

00:07:12.000 | or even proton therapy for other kinds of cancer,

00:07:15.760 | or a simple MRI machine or a CTI machine,

00:07:18.720 | they make deals with those countries

00:07:20.200 | that can't afford the prices of the instrumentation.

00:07:25.200 | So the hospitals and the clinics that buy those instruments

00:07:29.680 | pay a much, much lower price,

00:07:31.920 | and that gets passed down to the patient.

00:07:35.800 | Also, speaking of that,

00:07:38.600 | they utilize that instrumentation.

00:07:40.520 | I've seen it in clinic after clinic, hospital.

00:07:43.120 | I have seen MRIs just lying around

00:07:45.560 | gathering dust in US hospitals

00:07:49.040 | because one doctor in one department

00:07:51.320 | decides he wants some sexy MRI.

00:07:53.200 | Another doctor in another department says,

00:07:55.120 | "I want this MRI, I want that."

00:07:57.020 | And they're not utilized.

00:07:58.640 | And so the expense gets really high.

00:08:01.460 | You go to a hospital like, for example,

00:08:03.880 | Pomograd in Thailand.

00:08:05.920 | That thing is going 24/7.

00:08:09.520 | And in fact, they've got two prices.

00:08:11.580 | They've got a daytime price.

00:08:13.840 | It's about $450 for an MRI,

00:08:16.040 | as opposed to 25 to $3,200 here in the United States,

00:08:19.320 | if you're not covered.

00:08:21.240 | They have a nighttime price, which I really love,

00:08:24.440 | and it's $210.

00:08:27.680 | Same thing, same equipment,

00:08:29.120 | the same level of radiologists

00:08:31.680 | that is giving you the scan.

00:08:34.080 | And I went there just to check it out one night,

00:08:36.880 | and it was a very different world.

00:08:39.760 | And it was something that really touched me.

00:08:42.360 | There were a lot of farmers, peasants,

00:08:45.620 | people that weren't well off,

00:08:49.040 | and $215 was a month's pay for these people.

00:08:53.040 | But they offered it to them

00:08:56.560 | because they knew that they couldn't afford it.

00:09:00.140 | So it was kind of a little bit of a loss leader.

00:09:02.200 | The margins on it were very high.

00:09:03.720 | Most of it was for pediatrics,

00:09:05.240 | people trying to save their kids.

00:09:06.680 | It was just kind of cool to know,

00:09:08.080 | but the point being is those kinds of things add up.

00:09:11.160 | Cost of living is lower in other countries.

00:09:13.240 | Cost of instrumentation is lower.

00:09:15.400 | But I would also say that the efficiencies are much higher

00:09:18.760 | for those clinics and hospitals

00:09:20.080 | that specifically cater to the international patient

00:09:23.280 | because they got to get them in and out of there fast

00:09:27.640 | because a lot of them only have a weekend.

00:09:29.640 | They've only got four or five days to be there.

00:09:32.640 | So they have implemented strategies,

00:09:35.260 | which are really interesting.

00:09:36.400 | Maybe it's too much to go into here,

00:09:39.120 | but they have implemented strategies.

00:09:40.520 | If you want an implant in the United States,

00:09:43.240 | it's three or four appointments

00:09:44.720 | over a span of four or five months.

00:09:46.600 | That doesn't have to be that way.

00:09:49.680 | Your butt's in the dental chair a lot

00:09:52.380 | over that period of time,

00:09:53.480 | and some people might not be able to handle that.

00:09:56.080 | But you're in and out in three days.

00:09:58.560 | If you want like a dental implant or a root canal

00:10:01.280 | or a set of veneers.

00:10:02.760 | Same thing with a hip surgery.

00:10:04.640 | They've really accelerated the process

00:10:06.520 | without compromising the clinical excellence.

00:10:08.800 | - Yeah, I have a friend that just came back

00:10:10.120 | from Bumgarad and said,

00:10:11.960 | "The facility was just out of this world."

00:10:13.880 | He didn't know what his expectations were,

00:10:16.280 | but when he left, it felt better from a facility standpoint

00:10:20.760 | than many hospitals he'd been to in the US.

00:10:23.720 | One thing we didn't talk about, so maybe you can tell me,

00:10:25.760 | is how much should people be concerned

00:10:27.560 | with the quality of the doctors?

00:10:29.240 | Where are a lot of these doctors getting trained?

00:10:31.680 | Is that a worry for anyone?

00:10:34.640 | - Well, it can be a worry,

00:10:36.360 | and it should be certainly a concern.

00:10:38.680 | I mean, your doctor is the one

00:10:40.320 | that's got his or her hands on you.

00:10:42.200 | You wanna look at the quality of the clinic,

00:10:44.080 | and is it accredited?

00:10:46.360 | Does it have a lot of chops?

00:10:47.480 | Does it get great reviews?

00:10:48.400 | But the bottom line is you really wanna look at that doctor.

00:10:51.540 | So finding the right doctors is job number one

00:10:55.360 | once you've chosen your destination.

00:10:57.040 | - And are most of the doctors

00:10:58.120 | in these kind of premier facilities

00:11:00.480 | trained locally, trained abroad?

00:11:03.120 | - It's a mix.

00:11:04.320 | You get an interesting mix of doctors.

00:11:05.920 | I've talked to a fair number of them,

00:11:08.040 | and a lot of them are kind of refugees

00:11:11.000 | from the US healthcare system

00:11:13.160 | because they're tired of being harassed

00:11:16.040 | by the insurance companies to keep things moving along,

00:11:19.060 | to meet quotas because the reimbursement rates

00:11:21.200 | are so low, et cetera.

00:11:22.960 | So at Beaumont Grad, for example,

00:11:25.120 | it's the top international medical travel hospital

00:11:28.140 | in the world.

00:11:29.920 | Some 45% of their patients are from other countries,

00:11:33.840 | but they have 300 American board-certified

00:11:37.460 | doctors and surgeons in that hospital.

00:11:39.320 | That's an anomaly.

00:11:40.800 | So if you're checking on credentials,

00:11:44.000 | again, you're doing your own research.

00:11:45.640 | You're referring yourself.

00:11:46.880 | You have to trust that the University of Birmingham

00:11:51.120 | in the UK puts out good doctors.

00:11:54.080 | On the other hand, in the United States,

00:11:56.120 | one out of every seven surgeons is of Indian descent.

00:12:00.680 | They were trained in India,

00:12:02.600 | and they're now in the United States.

00:12:05.080 | And people don't really question that

00:12:06.400 | because they have a higher level of comfort

00:12:09.280 | when they're in the United States.

00:12:10.880 | If they knew this exact same doctor

00:12:13.680 | was gonna treat them in Bangalore or Chennai,

00:12:18.440 | they might run 100 miles from that.

00:12:21.440 | So a lot of it's a matter of perception.

00:12:24.220 | I'm not taking away from the research that's necessary,

00:12:27.640 | but to answer your question, yeah, it's a mix.

00:12:29.760 | There's a lot of American-trained doctors,

00:12:31.380 | especially in Mexico and Costa Rica,

00:12:33.740 | but there's a lot of doctors that have been trained

00:12:35.400 | in perfectly good, high-quality universities.

00:12:38.920 | India, Thailand, Turkey, believe it or not,

00:12:41.240 | has great training.

00:12:42.200 | They're one of the biggest manufacturers

00:12:43.640 | of U.S. pharmaceuticals in the world.

00:12:46.440 | Chances are, if you do a lot of pharmaceuticals,

00:12:48.960 | or any at all, it's coming from either Canada,

00:12:52.880 | Turkey, or two or three other sources.

00:12:56.080 | So people don't appreciate the fact

00:12:59.000 | that so much of the healthcare that we receive

00:13:02.200 | originates from foreign lands.

00:13:05.040 | It just happens to end up in the United States.

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00:15:40.720 | Okay, so obviously, cost savings, great.

00:15:43.200 | Quality can be great.

00:15:44.440 | What types of procedures are things

00:15:47.560 | that people should be considering,

00:15:49.280 | or maybe not considering, medical travel for?

00:15:52.420 | - Oh, that's a good question.

00:15:54.000 | And that took almost a year and a half worth of research

00:15:56.720 | when we first decided to do the book,

00:15:58.640 | because we just thought, well,

00:16:00.160 | just find out the hospitals and clinics

00:16:03.520 | that are offering these procedures,

00:16:04.880 | and find the great hospitals and clinics.

00:16:07.560 | But it's not that easy.

00:16:09.120 | So just from a procedural standpoint,

00:16:11.320 | it needs to be a procedure that doesn't take

00:16:14.800 | a massive amount of treatment over a long period of time.

00:16:19.640 | So the bad news first, cancer treatments are not great,

00:16:23.880 | because long, drawn out, multiple sessions.

00:16:27.600 | The best types of treatments are treatments

00:16:29.880 | that have quick times, short surgery times,

00:16:34.200 | and short recovery times.

00:16:36.920 | And oddly, those are procedures

00:16:40.200 | that you really wouldn't think about.

00:16:42.040 | Like for example, an open heart procedure,

00:16:44.180 | you would think would be not a candidate.

00:16:46.340 | But from a technical, it's a pretty simple procedure,

00:16:50.340 | and they want you up and walking around

00:16:51.940 | within two or three days.

00:16:53.640 | And 10 days, you're gonna be able

00:16:55.400 | to get on a plane and go home.

00:16:57.420 | That's a good procedure.

00:16:58.540 | Not a common procedure, but it's a good one.

00:17:00.920 | So bad procedures are ones that take a long time

00:17:04.540 | with multiple visits to the doctor,

00:17:07.400 | long, long recovery periods.

00:17:09.520 | That's one reason I don't like bariatrics

00:17:11.780 | and weight loss programs,

00:17:12.840 | even though they're heavily advertised.

00:17:15.000 | And you see a lot of that appearing in the media.

00:17:18.380 | But bariatrics has got all kinds of risks

00:17:20.800 | associated with it, and at least one or two visits

00:17:24.400 | to the doctor afterwards to check on complications.

00:17:28.980 | And so the better procedures, the good news is,

00:17:32.480 | about 15 or 20 procedures that are most recommended

00:17:38.880 | by doctors and most used by patients.

00:17:41.440 | So almost all dental procedures with the caveat

00:17:45.360 | that implants, as you may know,

00:17:47.520 | sometimes take a second visit.

00:17:50.280 | That's just the nature of an implant.

00:17:51.680 | They put the abutment in,

00:17:53.320 | your bone has to go around the abutment,

00:17:55.000 | then you have to come back.

00:17:55.840 | That's true in the United States

00:17:57.640 | and anywhere else in the globe.

00:17:59.940 | But it's got short recovery periods,

00:18:01.640 | and you go home after your first treatment,

00:18:03.120 | you come back three months later,

00:18:04.680 | you go home after your second treatment.

00:18:07.880 | Orthopedics is good.

00:18:10.200 | The surgeries have improved to the point

00:18:12.640 | where they want you up and walking around

00:18:14.880 | almost the next day.

00:18:16.280 | - Wow.

00:18:17.120 | - IVF is good if you're willing to travel

00:18:20.240 | a couple of times, because not every IVF is successful.

00:18:25.160 | So you get a failure rate.

00:18:26.540 | So you might have to go back a couple of times.

00:18:29.160 | So somebody from New York isn't gonna wanna go to Bangkok

00:18:33.200 | for IVF, it's expensive to travel.

00:18:36.640 | - One follow-up on that.

00:18:38.040 | My wife happened to go through IVF,

00:18:40.080 | and part of the process was egg retrieval, implantation,

00:18:43.480 | but also there were a lot of drugs,

00:18:45.680 | she had to administer shots.

00:18:46.920 | With some of these treatments that might require

00:18:50.040 | medication, prescriptions,

00:18:51.960 | do they provide all of those abroad?

00:18:53.960 | Do they work with your doctor at home

00:18:55.600 | to kind of help get all the medications you need?

00:18:59.060 | I know some of those medications

00:19:00.620 | often need to be refrigerated,

00:19:02.120 | so maybe you couldn't take home a full supply

00:19:04.760 | from your trip to Thailand.

00:19:05.800 | How does a lot of that work?

00:19:07.120 | - It's a good question.

00:19:07.960 | The prescriptions that I've had written for me,

00:19:10.360 | as long as they're in English,

00:19:12.700 | and they're on a doctor's stationery,

00:19:15.400 | can be filled in the United States.

00:19:17.040 | If it's not in that language,

00:19:20.040 | you wanna make sure that you've gone

00:19:21.280 | to a really great hospital that has their own pharmacy.

00:19:24.840 | Most of these big hospitals have their own pharmacies,

00:19:27.680 | and they don't mess around with the quality of prescriptions.

00:19:30.120 | So they're a lot like the US,

00:19:31.880 | they've got a lot of screening for counterfeit prescriptions

00:19:34.880 | for prescriptions made by poor manufacturers.

00:19:38.200 | And what you wanna do is also focus on the brand name,

00:19:42.000 | don't get the generic.

00:19:43.280 | - Okay.

00:19:44.120 | - Unless it's just prohibitively expensive.

00:19:45.840 | - So it sounds like for the prescriptions you might need

00:19:47.580 | that you can get at the time of the procedure,

00:19:49.760 | you can get them there.

00:19:50.840 | And if you need them later,

00:19:52.600 | they can actually write prescriptions.

00:19:54.160 | Do doctors ever do follow-ups virtually?

00:19:56.760 | - Not so much.

00:19:57.760 | A lot of people who are trying to save money

00:20:00.320 | on medical travel are ashamed to talk to their specialist,

00:20:03.380 | or they don't wanna let them know that they're traveling.

00:20:05.800 | It's really important to give your doctor a heads up.

00:20:08.480 | And there's no shame in saying, "Doc, I can't afford you.

00:20:11.540 | "And I found a great clinic, it's JCI accredited.

00:20:14.840 | "This is where I wanna go."

00:20:17.240 | It may or may not be that your doctor and your destination

00:20:20.040 | and your foreign country would follow up.

00:20:22.320 | But the fact that you've given your doc notice,

00:20:25.140 | and you've brought back all of your paperwork,

00:20:27.000 | that's another big mistake people make

00:20:28.960 | is they toss their paperwork,

00:20:30.160 | they leave it in the hotel room.

00:20:32.160 | You gotta bring back your screening, your blood tests,

00:20:35.440 | your consultation notes, all of that.

00:20:38.240 | And then a doc is gonna be able to pick up

00:20:41.200 | where your other doc left off if a complication develops,

00:20:45.160 | or if they need to go in and do something else

00:20:47.200 | or have some follow-up.

00:20:49.000 | - Yeah, the friend of mine who went to Bumrungrad

00:20:50.520 | in Thailand told me that the hospital has an app

00:20:53.360 | that has all of your medical records there.

00:20:55.940 | And he was just amazed when he came home.

00:20:58.140 | He took his father as well.

00:20:59.420 | And the access to the records of everything that happened,

00:21:02.500 | he thought were better than the access

00:21:04.220 | that he gets going to see a doctor in the US.

00:21:07.220 | - Oh, it's so frustrating.

00:21:09.460 | I'm at an age where I'm seeing a doctor

00:21:11.140 | a little more these days.

00:21:12.740 | And even at Duke Medical, which is one of the top,

00:21:16.460 | it was voted in Time Magazine many years ago

00:21:18.640 | the top medical facility in the United States.

00:21:21.980 | And they still haven't got

00:21:24.380 | your universal healthcare record together.

00:21:26.740 | They still, every time I come in,

00:21:28.860 | they have to ask me a series of questions,

00:21:30.460 | including, do you have black lung disease?

00:21:32.700 | No, I have not been in a coal mine

00:21:34.740 | in the last two weeks since I saw it,

00:21:36.380 | 'cause the technology for universal healthcare records

00:21:39.620 | is 20 years old.

00:21:40.980 | And yet, it just isn't centralized.

00:21:44.420 | I know they know everything about you,

00:21:46.060 | they just aren't making it available to the consumer

00:21:48.340 | and in many cases to the institution.

00:21:51.100 | The reasons for that are a mystery to me,

00:21:53.600 | but it is true that they have better healthcare records

00:21:56.360 | and a better bead on your health.

00:21:58.340 | And the notes, et cetera, et cetera,

00:21:59.880 | in other institutions that I've been to overseas.

00:22:03.660 | - Are there any treatments that someone listening

00:22:05.500 | might think, oh, wow, that seems like an obvious candidate

00:22:08.220 | for medical travel, but for some reason

00:22:10.180 | that maybe isn't obvious is actually

00:22:12.460 | really not a good candidate?

00:22:14.140 | - You mentioned before, what's the main reason

00:22:16.180 | people travel for care?

00:22:17.900 | And I said, cost, cost, and cost.

00:22:19.700 | And that is about 95% of it.

00:22:21.940 | But a lot of people travel

00:22:23.640 | because they wanna get access to care

00:22:25.620 | that isn't allowed in the United States.

00:22:27.660 | Like for example, stem cell treatments, right?

00:22:30.680 | So that's one that is dicey

00:22:34.300 | and that people need to really watch out for

00:22:37.100 | because stem cell is good for some joint stuff,

00:22:41.660 | but it's not a cure-all

00:22:43.780 | and it doesn't do a whole lot for cancer.

00:22:46.660 | So you wanna watch out

00:22:48.220 | for some of those experimental treatments

00:22:50.820 | that look like they might be a good deal

00:22:52.820 | or it might be a good thing to go for,

00:22:55.100 | or it's heavily advertised.

00:22:56.740 | So stem cell treatments are heavily advertised.

00:23:00.060 | If you search for stem cell Mexico,

00:23:03.380 | stem cell Thailand, stem cell Singapore,

00:23:06.340 | which is a lot of legitimate stem cell work,

00:23:09.700 | mostly for orthopedics, you're gonna get a lot of ads.

00:23:12.060 | You're gonna get a lot of sponsored stuff.

00:23:13.900 | And those are people that are trying to lure Americans

00:23:18.220 | and UK people and other folks to an experimental treatment

00:23:21.360 | that may or may not be a good idea.

00:23:23.340 | It's another one that's got a lot of prep work

00:23:25.660 | has to be done.

00:23:26.500 | There's a lot of post-analysis that has to be done

00:23:29.060 | that often can't be done remotely.

00:23:31.100 | So yeah, there are treatments like that,

00:23:34.740 | but the top treatments

00:23:37.340 | and the treatments that are the most sought after

00:23:40.260 | are the ones that are elective

00:23:41.460 | that aren't covered by insurance anyway.

00:23:43.660 | So dentistry, cosmetic surgery, a lot of orthopedics,

00:23:47.660 | especially if you're pre-Medicare

00:23:49.380 | and your insurance company

00:23:50.820 | is giving you trouble covering it, right?

00:23:53.260 | IVF for younger folks, that's really expensive.

00:23:56.560 | It's 40, 50 and $60,000 and up.

00:23:59.040 | You can get that in a JCI accredited clinic in Barbados.

00:24:03.940 | And they've got actually statistics that show

00:24:06.560 | that the less stress you're under

00:24:08.660 | when you undergo an IVF treatment,

00:24:11.140 | the higher your success rates.

00:24:12.460 | And why not chill out on a beach?

00:24:14.340 | It's not a surgery and contemplate having a baby.

00:24:18.680 | And this is one of the few JCI accredited

00:24:21.580 | fertility clinics in the world.

00:24:23.500 | You know, it's a plane flight away.

00:24:24.700 | - Now you mentioned JCI a bunch of times.

00:24:26.900 | What is JCI accreditation mean

00:24:29.420 | and how important is that when doing research?

00:24:32.080 | - Well, short answer to your first question is

00:24:33.700 | JCI stands for Joint Commission International.

00:24:36.420 | The Joint Commission is an accreditation agency

00:24:38.620 | that puts their seal of approval

00:24:40.800 | on hospitals throughout the United States.

00:24:42.900 | And it's so important that if you're a hospital

00:24:45.300 | that's trying to accept Medicare or Medicaid,

00:24:48.000 | you have to be JC accredited.

00:24:49.540 | About 25 years ago, hospitals began to export

00:24:52.820 | some of their services like Cleveland Clinic

00:24:54.940 | had plans to build in Abu Dhabi.

00:24:56.900 | John Hopkins went to Singapore

00:24:58.580 | and established a cancer institute.

00:25:00.980 | And JC, Joint Commission saw the writing on the wall

00:25:03.580 | and said, "Oh, we better go international."

00:25:05.900 | And what they did was they applied all the principles

00:25:08.340 | and all of the criteria.

00:25:09.500 | They have 3000 criteria that a hospital has to meet

00:25:12.580 | in order to be JCI accredited.

00:25:14.340 | And full survey, they do a full scan

00:25:17.260 | of the hospital physically.

00:25:19.180 | And then they accredit the hospital

00:25:21.220 | and survey it once every three years.

00:25:24.660 | So it's kind of a gold standard.

00:25:27.180 | Just to let you know, when we started researching the book,

00:25:30.100 | there were 27 JCI hospitals around the world.

00:25:33.280 | Today, there are over a thousand.

00:25:35.940 | So that gives you an idea of how much this industry

00:25:39.860 | has grown and how the quality of healthcare

00:25:43.340 | has improved in countries that used to be considered

00:25:45.740 | third world countries or industrializing nations.

00:25:49.220 | And their healthcare has improved dramatically.

00:25:52.220 | And they've got state-of-the-art equipment,

00:25:54.740 | state-of-the-art doctors,

00:25:56.100 | state-of-the-art strategies and procedures

00:25:58.620 | that we don't often have in the United States.

00:26:01.120 | That said, just because a hospital or clinic

00:26:03.880 | is not JCI accredited,

00:26:05.300 | doesn't mean it's not a great hospital.

00:26:08.000 | So you have to look for other sources of accreditation,

00:26:11.180 | like are they members of the Ministry of Health,

00:26:14.140 | is it as a Ministry of Health of Malaysia

00:26:16.180 | or Thailand or Mexico?

00:26:18.580 | Are they certified?

00:26:20.180 | Are they registered as a Ministry of Health?

00:26:22.280 | What's their ratings?

00:26:23.260 | That's why medical travel just isn't for everybody.

00:26:25.600 | It's for people that can do their own research

00:26:27.860 | and have the confidence that they can land on a hospital

00:26:31.260 | or a clinic that they believe is a quality clinic.

00:26:34.760 | And a lot of people don't really do research.

00:26:37.780 | They can't even research their own healthcare

00:26:39.300 | here in the United States

00:26:40.880 | and figure out whether a doctor is a good doctor.

00:26:43.020 | Many of them just blindly take the referral

00:26:45.940 | from their general practitioner,

00:26:48.020 | walk into the specialist's office,

00:26:49.520 | don't ask anything about the background

00:26:51.220 | and lay down on the operating table.

00:26:53.940 | I don't think that's a good idea in the US

00:26:55.660 | and I certainly don't think it's a good idea abroad.

00:26:57.820 | - Funny enough, this reminds me of something

00:26:59.900 | related to airline points and miles.

00:27:02.460 | And that is that to get the most value

00:27:05.340 | from your credit card or airline points,

00:27:08.080 | you really need to find the right flights

00:27:11.260 | on the right dates and you can make those points

00:27:13.420 | worth sometimes five, 10 times as much as they would be

00:27:16.420 | if you just log in and book the flight you were looking for.

00:27:19.680 | And I know a lot of people

00:27:20.700 | that just don't have the time to do that,

00:27:22.660 | but the savings is so great that there's a whole industry

00:27:26.000 | of what's called award booking services

00:27:28.460 | where you might pay them $200 and tell them,

00:27:31.620 | "Here's how many points I have with this bank

00:27:33.580 | "and this credit card."

00:27:34.580 | And they'll go out and find you the flight to Japan

00:27:37.120 | that might save you $5,000.

00:27:39.580 | And so does something like that exist in this world

00:27:43.620 | where if I know that I have a treatment

00:27:45.820 | or a surgery that's $20,000,

00:27:47.900 | I know I can save a significant sum of money.

00:27:51.540 | Are there people I could hire with some of that savings

00:27:55.160 | to help me through this process and say,

00:27:56.860 | "Hey, I need a hip replacement.

00:27:58.940 | "It's not gonna be covered.

00:28:00.660 | "Can you help me find a good facility overseas

00:28:04.020 | "to make this easier?"

00:28:05.180 | - Yes, there are medical travel agencies

00:28:07.580 | that help patients in need identify the best destination,

00:28:12.580 | the best hospitals, the best clinics.

00:28:15.060 | It's online, it's transactional,

00:28:17.460 | but yes, it's kind of a mom and pop business

00:28:20.260 | that really is often started by well-meaning patients

00:28:24.060 | that has a relationship with a hospital.

00:28:26.100 | There are very few agents that have a full-blown network

00:28:31.100 | that you can choose from

00:28:33.060 | and that you can contact patient services representative

00:28:36.780 | and get a little bit of help.

00:28:38.660 | We've worked closely in the past

00:28:40.060 | with a group called Medical Departures.

00:28:41.700 | They started out as a dental departures.

00:28:43.980 | Actually, it was a former Expedia executive

00:28:46.060 | that decided he was going to establish

00:28:48.900 | TripAdvisor for medical tourism.

00:28:50.660 | - Okay.

00:28:52.020 | - Hired his family off to Mexico, found 200 clinics,

00:28:55.420 | started to do really well.

00:28:56.940 | They were really good quality clinics,

00:28:58.420 | and then the cartels kind of got in the way,

00:29:00.940 | and he fled to Thailand

00:29:02.940 | thinking everything was gonna crash.

00:29:04.500 | His business did not crash.

00:29:05.700 | Mexico still is the largest go-to destination

00:29:10.460 | for Americans seeking health care.

00:29:12.500 | He went off to Thailand to serve the Australia,

00:29:15.460 | Oceania, Southeast Asia market and did really well there,

00:29:20.460 | and they've got a network of around 3,000 clinics

00:29:23.700 | and some 27 countries,

00:29:26.220 | and they're probably the largest

00:29:30.620 | medical travel agency serving Americans.

00:29:33.140 | There's a lot of agencies like Medigo.

00:29:36.020 | There's another one in Ireland.

00:29:37.340 | It's called what clinic?

00:29:38.500 | And they also serve patients who are in need,

00:29:42.900 | don't trust themselves enough to do their own research.

00:29:45.140 | These agencies do the research, vet the clinics,

00:29:47.580 | vet the doctors, keep the profiles up to date,

00:29:50.420 | make sure the certifications are up to date,

00:29:52.340 | and recommend clinics and doctors.

00:29:54.580 | - Okay.

00:29:55.420 | - And they often work by taking a commission

00:29:57.820 | out of the treatment, so usually the services are free.

00:30:01.220 | - And so if someone listening thinks,

00:30:03.220 | "Gosh, I have the procedure,"

00:30:05.060 | whether it's any of the ones you listed

00:30:07.020 | that's a good candidate for this,

00:30:09.060 | what's kind of a framework for how they might think

00:30:11.140 | about the steps between do I wanna do this

00:30:15.060 | to I've found the facility and I'm going?

00:30:17.620 | What's the first thing someone should do?

00:30:19.460 | - It really depends on the patient.

00:30:21.220 | It's individual, but for me,

00:30:24.020 | the first thing you wanna do is figure out

00:30:27.060 | which destination is best for your treatment.

00:30:30.100 | Some destinations are better

00:30:31.940 | for some treatments than others.

00:30:33.180 | Oddly enough, India is great

00:30:34.860 | for hips and knees orthopedics.

00:30:36.620 | But in general, you wanna choose your destination first.

00:30:39.700 | And some people have a preference.

00:30:40.940 | They might have a family member in Istanbul.

00:30:44.020 | They might have a friend.

00:30:45.660 | They might wanna travel to a particular destination

00:30:49.460 | for a procedure that doesn't demand

00:30:52.060 | more than eight or nine days of recovery,

00:30:53.820 | and they'd wanna recover in that particular country.

00:30:56.420 | So choose the destination first.

00:30:58.180 | The destinations that we outlined

00:30:59.540 | in "Patients Beyond Borders,"

00:31:00.660 | there's some 15 or 20 of them.

00:31:03.100 | Took us a year and a half to eliminate

00:31:05.100 | a lot of the destinations that might have good healthcare,

00:31:07.460 | but bad travel ability.

00:31:09.460 | Can't get there in less than two hops.

00:31:12.140 | So it's complex, but if you do your research,

00:31:16.900 | you're naturally gonna find those destinations

00:31:18.820 | from those service companies

00:31:20.100 | or from a book like "Patients Beyond Borders,"

00:31:22.380 | and that'll be a screen right there.

00:31:24.460 | We're not gonna recommend Cyprus.

00:31:26.260 | It's too hard to get to.

00:31:28.020 | They've got great healthcare, too hard to get to.

00:31:30.540 | We're not gonna recommend the Philippines.

00:31:32.140 | The quality of care isn't great,

00:31:34.300 | even though they've got a lot of care.

00:31:36.800 | That said, if you're looking for a hair transplant,

00:31:41.780 | you wanna look at Turkey,

00:31:43.820 | because they're the top dog for hair transplants

00:31:46.300 | for one reason or another.

00:31:47.540 | If you're looking for dental work,

00:31:51.180 | there's plenty of great dental work

00:31:52.620 | along the border in Mexico or in Cancun or in Puerto Vallarta.

00:31:58.060 | Or in Mexico City.

00:31:59.580 | And at least 100 clinics that are just top quality

00:32:03.340 | can match any clinic in the United States.

00:32:05.420 | - Mexico is to the US and how cheap it is to travel there,

00:32:09.100 | even some parts of Central America.

00:32:11.360 | Are there other procedures like dental

00:32:13.620 | that are worth looking closer to home early on

00:32:16.740 | that aren't as far away as Thailand and Turkey?

00:32:19.100 | - Well, money's always gonna be an issue.

00:32:22.740 | So the further away a destination is,

00:32:25.860 | the more it's gonna cost in travel.

00:32:27.980 | Now that might be offset by Thailand,

00:32:29.760 | which once you get there is incredibly inexpensive.

00:32:32.860 | But there are a lot of other issues.

00:32:34.260 | So if you're morbidly obese

00:32:37.100 | and you're going in for a hip procedure,

00:32:39.320 | it's a little tougher to get on a plane and fly out there.

00:32:42.220 | So we think of medical travel in concentric circles

00:32:47.260 | of four-hour time slots around the globe.

00:32:51.260 | And so generally, as a rule of thumb,

00:32:54.580 | if you have to travel more than four hours for your care,

00:32:58.740 | you wanna make sure that you're doing it

00:33:00.220 | for the right reasons.

00:33:01.740 | So for the United States, it's Mexico,

00:33:04.940 | Costa Rica, and Colombia are the best destinations.

00:33:09.280 | So it may not be sexy to talk about,

00:33:11.540 | but some 80% of outbound US travel

00:33:14.980 | is in fact for complex dental care.

00:33:17.020 | Wherever you go, that's the number.

00:33:19.580 | And some 70 or 80% of that is to Mexico.

00:33:23.940 | So Mexico, and I know the media loves to talk about,

00:33:27.420 | you know, heroic heart procedures and cancer treatments

00:33:31.080 | that saves the life of a medical travel,

00:33:33.440 | but that's not really the reality.

00:33:34.820 | It's usually pretty mundane,

00:33:36.540 | but it saves people their lives in some cases.

00:33:39.700 | There was a guy in Iowa

00:33:40.860 | that was literally on the verge of selling his farm.

00:33:43.940 | And he ended up getting a hip procedure

00:33:45.740 | in India, in Chennai, and it was a great success.

00:33:48.580 | And he saved a boatload of money.

00:33:51.380 | As far as proximity goes, yeah,

00:33:54.060 | Mexico for dental, for orthopedics,

00:33:59.060 | for some IVF, IVF is coming up in Mexico,

00:34:04.060 | for wellness checks.

00:34:05.380 | They're beginning to offer a lot of wellness checks.

00:34:07.980 | Simple scans, an MRI, a CT.

00:34:11.140 | When I blew my shoulder out and I was pre-Medicare,

00:34:16.580 | I couldn't get the price of an MRI

00:34:18.300 | and they didn't wanna authorize it.

00:34:20.060 | I can't remember exactly what the circumstances,

00:34:22.220 | but Duke wasn't going to write the code

00:34:24.740 | to authorize that MRI.

00:34:26.140 | And so I nosed around,

00:34:29.340 | finally went into the accounting department

00:34:31.300 | and some dusty accountant said,

00:34:32.940 | ah, he's flipping through receipts.

00:34:35.320 | 2,500, 31, I don't know, it's about $3,200

00:34:38.860 | for an MRI, out of pocket.

00:34:40.940 | I ended up at Bumengrad and it was $416.

00:34:45.020 | So it was worth the trip to Thailand.

00:34:47.980 | Now I'm in the unusual position of doing a lot of travel.

00:34:52.020 | A lot of people don't have that luxury,

00:34:53.500 | so it's gonna be more important for them

00:34:54.740 | to wanna look at places closer to home

00:34:57.900 | and see if that procedure is offered in a Mexico

00:35:01.060 | or a Costa Rica or a Colombia.

00:35:03.060 | Colombia has great heart work.

00:35:05.180 | Costa Rica has two or three JCI accredited hospitals

00:35:08.060 | in San Jose and Escazú.

00:35:09.980 | Escazú, there's a hospital, CIMA, C-I-M-A,

00:35:13.940 | that is JCI accredited.

00:35:16.460 | They're in a town, a suburb of San Jose,

00:35:18.380 | which is kind of seedy,

00:35:19.300 | but the suburb looks like any American town.

00:35:21.580 | It's got a Ritz Carlton right next to it

00:35:23.700 | and right next to that is a Hampton Inn.

00:35:25.740 | So you can go budget, you can go luxury

00:35:27.900 | and end up at a hospital that's a multi-specialty hospital

00:35:31.260 | and get almost any kind of normal procedure

00:35:33.380 | that you're looking for.

00:35:34.620 | - And for your MRI example, is this,

00:35:37.300 | you mentioned you should tell your doctors at home

00:35:40.200 | what's happening, but is this something

00:35:41.580 | you could plan with them in advance?

00:35:43.340 | One of the procedures that I looked at

00:35:45.220 | when I got a positive calcium score

00:35:47.660 | was to get a CT angiogram

00:35:49.780 | and somehow insurance covered it,

00:35:51.900 | but even though I don't think they were supposed to,

00:35:53.680 | which is not a typical situation,

00:35:56.080 | but it was gonna be thousands of dollars.

00:35:58.320 | Could I work with my doctor and say,

00:35:59.700 | hey, could I go get this somewhere else

00:36:01.860 | where it's $400 and have the results sent over to you

00:36:04.780 | and kind of do it in partnership?

00:36:06.660 | Have you seen doctors be receptive

00:36:09.700 | to doing the imaging work in other countries

00:36:12.960 | where the MRIs or the CT scans are a lot less expensive?

00:36:16.540 | - That's a good question.

00:36:18.140 | I don't know that doctors would have predispositions

00:36:21.140 | about going overseas.

00:36:22.740 | They haven't been overseas themselves a lot of times.

00:36:25.820 | They're not big travelers sometimes,

00:36:27.680 | and so they cast a jaundiced eye

00:36:32.100 | on medical tourism in general.

00:36:33.780 | Also, they feel somewhat competitive.

00:36:35.940 | It's one of the reasons why cosmetic surgery costs

00:36:38.000 | in the United States have been held down

00:36:39.420 | because so many people in the 20th century

00:36:42.540 | traveled for cosmetic surgery work

00:36:44.740 | to the point where it was actually cutting in

00:36:47.240 | to the care that was being offered in the United States.

00:36:50.460 | What I would say, though, for something like a scan,

00:36:52.900 | like an MRI or a CT, just go ahead and get it.

00:36:56.380 | They're all the same.

00:36:57.380 | They have exactly the same results.

00:36:59.260 | They're recorded by the same machines.

00:37:01.940 | Just make them make sure they're in English

00:37:04.020 | and then bring the results home,

00:37:05.340 | which is exactly what I did

00:37:07.060 | when I went to Bumgarad with my MRI.

00:37:09.820 | - And you had no issue with your doctor saying,

00:37:11.300 | "Here are my results," and they were like,

00:37:13.420 | "Oh, they look just like the results I would get here."

00:37:16.180 | - Yeah, exactly, yeah,

00:37:18.020 | and they're done by qualified radiologists, et cetera,

00:37:20.420 | so the doctor doesn't have much to argue with there,

00:37:23.700 | and that's why you wanna form your doctor first

00:37:25.780 | before you leave because if you do have complications

00:37:28.180 | when you come back, your doc at least has been informed,

00:37:31.020 | and they can dig in using your paperwork

00:37:33.620 | or your X-rays, your blood work,

00:37:35.780 | all the aftercare stuff, all the notes,

00:37:38.340 | and then pick up where the doctor left off.

00:37:39.940 | After all, healthcare is becoming

00:37:41.300 | more and more plug and play.

00:37:42.540 | I know a lot of people that in later stage cancer,

00:37:45.580 | they wanna take their wives to Israel

00:37:47.380 | 'cause they've never been to Israel

00:37:48.820 | or never been to Turkey,

00:37:50.380 | and they can get their chemo there if they schedule it,

00:37:53.180 | and they got the right prescription for chemo.

00:37:55.340 | They can just drop into the hospital, arrange it,

00:37:57.940 | get their chemo or their radiation done in a foreign country.

00:38:01.420 | The reason we don't like cancer is because

00:38:03.940 | if you've adopted that country for all of your cancer care,

00:38:07.340 | you're gonna end up going back all the time

00:38:09.620 | for what, six, eight, 10 treatments,

00:38:11.420 | whatever the chemo prescription is,

00:38:13.420 | whatever the regimen is.

00:38:14.660 | But healthcare has become more plug and play.

00:38:18.860 | So for scans, if you have an executive checkup,

00:38:21.340 | like Malaysia is really great

00:38:23.060 | with executive medical checkups.

00:38:26.140 | South Korea is really good.

00:38:29.540 | So if you brought that back in English,

00:38:32.620 | that should satisfy any specialist or any GP.

00:38:36.100 | - Yeah, the procedure that the friend of mine

00:38:38.980 | who went to Bumrungrad got

00:38:40.260 | was actually an executive checkup for himself and his father.

00:38:43.420 | And this actually became the subject

00:38:45.220 | of a dinner conversation last night

00:38:47.540 | because my in-laws are here,

00:38:49.220 | and they just never even heard of this idea

00:38:51.420 | of going to get an executive physical.

00:38:53.460 | And we talked a lot about

00:38:55.220 | concierge medical practices in the U.S.

00:38:57.420 | where you might spend 10, 15, $20,000 a year

00:39:01.420 | and have a doctor who's going to do all the diagnostics.

00:39:04.340 | They're gonna do all the blood work,

00:39:05.460 | all the ultrasound, the MRI, all the scans,

00:39:08.540 | and sit down for hours with you

00:39:10.580 | to talk about all the results

00:39:12.020 | to make sure that there's not anything important

00:39:13.740 | to follow up on.

00:39:14.620 | For some people, they can afford that.

00:39:16.180 | For some people, there are enough new companies,

00:39:18.980 | and I'm actually gonna probably do an episode on them,

00:39:21.100 | where you could just go do the blood work, right?

00:39:23.340 | You could spend $300 to $700

00:39:27.020 | and get a bunch of biomarkers tested,

00:39:28.860 | or you can schedule a DEXA scan or a VO2 max.

00:39:31.820 | But I was looking at this list,

00:39:33.460 | and for hundreds of dollars, less than $1,000,

00:39:37.540 | you can get the full suite of executive physical things,

00:39:41.860 | stress tests, EKGs, ultrasounds, CT scans,

00:39:45.380 | and all the blood tests,

00:39:47.100 | you know, urine tests, stool tests,

00:39:49.460 | all of it in a day

00:39:52.340 | with a couple hours with doctors

00:39:54.220 | to be able to talk about the results for under $1,000.

00:39:57.580 | And my father-in-law was like,

00:39:58.980 | "When are we going to Thailand?"

00:40:00.300 | This is amazing.

00:40:01.380 | And the friend of mine who went

00:40:03.300 | is now gonna just make it part of his annual thing.

00:40:05.780 | Every year, he's gonna fly to Thailand

00:40:07.820 | to go to this hospital.

00:40:08.660 | They've got all his records,

00:40:10.140 | and he can get everything checked up and follow up.

00:40:12.540 | And yes, you can do that in the U.S.,

00:40:14.340 | either by piecing it together yourself

00:40:16.660 | or spending probably tens of thousands of dollars.

00:40:19.900 | But viewing this not just from the lens of I need treatment,

00:40:23.820 | but I wanna be preventative with my healthcare.

00:40:26.260 | I wanna diagnose, you know,

00:40:27.940 | anything that I need to be worried about.

00:40:29.460 | I wanna understand any of my deficiencies.

00:40:31.500 | Even I, you know, until researching this episode

00:40:34.260 | and talking with a friend of mine, didn't realize

00:40:36.820 | that this is not just an option for I need to replace a hip,

00:40:40.100 | I need to do IVF, I need to do this thing,

00:40:41.980 | but I just wanna stay ahead of my health.

00:40:44.460 | And it costs a fraction of what it would cost

00:40:48.260 | to do those things here.

00:40:49.860 | And so, yes, it's great that there are a bunch

00:40:52.140 | of new companies launching a lot of these tests

00:40:54.620 | to make it cheaper in the U.S.,

00:40:56.900 | but it's not even close.

00:40:58.220 | A full blood panel with a lot of companies in the U.S.

00:41:01.140 | is not that different from an entire day onsite

00:41:04.780 | with a doctor who focuses on interpreting these results

00:41:07.860 | and thinking about longevity

00:41:09.380 | and a bunch of other much more expensive tests.

00:41:11.860 | So that's one, I'm glad you re-brought up

00:41:14.460 | executive physicals, 'cause I'm not sure

00:41:16.620 | if everyone knows what the term executive physical is,

00:41:19.340 | but it's really a lot more than height, weight,

00:41:21.900 | cholesterol panel, and blood panel.

00:41:23.500 | It's very thorough.

00:41:24.980 | - Yeah, kind of what you get in the United States.

00:41:26.940 | When I was in South Korea getting a physical,

00:41:28.900 | I finally had to stop when they wanted to do

00:41:30.980 | an endoscopy and a colonoscopy.

00:41:32.700 | I was like, "Enough, enough.

00:41:34.740 | "I've had the CT, I've had the MRI."

00:41:36.540 | I think it was around $1,100 for the whole thing.

00:41:39.660 | - Yeah. - It was crazy low.

00:41:41.220 | And again, top hospitals, super clean,

00:41:44.180 | all the right equipment.

00:41:45.220 | Those are the kinds of things

00:41:46.060 | that you almost have to see to believe.

00:41:47.500 | - Yeah, and so now I'm a promoter for a hospital

00:41:51.700 | I have no affiliation with,

00:41:52.940 | and I'm sure there are other hospitals

00:41:55.420 | that do just as great a job.

00:41:56.660 | You did it in South Korea.

00:41:58.100 | So that's just something I'll encourage people

00:42:00.180 | to take a look at if they wanna be more proactive

00:42:02.860 | about their health and don't wanna spend the cost it takes

00:42:06.420 | to be that proactive in the US.

00:42:08.260 | So that's really helpful.

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00:44:13.900 | or click the link in the description.

00:44:15.620 | Different topic, but something we didn't talk on

00:44:17.940 | in that checklist.

00:44:18.780 | You said, start with where you're gonna go.

00:44:20.460 | Do some research, find the right facility.

00:44:22.380 | We talked about accreditation.

00:44:24.140 | You know, your book has a ton of resources.

00:44:26.860 | In fact, the reason we're talking

00:44:28.660 | is because I tried to find a person

00:44:31.620 | who's researched more than one destination,

00:44:34.340 | and you were clearly the standout.

00:44:36.220 | Everyone else I looked for was like,

00:44:37.740 | I know a lot about Turkey or Thailand or a region.

00:44:40.340 | What do you suggest people look for

00:44:42.460 | when they're picking the actual doctor

00:44:44.500 | they would work with overseas?

00:44:46.060 | We outline that in detail in the book,

00:44:49.180 | but in short, you look for doctors

00:44:51.300 | that have been board-certified in their country.

00:44:53.940 | You look for doctors that have been registered

00:44:56.300 | in their home country.

00:44:57.380 | You know, if you can find an American board-certified doctor

00:45:01.220 | or surgeon, all the better.

00:45:03.820 | Reviews are becoming really important.

00:45:05.740 | I know they get gamed, and sooner or later,

00:45:08.380 | Google's gonna start gaming their reviews,

00:45:10.660 | but for now, they're pretty straight up.

00:45:12.300 | If you look up a doctor or you look up a clinic,

00:45:14.620 | the reviews are pretty straight up,

00:45:16.020 | and they haven't been tampered with,

00:45:17.580 | and reviews are becoming more and more important

00:45:20.100 | in the healthcare community,

00:45:21.300 | just like they're important on Amazon

00:45:23.380 | or TripAdvisor or Airbnb or whatever.

00:45:26.620 | Healthcare is becoming commoditized in that way,

00:45:29.620 | and I put a lot of weight on reviews

00:45:32.780 | when I research clinics and hospitals.

00:45:35.620 | I put a weight on the number of reviews

00:45:37.900 | and, of course, the rating.

00:45:39.020 | If it's 20 reviews, not so much.

00:45:41.500 | If it's 1,000 reviews with a 4.6 or 4.7 rating, that's great.

00:45:46.500 | - One thing we didn't talk about,

00:45:47.700 | how far in advance do people need to plan

00:45:50.380 | for a lot of medical travel?

00:45:51.980 | I know in the U.S., I waited three, four months

00:45:54.700 | to see a cardiologist, so is this something

00:45:57.900 | that you plan incredibly long out,

00:46:00.020 | or can you plan it as late as I'm in Thailand,

00:46:03.900 | right now, listening to this podcast,

00:46:05.580 | maybe I should go get this executive physical tomorrow?

00:46:08.100 | - That might be a stretch, but you wouldn't have

00:46:10.460 | to wait more than a couple or three days,

00:46:12.080 | and often, they will find a way to fit you in.

00:46:15.580 | How they do that, I don't really know,

00:46:17.260 | because they don't sacrifice the quality,

00:46:19.440 | so it's kind of a bifurcated question.

00:46:21.420 | The wait times are much, much shorter

00:46:24.340 | in clinics and hospitals that serve international patients,

00:46:28.100 | because they know that they have to do things very rapidly.

00:46:31.340 | However, as far as your planning goes,

00:46:34.440 | you should be planning your trip four to six months out,

00:46:38.140 | so that you can get the very best plane fares,

00:46:40.800 | you can get the very best deals on your hotel.

00:46:43.660 | You wanna get a hotel that's close to your hospitals,

00:46:45.860 | 'cause you don't wanna get caught

00:46:46.740 | in some of the amazing, snarly traffic

00:46:51.340 | in Bangkok, or Kuala Lumpur, or even in Cancun.

00:46:55.860 | So, you wanna do your actual planning,

00:46:58.880 | once you've decided on a doctor or a facility, further out.

00:47:02.500 | That said, if you're in-country,

00:47:04.980 | and you wanna go to a top-quality dentist,

00:47:08.020 | they can almost always schedule the next day,

00:47:10.660 | these people work 24/7, they're maniacs.

00:47:13.180 | It's not a good idea to have your son meet you in Bangkok,

00:47:15.860 | when he's like 22 years old.

00:47:18.020 | But, he gets off the plane,

00:47:19.820 | and I said, "Well, let's go get a massage."

00:47:21.820 | And he said, "You know, Dan, I thought we got,

00:47:26.020 | "you had really good, cheap healthcare here in Bangkok."

00:47:30.140 | And I said, "Yeah, you do, you wanna go to a dentist?"

00:47:33.540 | And he said, "Yeah, I've got a toothache."

00:47:35.780 | So, we scheduled the next day,

00:47:40.280 | and really high-quality clinic in a gorgeous shopping mall,

00:47:45.280 | four stories of shopping,

00:47:47.040 | across from a foreign car company.

00:47:49.180 | I don't know how they got those cars on the fourth floor,

00:47:51.160 | Lamborghinis and Bugattis, and all BMWs,

00:47:54.920 | and all kinds of stuff.

00:47:55.840 | And the clinic was right across from that.

00:47:57.700 | And he got his teeth done, and when he was walking out,

00:48:00.720 | he was begging the dentist,

00:48:02.660 | when he got the bill, to go do more work.

00:48:04.880 | And the guy says, "You don't need more work,

00:48:06.440 | "I'm not gonna do more work on you."

00:48:08.440 | But the whole bill was like $180 for all kinds of work.

00:48:11.540 | So, yeah, the wait times can be very, very, very short

00:48:17.820 | for a lot of the traditional stuff.

00:48:20.000 | If you need a heart procedure,

00:48:22.000 | yeah, it might take a week or two to work that in.

00:48:25.640 | Speaking of which, transplant, that's a no-no.

00:48:29.480 | People ask me a lot about transplants,

00:48:32.680 | because transplants are so incredibly expensive.

00:48:35.740 | But we don't even deal with transplants.

00:48:37.840 | It's just too much red tape.

00:48:39.240 | - You don't mean hair transplants,

00:48:40.520 | you mean like organ transplants.

00:48:41.880 | - Liver transplants, heart transplants, you know.

00:48:45.120 | People are on waiting lists, and they're desperate.

00:48:48.000 | - And to your point about wait times,

00:48:49.760 | my friend was at Bummergard with this executive physical,

00:48:52.440 | and the doctor came to him and said,

00:48:53.660 | "Hey, you know, there's a few spots on your back.

00:48:56.000 | "I'd love a dermatologist to look at it,

00:48:58.060 | "and if they need to do anything, they can do it,

00:49:00.580 | "but it's gonna be a wait."

00:49:01.940 | And he goes, "Oh, do I need to come back tomorrow?"

00:49:04.000 | He goes, "No, no, no, no, maybe 20, 30 minutes."

00:49:06.800 | You know, like, and he was just dying that like,

00:49:09.640 | they were so apologetic that seeing a dermatologist

00:49:13.360 | to do a check and a procedure last minute

00:49:17.160 | would take 20 or 30 minutes,

00:49:19.240 | and he added $100 to the visit.

00:49:21.720 | - I always bring my laptop with me to a hospital

00:49:23.920 | because I like to work

00:49:25.680 | rather than just sit around and twiddle my thumbs.

00:49:28.200 | And the third time that I sat down at Bummergard,

00:49:32.420 | and was greeted by a nurse, three minutes later,

00:49:35.340 | I looked up and I said,

00:49:36.280 | "How do you get any work done around here?"

00:49:38.220 | You know?

00:49:39.120 | And it was hilarious because, yeah,

00:49:41.880 | I don't wanna oversell it,

00:49:42.920 | but it's a really different experience.

00:49:44.800 | And people that go to the right hospitals

00:49:47.360 | and the right clinics for the right reasons

00:49:50.040 | come back glowing.

00:49:51.280 | And that's one of the big reasons

00:49:52.720 | why medical travel is growing so rapidly

00:49:54.560 | is number one, the inventory is growing

00:49:56.440 | of quality clinics around the world

00:49:58.360 | that wasn't there 15 and 20 years ago.

00:50:01.680 | And that leads to more and more patients

00:50:04.080 | having patient experiences,

00:50:05.900 | which leads to word of mouth,

00:50:07.260 | which leads to a growing industry,

00:50:09.980 | not to mention the fact that healthcare costs

00:50:11.780 | rose another 8% last year out of pocket.

00:50:15.140 | - Do you recommend people get kind of a more beefed up

00:50:18.260 | travel insurance policy or anything like that

00:50:21.300 | when they're doing medical travel?

00:50:23.560 | - Not really.

00:50:24.400 | I mean, I'm not a lawyer.

00:50:26.300 | I don't wanna be liable for it,

00:50:27.580 | but I would say you're probably at less risk

00:50:30.420 | because you're in a very protected environment.

00:50:32.280 | In most medical travel experiences,

00:50:34.980 | a shuttle or even a limousine picks you up at the airport,

00:50:38.420 | takes you to your hotel or takes you to your hospital.

00:50:41.180 | You're in a very sheltered environment

00:50:42.940 | and you're not gonna be out there partying

00:50:44.980 | and wandering around the streets,

00:50:47.420 | drinking and having a ball.

00:50:49.660 | So your chances of actually coming to some kind of harm

00:50:53.020 | and needing travel insurance

00:50:54.460 | are probably lower as a medical traveler,

00:50:56.620 | but it all depends on your appetite for risk.

00:50:58.940 | So if you want travel insurance, fine.

00:51:01.380 | If you don't, that's fine,

00:51:02.400 | but don't confuse travel insurance

00:51:04.520 | with medical travel insurance

00:51:06.320 | because travel insurance has nothing to do

00:51:08.040 | with premeditated planned medical travel.

00:51:11.440 | - And is there anything that people should be thinking about

00:51:14.000 | on that front if they're kind of worried

00:51:16.320 | something could go wrong and they wanna be protected?

00:51:20.080 | - There just isn't enough.

00:51:21.360 | I mean, it's still basically a very large cottage business.

00:51:25.080 | If you're asking is there some kind of an insurance

00:51:27.440 | that covers the medical traveler,

00:51:29.640 | there is, but it's too expensive.

00:51:31.240 | - Okay, and last, what are some common mistakes

00:51:34.400 | or things that kind of a first timer might overlook

00:51:37.840 | or kind of your list of don'ts

00:51:39.660 | when someone's looking to go do some medical travel?

00:51:43.140 | - The main thing, and I can't emphasize it enough,

00:51:46.040 | don't cost shop.

00:51:47.900 | Once you've done your research,

00:51:49.440 | don't try to get the best price.

00:51:51.940 | Don't try to get the greatest discount

00:51:53.700 | 'cause that's what gets so many patients in trouble.

00:51:57.080 | Don't fail to do your research.

00:51:59.180 | Don't fail to really thoroughly research your doctor

00:52:02.360 | or your clinic.

00:52:04.740 | I would also say don't scrimp on lodging

00:52:06.840 | and accommodations.

00:52:07.880 | You don't need to go to the Ritz or Four Seasons,

00:52:11.940 | but don't go to some guest house

00:52:14.440 | that doesn't have a lot of facilities.

00:52:15.880 | You wanna spend quality time recovering

00:52:18.760 | from the shock of a complex dental treatment or a surgery.

00:52:25.080 | I would say don't settle for second best.

00:52:29.620 | You wanna get a clinic that's really, really

00:52:34.300 | well-accredited, looks good, feels good,

00:52:37.500 | and don't fail to walk away.

00:52:39.620 | If you've done all your homework and you get there

00:52:41.380 | and you've had a great customer experience

00:52:42.980 | and you see the doctor and you actually get to the clinic

00:52:45.880 | and somehow you don't like it, walk away.

00:52:49.780 | Even in country, while you're there,

00:52:52.840 | you might be able to find a clinic that's even better.

00:52:55.460 | But trust your instinct, and they're most often right.

00:52:59.180 | I mentioned cuisine.

00:53:00.620 | Watch out for the local cuisine.

00:53:02.420 | Don't be too adventurous.

00:53:03.540 | Save that for a little later after you're fully recovered.

00:53:06.380 | And once again, I can't emphasize it enough,

00:53:09.640 | don't cost shop.

00:53:10.940 | That's what gets most of our people in trouble.

00:53:13.060 | - And you said, if you don't be too adventurous

00:53:15.300 | right before your procedure, two things.

00:53:17.620 | One, how much buffer time do you like to put

00:53:20.540 | around your medical travel, and how appropriate is it

00:53:23.920 | to combine it with a vacation?

00:53:25.540 | - That depends on the depth of the procedure.

00:53:27.300 | If you're just going for a teeth cleaning

00:53:28.840 | or a veneers or a whitening or something like that,

00:53:31.740 | and there's not a lot of invasive activity,

00:53:34.080 | you can plan a vacation around it.

00:53:35.920 | The other choice is to take your vacation first.

00:53:38.520 | A lot of people don't like doing that

00:53:40.680 | because, ah, I've got this dental procedure ahead of me,

00:53:43.220 | or I've got this medical procedure, it makes me nervous.

00:53:45.980 | But you could always take it first

00:53:47.460 | and then go in for your treatment.

00:53:49.660 | Most doctors want eight to 10 days

00:53:52.340 | for you to stay in country,

00:53:53.460 | and they often make you sign paperwork

00:53:56.040 | that commits you to staying eight to 10 days.

00:53:58.460 | Because if you don't have a complication

00:54:00.140 | eight to 10 days out,

00:54:02.220 | then chances are you're not gonna have a complication.

00:54:04.580 | The wound management is gonna be behind you.

00:54:07.260 | The antibiotics regimen will be largely behind you,

00:54:12.080 | and they want you to stay in country to protect you.

00:54:15.320 | So if you've got the time, and most people don't,

00:54:18.380 | 10 days after your procedure,

00:54:20.580 | knock your lights out, party on.

00:54:22.660 | But don't do what I did.

00:54:24.040 | I got an implant in Costa Rica.

00:54:26.900 | The next day, got on a bus for Dominical on the coast,

00:54:30.800 | and literally fell out of the bus halfway

00:54:32.940 | because the roads were so bumpy that it was killing me,

00:54:35.940 | and I was swelling by the hour.

00:54:38.060 | I should have never left my hotel room.

00:54:40.340 | This was my first medical travel experience

00:54:43.020 | early in the research stages of the book.

00:54:45.200 | So the mistakes that you see that I list in the book

00:54:48.480 | are mostly mistakes that I and colleagues of mine

00:54:51.400 | have made in their journeys.

00:54:53.120 | - Yeah, the book's fantastic.

00:54:54.680 | Anyone that wants to go deep should check it out.

00:54:56.880 | You mentioned you're working on a new version.

00:54:59.000 | When does it come out?

00:55:00.160 | - It comes out in the late summer, early fall.

00:55:02.820 | It's taken even more time for us to do the research

00:55:05.520 | 'cause the data took so long to rebuild after the pandemic

00:55:09.160 | where everything went to zero.

00:55:10.480 | Clinics weren't open, borders weren't open,

00:55:13.480 | medical travel dropped to zero.

00:55:14.960 | As far as the general information,

00:55:16.520 | there's some updated stuff in there for technology.

00:55:18.760 | The introduction is gonna be a little more political

00:55:21.320 | because of some of the recent occurrences.

00:55:24.820 | A wound has been lanced, a boil has been lanced

00:55:29.200 | with some of the recent events,

00:55:31.520 | and the shortcomings of U.S. healthcare

00:55:35.040 | are now very much out in the open,

00:55:36.680 | and people like me are no longer lone voices

00:55:39.300 | in the wilderness.

00:55:40.140 | And I do believe that medical travel's gonna become

00:55:42.920 | more and more of an option, especially for younger folk,

00:55:45.120 | 40s and 50s, I'm an old geezer,

00:55:47.300 | but they're gonna be much more prone to looking for options

00:55:51.640 | because a lot of people right now are really pissed off

00:55:55.600 | and they want to find options.

00:55:57.040 | And the options, unlike 15 and 20 years ago,

00:56:00.440 | are now out there for almost every reasonable procedure

00:56:04.220 | that you can think of.

00:56:05.320 | - For the people listening to this show,

00:56:06.640 | I think they're probably well-versed

00:56:08.760 | in the game of points and miles,

00:56:10.700 | which can take the travel cost of medical travel

00:56:14.040 | down to almost nothing.

00:56:15.600 | And so if you figure the right credit card signup bonus

00:56:19.240 | might cover your entire trip

00:56:21.480 | to whatever country you're going to,

00:56:23.240 | and that just makes it an even more valuable proposition

00:56:26.360 | to consider medical travel.

00:56:28.040 | - There are some larger companies

00:56:29.920 | that are actually very close to carving out partnerships

00:56:33.280 | with some of these medical travel providers

00:56:35.040 | to provide a loyalty card strictly for medical travel.

00:56:38.960 | So watch out for that.

00:56:40.440 | We covered a lot.

00:56:41.400 | Where can people find you and the book

00:56:43.880 | and any other resources you've put together?

00:56:45.880 | - Patientsbeyondborders.com.

00:56:48.720 | And you can find the book anywhere.

00:56:51.240 | It's in digital form, it's in book form.

00:56:53.960 | But I hate to say it,

00:56:55.520 | but I'd advise people to wait a few months

00:56:58.560 | until the fifth edition comes out.

00:57:00.300 | But the general information in the fourth edition,

00:57:02.760 | how to plan your trip, what to do when you get there,

00:57:05.360 | how to keep yourself safe when you get back

00:57:07.600 | is all remains current

00:57:09.440 | 'cause healthcare doesn't really change that much.

00:57:11.920 | How to take care of yourself pre-surgery and post-op

00:57:15.960 | has not changed very much in the last five years.

00:57:18.320 | - Great.

00:57:19.160 | We'll put links to everything you mentioned

00:57:20.240 | in the show notes.

00:57:21.360 | Joseph, thank you so much for being here.

00:57:23.400 | - Well, thank you.

00:57:24.360 | And I appreciate your time.

00:57:25.600 | And I wish anyone who is influenced by this show

00:57:28.200 | a safe and healthy medical journey.

How Medical Travel Can Save You Thousands on Surgery, IVF, and More

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