The News & Observer Thursday, September 23, 2004 
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Published: Sep 23, 2004
Modified: Sep 23, 2004 5:47 AM
Americans increasingly find health care abroad




Staab will have heart surgery in India.

For most of his 53 years, Howard Staab of Durham has worked as an independent carpenter-contractor. He's health-conscious, the kind of guy who cooks organic meals with vegetables from his own garden.

Years ago, he decided to eschew health insurance. He was making enough to pay his own doctor's bills, and he didn't like the idea of lining the pockets of insurance executives.

Recently, a routine physical turned up the worst possible news: His heart was failing. He needed open-heart surgery, as soon as possible.

Staab and his partner, Maggi Grace, shopped around. The estimate at Durham Regional Hospital was $100,000 for hospital fees, and another $100,000 to pay the cardiologist and other health-care providers, Grace said. They don't have that kind of money.

So today, Staab and Grace will board a flight to leave the City of Medicine for India. There, New Delhi doctors estimate the operation will cost $6,000 to $10,000. Staab and Grace are among many U.S. residents who leave the country for medical care.

"It's just an amazing idea. ... He works all the time. And then to have nothing left," Grace said of the idea of paying $200,000 for an operation. "His son said, 'Does this mean I can't go to college?' It shouldn't be that way. Two hundred thousand dollars is a lot for anybody."

Staab was not available for an interview this week because he was preparing to leave for India, she said.

Katie Galbraith, a spokeswoman for Durham Regional, said she couldn't comment on Staab's case. But in general, the hospital works with patients without the resources to pay their bills by determining whether they qualify for public assistance, for Duke University Health System charity care, or for a payment plan.

Don H. Taylor Jr., assistant professor of public policy at Duke, said that being uninsured is becoming a middle-class problem. "A large number of people who are uninsured either have a job or are married to somebody with a job, or are a kid of somebody with a job," he said. And insurance for small employers or the self-employed can be very expensive.

Higher prices

Because insurance companies can negotiate better prices for services, there are also stark differences in what hospitals charge the insured versus self-pay patients. According to Blue Cross and Blue Shield of North Carolina, the average price for heart surgery in the state, based on claims the insurance company received, was $54,000 to $85,000, said Mark Stinneford, a spokesman. Actual costs vary depending on length of stay and complications.

"It's sort of like airline tickets," Taylor said. "They would love to sell a full-fare airline ticket, but everyone flying on the airplane pays a different price for their seat. It's the same thing with health care. ... Basically, uninsured people are going to be charged full freight."

Many Americans go overseas for medical procedures, especially plastic surgery. One consulting firm reported that India's "medical tourism" business could amount to $2 billion per year by 2012, according to a report from The Wall Street Journal. Clinics in Argentina, Singapore, Barbados, Malaysia and Costa Rica court patients from wealthier nations, offering medical treatment at a fraction of the cost.

Still, health-care policy experts doubted that travel abroad for open-heart surgery was a trend.

"Flying to India is a new one," Frank A. Sloan, director of Duke University's Center for Health Policy, Law and Management, wrote in an e-mail response. "This is very uncommon."

Grace is worried about the toll the long flight will take on Staab's weakened heart. She marvels that they will soon land in a city of millions, where they will get around by rickshaw -- a small, two-wheeled vehicle pulled by a person.

She has immunized herself against hepatitis A, tetanus, meningitis and polio. She has been warned about malaria and been told that even bottled water can be unsafe. But she said she doesn't think they have a choice.

'Broken' system

"The American Medical Association would find it most unfortunate that an American, or a North Carolinian ... would need to go out of his country and community to get the health care he needs," said Dr. Rebecca Patchin, a trustee with the American Medical Association. "This is a sign that our health-care system in this country is broken. We need to fix it."

Jennifer Morcone, a spokeswoman with the Centers for Disease Control and Prevention, said, "If you travel outside this nation, the same protections that are built into the health-care delivery system here may not apply."

Grace said that when they arrive in India, they will meet with Dr. Naresh Trehan. Formerly a top heart surgeon in New York City, Trehan established the Escorts Heart Institute and Research Center, a private hospital, in New Delhi in 1988.

Many people have told Staab he was irresponsible not to have had health insurance in the first place, Grace said. Now, he can't get coverage for his pre-existing condition. But other than wishing that he didn't have heart problems, "he does not have any regrets," she said.

(News researcher Toby Lyles contributed to this report.)

Staff writer Vicki Cheng can be reached at 829-4816 or mailto:vcheng@newsobserver.com



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