Going Abroad to Find Affordable Health Care

Going Abroad to Find Affordable Health Care
By WALECIA KONRAD

WHEN Ben Schreiner, a 62-year-old retired Bank of America executive, found out last year he would need surgery for a double hernia, he started evaluating possible doctors and hospitals. But he didn’t look into the medical center in his hometown, Camden, S.C., or the bigger hospitals in nearby Columbia. Instead, his search led him to consider surgery in such far-flung places as Ireland, Thailand and Turkey.

Ultimately he decided on San José, Costa Rica, where just a week or so after the outpatient procedure and initial recovery, he and his wife were sightseeing throughout the country, then relaxing at a lush resort. He was home four weeks later, with no complications.

Mr. Schreiner is what’s known in the health care world as a “medical tourist.” No longer covered under his former employer’s insurance and too young to qualify for Medicare, Mr. Schreiner has a private health insurance policy with a steep $10,000 deductible. Not wanting to spend all of that on the $14,000 his operation would have cost stateside, he paid only $3,900 in hospital and doctor’s bills in Costa Rica.

“I didn’t have to fork over my entire deductible,” Mr. Schreiner said. “What’s more, they bent over backwards there to take care of me — no waiting, a friendly staff, everyone spoke English.”

At least 85,000 Americans choose to travel abroad for medical procedures each year, according to a recent report by the consulting firm McKinsey & Company. Treatment includes dental implants, hip and knee replacements, heart valve replacements and bypass surgery. The cost of surgery performed overseas can be as little as 20 percent of the price of the same procedure in the United States, according to a recent report by the American Medical Association.

Medical tourism is expected to expand quickly in the coming years because of rising health care costs in the United States, increasing availability of international facilities with United States accreditation, and the fact that insurers and employers are beginning to embrace the practice.

Blue Cross Blue Shield of South Carolina, for example, has started a subsidiary company, Companion Global Healthcare, to offer medical tourism services to individuals and businesses. Hannaford supermarkets in Maine recently added an international option for hip replacements to its health care plan.

At the moment, however, the bulk of medical tourism candidates are uninsured and underinsured people paying their own bills and looking for low-cost alternatives to American care. Medical tourism advocates argue that the quality of care overseas is often equal to or better than that in the United States. Many countries have high success rates, American-trained English-speaking doctors and the newest facilities, often built specifically to attract foreign patients.

But there are no comprehensive data that adequately compare overseas surgical outcomes or other quality measures to those used in the United States, said Dr. Sharon Kleefield of the Harvard Medical School and a specialist in overseas health care quality measures.

“No matter how high your hospital is rated, there are issues with regard to quality and safety when you travel for medical treatment,” she said.

The American Medical Association, also worried about the risks associated with overseas medical travel and the difficulty in getting adequate follow-up care, issued guidelines on medical tourism last June. (They’re available on the Web at tinyurl.com/cpklcw.)

With those cautions in mind, here’s what you need to know if you are considering an international medical option:

Determine whether you are a good candidate. “Traveling for surgery is a big deal,” said Josef Woodman, author of “Patients Beyond Borders: Everybody’s Guide to Affordable World-Class Medical Tourism.” Recovery time is often compressed, and a long flight home can cause complications like a blood clot. You’ll need to provide a thorough health history and have a physical stateside before you go to make sure you can withstand the trip.

Mr. Woodman points out that not every condition should be treated overseas: “Orthopedic and nonemergency heart procedures have some of the highest success rates. But with something like cancer, you need the ongoing relationship with your oncologist and health care team.”

Get a reliable middleman. Dozens of medical tourism facilitators and planners have sprung up in the past decade hoping to capitalize on the trend and simplify the process for consumers. “Unfortunately, plenty of unreliable firms have sprung up, too,” said Jonathan Edelheit, president of the Medical Tourism Association, a nonprofit organization made up of hospitals and facilitators that cater to traveling patients.

Good firms, said Mr. Edelheit, will match your medical needs with the best overseas hospitals and physicians; make your travel, lodging, visa and local transportation arrangements; handle billing; and help arrange follow-up care. For a list of facilitators vetted by the association, go to medicaltourismassociation.com. Once you narrow your search, ask each potential firm for references and former patients you can interview.

Check out quality yourself. Although medical tourism firms will say they work only with the highest quality hospitals and physicians, you’ll still need to check the records. Don’t be swayed by the luxurious private hospital rooms, gourmet food and other amenities splashed on the Web sites. You want to be sure you’re going to a hospital accredited by the Joint Commission, the organization that reviews both American and international medical and dental facilities, using United State standards. (Find it at www.jointcommissioninternational.org/.)

Be sure to read carefully, a commission spokeswoman, Elizabeth Zhani, warned. You may find a facility’s name on the accreditation list, but it may be that only an affiliated lab or clinic is accredited, not the entire facility.

“Keep in mind that commission accreditation is the floor, not the ceiling,” said Dr. Kleefield. You’ll want to ask your own questions about the facility’s blood safety, medication safety, infection rates and unexpected morbidity rates for the procedure you’re undergoing, and discuss the data with your American doctor.

Just as you would in the United States, you’ll want to interview the physician handling your case before you arrive. Ask if he or she was trained in the United States and is fluent in English, how often he or she has done the procedure you’re having, and what the long-term outcomes have been. Conducting this interview beforehand will also help you establish a rapport with your doctor before you go under the knife.

Arrange your follow-up care in advance. “The biggest stumbling block with medical travel is getting care when you return,” said David Boucher, chief executive of Companion Global. Doctors often balk at treating complications from overseas surgeries because they are unfamiliar with the procedures or prosthetics used or are worried about liability.

Meet with your general practitioner and any specialist who may have been treating you before you go, said Dr. Ted Epperly, the president of the American Academy of Family Physicians: “They’ll be able to provide your medical records, either electronically or on paper, to your overseas doctors.”

Give your doctors in the United States specific details on where you are going for your procedure and contact information for your overseas doctors. And be sure to ask what medical records and information you need to bring home to complete your care.

Finally, before you leave, do your best to arrange a phone or e-mail conference between your doctors at home and abroad so communication will be established before a problem arises.

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世界貿易量９％減、戦後最大の落ち込みに　０９年見通し

2009年3月24日11時39分

　【ロンドン＝尾形聡彦】世界貿易機関（ＷＴＯ）は２３日、０９年の世界の貿易量が実質ベースで前年比約９％減となり、第２次世界大戦後で最大の落ち込みになるとの見通しを発表した。昨年秋の金融危機の深まりで世界各地の経済が一斉に減速したため。世界貿易は過去約３０年間一貫して拡大してきたが、０９年は一転する。

　世界貿易は、０７年は６％増と堅調だった。０８年は当初は４．５％の成長を見込んでいたが、金融危機のあおりで急激に冷え込み、推計で２％成長にとどまったという。

　０９年の輸出は、先進国で１０％減、途上国でも２～３％減に落ち込む見通しという。中国の輸出が今年２月に前年比で２６％減となるなど、急激な変化を指摘している。

　ＷＴＯは貿易縮小の原因として、世界各地の経済が同時に減速したことに加え、国境を超えて生産を分業する仕組み全体が影響を受けていることや、金融危機に伴う貿易金融の減少などをあげた。保護主義の広がりがさらに貿易の足かせになりかねないため、ラミー事務局長は「各国政府は保護主義的措置で状況を悪化させることを避けなければならない」と訴えた。

　０８年の各国別のモノの名目輸出額では、ドイツが１兆４６５０億ドル、中国が１兆４２８０億ドル、米国が１兆３０１０億ドル、日本が７８２０億ドルの順だった。

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ネット証券大手２社が業務停止、不十分なシステム管理で

　金融庁は２４日、インターネット証券大手のマネックス証券（東京都千代田区）と楽天証券（同品川区）に対し、システム管理が不十分だとして、新たなシステム整備を伴う一部業務の停止命令を出した。

　同時に出した業務改善命令では、経営陣を含む責任の明確化などを求めている。

　処分は両社とも４月１日からで、期間はマネックスが３か月間、楽天が１か月間。ただ、既存契約者は、現在両社が提供している金融サービスを引き続き利用できる。

　金融庁によると、マネックス証券は２００６年６月、システム管理が適切でないとして業務改善命令を受け、改善計画を提出した。しかし、その後もシステム障害を多発させた。

　楽天証券は、０５年１１月と０７年６月に業務改善命令を受けたが、大規模なシステム障害の発生を防げず、復旧体制も不十分だった。

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仏、核実験の被害者補償へ転換　実験情報も公開（1/2ページ）

2009年3月24日20時53分

　【パリ＝国末憲人】フランスのモラン国防相は２４日、サハラ砂漠と南太平洋で実施した核実験による被曝者（ひばくしゃ）に対して大規模な補償を実施する方針を明らかにした。このためにまず１千万ユーロ（約１３億円）を拠出、これまで機密扱いだった核実験情報も公開する。

　同日付フィガロ紙に掲載されたインタビューで国防相が明言した。米など核保有各国が次々と被害者補償に踏み切る中、仏は被曝者の存在自体を認めない態度をとり続けてきただけに、大きな転換と受け止められている。

　フランスは６０～９６年、サハラ砂漠にあるアルジェリアのレッガーヌ、インエケルと、南太平洋の仏領ポリネシアにあるムルロア環礁、ファンガタウファ環礁で、計２１０回の核実験を実施した。国防相によると、実験に携わって被曝した可能性がある兵士や作業員は１５万人に達する。周辺住民を加えると、補償対象者はさらに広がるという。

　計画では、医師や法律家で構成する独立委員会がこれらの人々の健康状態や作業時の状況を、国際基準に照らし合わせて審査する。補償のため、仏国防省は初年度に１千万ユーロを用意する。

　仏政府は長年「核実験は安全で被害者は存在しない」と繰り返してきた。近年は退役軍人の求めなどが相次ぎ、一部の補償に応じるようになったものの、核実験と健康被害の因果関係の証明が被害者側に求められていた。モラン国防相は「もはや証明責任を被害者側に求めない。健康被害が実験によるものでないと国が証明した場合にだけ補償を拒む制度とする」と述べた。

　国防相は大気の汚染状況など核実験情報を大幅に公開する意図も表明。公開すべき情報を選ぶ作業を医師と科学者による専門家チームが進め、今年１２月に答申を受ける。

　仏領ポリネシアで核実験被害の解明活動を続けているブルノ・バリヨ氏によると、ムルロア環礁での核実験に従事した住民８人が２７日、補償を求めてパペーテの労働裁判所に訴えを起こす予定だった。支援者の間では、提訴前に政府が先手を打ったのでは、との憶測も呼んでいる。

　モラン国防相は「このような方針を打ち出すことに対して『核抑止力を築いた努力が報われないのでは』との疑念が政府内でも強かった。ただ、もはや補償を拒み続ける時ではない。仏戦力の整備に貢献した人々が長い裁判にかかわる事態を避けたかった」と説明した。

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March 25, 2009
France Agrees Payment for Nuclear Test Victims
By ALAN COWELL

PARIS -- After decades of rejecting ties between its nuclear weapons tests and health problems among personnel carrying them out, France said on Tuesday that it would “be true to its conscience” and pay compensation to those suffering illnesses linked to radiation.

Defense Minister Hervé Morin, told Le Figaro newspaper that France believed for a long time that “opening the door to compensation would pose a threat to the very significant efforts made by France to have a credible nuclear deterrent.”

Between 1960 and 1996, France carried out more than 200 nuclear tests, first in Algeria, then in French Polynesia in the Pacific Ocean. Up to 150,000 civilian and military people who worked on the testing program had been “theoretically” affected, Mr. Morin said.

However, the scale of compensation may be limited. Mr. Morin said the government had set aside about $13.5 million to pay claims adjudicated by a panel of physicians and a magistrate.

For decades France was at pains to establish its independence from the United States and other NATO countries as a nuclear force, developing what is called a “force de frappe” -- a strike force -- of nuclear weapons and announcing in 1966 that it was withdrawing from NATO’s integrated military command.

Earlier this month President Nicolas Sarkozy announced that France intended to return to full membership of NATO, 43 years after Charles de Gaulle ordered NATO and American forces out of the country.

Since the end of the cold war, France has aimed to halve its nuclear arsenal to around 300 , but it has kept the scale of its nuclear capability secret. Last year, the Federation of American Scientists, which tracks nuclear arsenals, said France had 348 warheads -- 288 on submarines, 50 on air-launched cruise missiles and 10 on bombers.

France went to extremes to protect its nuclear testing secrecy. In 1985, France dispatched undercover agents to New Zealand to sink the Rainbow Warrior, a vessel from the Greenpeace environmental campaigning group, to prevent it from disrupting nuclear tests.

Mr. Morin said the French authorities had now agreed to publish archives explaining how nuclear tests were conducted. The moves followed many court cases in which testing personnel and residents living near nuclear test sites complained of diseases such as leukemia and other cancers.

Last February, 12 former soldiers suffering from serious illnesses took their claims for compensation to an appeals court in Paris to try to force the government to recognize a link with the tests, Reuters reported.

After the years of stonewalling on the health risks associated with nuclear testing, Mr. Morin said, “it is time for France to be true to its conscience.”

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「規正法違反が限度」＝小沢氏聴取、一時検討も見送り－検察当局

　西松建設の違法献金事件で、東京地検特捜部は小沢一郎民主党代表の参考人聴取を見送った。特捜部は聴取の有無について明言を避けたが、ある検察幹部は「献金を『わいろ』と認定するのは不可能。談合組織への口利きを政治資金規正法違反罪で起訴するのが限度だった」と話した。

　東北地方の大型公共工事で、小沢氏の事務所が行ったとされる「口利き」。検察幹部は「小沢氏の事務所には工事発注などの職務権限がない。口利き行為はあくまで談合組織に対するものだった」と明かした。

　ある幹部は秘書の逮捕後、「事件の構図が固まり次第、小沢氏本人に参考人聴取を要請する」と前向きだった。

　しかし、逮捕後の捜査で規正法違反と小沢氏の認識を結び付ける証拠は出ず、「政権交代」を前面に掲げた同氏の捜査批判で半ば逆風下に置かれた。特捜部は、参考人聴取の根拠が希薄なまま実施した場合の影響も考慮したとみられる。（2009/03/24-22:22）

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小沢氏、会見で続投表明「頑張る決意新たにした」
2009.3.24 22:04

　民主党の小沢一郎代表は２４日夜、東京・永田町の党本部で記者会見し、「自分の、民主党の、国民のみなさんの期待に応えるよう、今後も頑張って参りたいと決意を新たにした」と述べ、代表職の続投を表明した。

　小沢氏は「なんとしても、日本に議会制民主主義を定着させることは、自民党を離党して以来の大目標であり、自分の思いである」とし、「これが、最後の機会であり、この機会になんとしても、国民の理解を得て、政権の交代を実現することで、官僚の上に立った自公政権を覆し、国民の側に立った政権を樹立させる。それが私の最後の仕事だと思う」と述べた。

　東京地検特捜部が同日、政治資金規正法違反の罪で小沢氏の公設第１秘書、大久保隆規容疑者らを起訴したことを受け、小沢氏の進退が注目されていた。

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小沢代表、記者会見で続投表明　秘書の起訴「国民におわび」

　民主党の小沢一郎代表は24日夜、記者会見し、同日の党役員会で「何としても日本に議会制民主主義を定着させることが自民党を離党して以来の大目標だ。これが最後の機会だ。なんとしても国民の理解を得て、国民の側に立った政治を実現する。今後も力をあわせて頑張っていきたい」と述べ、代表続投を表明したことを明らかにした。

　西松建設の巨額献金事件による秘書の起訴に関して「国民の本当に大勢のみなさんに心配と迷惑をかけたことを心からおわびする」と述べた。

　一方、「過去の例をみても、この種の例で逮捕、強制捜査、起訴は記憶にない。政治資金規正法の趣旨から言っても、納得がいかないという心境だ」と指摘した。さらに「特に衆院選が控えており、そういう結果については自分としては納得できない」と強調した。 (22:05)