Why medical tourism is drawing patients, even in a pandemic

New York

ON A cold February morning last year, as she lay curled up in a foetal position on her kitchen floor, Melissa Jackson called her manager at a New Jersey beauty salon to ask for some unpaid time off.

It was the sixth consecutive week that the 39-year-old beauty technician was unable to work full time because of the debilitating pain in her pelvis caused by endometriosis, a chronic condition triggered by the growth of uterine tissue outside of the uterus.

As her symptoms worsened, she started exploring options to get less costly medical care abroad.

In recent years, while still on her ex-husband's health insurance policy, she had received hormonal treatments to ease the pain so she could go about her daily life. But since her divorce last year and the coronavirus restrictions placed on the beauty industry in March, those treatment costs have become prohibitive, especially with no insurance.

"There is no real cure for endometriosis, but if I want to free myself from this pain then I need to get a hysterectomy," Ms Jackson said, her voice shaking as she described the procedure to remove her uterus.

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"As if the surgery isn't bad enough, I need to find 20,000 bucks to pay for it, which is just crazy, so I'm going to have to find a way to go to Mexico."

The coronavirus pandemic has pushed millions of Americans into poverty and stripped more than 5.4 million American workers of their health insurance, according to a study by the nonpartisan consumer advocacy group, Families USA.

Many people like Ms Jackson have experienced a significant deterioration in their health because they have delayed medical procedures.

The fear of large medical bills has outweighed fear of contagion for some, giving rise to an increased number of patients seeking medical treatment in a foreign country.

"We are seeing a pent-up demand for medical tourism during the pandemic, particularly in the US where a fast-growing number of Americans are travelling across the land border with Mexico for health purposes," said David Vequist IV, founder of the Center for Medical Tourism Research, a group based in San Antonio, and a professor at the University of the Incarnate Word in San Antonio.

Even before the pandemic, millions of Americans travelled to other countries for savings of between 40- 80 per cent on medical treatments, according to the global medical tourism guide Patients Beyond Borders.

Mexico and Costa Rica have become the most popular destinations for dental care, cosmetic surgery and prescription medicines while Thailand, India and South Korea draw in patients for more complex procedures including orthopedics, cardiovascular, cancer and fertility treatment.

In 2019, 1.1 per cent of Americans travelling internationally did so for health treatments, according to the National Travel and Tourism Office, although that figure only accounts for those who travelled by air and does not include the thousands of travellers who crossed the US-Mexico border. Definitive statistics on medical tourism are hard to come by because countries have different recording methods and definitions of the sector.

Medical tourism has been decimated by coronavirus restrictions, but, even so, the twin crises of the economy and the enormous strain that Covid-19 has placed on the already faulty American health care system are pushing many patients to travel. Demand for nonessential surgeries has also been building up after more than 177,000 scheduled surgeries were postponed in the United States between March and June in 2020, according to the Center for Medical Tourism Research.

"Our market has always been what I call the 'working poor' and they just keep getting poorer," said Josef Woodman, chief executive of Patients Beyond Borders.

"The pandemic has gutted low-income and middle-class people around the world, and for many of them the reality is that they have to travel to access affordable health care."

Before the winter resurgence of the coronavirus, Ms Jackson had started to plan and save for a trip to Mexicali, a border city in northern Mexico, where she can get a hysterectomy for US$4,000, one-fifth the cost of the procedure offered in New Jersey. Her best friend had offered to drive her there and pay for the gas and accommodations.

"We wanted to make a vacation out of it and have some fun before the surgery because it's such a heavy and dark thing with real consequences," Ms Jackson said. "At 39, I have to come to terms with the reality that I'll never have kids. That's even more painful than my condition."

For now, she has put the surgery on hold and will wait until the virus is brought under control. Her doctor had pointed to cheaper options for the operation in New Jersey, starting at US$11,000 in a local outpatient facility. But Ms Jackson is adamant about having it in the hospital and says the aftercare is more thorough in Mexico.

"Going for the cheaper option at home means getting lower quality care and taking a risk. That just isn't the experience for people who do this in specialised hospitals in Mexico," she said. "It's cheap and safe." (Many hospitals and clinics in Mexico and other countries have accreditation to ensure their standards are equivalent to medical facilities in the United States.)

In recent weeks, Ms Jackson has had a flare-up of symptoms, which is common when the condition goes untreated. "I'm not sure if I will be able to wait for Covid to get better," she said. "This thing cripples every part of my life." NYTIMES