Traveling to India -- for a new hip

Robert Lupo had never been on an airplane until last month, when he flew to India to get his hip replaced.

The 45-year-old self-employed contractor from Santa Rosa, Calif., had dropped his medical coverage before an uninsured driver hit him last summer while riding his motorcycle. A $50,000 settlement covered immediate medical bills and living expenses while he was unable to work, but Lupo later learned he needed a hip replacement -- a $30,000 operation he couldn't afford.

With pain as his primary motivator, Lupo started researching online his options. He eventually found his way to WorldMed Assist, a 2-year-old California company that is part of a growing industry that makes arrangements for Americans to get medical care abroad.

Lupo's hip surgery and hospital stay cost $8,880 at Wockhardt Hospital in Bangalore, India. Even with the $1,300 airfare, the procedure totaled about a third of what it would have cost Lupo at a California hospital.

"My hip feels great," said Lupo, who was recovering at home while making magnets out of photographs from India to send back to the nurses and hospital staff in Bangalore. "But I really don't want to go to another Third World country again."

No official statistics are kept on how many Americans travel overseas for medical care, but one estimate places the number at 150,000 in 2006.

Other trends are more clear-cut. Many Americans are uninsured -- nearly 47 million at last count -- and others have health insurance that does not adequately cover procedures they desperately want or need.

Crossing international borders for medical care is not new. For decades, Americans have sought certain types of care in other countries, specifically elective or cosmetic procedures, along with treatments that are not approved by the U.S. Food and Drug Administration.

But now, industry experts say, Americans are going overseas for increasingly complex surgeries. In addition, more patients seem willing to accept that quality of care in some foreign hospitals may be the same or higher as that found on U.S. soil, at a fraction of the cost.

Wouter Hoeberechts, chief executive of WorldMed Assist, doesn't like the term "medical tourism" because he says it trivializes the industry by conjuring up images of post-operative patients recuperating on the beach drinking margaritas.

"Typically, what we have seen is people who want to save money -- who don't have insurance or have poor insurance," he said, adding that his company is paid by the international hospital rather than by patient fees. "But we're seeing a shift where it's not just all about money. Quality is becoming very important."

Heart bypass surgery, which can cost more than $130,000 in the United States, can be performed for $10,000 in India and $19,000 in Turkey. Gastric bypass surgery, typically $18,000 to $25,000, can be done for $10,000 to $15,000 in many other countries, while the newer "lap band" procedure, which costs about $16,000 here, can be performed for half that price in countries like Mexico and Turkey.

But will the quality of care be as good as here at home? That depends on whom you talk to. Industry experts recommend going to foreign hospitals with recognized international accreditation, such as from the Joint Commission International or the International Society for Quality in Health Care Inc.

American physicians warn that patients who seek care overseas for complex procedures may underestimate the potential for something to go wrong, both overseas and upon their return.

A major insurer -- Blue Cross and Blue Shield of South Carolina -- last year became the first U.S. health plan to form a subsidiary to help members seek care abroad.

Lupo, who otherwise would not have been able to afford surgery, praised the quality of care by the nurses and doctors in the Bangalore hospital, which he said was every bit as modern as an American facility.

His new hip was more than worth the 28-hour travel time, the occasional mosquito in his hospital room and the fight with a taxi driver who tried to take him to his uncle's rug shop instead of his destination, he said.

"We've got a lot of stuff that's wrong here," Lupo said. "I left here thinking this really sucks that I have to go to another country to get hip surgery because I can't afford it. But after I got it done and got back, I realized we don't really have it that bad."

(E-mail Victoria Colliver at vcolliver(at)sfchronicle.com.)

(Distributed by Scripps Howard News Service, www.scrippsnews.com.)