Passage to India, for Surgery

The cost disparity between health care in the United States and in other countries helps create a market that companies like Planet Hospital thrive in.

"An international price comparison of 15 procedures reveals that there could be savings of around $1.4 billion annually, even if only one in 10 U.S. patients choose to undergo treatment abroad," World Bank economist Aaditya Mattoo wrote in the journal Health Affairs.

However, the World Bank report also found that health insurance providers discriminate based on location of care, meaning many just won't pay for medical care overseas. There is only so far "out of network" you can be.

In the room next to Gilmore's at her New Delhi hospital was another American hip patient, Rick Thues, a 53-year-old computer consultant from California who loves to skydive and wanted legs strong enough to land on.

He said he would have preferred to go to a hospital in Orange County, Calif., where one of the pioneers in the field works, but that his HMO let him down.

"They denied my requests for hip resurfacing, even though it costs no more -- they didn't have a code for it -- and therefore they flat denied my hip resurfacing as opposed to hip replacement," Thues said.

Thues took his claim to the state board of appeals and lost, although one doctor agreed that it was the right surgery. The other two believed there wasn't enough historical evidence: Hip resurfacing has only recently been approved in the United States.

"I don't think I had another choice. I really don't. What could I have done? I -- well, I could've paid more money. I could've waited four to six months. I could've gotten last year's prosthetic. But I didn't. I decided I wanted the state of the art, and I wanted it now because I needed it now," he said.

Max Hospital is one of nearly a half dozen new hospitals popping up within a half hour of the Delhi International Airport. By the year 2010, there will be 2000 more Western-standard hospital beds -- at Indian prices.

Many of the new hospitals are already accredited by an organization called the Joint Commission, which also helps set the standard for thousands of hospitals in the United States, and has approved more than 100 hospitals around the world in the past six years.

One of India's most ambitious new hospitals, in the town of Gurgaon, was spearheaded by Dr. Naresh Trehan, the most prominent heart surgeons in India today. He used to work in the United States but came back to build a hospital that offered the same standard of care for his countrymen back home.

The existing hospital already handles a volume of heart surgeries greater than most Western hospitals, but his latest research specialty institution hopes to combine the best of Eastern and Western medicines for both international and domestic clients.

"International patients are great, but you have to realize there are 300 million middle-class Indians who can afford the kind of care we are providing," Trehan said.

Analysts wonder what impact this will have on health care in the United States. People like Dodie Gilmore are finding less-expensive health care outside the United States, and the quality of care she received in India has reset the bar for what she feels entitled to in a medical experience.

"I really believe that health care is really the only industry in America that's never really had competition before, and competition is healthy," PlanetHospital's Rupak said.

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