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(C.A. News) — The opening of new spas, hotels and tourism projects offering medical services and plain relaxation in Guanacaste is just a mere sample of Costa Rica´s so-called “medical tourism” sector which has been on a growth spurt.
According to data from the Costa Rican Tourism Institute (ICT)), during 2005, 4975 tourists entered the country for health reasons, 0.4% of the total number of visitors for that year and 15% more than in 2004 (4207 visitors).
Between January and August, 2006, approximately 2272 visitors mentioned health as one of the main reasons for taking their trip. Out of this group, most were from the United States, Canada and Europe.
This data is based on ICT surveys at airports throughout the country. However, these projections may vary since many travellers are hesitant to state that they are visiting the country for medical purposes.
Jorge Cortes, director of the Hospital Clinica Biblica in San José, states that approximately 10 to 15% of their patients are foreigners. In 2006, approximately 1,200 tourists came to Costa Rica for medical treatments. The services that are most sought after by tourists are plastic and cosmetic surgery, dental treatments, preventive medicine, bariatric surgery (surgery for overweight patients) and eye surgeries, added Cortes.
One of the main reasons that foreigners take medical trips to Costa Rica is the high quality medical care offered in the country, not to mention the fact that doctor fees and treatment costs are about a third to half of what they would pay in their home countries.
Plastic surgery is particularly popular among tourists since this type of surgery is not covered by their medical insurance back in their home countries. Costs for the different treatments are roughly 30% to 70% less expensive than what they would pay back home.
Dr. Steve Cascante, from Exobess, a company based in Liberia, Guanacaste specializing in the multi-disciplinary treatment of obesity, stated that a gastric bypass, for example costs $15.000 in Costa Rica, while in the United States the same surgery is over $40.000.
Dental treatments area also services that draw many medical tourists. The most sought-after dental services are cosmetic and restorative treatments including implants and whitening of the teeth. .
According to Dr. Rodrigo Jimenez, a Prosthodontist or cosmetic dentist at the Clinica Gil who specialized at Louisiana State University, “Although the fees area always lower and the quality comparable and, in some cases even superior, Practices are not as crowded as in the US and the patient spends more time and effort on each patient.“
Tourism and medicine hand-in-hand
Other reasons motivating foreigners to flock to Costa Rica are the country’s great health indicators, the high quality infrastructure of its medical services as well as the proximity and political stability of the country, not to mention the fact that waiting lists are shorter and many of the country’s medical professionals have outstanding credentials. At the same time, Costa Rica is a popular tourist hot spot. So why not combine a doctor’s visit while visit the rainforest and the many other beautiful spots that the country has to offer?
“Tourists do both”, comments Cortes, “Plastic surgery patients, for example, stay at the hospital for about a day and then rest at the many convalescence homes throughout the country for the next 12 days.”
Dr Luis Kaver, a dentist, adds that tourists like to spend a few days resting and take advantage of the free time to seek dental care. “We have many patients who do not live in Costa Rica. The number of patients depends on whether we are in the high or low tourism season”, stated Kaver.
Dr. Kaver points out that another factor that contributes to the high growth of medical tourism is the Internet. Costa Rica has now become globalized and competes with countries such as India and Thailand who also have a strong medical tourism industry given the wide-scale publicity that is available on the World-Wide-Web.
At Exobess, the Internet allows doctors to publicize their services to potential clients. “Bariatric (obesity) surgery is not covered by medical insurance. This opens the door for anyone who interested in obtaining information about our services to look us up on our website. We are currently negotiating alliances so that individuals my contact us through the Internet”, stated Cascante.
Dr. Rodrigo Jimenez states that although patients are willing to spend less, many are apprehensive at first “About 40% of my patients are foreigners that either live in Costa Rica or come to see me just for dental purposes”. At first patients are concerned about standards of infection control and quality of services. But after see they my office and realize that we have state-of-the art equipment and materials, they realize that we compete with the best dental practices in the United States and abroad.
Costa Rica´s fame as an accessible medical destination has been growing for the past few years since with the spurt of medical tourism companies which have spread the reputation of Costa Rica as a destination for high medical care at a low cost. One of these companies is Planet Hospital www.planethospital.com), which, last year, added Costa Rica to its destination list.
“Guanacaste has more foreigners each year who come to have surgeries done”, added Cascante.
Relaxation and wellness
Another variation of medical tourism that has recently become more popular is “wellness” tourism which includes spas, gyms and hotels specializing in the area of relaxation, cosmetic, facial and body treatments combined with travel packages to tourism attractions.
An example of this latest trend is the Ailanto Wellness Resort & Spa, at the edge of the Miravalles volcano in Guanacaste and hotels and rest homes such as Paradise Cosmetic Inn, in Escazu which is also a convalescence home for patients who have undergone plastic surgery, Hotel Che Tica Rancho and the Hotel Martino Resort & Spa in La Garita de Alajuela.
Ilia Portocarrero, from the Hotel Martino Resort in Alajuela, offers her spa services to both nationals and foreigners who would like to pamper themselves with a facial, massage, body treatments or even hair implants
“Our mission is to offer specialized and complete spa services for an alternative relaxation experience”, added Portocarrero. “Many of our treatments include packages for visiting other areas, such as a one-day tour to a volcano, while they also enjoy a day of treatment during their vacation”.
Another initiative that illustrated this growing tourism trend for relaxation is the
Innovative Rebalancing Bodywork Program (www.becometocostarica.com) which lasts 400 hours and is scheduled for next November to January. The program includes holistic work, meditation, yoga and techniques for liberating negative energy from the body and positively developing the mind in order to avoid diseases through proper energy flow and ultimately improves the quality of life for participants. The next workshop will be held at the Hacienda del Sol complex near beautiful Playa Nosara in Guanacaste.
In the new world of medical tourism, hundreds
of thousands
of U.S.
residents are going overseas for healthcare
Posted on Sun, Sep. 30, 2007
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
Hammered by lack of insurance and high prices for healthcare, many Americans are looking overseas for care.
No one has exact numbers, but the new Medical Tourism Association, based in West Palm Beach, estimates that hundreds of thousands of Americans are now traveling out of the country for care.
Prime example: Madeline Del Sol of Pembroke Pines. With no insurance, she needed extensive dental work, including
an implant, root canals and fillings replaced. South Florida dentists gave her estimates of $11,000 and $13,000.
A Colombian friend suggested she go to Barranquilla, and recommended a dentist. Del Sol was impressed by how warmly she was treated. "I felt like a human being. In the United States, I'm just a dollar sign."
She had a bone implant, two root canals and 13 old fillings replaced for $2,000. The work was superb, she said. "It's probably the best experience I've ever had with doctors."
Still, in the world of medical tourism, it is a matter of buyer beware. Earlier this summer, a woman in Royal Palm Beach died from complications of gastric bypass surgery in Mexico, according to the Palm Beach Post.
Stephan Baker, a cosmetic plastic surgeon in Coral Gables, said he's treated two patients who suffered overseas disasters -- a tummy tuck done in Panama that resulted in a fluid build-up in the abdomen and a tummy tuck done in Costa Rica that ended up with "a pretty significant infection."
Those patients may have saved money on the front end, Baker said, but the resulting problems would have caused them huge post-operative expenses that could have been much more than the savings.
For some years, dental work and plastic surgery have been the primary healthcare reasons for going to Latin America, but with the graying of the baby boomer generation and the number of uninsured climbing toward 50 million, Americans' interest in Latin America healthcare is broadening.
"What's mostly on the increase is the complexity of surgeries, " said Carole Veloso, chief executive of the CIMA San Jose Hospital in Costa Rica.
"People are now actually asking about heart surgery, orthopedics and a lot of gastric bypass surgery or banding" of the stomach.
Veloso said gastric bypass in San Jose can be done for about $7,000, not including travel costs -- a huge
reduction over the $20,000 to $30,000 it's likely to cost in South Florida.
CIMA is part of a chain owned by the Dallas-based International Hospital Corp., which is dedicated to maintaining U.S. quality standards at its eight hospitals in Mexico, Brazil and Costa Rica.
While most of its patients are local, CIMA Chief Operating Officer Clifton Orme said the chain is working hard to gain accreditation through Joint Commission International, a sister organization of the group that accredits U.S. hospitals.
Such approval could take several years of preparation. In Latin America, the commission has so far accredited just 11 hospitals in Brazil.
For consumers, another possibility is seeking out an overseas facility with links to the United States. Johns Hopkins, for example, has working relationships with four hospitals and clinics in Latin America. The University of Miami is working to set up its own links, starting with Cartagena, Colombia, where several UM-trained doctors practice.
"There are great physicians everywhere in the world, " said Eduardo de Marchena, director of UM International Medicine Institute. "But it is very difficult to know where you are going to find quality."
Trying to bring order to that uncertain marketplace is the not-for-profit Medical Tourism Association.
Its goals include controlling standards and credentials, protecting "the reputation of medical tourism from disreputable hospitals" and creating "a comprehensive Web portal for people to learn about medical tourism."
"A lot of people are trying to fill this market, " said John F. P. Bridges, a Johns Hopkins professor who is on the MTA's advisory board.
"Far too many of them are dot-com entrepreneurs" seeking a new business. "I call them vultures."
Bridges, an economist, said many details need to be worked out -- guidelines about quality,
healthcare information and much more -- but he sees a certain inevitability in moving to a global healthcare system.
"Mexico isn't a third-world country when it comes to healthcare, " Bridges said. "If someone's going to say it's a spin of Russian roulette when you go south of the border, I don't think that's the case . . . Every other market has embraced globalization, why not healthcare?"
Overseas healthcare simply presents consumers with another choice, Bridges said, and they should research doctors and facilities overseas the same way they would in the United States -- looking for credentials, board certifications of doctors and word-of-mouth recommendations.
You can have surgery for less than half the price, but only in countries where you wouldn't drink the water. Is "medical tourism" a brilliant solution — or a too-risky business?
Two years ago, Jeanne Bennett could barely walk. Severely arthritic at 48, she had tried every nonsurgical remedy — prescription medicine, physical therapy, even acupuncture — but nothing helped. Her best option, said doctors at Duke University School of Medicine, was hip resurfacing, a new procedure developed in England that was in clinical trials in the United States. Since resurfacing was not yet FDA-approved, Bennett's insurance wouldn't cover the $48,000 cost. The married mother of two from Raleigh, NC, had that much in savings, "but the money was supposed to be for the kids" college fund and our retirement," she says. "I had to find an alternative."
Bennett approached her doctor about cheaper options abroad, where the surgery was regularly performed. He suggested the United Kingdom, where she would pay half the U.S. price. Around the same time, in April 2005, Bennett saw a 60 Minutes segment on medical tourism that featured Apollo Hospital in Chennai, India. "I asked my doctor what he thought about going there, but he didn't recommend it," says Bennett. "India's a third world country — he didn't trust the quality of care."
While considering England, Bennett also made contact with Vijay Bose, M.D., a doctor at Apollo Hospital who'd been interviewed on the show. He quoted her a price of $5,600 for the operation and her stay at Apollo Chennai, which is one unit of the 38-center Apollo Hospitals Group. He also gave her the names and phone numbers of two patients he'd treated — one American, one Canadian. When she called them, says Bennett, "they could not have spoken more highly of Dr. Bose as a man and as a surgeon." It was enough to convince her to choose India.
That summer, with one child at camp and another ensconced at her mother-in-law's house, Bennett and her husband boarded an 18-hour flight to Chennai. A hospital representative picked them up at the airport, took them to their hotel, and brought Bennett to Apollo the next day. "There was no checking in — I was taken straight to my room," she says. "Then a parade of people came in to introduce themselves: my surgeon, the head of the nursing staff, the international coordinator, a nutritionist, even the director of the hospital." Bennett stayed at Apollo for five days. "I felt totally taken care of."
Afterward, the hospital's international coordinator arranged for her to spend another five days recuperating 45 minutes away at a luxury beach resort on the Bay of Bengal, for about $700. Dr. Bose recommended she stay there 10 days, but Bennett needed to get home. "By the time I left the hospital, I already felt better than I had in years," says Bennett. Today, she walks normally, without pain. "It's like I never had a hip problem. There were no downsides."
Bennett is one American among tens of thousands who've traveled the globe in recent years for surgery at prices exponentially lower than those in the United States. But while many receive good-quality care, and sometimes even the movie-star treatment that Apollo staffers gave Bennett, patients abroad can also run into problems. "The level of standardization we have in the U.S. doesn't exist in most of the world," says Anmol S. Mahal, M.D., president of the California Medical Association. "Currently, there is no good system in place to help guide people through the maze of interpreting what is good medical care abroad."
Map of Medical Tourism: A Snapshot
Some tourism officials now tally the annual number of foreigners (including Americans) who use their health facilities. Caveat: In compiling these statistics, some countries defined medical tourism very broadly, as anything from surgery to a spa massage.
No one knows exactly how many Americans have traveled overseas for operations. Excluding cosmetic surgery and dental patients and counting just those seeking essential medical procedures, companies in the business of sending patients abroad estimate an annual total of only about 10,000. "It's simply not as big as it's often reported to be, but it's growing every year," says Patrick Marsek, managing director of MedRetreat, a Chicago-based booking agency that sent 200 patients overseas in 2005 and expects to send 650 in 2007. Other booking companies (often called medical concierges) report similar growth: New York–based Medical Tours International (MTI) arranged care for 60 Americans when it opened in 2002; they project at least 900 clients for 2007. California-based Planet Hospital says this year's number will be 1,200, up from 500 in 2006. Seeing this increased interest, some health insurers have begun selling packages to Americans who want to go abroad for health care.
To leave their country, in some cases for the first time, and undergo surgery halfway around the world, people need to be motivated — and the dollar savings of medical tourism (also known as surgical off-shoring) are persuasively large. In the U.S., heart bypass surgery is $113,000 and up for the operation alone; in Thailand, only $11,000. A hysterectomy, about $20,000 here, costs around $3,000 in Malaysia. And a knee replacement that would run around $48,000 here is $8,500 in India.
Price cuts that enormous might appeal to anyone, but for Americans without health insurance (the number is more than 45 million, reports the U.S. Census Bureau), lower costs can mean the difference between life and death. Researchers at the Institute of Medicine found that more than 18,000 U.S. citizens die every year because they don't have insurance. The National Coalition on Health Care (NCHC), a nonprofit group whose mission is to improve America's health system, estimates that there are also 35 to 40 million other Americans who are either underinsured, like Bennett, or have coverage that doesn't address the reality of their medical needs. Even people with good coverage can end up out of luck if health-plan administrators deny claims, alleging that the treatment isn't "medically necessary." That was dramatized this year in Michael Moore's film Sicko, as was the problem of escalating premiums, which have doubled in the last six years. Many employees are now forced to turn down coverage because they can't afford to pay their share. "Our system is not caring for people the way it should," says Scott Rubinstein, M.D., associate clinical professor of orthopedics at the University of Illinois School of Medicine in Chicago, who has provided follow-up care for medical tourists when they've returned home.
The situation is so dire that in 2001, medical costs drove an estimated two million Americans into personal bankruptcy, even though 75 percent had medical insurance at the onset of their illnesses, report researchers at Harvard University.
In 2006, middle-class men and women who become medical tourists to avoid plunging into poverty were dubbed "America's new refugees" by the New England Journal of Medicine. One such person is Howard Staab, an uninsured carpenter who testified last year before the U.S. Senate Special Committee on Aging. In 2004, Staab ventured to India for a mitral valve replacement that would have cost about $200,000 in his hometown of Durham, NC. At New Delhi's Escorts Heart Institute and Research Centre, the price was 96.6 percent less, or $6,700.
"The cost of health care is high, and people have started to vote with their feet. In time, there will be a lot of vacant American hospital beds," says Senator Gordon Smith (R-OR), former chairman of the Committee on Aging, who has enlisted the help of the Departments of State; Commerce; Health and Human Services; and Homeland Security to build a medical tourism task force. "But if Americans are going to travel for reasons of cost, they should have some assurance that the services they engage are legitimate, and not some snake oil abroad." Adds Kimberly Collins, the senator's spokesperson, "This is an industry ripe for fraud and abuse."
Saving Big Bucks
If you have surgery overseas, the prices can be staggeringly lower — in some cases, as much as 97 percent. Here's how the numbers stack up in five countries. Note: Most of these estimated dollar amounts were provided by Josef Woodman, author of Patients Beyond Borders, who surveyed hospitals to find averages.
Surgery:
U.S.
India
Thailand
Singapore
Malaysia
Mexico
Heart Bypass (CABG)
$113,000
$10,000
$11,000
$18,500
$9,000
$3,250
Heart Valve Replacement
$150,000
$9,000
$10,000
$12,500
$9,000
NR
Angioplasty
$47,000
$9,000
$13,000
$13,000
$11,000
NR
Hip Replacement
$47,000
$8,500
$12,000
$12,000
$10,000
$17,300
Total Knee Replacement
$48,000
$8,500
$10,000
$13,000
$8,000
$14,650
Gastric Bypass
$25,000
$6,000
NR
$26,000
NR
$8,000
Hip Resurfacing
$47,000
$8,250
$10,000
$12,000
NR
NR
NR: This country not currently recommended for this procedure.
Surgery can go wrong, regardless of the country where it takes place, the hospital where it's performed, or the doctor holding the knife. And, of course, quality of care varies from hospital to hospital, just as it does in America. That's why it's essential for patients to minimize the risks as much as possible by making good choices — something that's difficult to do, say critics of medical tourism, in nations where the standard of care is inconsistent and qualitative measures are often vastly different from those in the States.
"One of the struggles is that there is no data," says Arnold Milstein, M.D., medical director of Pacific Business Group on Health, a nonprofit group that focuses on improving the quality of health care while controlling costs. "All you can say is that there is more uncertainty about quality with this form of care than there is with American care." Dr. Mahal agrees that overseas treatment can be unpredictable. "While the best hospital in New Delhi is on par with some of the best hospitals in the United States, if you start comparing an average hospital in New Delhi to an average one in America, you would find an enormous discrepancy," he says.
Many medical tourists understand that they're leaving the safety net of health-care standardization. "It was scary going abroad. But life is not risk free," says Patty Sanden, from North Bend, OR, who needed a hysterectomy this year and saved at least $13,000 by having it in San José, Costa Rica. She relied on the booking agency MTI to prescreen doctors. Her surgery went well and the hospital staff, she says, "treated me like a celebrity."
Jennifer Schilling, 38, also used a concierge to schedule a hysterectomy abroad, but she did more research than Sanden. Still, she found it hard to get a clear picture. Learning earlier this year that she needed an operation, Schilling called her local hospital in Springfield, MO, to find out how much her stay would cost, apart from the surgeon's fee. "They told me the mean was $30,000, but that it could go as high as $200,000 if there were complications," says the married mother of two, who owns an equipment rental company. Knowing that her insurance had a $5,000 deductible and a 20 percent co-pay, she did the math and drew her own conclusion: "If something went wrong, my co-pay could've been $40,000. I couldn't take that risk." So she contacted MedRetreat. What she learned: Treatment in Penang, Malaysia, would cost $8,000, including the surgery, hospital stay, tests, travel, and 18 days at a five-star hotel.
MedRetreat recommended Suresh Kumarasamy, a surgeon at Gleneagles Medical Center. Schilling went to the hospital's Website and read the doctor's bio, which stated that he had trained in England. She searched other sites in hopes of verifying that information, but she couldn't get the facts nailed down. And although she had a list of his degrees (from his bio and from materials sent to her by MedRetreat), she was baffled by the acronyms, such as M.B.B.S., M.Ob.Gyn., and MRCOG. So she tried another angle: talking to one of Dr. Kumarasamy's former patients (MedRetreat supplied the name and phone number). "I could tell this woman was hard to please, and she thought very highly of Dr. Kumarasamy," says Schilling. Reassurance also came from MedRetreat's destination program manager, an American woman who lives in Penang and volunteers at the hospital.
Once at Gleneagles, Schilling was further impressed when, during presurgical testing, Dr. Kumarasamy told her that she had a heart murmur. "No one in the States had ever caught that," she says, "and he heard it through his stethoscope."
When Good Housekeeping asked Patrick Marsek of MedRetreat to explain the acronyms in Dr. Kumarasamy's degrees, he admitted he didn't know what they meant. "Most patients don't ask these kinds of questions," he said. Perhaps that's because most are accustomed to simply accepting referrals from doctors and trusted family members and friends. But operating overseas, outside one's local medical network, requires much more vigilance.
Marsek promised to investigate the degrees for us (stressing that he would do the same for any patient who asked), and in a later e-mail, he supplied the answers: M.B.B.S. is an Indian Bachelor of Medicine and Bachelor of Surgery degree, achieved after five to six years of study; an M.Ob.Gyn. is the Malaysian equivalent of a postgraduate program combined with a residency in obstetrics and gynecology. MRCOG means that the doctor is a member of the elite Royal College of Obstetricians and Gynecologists in London. But even if a medical concierge delivered this kind of information to a patient, how could she evaluate and verify it?
The first step is to ask the booking agency if they've done any vetting of the doctors and hospitals they propose. Stephanie Sulger, R.N., M.S., director of International Medical Services at MTI, says it's dangerous to research cost and take the rest on faith. "When someone who's desperate for care Googles 'cheap' and 'hip replacement' or 'gastric bypass,' they're likely to go with whatever they find because they've been led to believe that everything overseas is OK. It's not," explains Sulger. She says that the company spends 30 percent of its time researching overseas doctors, checking with the credentialing boards in each country, and verifying that any memberships they claim in important medical organizations are current. She says MTI no longer sends patients to certain hospitals because of concerns about some of their doctors' credentials.
Whatever efforts are made by booking agencies, what's missing is a comprehensive accreditation process by which established medical experts in the U.S. can evaluate foreign hospitals. In America, the gold standard is the Joint Commission, which evaluates some 15,000 health-care organizations (from hospitals to labs). JC has an international branch, Joint Commission International, which started accrediting in 2000. But so far its reach is too limited for its credential to be considered the last word. JCI currently accredits 127 international hospitals and has about 100 others now preparing for review. Foreign hospitals aren't required to apply, and many don't; some of those facilities may be substandard, but others are possibly put off because the process takes most hospitals 18 to 24 months and costs, on average, $30,000. So while the JCI credential is meaningful in judging a hospital, its absence may not be a problem.
Some experts even question the quality of JCI's reviews. "It's very difficult to evaluate the medical training of practitioners and the ongoing quality of facilities outside the country," explains Joel Miller, senior vice president of operations for NCHC.
Consumers looking beyond JCI for endorsements from the U.S. medical community may find themselves in a sea of salesmanship. The key is knowing which claims are legitimate. For instance, on its Website, Wockhardt Hospitals, Mumbai (a JCI-accredited facility in the Wockhardt Hospitals Group) touts its association with Harvard Medical International, a branch of Harvard Medical School. That affiliation is confirmed by HMI, which explains that although the Mumbai, India, hospital is not staffed with Harvard-trained doctors, as some prospective patients might assume, HMI has provided a range of training and education services to Wockhardt, from professional management to systems development to helping the hospital prepare for JCI accreditation review.
But not every hospital's claims are as substantial as Wockhardt's. In July 2007, when Good Housekeeping checked out the Website of the Asian Heart Institute in Mumbai, we found the logo of Ohio's Cleveland Clinic, an elite cardiac-care center. We also learned that the clinic's name appeared on AHI stationery and was engraved in stone at the Mumbai hospital's entrance. All this was news to Cleveland Clinic spokesperson Eileen Sheil, who says that her hospital's only connection with AHI was to consult on purchases of new technology and the use of medical equipment on an as-needed basis. "The Cleveland Clinic is in no way involved with hospital management or patient care at the Asian Heart Institute," Sheil says. The Cleveland Clinic terminated its already limited relationship with AHI in July, and is investigating the hospital's use of its logo. Within a week of Good Housekeeping's conversation with Sheil, the Cleveland Clinic logo was removed from AHI's Website.
These women traveled the world for cheaper surgery
Patty Sanden, 50 SHE STAYED IN PARADISE COSMETIC INN HOTEL!!!!!
Hysterectomy, May 2007, Costa Rica
She saved: $13,000*
Why I went abroad: "I needed a hysterectomy, but it would have run around $17,000 in the U.S. In Costa Rica, it was $3,500 (not including airfare and hotel, which were around $3,000). My husband also needed major dental work — $6,000 in the U.S. versus $1,400 in Costa Rica." (Read her story here.)
Best part: "How professional and thorough the doctors were. And the staff treated me like a celebrity."
Worst part: "My American doctor refused to speak to my surgeon in Costa Rica. She said she didn't feel comfortable, and left it at that. She agreed to send a copy of my records, but they didn't arrive until three weeks after my operation. Luckily, I'd gotten an ultrasound elsewhere, so my surgeon had that to work with. As for the language barrier, the doctors all spoke English, but few people on the support staff did, so my bilingual driver did a lot of translating."
What I wish I'd packed: "More clothes. We had no facilities to wash our own, and the hotel's laundry rates were much higher than I expected."
My advice: "Get a copy of your medical records before you go, and work with a booking agency. It was really helpful that the company I used [Medical Tours International] took care of prescreening doctors and hospitals."
She lies limp on the operating table, like Christ on the cross, arms spread open, feet together. Her bare breasts and torso glisten with a red antiseptic spray beading on her flesh. A respirator pumps oxygen through her lungs, causing her chest to rise and fall to the beat of the techno music to which the doctors choose to work. Marker sketches work their way up her abdomen from her pubic hair like a blue grid.
Sucking It Up: Dr. Cristian Rivera, right, uses a vibroliposuction device to extract fat from a patient’s back at theIberoamérica University clinic in Tibás
They have just flipped over her body after sucking the fat out of her back with a footlong vibrating wand Dr. Cristian Rivera jabbed beneath her skin. Some of her orangeyellow fat sits in a cup on a table next to her.
Rivera proceeds to carve a slab of skin and fat the size of a prize-winning bass from her stomach.He uses an electro-coagulating tool to cut and burn through the fat, causing small clouds of burning human to rise into the operating light. His assistants toss the slab into a plastic sack, making the sound of a textbook dropping into a shopping bag.
Just a couple of hours after they put her to sleep, they yank the unnamed Costa Rican patient’s skin down from her abdomen and sew shut the hole they have just cut into her.
Just like that. A tummy tuck.
This is the future of tourism in Costa Rica, officials say. This, and breast implants, facelifts and liposuction.
Plastic surgery tourism will help rescue the industry’s sluggish growth rate by attracting foreigners such as Idaho resident Sally Shephard to Costa Rica’s operating tables and beaches, according to Costa Rican Association of Tourism Professionals (ACOPROT) vice-president Carlos Lizama.
Two birds, one stone.
“It’s like a vacation,” says Shephard, as she lies in a hospital bed in the Iberoamérica University (UNIBE) clinic in the northern San José district of Tibás, a day after Rivera used a vibroliposuction wand to slurp four kilograms of fat from her stomach and back.
“I want to go down to the beaches now.”
Patients such as Shephard can come to Costa Rica and pay a fraction of the cost they pay at U.S. hospitals, where prices are higher because of insurance and labor costs.
Shephard spent $5,000 on her procedure. Afterwards, she’ll go to one of the few hotels dedicated to exclusively caring for plastic surgery patients. Once she’s better, she’ll meet up with her husband and her niece (who is getting her mamas, or breasts, done), and go to the beach. She plans to spend a month in the country.
Exclusive Resorts
Up in the hills of San Antonio de Escazú, a western suburb of San José, Raúl Cossío has been building what will be the country’s biggest resort exclusively for plastic surgery patients. The 32-room hotel, which will have its own dentist on-site and nurses to tend to healing patients, is situated on 4.5 acres with a panoramic view of the city below.
Cossío’s Paradise Cosmetic Inn resort will also feature a butterfly farm and a spa offering patients lymphatic massages.
“We’ll have bingo, too. And we’ll make it interesting. If you win, you get a free shot of Botox,” he says, his smile stretching tight across his skull.
Cossío, a Cuban-American real estate lawyer whose face is wrinkle-free, spent $3 million with partners to front the cost of his dream.
“There are lots of hotels like this, but only in Brazil,” he says, looking out upon the half-constructed hotel, which is set to open this month.
After the United States, home to 5,000 registered cosmetic surgeons, Brazil, with about 4,000, comes in a close second as the biggest country for cosmetic surgery, according to the American Society of Aesthetic Plastic Surgery.
Costa Rica has about 40 surgeons, according to Rivera. But the market here is growing fast – at about 20% a year, according to Hernán Campos, a Chamber of Industries researcher who did a study on the plastic surgery market in Costa Rica. In 2006, nearly
6,000 patients were operated on here, he says.
Though Costa Rica’s growing market is relatively small compared to the two giants, the tiny country’s plastic surgery market is posed to bank off cheap costs for clients, a market with quality surgeons, and a country where plastic surgery can go hand in hand with sunny beaches.
In Costa Rica, breast implants, for example, can cost a third of what they cost in the United States (about $6,000).
Also, Rivera says Costa Rican surgeons have more than a decade’s head start when it comes to silicone breast implants, which were virtually banned in the United States for 14 years and only recently regained U.S. Federal Drug Administration approval.
Cosmetic Vacations
Cossío, 56, doesn’t look 56. He came to Costa Rica five years ago to get a face-lift. The trim, tennis-playing Miamian has hair implants, “and I won’t say what else I’ve had done,” he laughs.
He says that while healing after the facelift he explored San José with fresh bruises from the surgery.
“I didn’t care if anybody saw me,” he says. “I didn’t know anybody.”
Anonymity: another market advantage Costa Rica has for foreigners.
When Cossío arrived, he stayed in a small guesthouse with ho-hum food and service. That’s when the idea hit him. Plastic surgeon friends of his confirmed his hunch.
“We have a problem: there aren’t enough quality lodgings to meet the increasing demand (for foreign plastic surgery patients),” Rivera says.
He’s been marketing his “cosmetic vacations” product to try to get a piece of the U.S.’s $12.4 billion cosmetic surgery industry. Specifically, he targets married couples nearing retirement, from the United States and Canada.
Lizama calls Paradise Cosmetic Inn “a very interesting initiative that tells us this could grow much more.”
He says health and medical tourism, which will attract people coming to Costa Rica for the health benefits of its climate and the affordability of its medical treatments, will be a big market in 2007. The average plastic surgery patient stays for up to two weeks and spends between $8,000 and $12,000 (about five times the country’s percapita income).
“I’m glad you see the value in this market,” Tourism Minister Carlos Benavides told Cossío at a recent event at the Casa Presidencial.
“It’s health tourism. It reinforces the quality of this destination and gives it a better image. And it always brings them back for a second visit,” Benavides later told The Tico Times.
Vanity Fair?
Back at the UNIBE clinic, Shephard sips a glass of water and munches on saltine crackers.
This is the first time the 54-year-old grandmother has been in a hospital. About a year ago, a friend came to get liposuction here, and returned home happy. So Shephard decided it was her turn. She was willing to take the risk of not being able to sue a Costa Rican doctor should something go wrong.
“Fat. I just wanted to get rid of it,” she says. She saved thousands on operation costs here, which she will put toward her subsequent beach vacation, she says.
Rivera says that nowadays everyone knows someone who has had plastic surgery. Shephard says she has three friends who have hit the cutting board, and her niece is next. “I think we are vain, but that’s how society is,” she says.
Rivera, 34, says about a third of his clients are foreigners – virtually all North Americans. There is a “growing wave” of foreigners coming to Costa Rica for plastic surgery, a market that is ready to explode, he says.
“The boom hasn’t arrived yet,” says the doctor who nonchalantly carries on conversations with a cellular phone earpiece while operating.
He says low prices aren’t the only thing Costa Rica has going for it. The country also has quality doctors, who offer cutting-edge procedures such as the most recent form of liposuction, known as “vibrolipo.”
Rivera specializes in the latest liposuction technology, which takes out more fat in a fraction of the time, is less obtrusive than traditional liposuction, and means faster recuperation for patients.
Most of his clients come for aesthetic operations, with breast implants and vibroliposuction the most popular. About 20% come for reconstructive surgery, or because their doctors sent them to get liposuction because of obesity problems. Another 20% are patients who lost weight and want skin removed.
Rivera says that though many patients come back for different surgeries (about a third of his patients return), he doesn’t believe there is such a thing as addiction to plastic surgery.
“They’re just losing their fear of plastic surgery,” he says.
Rivera says his team of 10 employees takes before and after photos of each patient. Many look like completely different people. Some have had to get new ID cards.
“It is very meaningful when you see their facial expressions afterwards; they’re smiling… it helps people improve their selfimage, makes them more socially productive,” he says.
Unfortunately, he says, most people can’t afford the procedures.
In searching for your recovery retreat in Costa Rica you will find under Plastic Surgery Forums all there is to know about recovery retreats in Costa Rica. Plastic Surgery Forums will also assist you in your search for a Costa Rican Plastics Surgeons. You will find that Costa Rica Plastic Surgery is affordable. Plastic Surgery in Costa Rica is generally one-Third the price of the same procedure in the U.S.
We invite you to visit the Plastic Surgery Forums , Costa Rica Plastic Surgeons and Costa Rica Recovery Retreats. We here at Paradise Cosmetic Inn believe that our best customer is an educated customer.
Welcome to www.paradisecosmeticinn.com web site: welcomes patients from Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Virgin Island, Washington, Washington DC, West Virginia, Wisconsin, Wyoming, Costa Rica, BRAZIL, ARGENTINA, PANAMA, EL SALVADOR, MEXICO, COLOMBIA Although referral services to medical specialists are provided upon your request, we do not sponsor, endorse, recommend or approve of any medical specialist or other service provider who offers services through this site.
(C.A. News) — The opening of new spas, hotels and tourism projects offering medical services and plain relaxation in Guanacaste is just a mere sample of Costa Rica´s so-called “medical tourism” sector which has been on a growth spurt. 
