The Center for Disease Control’s 2010 travel health guide has a much-expanded section on medical tourism, the practice of going abroad for your medical care. U.S. citizens going overseas for medical or dental procedures often cite lower costs as their primary motivator.

The CDC updates its Health Information for International Travel (also called the “Yellow Book”) every two years. The latest edition discusses the pros and cons of medical tourism, and explains why the practice is on the rise.

“In recent years, standards have been rising in other parts of the world even faster than prices have surged in the U.S. Many physicians abroad trained in the U.S. and the Joint Commission International (JCI) applies strict standards to accreditation of offshore facilities. Those facilities use the same implants, supplies, and drugs as their U.S. counterparts. However, a heart bypass in Thailand costs $11,000 compared to as much as $130,000 in the U.S. Spinal fusion surgery in India at $5,500 compares to over $60,000 in the U.S.”

The CDC guide quotes the American Medical Association’s tip for planning a surgery abroad:

–Patients should check to see if the medical facilities abroad have been accredited
by recognized international accrediting bodies such as the Joint Commission International or the International Society for Quality in Health Care.

– Prior to travel, arrange local follow-up care to ensure continuity of care when you return from medical care outside the US.

It’s free to use CDC’s Yellow Book online, but if you’d like a hard copy, its $29.95 from Elsevier.

See also:  Medical tourism 101

Medical tourism, the practice of going abroad for medical care, is growing at an astonishing rate. The Centers for Disease Control (CDC) estimates that in 2006, half a million Americans traveled abroad for health care. According to the Deloitte Survey of Health Care Consumers, the number rose to 750,000 in 2007; the report projects that the figure will increase to 6 million by 2010.

The motivation is simple. Traveling halfway around the world for medical care has one enormous advantage, at least for U.S. citizens: you save money–often tens of thousands of dollars. And if you choose wisely, the quality can be as high as the best care you’d get in the U.S.

People travel abroad for root canals, routine dental work, face lifts, hysterectomies, joint replacement, and bypass surgery, to name just a few of the more common procedures. Some of those heading overseas are among the nearly 50 million Americans without health insurance. Some have insurance that doesn’t cover what they need or that has a deductible or co-payment so high it’s cheaper to pay out of pocket in another country. A small minority of the people going abroad for care are sent by their own insurance companies.

Recently, the nation’s largest health insurer, WellPoint, began a pilot program with Serigraph, a graphics company with operations in Wisconsin, Mexico and Asia. U.S. employees of Serigraph can opt to travel to India to have non-emergency surgery. WellPoint says the cost of care is about 80% lower in India, largely because of dramatically lower charges for labor, drugs and medical devices. WellPoint is partnering in India with Apollo Hospitals, a consortium of 47 medical facilities.

Just how much can you save?  Recent figures from the CDC: spinal fusion surgery in India costs $5,500, compared to over $60,000 in the U.S.; a heart bypass in Thailand costs $11,000, compared to as much as $130,000 in the U.S. A report last year in Business Week echoed the CDC’s figures for heart bypass operations in Thailand and the U.S., adding that in Singapore that operation would cost $18,500 and in India $10,000.

See more on Wellpoint in the Los Angeles Times.

Intense training can be a risk in travel-related DVT

In hospitals, deep vein thrombosis (DVT) may occur after surgery, especially surgery below the waist, like hip surgery. And it’s true that you should avoid surgery for at least 30 days after air travel if possible.  But the risk factors for DVT on an airplane are very different from those in a hospital, and include recent intense athletic conditioning, particularly training for endurance sports like marathons.

According to Airhealth, the most common travel-related risk factors for DVT are:

1. Athletic training, especially training for endurance sports like marathons.

2. Recent surgery or injury. If you have just run a marathon, you probably have at least minor bruising that can trigger clotting. Kick-boxing also produces such injuries.

3. Personal or family history of DVT.

4. Cancer, heart disease, diabetes. Obesity is often cited as a risk factor, but probably ranks much lower than the preceding diseases.

5. Women who are pregnant or taking estrogen as birth control or hormone replacement.

6. Age over 40 is often cited as a risk factor; sometime age over 60 is cited. Butin Airhealth’s registry, over 80% of those suffering DVT while traveling are under age 60, and the majority are under 50.

See also How to avoid blot clots while traveling.

They're squeezing more and more passengers into coach these days. Photo from blisstree.com

Take heart, obsessive travelers: according to the Centers for Disease Control (CDC), more than 63 million Americans travel abroad each year, and the great majority of them never have any major problems.

Still, we need to pay attention to the risks of travel. A study released yesterday by doctors at Harvard University found that travel is associated with a 3-fold higher risk for blood clots, called deep vein thrombosis (DVT), with the risk increasing for each 2-hour increase in travel time.

The clots, which often form in the deep veins of the legs, may occasionally break loose and head for the heart or lungs, which may lead to heart failure or stroke (which may, in turn, lead to death). Lots of “maybes” in that chain of events, but still, we need to pay attention.

Any type of travel where you sit still for long periods can be potential dangerous, but flying seems to be especially problematic. It’s harder to get up and move around on a plane, your legs are often stuffed into a woefully small space (in fact, DVT is often called “economy class syndrome.”) And the air in planes is also very dry, raising the risk of dehydration.

Scary, to be sure. But the CDC offers some simple but effective steps to minimize your risk.

While traveling

1. When sitting for long periods of time, such as when traveling for more than four hours:

• Get up and walk around every 2 to 3 hours.
• Wear loose-fitting clothes.
• Drink plenty of water, and avoid drinking anything with alcohol or caffeine in it.

2. Exercise your legs while you’re sitting by:

• Raising and lowering your heels while keeping your toes on the floor
• Raising and lowering your toes while keeping your heels on the floor
• Tightening and releasing your leg muscles

Lifestyle changes that help you avoid DVT:

• Exercise regularly
• Maintain a healthy weight
• Don’t smoke
• If you have a family history of DVT, talk to your doctor about medication (anticoagulants) to prevent or treat DVT

At Airhealth.org you can download a handy wallet card that reminds you of how to avoid DVT.

Icon by The Lighthouse, a center for architecture and design in Glasgow

You’re trekking in Nepal, touring the Russian Steppes, or just out for a long day of siteseeing. It’s not that the toilets are terrible. It’s that there are no toilets, period. And you’re on yours.

Or that murky coffee from a street vendor has kicked in and is kicking your butt, literally. The need to relieve yourself is so strong you’re sweating and trembling. What do you do? Pop a squat behind a bush or parked car? Use your visa to wipe yourself?

When you do find a toilet abroad, what’s your procedure? The ways we relieve ourselves in public toilets say everything about our upbringing and attitudes. Would you never in a million years let your flesh touch a public toilet seat? Are your thigh muscles like iron from years of hovering? Or do you “feather your nest,” carefully layering toilet paper onto the seat?

And what do toilets say about the country they’re in? In “Toilets of the World,” Morna Gregory and Sion James write: “The variety of toilets in different countries is astounding. Toilets often (though not always) reflect the development of a given country or region via design, placement, material and mechanics. Aren’t toilets the same everywhere? In a limited geographical area, perhaps. On an international scale, toilets are very, very different.”

Tell us your stories. Share your tactics. And come back to the site often to see what other people have to say.