In yesterday’s interview with Dr. Miguel Alfaro of Costa Rica, he candidly noted that the number of plastic surgery patients coming to Costa Rica from outside the country is down by perhaps 15-20 percent in 2008. This should surprise no one, given the state of the economy in the United States. In fact, Costa Rican plastic and cosmetic surgeons are probably weathering the economic slowdown better than are their higher priced counterparts in the U.S. The American Society of Plastic Surgeons estimates that business is down more than 50 percent, according to CNN, as reported by the Business and Media Institute.

The market for cosmetic procedures in Costa Rica, Mexico and other medical travel destinations has held up better than the U.S. market primarily because of the large price differential and because more Americans than ever before are aware that plastic surgery abroad is a relative bargain. Plastic surgery and dentistry travel (or both, combined) remain among the top choices of BridgeHealth International clients in 2008. People who might have opted for procedures costing $10,000 to $30,000 or more at home are instead getting the same work done abroad for perhaps $3,000 to $10,000.

The CNN report linked below looks only at the sharp decline in cosmetic surgery in the U.S. We thank Dr. Alfaro for his estimate regarding patients in Costa Rica. The video is better viewed on their site due to the format of the file.

Plastic Surgery’s Nip: CNN

Costa Rica was among the first well-known destinations for modern medical travel, dating back to the 1970s and early 1980s when some pioneering plastic surgeons and dentists first began serving international clients. Among them was Dr. Miguel Alfaro, who, like many Costa Rican surgeons, came to medical school in the United States and was trained in general and plastic surgery at the University of Colorado; the University of Missouri and the University of Michigan. He returned to Costa Rica in 1976 and worked for years for the country’s public health care system, while building his private practice in plastic surgery on the side. Most recently, Alfaro has been chairman of the Department of Surgery at Hospital San Juan de Dios in San José, Costa Rica.

Among other professional associations, Dr. Alfaro belongs to the International College of Surgeons; the Costa Rican Plastic Surgery Association; and the Plastic Surgery Association for Iberoamerica. He is a Fellow of the International College of Surgeons, a member of the American College of Surgeons and a Founding partner of the Costa Rican Association of Mastology.

Alfaro prides himself on being a conservative plastic surgeon and has built his international reputation in plastic surgery on excellent results as well as a safety record that is second to none.

“I have very good results,” he said in a recent interview with The Bridge. “I have done thousands of operations and I am very conservative … I mean, if I see a change in technique going on, I will wait a few years, frankly. I want to be sure it is safe, see what complications are encountered by others.”

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It should not surprise anyone that there is no mention of medical travel and tourism in the platform of either the Republican or Democratic parties. However, it’s lurking beneath the surface.

GOP candidate John McCain’s healthcare policies and positions would encourage Americans to take greater individual responsibility for their healthcare choices. Health benefits would no longer be treated as tax-free income; instead, individuals and families would get substantial tax credits for medical spending and would have tax-free health savings accounts.

Obama’s plan calls for most employers to either provide benefits or to pay into a national healthcare plan. He would create a National Health Insurance Exchange where insurers would sell coverage to small businesses and individuals. To participate, insurers would have to disclose costs and benefits of various plans and the percentage of premiums that go to patient care as opposed to administrative costs. The goal is to create a transparent market for health insurance that will improve quality, efficiency and value.

It is easy to see how medical travel would continue to grow under the administration of either man. Under McCain, consumers would presumably pay more attention to their own medical costs and might opt for care abroad. Under Obama, it is more likely that insurers bidding to be competitive with individuals and small businesses will look to provide innovative plans that keep costs down.

The odds are that you’re not going to be hearing either candidate out on the campaign stump extolling the virtues of outsourcing; more likely you’ll hear the opposite. But when all is said and done, there is nothing in the healthcare proposals of either party that is inimical to medical tourism.

A tip of the hat and a link to Amanda Hayes-Kibreab and Natasha Bellroth, who wrote a more extensive analysis:

How Would Obama and McCain’s Healthcare Proposals Impact Medical Travel?

The authors say McCain’s proposals are more friendly to medical tourism than are Obama’s. The only thing I’m sure of is that we probably don’t get to try both routes to healthcare reform.

Medical tourism seems likely to be part of the solution, either way.

Syndicated columnist Froma Harrop of The Providence Journal in Rhode Island writes about the “good and bad” of medical tourism in a piece that has appeared in newspapers from coast to coast over the past few days (including in The Seattle Times: Medicine through the back door.) Harrop fancies herself something of a pioneer as a medical tourist, having had Lasik ™ eye surgery in Toronto in 2000, paying about a quarter of what she would have in the United States, saving $3,000. She says that, at the time, “Canadian doctors had more experience with Lasik surgery than most of their American colleagues.”

I took 10 minutes to surf about the web and see what I could find out about traveling to Canada for eeye surgery now, in 2008. Disconcertingly, even in that small amount of time I could tell that it is very difficult to cut through the data smog I wrote about the other day. There is not a lot of concrete, objective information about getting Lasik in Canada that is immediately visible. Almost certainly, the cost difference between the U.S. and Canada has narrowed. A Canadian dollar was wotth only about 70 cents in U.S. money in 2000; today the currencies exchange at approximately 1:1.

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