What is Medical Tourism?
Medical tourism (also known as medical travel or health tourism) involves traveling to a foreign country for a medical procedure. Historically, medical tourism was less tourism and more medical—patients from less developed nations traveled to Europe or the U.S. for medical procedures that were unavailable in their own country. These days, however, things are different. People from developed countries like the U.S. and Canada are increasingly traveling abroad for medical procedures. Drawn by affordable prices, convenient travel options and short wait times, these people are getting the dental work, specialty surgeries, and check ups that they need. The doctors are high-quality (many have been trained in the U.S.) and the facilities are top-notch. There are many reasons why people travel for medical procedures. The following are the most common. Due to inefficiencies in the healthcare system of their home country, there may be extensive wait times for a procedure. This is the case in Canada, where in 2012 the average wait time between referral and procedure was almost 18 weeks. Cost is another huge factor. Often times, the cost of a procedure abroad is around half the price of the same procedure at home—even with the added expenses of travel, patients typically save a large sum of money. Insurance factors into the equation as well. Some people may be uninsured or underinsured, or want elective surgeries that their insurance provider will not cover. In cases like this, people travel abroad to receive treatment that would be too expensive at home. As the world becomes increasingly more connected, travel is getting easier and more affordable. The cost and duration of a flight to Central America is now comparable to domestic travel. This has made combining a vacation with medical treatment much more enticing and realistic.
Misconceptions About Medical Tourism
People often question the legitimacy of doctors and hospitals in other countries. This is, in fact, a good thing. You should be interested in the qualifications of the doctors who treat you and the type of equipment they use. Both can have a tremendous impact on your health.
There is an endless amount of information on the Internet about medical tourism. Appropriately, there are a great deal of misconceptions regarding medical tourism. The following are some of the most common.
The first misconception is that foreign doctors are less qualified than doctors in the U.S. or Canada. In some parts of the world, this may be true—the doctors, for example, in rural Africa are no doubt less qualified than doctors in the U.S. However, in places like Asia and Central America, this is simply not the case. Many physicians, dentists and doctors in developing nations are educated in American or western European medical schools. They undergo the same rigorous training as native citizens and must be fully accredited by their home country’s governing medical body. It’s common for these doctors to be part of a government program that requires them to return home and practice.
The second most common misconception is that foreign hospitals or clinics do not have proper medical facilities or equipment. International standards require these facilities to be safe and secure and many hospitals decide to become accredited by an international organization, such as the Joint Commission International (JCI) or the American Association for Accreditation for Ambulatory Surgery Facilities International (AAAASFI), to gain the confidence of foreign patients. Due to this, many of these hospitals/clinics have state-of-the-art equipment (much of which is imported from the U.S.) and offer the most up-to-date procedures. Most dentists in Costa Rica, for example, import their equipment from the U.S. and use the same products for crowns, implants and veneers that a dentist in the U.S. would use.
Many people assume that foreign doctors do not speak English. In most cases, this is not true. As previously stated, many foreign doctors train at universities in the U.S. or Europe where English is required. English is also often compulsory in some primary and secondary schools in Costa Rica. Because of this, these doctors speak excellent English and can communicate confidently and precisely.
A final misconception is that the cost of travel will more than account for the savings incurred from an affordable medical procedure. Although the amount you save depends on the type of procedure and the duration of your stay, most medical tourists end up saving money. As you will see in the next few pages, treatment abroad is significantly more economical—so much so that the savings more than cover the amount of money you will spend on airfare, hotels, and food along the way.
Medical Tourism in Costa Rica
Rising healthcare costs in the 1980s and 1990s lead patients to look overseas for more affordable options. The close proximity and high standard of care in Costa Rica began to attract medical tourists, especially for dental work. During this period, Americans began traveling to Central America to get dental work that was not covered by their insurance or that they could not afford.
Costa Rica’s medical tourism industry continued to grow. Today, Costa Rica is one of the most reliable, affordable and efficient countries for medical procedures. In 2011, San José, the capital of Costa Rica, registered 46,474 foreign patients. The number of medical tourists in Costa Rica is expected to continue rising. Nearly one-quarter of Americans now have passports and flights to Central America are more affordable than ever.
Costa Rica has high-quality doctors and dentists, many of whom were trained in the U.S. and are fluent in English. Although there are dentists and doctors throughout Costa Rica, the majority of procedures are carried out in San José. San José has the country’s best clinics and hospitals, including the CIMA, Católica and Bíblica hospitals.
Types of Procedures
From dental work to cosmetic surgery, there is a wide range of medical procedures offered in Costa Rica. We’ve boiled down some of the most common and listed them here.
The specialties most sought by medical tourists include dentistry (42%), gynecology (22%), preventive medicine (16%), plastic surgery (10%), orthopedics, and bariatrics. Other specialties include general surgery and dermatology.
For in-depth information on any individual procedure, please visit HuliHealth’s website. The waiting time, cost, and recovery for each procedure is different. If you are thinking of traveling to Costa Rica for a medical procedure, research the specifics of what is involved.
The following list compiles the most common specialties and procedures.
Dentists: implants, crowns, veneers, bridges, dentures
Plastic surgeons: plastic surgery, reconstructive surgery
General surgeons: gastric bypass, gastric sleeve
Orthopedic surgeons: hip, knee, and shoulder replacements
Dermatologists: laser removals, Botox
Savings and Costs
One of the best things about traveling to Costa Rica for medical care is that you save money without cutting quality. On average, medical tourists save 40-70 percent by getting a procedure done in Costa Rica. For example, a dental crown in the U.S. typically costs around $1,000, while in Costa Rica it is $500; a dental implant runs around $3,000 in the U.S. and is $900 in Costa Rica. With more serious medical work, the price goes up and the savings are larger.
The following list will give you an idea of how much some procedures cost.
Cost in United States
Cost in Costa Rica
$1,000 + per tooth
Abdominoplasty (Tummy Tuck)
In addition to the cost of the procedure, there are other costs that should be considered. Flights from the U.S. or Canada to San José typically run around $400-$700 (flying from Canada is usually more expensive). A mid-range hotel for two people will cost around $115–$140 a night.
In-country transportation costs are extremely variable and depend on if (and where) you plan to travel after your procedure. If you plan to spend a week in Costa Rica and visit popular destinations like Arenal, Monteverde or Manuel Antonio, a shared shuttle will cost around $40 per person. Private transportation is a bit more expensive and is around $150 for your own van and driver.
Food expenses are usually around $30–$50 per person each day. Taking a few tours will also increase the cost of a trip.
All that said, in most cases it is still more economical to travel to Costa Rica for medical procedures than it is to have them done at home. In fact, many travelers save hundreds, if not thousands, of dollars. Travelers often come to Costa Rica for more than one procedure – for example, your dental work might require four dental implants, which can include crowns, a sinus lift and a bone graft. Some people combine a tummy tuck with a breast lift, or liposuction with breast implants. The list of potential combinations is huge.
In addition to saving money, there are other advantages that medical tourists should consider.
The second word in the phrase “medical tourism” is important. Traveling to Costa Rica for a medical procedure also allows you to explore a foreign land. Costa Rica is a vibrant country that draws people from around the world. They come to hike in its rainforests, lounge along its beaches, and relax in its hot springs. It is also a place with more biodiversity than most everywhere on Earth—during your time here, you may spot monkeys hanging from trees or herons walking through estuaries.
Costa Ricans, known locally as ticos, are friendly and approachable. They welcome visitors with a smile and are keenly interested in showing travelers their country. If you’ve never practiced Spanish outside a classroom, this is a good place to start. The people are patient and helpful with those who attempt to speak their language.
Aside from the natural and cultural attractions of Costa Rica, the country has top-notch recovery facilities and spas. These places offer a comfortable and supportive environment for patients to recover after a procedure. Many have 24-hour nursing services, all-inclusive meal plans, and massage parlors.
The waiting time for medical procedures in Costa Rica is minimal. As opposed to places like Canada where you may have to wait several months for surgery, procedures in Costa Rica can be arranged to fit your schedule. The doctors and clinicians are flexible and are sometimes willing to adjust their schedule to see a foreign patient. HuliHealth has a convenient feature that allows patients to compare the availability of various doctors and dentists.
Costa Rica also benefits from medical tourism. In 2011, the average medical tourist to Costa Rica spent $7,000—in total, the industry brought in $337.7 million USD in revenue that year. Needless to say, this is a huge boon to the Costa Rican economy. Considering the country’s small size, medical tourism can have a widespread impact. The added revenue helps build better medical facilities and increases the funding for public services like schools and hospitals.
Another benefit of medical tourism for Costa Rica is a phenomenon that some have termed the “reverse brain drain.” This phrase refers to doctors and dentists who are trained at universities in the U.S. or Canada and return home to open a practice and educate their peers. By doing so, these doctors are helping set a higher standard of care in their country.
As with all medical procedures, there are risks associated with medical tourism in Costa Rica. Some of these risks include malpractice, operational risks, and miscommunication with the doctor.
A notable risk in Costa Rica is doctors or dentists who market a product, surgery or service that they are not legally allowed to perform. In these cases, the doctor or dentist may not have experience or training in the procedure they are advertising. An good example is a dental assistant who starts their own clinic and markets inexpensive dental work that is well beneath the dental board’s minimum price. Other dentists may claim to have specialty degrees, but have only completed a weekend course or internship. For this reason it is extremely important to thoroughly research the doctor or dentist you plan on visiting.
A specialty program typically lasts 2–3 years. The American Dental Association (ADA) currently recognizes nine specialties: endodontics, prosthodontics, oral and maxillofacial pathology, oral and maxillofacial surgery, oral and maxillofacial radiology, dental public health, pediatric dentistry, and periodontics. Cosmetic dentistry, dental aesthetics, and implantology are not recognized by the ADA as specialties, but make great marketing terms for some dentists. Beware any dentist that uses these phrases.
Although general dentists are legally allowed to perform any dental procedure, the ADA states that a dentist should only perform procedures in which they have substantial training and experience.
One other complication of medical tourism is the follow-up visit. It can be costly and complicated to arrange a follow-up visit in Costa Rica. If this is the case, patients can see a doctor at home. If you schedule a follow-up visit with your regular doctor, your medical records can be transferred to the appropriate hospital or clinic.
Choosing Good Doctors
Given these risks, it’s recommended to use a service to verify the doctor’s/dentist’s education. You can check the board of dentists (Colegio Dentistas Organization) or the board of doctors, known as Colegio do Medicos y Cirujanos Republica de Costa Rica (Medicos Costa Rica) to make sure that the practitioner is registered, active, and has the specialty they claim.
You can also use the [HuliHealth Doctor Directory][Directory]. HuliHealth verifies the qualifications, education, board certifications, and specializations of each doctor on their website. The vetting process is rigorous and involves regular screenings. As a result, only the top doctors in Costa Rica are offered on the site—these are the doctors, it so happens, that are recommended repeatedly by various medical associations and specialists. Patients can also write reviews of doctors after (and only after) they’ve booked an appointment on the site. And if a doctor receives bad reviews, they are pulled from the directory.
Once you have lined up a few doctors/dentists, feel free to contact them individually and ask questions. Ask about the procedure, their qualifications, or the recovery process. The more information you have, the better. Hospitals and clinics can usually be reached by phone and email.
Once you have found a doctor or dentist, booked a flight, and traveled to Costa Rica, it’s time to have the procedure.
There is no standard protocol for procedures, but most begin with a visit to your doctor or dentist. At the clinic or hospital, you’ll fill out necessary paperwork and be given a rundown of the procedure by the doctor or an aid. Paperwork and other pre-procedural exams (such as X-rays and CT scans) can sometimes be completed prior to traveling. Ask your doctor or dentist about this before you leave home.
In some cases, your procedure will be the same day as your initial visit. For more serious surgeries (especially those that involve anesthesia), your procedure may be scheduled a day or two later. Your doctor or dentist will tell you what to expect and advise you about any dietary or medical restrictions that may apply.
Following the procedure, you will be given instructions for recovery and care—these usually involve rest, dietary suggestions, and pain medication. In most cases, you will be transported to your hotel (driving after anesthesia is dangerous and not advised) and may schedule a follow-up visit. More serious surgeries may require you to stay overnight in the hospital or a post-care facility. The follow-up visit is typically included in the overall medical package.
More involved surgeries will require downtime after the procedure. Depending on the severity of the surgery, your recovery can take place on a beach, in a hotel, or at a recovery center.
There is a wide range of recovery centers in Costa Rica. These centers cater to medical tourists by mixing traditional hotel facilities with medical amenities. Many centers are set in the hillsides above San José. This area is peaceful and beautiful, but is also close to the city’s hospitals and clinics.
Most recovery centers include transportation to and from the airport, as well as transportation to and from all medical appointments. This is especially important after the procedure, when you may be unable to drive. The centers typically offer 24-hour nursing care, with monitoring and supervision of the patient’s condition; some even have an onsite doctor. Recovery centers may have spas or massage parlors, and those that don’t can usually arrange for massage therapists to visit your room. Physical therapy can also be arranged. All meals are included at the recovery center, which saves patients the need to worry about where (or what) to eat. Cable TV and wireless Internet is common and can be crucial during bouts of boredom.
In addition to post-surgery centers, there are also recovery centers for drug and alcohol addiction. These offer various treatment plans and range in length from 30 to 90 days. Services include intervention services, individual and group therapy, 12-step meetings, recreational activities, art therapy, educational lectures, and medication management. Some rehabilitation centers favor a medical approach, while others approach healing through holistic and spiritual means. Many of these centers are set in naturally beautiful areas that encourage rest and reflection.
A final option for medical tourists includes health and wellness retreats. Guests of these centers may or may not have received medical care in Costa Rica. These places typically offer a range of services aimed at physical and mental health. These include yoga and meditation classes, acupuncture, massage, Reiki, naturopathy, floral therapy, detoxification programs/cleanses, and stress and weight management techniques. Many have swimming pools and saunas, as well as restaurants that serve healthy organic food.
A big question for most people is whether their insurance provider will cover procedures abroad. This is a big and complicated question. Every company has different policies and it’s impossible to generalize about any of them.
Ten years ago, most insurers would have scoffed at the idea of covering medical procedures performed abroad. These days, things are slowly changing – companies like Blue Cross & Blue Shield are signing contracts with overseas hospitals, and others insurers may soon follow suit.
That said, most insurance companies still don’t cover the trips, despite the fact that they can save money by doing so. One reason involves the credentials of doctors. Insurance companies need to ensure that overseas providers are safe and provide reliable, high-quality care. The Joint Commission International (JCI) is an American nonprofit that accredits U.S. hospitals and is beginning to accredit hospitals overseas. A hospital with this accreditation has a much better chance of being covered by your insurance.
There are also other issues, such as claims processing and continued care, that insurance companies must consider.
Before booking a medical procedure in Costa Rica, check with your insurance provider to see what they will cover. Ask if and what procedures are reimbursable, how much they reimburse, and what doctors or hospitals are covered. The reimbursement process for many insurance companies involves bringing a reimbursement form to the Costa Rica, having the doctor fill it out, submitting the paperwork when you return home, and awaiting the company’s response on reimbursement.
The insurance issue is complex and important. Do the research and find out exactly what is and what is not covered. In some cases, patients may choose to pay for the procedures out of their pocket rather than deal with an insurance provider.
Ask A Doctor
We asked the doctors in the HuliHealth network for thoughts and advice on traveling to Costa Rica for a medical procedure. We covered a range of topics, including how to build trust with patients, misconceptions about medical tourism, and what activities they recommend for visitors.
What do you recommend for travelers to Costa Rica? It might be a favorite beach, volcano or activity.
“Tamarindo and Flamingo are some of the country’s best beaches, and the Arenal Volcano is my favorite volcano. As for activities, canopy tours and ATV rides are some of the best.” – Dr. Jorge Badilla, Plastic Surgeon
“It depends on what travelers like. If they enjoy the mountains, I recommend San Carlos and the Arenal area—there are hot springs and the mountains are great. If they like the beach, I recommend Playa Conchal in Guanacaste. It is a beautiful beach with a wonderfully clear ocean.” – Dr. Chun Chen Lin Yan, Opthalmologist
What are your most common procedures for medical tourists?
“Tummy tuck, facelift, breast augmentation, rhinoplasty, and mastopexy with implants.” – Dr. Jorge Badilla, Plastic Surgeon
“One of my most popular procedures is eyelid surgery (upper biepharoplasty or lower eyelid biepharoplasty), which consists of removing the “bags” beneath your lower eyelids. Botox and dermal fillers are popular as well.” – Dr. Chun Chen Lin Yan, Opthalmologist
“In dentistry, the most common procedures are dental implants and dental crowns.” – Dr. Eugenio Brenes, Prosthodontist
What practices do you and your administrative team use to prepare a patient for a procedure?
“Before every procedure, we do a check up on the patient that involves education, recommendations, and possible complications. Then we do pre-op exams (ECG or X-rays, for example), take pictures, and have the patient sign an informed consent waiver. We also give them pre-op antibiotics if necessary.” – Dr. Jorge Badilla, Plastic Surgeon
“I have a comprehensive consultation with my patients. After a careful examination I give them recommendations and they decide what they would like to do. Finally, we discuss the risks and benefits of surgery. The best practice is to have a great channel of communication and work with a top surgical team, which I do.” – Dr. Chun Chen Lin Yan, Opthalmologist
In your experience, what is the most common concern that patients have prior to their trip?
“Patients are often concerned about recovery time, communication (i.e. the language barrier), the qualifications of the surgeon, and the facility where the surgery or treatment will be done.” – Dr. Chun Chen Lin Yan, Opthalmologist
“Patients generally ask questions about price and predictability. Other concerns include the timeframe and sequencing of treatments.” – Dr. Eugenio Brenes, Prosthodontist
Travel can be stressful and medical procedures can cause anxiety. Many of your patients may be dealing with these emotions when they arrive at your clinic. What strategies do you employ to help visiting patients feel confident in your medical abilities and also feel relaxed during their time in Costa Rica?
“We establish a very clear line of communication with the patient. Before they step foot in my office, they will have already talked to us several times on the phone. We establish a link of confidence. Patients that are satisfied with our service also sometimes speak with people that are considering treatment, which can be very helpful.” – Dr. Eugenio Brenes, Prosthodontist
“We have a friendly and caring environment at our office and we try to make our patients feel at home. Our doctors are always willing to answer questions that patients may have during the treatment process. There is also a section of our website that lists each dentist’s credentials and resume, which helps reassure patients of our medical abilities.” – Dr. Vinicio Prada, Prosthodontist
What is the biggest misconception that patients have (i.e. time, total cost, etc.)?
“The most serious misconception is that we are an underdeveloped nation and our medical procedures are unsafe and inexpensive. The truth is that we have highly qualified professionals in Costa Rica. The costs for medical procedures are much lower than the U.S., but are still are not a fraction of the cost, like some people think.” – Dr. Chun Chen Lin Yan, Opthalmologist
“That a treatment can be done in two or three days. To help with this, we teach the patient about laboratory and healing times. Patients also need help differentiating dentists in Costa Rica. Not all professionals have the same training and not all of the offices use the same equipment.” – Dr. Eugenio Brenes, Prosthodontist
How do you build trust with a foreign patient?
“Each of our dentists builds trust individually with their patient. Our dentist almost act as advisors, offering each patient solutions according to their specific needs and possibilities. Everyone in our office works together to achieve the health, wellness and comfort of our patients.” – Dr. Vinicio Prada, Prosthodontist
“Trust is built with honesty. It is gained by showing up on time, having clear communication, and taking the time to explain details or changes.” – Dr. Eugenio Brenes, Prosthodontist
With rising healthcare costs in the U.S. and Canada, excessive wait times and thorny insurance issues, medical tourism is becoming a safe and viable alternative for many people. Costa Rica’s reputable hospitals and close proximity to North America have helped position it as a leader in medical tourism. Examine your insurance policies and consider combining travel with your procedure. If you do decide to undergo a medical procedure in Costa Rica, you may return home healthier and happier.