Club Med

Traveling abroad for dental work is part of a larger trend of medical vacations — and the main attraction is not the exotic locale but, rather, treatment costs far below those in the U.S. Mentor explores the phenomenon of “dental tourism”

By Mary Otto

In the old days, the phrase “medical tourism” conjured up images of movie stars and business tycoons winging away to Switzerland for discreet beauty treatments or miracle cures. But times have changed. The medical tourist of today is more likely to be a baby boomer booking a cheap flight to Mexico or Costa Rica for a knee replacement — or a full-mouth restoration.

Experts agree that dental travelers now make up a significant share of a global and growing multibillion-dollar medical tourism market. Although no one can gauge their numbers with complete certainty, research suggests that Americans by the hundreds of thousands may now be crossing the nation’s borders for dental care.

And dental tourism is expected to continue to grow — a scenario that poses unknown ramifications for American dental offices, as well as dental manufacturers, distributors and sales personnel.

Many factors are driving this phenomenon. The average age of the U.S. population is climbing. Millions lack dental insurance. And when they’re paying out of pocket, some patients seem willing to shop and travel for dental care, aided by easy access to air travel, the Internet, and an increasing number of dental travel resources. All the while, sophisticated foreign clinics are stepping up outreach efforts with promises of significant savings and high standards of care.

THINK TWICE BEFORE OPENING WIDE

Although the prospect of saving on dental treatment has obvious appeal, the American Dental Association (ADA) and dental safety advocates caution would-be dental tourists to consider all angles before considering a root canal in Tijuana or an implant in Bangkok. Besides cost savings, patients are urged to consider potential language barriers, the difficulty of pursuing follow-up care or redos with a foreign provider, the possibility of botched treatment, or the risk that materials and infection control protocols may not meet the standards found in the U.S.

Still, for those who have researched and planned carefully, a dental vacation can yield positive outcomes, as Chapel Hill, North Carolina-based author Josef Woodman notes. Woodman recalls being surprised and a bit mystified a decade ago when his aging father announced he was headed to palmy Puerto Vallarta, Mexico, for a mouthful of new teeth.

Although Woodman was initially dubious, it turned out the clinic his father had chosen was modern and the care was good. “He did his homework. All told, my dad ended up spending $14,000 for the extractions, implants and crowns he needed — care that a dentist here in the states had said would cost $31,000,” Woodman tells Mentor. “My father was very satisfied with the work. And he saved $17,000.”

For Woodman, the trip was just the beginning of a journey that is still unfolding.

He went on to write a book, now in its second edition, entitled Patients Beyond Borders. The book helped spawn a publishing and communications enterprise that has become a popular source for information on medical and dental travel destinations worldwide. And Woodman now travels the world, lecturing and visiting clinics. He says he has met countless dental tourists, and is convinced his father represents a far larger segment of the American patient population than some might imagine.

“There is an entire generation of people aging into expensive dental care,” he reports. And when they learn from an American dentist that the treatment plan will cost thousands of dollars, they are willing to take to the road. “When people can, and when they have a choice, they are traveling. That is a big part of the market,” he says.

GLOBAL HEALTH CARE ‘CONSUMERS’

And it’s not just American patients who are shopping exotic locales for care. In sdfsf, Woodman values the global medical travel market at between $24 billion and $40 billion, with patients spending on average between $3000 and $5000 per trip for transportation and treatment. He estimates that 900,000 Americans sought care abroad in 2013, and, based on his company’s inquiry rate, he believes roughly half of them were traveling for dental services.

Research from the Deloitte Center for Health Solutions, the health services research arm of the U.S. branch of Deloitte, a global advisory services company, has placed the number of American medical travelers even higher. It estimates that 1.6 million Americans traveled abroad for all types of medical care in 2012, with dental treatments heading the list of services sought.

While the American Dental Association (ADA) does not offer any statistics on the size of the dental tourism market, research conducted for the organization acknowledges the significance of the trend. “As the cost of care rises, ‘medical tourism’ is also increasing,” observes a 2013 report entitled “Critical Trends Affecting the Future of Dentistry.” Commissioned by the ADA and prepared by the California-based health policy consulting firm Diringer and Associates, the paper notes, “Over one third of Americans (37%) would consider traveling to another country to receive medical or dental care if the cost were significantly lower.”

At the same time, the ADA reports that American consumers are becoming “more astute purchasers of health care, and [are] seeking value for their spending.” Attitudes toward care are changing too. “There is a shift among the American population from wanting to be regarded as ‘patients’ to one in which they view themselves as health care ‘consumers,’ with differing behaviors, expectations and needs,” the study notes.

These attitudes — and the promise of savings abroad — are fueling dental travel. According to Deloitte, oral health care services in Mexico cost 25% to 35% of what they do in the U.S. And in Costa Rica, another popular dental vacation destination for Americans, dental care costs 30% to 40% of what it does in this country.

ISSUES TO CONSIDER

Although some potential travelers might be concerned about difficulties obtaining follow-up care or surmounting language barriers, others find the thought of mixing a vacation with cost-saving dental treatment appealing. And for those with immigrant roots, the prospect of returning to a native country for inexpensive and culturally sensitive care is especially attractive, the ADA study says.

The concept of dental travel is nothing new to Maria Lopez Howell, DDS, an ADA consumer advisor spokesperson. The San Antonio, Texas-based general practitioner grew up in an extended Mexican-American family that includes 13 dentists working on both sides of the border.

“I’ve been familiar with dental tourism since I was a kid,” she says. From her earliest years, Howell remembers snowbirds from the Midwest coming south in the winter and seeking dental care in Mexico. They still do.

And while Howell notes “there are good dentists all over the world who do wonderful clinical work,” she maintains that Americans enjoy the highest standard of care right here in the U.S. To reinforce her point, she tells of one of her patients sheepishly returning to her care after getting some bad crowns in Mexico. “I had to redo those restorations,” she recalls, “and the poor patient, trying to save money, actually ended up spending more.”

Yet the lure of care in places such as Mexico and Costa Rica will remain a reality for American dentists and their patients, she believes. “The elephant in the room is cost,” notes Howell. “Dental fees are based on the economy. And if a country’s economy is different than ours, of course the fee structure is going to be different.” Even so, she asserts that American dentists need to stress — and patients need to remember — that “you get what you pay for.” Another important thing American dentists can emphasize is prevention, she adds. Patients should understand that keeping up with routine care just might make costly journeys abroad unnecessary.

 

CLINIC SAFETY CONSIDERATIONS

When it comes to dental clinics, not all providers are created equal, says Eve Cuny, MS, an international infection control expert and director of global outreach for the Organization for Safety, Asepsis and Prevention, a nonprofit that advocates for the safe and infection-free delivery of oral health care worldwide. “There is huge variation in the quality of care you will encounter in emerging countries,” notes Cuny. “It ranges from very poor quality to the same level of care you’ll find in the U.S.”

Here are questions Cuny suggests to keep in mind when one of your clients’ patients is considering clinic safety abroad:

  • How do they filter their dental unit water?
  • Do they routinely test water quality?
  • What methods do they use to sterilize their instruments?
  • Does the practice follow a validated sterilization process?
  • Are all clinicians wearing exam gloves, masks and washing their hands?
  • Where did the dentist receive his or her training?
  • If something goes wrong, what kind of emergency medical care is available?
  • And, finally, does the clinic readily answer all of your questions? If not, think twice before being treated there.

SUPPLY AND DEMAND

The subject of dental tourism makes many American dentists uneasy, reports Paul McTaggart, CEO of Dental Departures, a 3-year-old Seattle-based firm that links dental travelers with dentists in 29 countries. “We’ve had some really progressive U.S. dentists who say, ‘Oh yeah, I think this is a great value. I could never perform these procedures at those prices — my insurance and labor costs are too high.’ But the vast majority of U.S. clinicians see it as a threat.”

The detractors really needn’t worry, he insists. “Dental tourism is not going to wipe out the dental profession in the U.S. any time soon,” he says. “We’re simply trying to give people another option.”

McTaggart sees the phenomenon as just one more response to the law of supply and demand in a changing world. Americans now buy high-quality, low-cost cars and computers produced in foreign countries, he points out. Why not dental care? “It’s just another evolution of globalization,” he adds.

Yet McTaggart believes the very terms “dental tourism” or “dental vacations” are misleading. The travelers who seek out Dental Departures — with its website offering virtual tours of hundreds of dental clinics, cost quotes and help with setting up appointments, hotels and financing — are not mainly after sun and fun. They are seeking needed oral health care at prices they can afford.

Clinics that become part of the Dental Departures network must undergo a review process designed to determine whether they are properly licensed, registered and operated. In addition to working with firms such as McTaggart’s, some foreign clinics are making themselves more attractive to American patients by seeking accreditation from organizations such as the American Association for the Accreditation of Ambulatory Surgery Facilities International (AAAASFI), and the Accreditation Association for Ambulatory Health Care that review and inspect clinics for high standards of care.

Some foreign clinics are also taking steps to help patients submit insurance claims. Yet insurance coverage for such care is not yet commonplace, notes Evelyn Ireland, executive director of the National Association of Dental Plans. “Dental tourism is not really on our industry’s radar screen,” she says. “From what our carriers tell us, it is not a widespread phenomenon for patients who are insured.”

Even after 10 years of study, Woodman admits there is a lot more to learn about dental tourism. Some lessons are easier than others, as he was reminded when a dental implant he had received in Costa Rica failed en route to a conference in Medellin, Colombia. Woodman recalls, “When the crown came loose, I said, ‘Oh great. This invalidates everything I am doing.'” Luckily, he was able to find excellent care at a modern clinic in Medellin with AAAASFI accreditation. His clinician was a certified implantologist, knowledgeable and caring, with offices overlooking the hills once haunted by an infamous drug kingpin. “The work was impeccable,” he says.

Yet Woodman’s own mixed experiences as a dental traveler have offered an important lesson about medical tourism. “The medical travel highway is not completely paved yet,” he says. “There are a lot of potholes in it.” Travelers beware.

MENTOR March 2014,5(03):26–29.

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