BOGOTA, Colombia -While Orlando Gonzalez visits his native Colombia, he will bask in the warmth of friends, and get his eyes checked. He will stop by the sauna at his favorite country club, breathe the stinging scent of eucalyptus branches, and get his teeth cleaned. He will watch his daughter, a skilled golfer, tee off on their old green, and then take her to have her tonsils removed.
“The health system in Colombia is very good, very human,” said Gonzalez, a real-estate developer based in Pembroke Pines, Fla., explaining his decision to sprinkle medical appointments into a vacation otherwise characterized by leisure. “In the States … it’s in shambles. The only concern is the almighty dollar.”
The doctor’s office often is to a Colombian vacation as Graceland is to a holiday in Memphis, Tenn. Like Gonzalez, many Colombians who live in the United States travel back to their dangerous and war-weary country for medical treatment, citing bargain prices and a more relaxed bedside manner. Patients flock to other Latin American countries too, especially for plastic surgery, but Colombia is regarded as having a particularly sound health sector for those who are not gravely ill and can afford private treatment.
The trend runs counter to the perception of undocumented and uninsured immigrants running up costs at U.S. clinics and public hospitals. But it also underscores surging health insurance premiums in the United States that have pushed millions off insurance company rosters.
The result is an army of Colombians stacking up their holiday calendars with fertility treatments, dental work or refractive eye surgery – procedures excluded from or only partially covered by health plans in the United States.
Others sign up for something akin to an extreme medical makeover, dipping out of one doctor’s office and into another, seeking out everything from obesity-busting gastric bypass surgery to perkier breasts to herbal remedies. And as word spreads, even non-Colombians are finding their way to Bogota’s upscale clinics.
Gonzalez and his wife pay privately for basic health insurance in the United States, which assures them of emergency care. For smaller complaints, they find the money they save in Colombia easily covers the cost of their plane tickets. Gonzalez adopted this system five years ago, he said, after going to a Miami hospital emergency room for a few tests and an injection and receiving a bill for more than $2,000. Other Colombian immigrants said U.S. coverage and treatment were simply out of their reach.
One popular destination is the aquarium-adorned office of the family dentist, like the sunny quarters in an elegant northern sector of Bogota where Dr. Jorge Gomez fills cavities. U.S. insurance policies generally cover about 50 percent of dentistry costs. But with Colombia’s competitive prices and an attractive dollar-to-peso exchange rate, full prices on Colombian dentistry often fall below the deductible that U.S. patients are expected to pay.
“They come for a weekend. They see their mom, they have a good time, and they visit me,” said Gomez, who has 50 regular patients from overseas, as he peered into an open mouth. “It’s not because they love me,” he said with a chuckle. “It’s about the pocketbook.”
Some patients, however, say they prefer their Colombian physicians for reasons beyond economy. Robert Baron, an American choreographer based in Los Angeles, first visited Gomez while he was working on a musical in Bogota and needed some enamel work done. But it was the dentist’s warmth that brought him back for orthodontic work.
“He invited me out to his family farm to have dinner, and told me to try such-and-such restaurant around the corner.” Baron said. “There’s a little more humanity, as opposed to our system, where it’s, “Come in, ciao, you’re done.”‘
Dr. David Himmelstein, co-founder of the Center for National Health Program Studies at Harvard Medical School, said the medical migration must be taken against a backdrop of narrowing coverage in the United States and steady rises in premiums, and of huge profits flowing into the pockets of drug and insurance company executives.
“Our health care prices are way out of line with the rest of the world’s. We have a system that costs an extraordinary amount, and delivers incredibly bad value for money,” said Himmelstein, who supports a government-financed health plan in line with the Canadian model.
According to industry figures, some 85.2 million U.S. residents have spent at least some time without health insurance over the last two years, a figure equivalent to one in three Americans younger than 65, when Medicare kicks in.
Reacting to Colombians’ assertion that their nation’s physicians are more personable, Himmelstein added: “Poking and prodding, sticking a needle in someone. … Almost anything you do to a patient (in the United States) is paid at a per-minute rate that is hugely out of scale with what you’re paid to sit and talk to them.”
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Colombia’s health system also cuts deep along economic lines. While high-end doctors like the ones favored by overseas patients line their walls with diplomas from U.S. and European universities, public hospitals are overcrowded and undersupplied. Some struggle just to keep sutures in stock.
An exception is the renowned Barraquer Clinic for eye care. It charges its wealthier patients extra to subsidize services for the poor. The imposing white building is named for its founder, Dr. Jose Barraquer, who pioneered the techniques that later evolved into the popular LASIK eye surgery. The procedure is not covered by insurance and can cost upwards of $2,000 an eye in Boca Raton, Fla., or $550 in Bogota. Not surprisingly, it has helped to draw thousands of foreign patients to the facility.
“Tourism has grown up around this clinic,” said Cesar Navarrete, the clinic’s administrator, who keeps a file of hotel brochures stacked between medical journals on a messy desk.
“Everyday I’m invited to lunch” by hotel managers, Navarrete joked. Asked if he might try to capitalize on the overseas visitors to raise more money, however, he frowned and said: “That’s not what we’re about.”
One floor down, speaking between consultations, Barraquer’s son, Dr. Jose Ignacio, elaborated.
“My father’s idea was to improve the quality of life for the patients, not the surgeons,” he said.
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(c) 2005 South Florida Sun-Sentinel.
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AP-NY-03-10-05 0619EST
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