Tens, if not hundreds of thousands of Americans travel to other countries each year for lower-cost healthcare. Some reports place the number upwards of 250,000. Accurate statistics are extremely hard to come by. One thing that is known, however, is the incredibly important role that the Internet plays in so-called medical tourism.

Often, the first thing a patient does when searching foreign healthcare options is to begin an extensive Web search.

“Medical tourism entails the splicing of two sectors, medicine and tourism,” write Milika and Karla Bookman in their report “Medical Tourism in Developing Countries,” which came out this year. “Both are labor intensive and both rely heavily on the Internet to spread information.”

When potential patients hit the Web, they are confronted with a broad range of slick websites posted by clinics from Bangkok to Brazil, often touting luxury recovery facilities in a resort-like setting, top-quality doctors and prices far lower than those available in the U.S. So how does one separate the legit from the shoddy? An appealing front-end website does not a qualified clinic make.

That’s where consultant David Williams’ site, MedTripInfo.com comes in.

“The reason I started it was to provide a sort of healthy business blog for medical tourism. It’s a useful thing to talk about and I noticed there is a lot of interest but a lack of good info,” Williams said.

“Medical tourism Web portals are front ends promoting travel arrangements but don’t really provide good information for patients. The idea of MedTripInfo was to have patients be able to discuss their experiences with one another. It’s a platform for peer discussions and a way for providers overseas to get their information out there.”

The site features country-by-country profiles, patient testimonials and healthcare policy information. Because medical tourism–or as Williams prefers, “international medical travel”–is so new, MedTripInfo is really the first of its kind: a med tourism website watchdogging other websites.

The site is free to use and entirely supported by advertising. Williams, who also runs a healthcare consulting firm called MedPharma Partners, hopes to inject a bit of sanity and careful reporting into an industry that is often characterized by hearsay and alarmist rhetoric.

“The challenge is that you’re trying to put a quantitative objective view on an issue that’s still emerging. It’s hard to be definitive,” he said.

Most media reports about medical tourism tend to focus on botched jobs performed in back-room clinics and ignore the reality: that a growing number of informed healthcare consumers are turning overseas for lower-cost, often higher-quality care.

“Some journalists do just look to find something shocking, exciting.”

Scarcity of information

Getting a handle on the trend is almost impossible. As was earlier stated, the numbers are the source of the problem. “It has been said that medical tourism is so new it can’t even be measured,” write Bookman and Bookman. Williams says that since American healthcare institutions have no way of tracking how many patients leave the system to go elsewhere, the numbers must come from hospitals and clinics abroad, who often misrepresent how many patients seek their services. “They’re putting out the numbers for their own self interest.”

Major healthcare destinations like Bangkok’s Bumrungrad Hospital often count each consultation as a separate visit and therefore a different patient, which drastically inflates their numbers, Williams said. The truth is, no one really knows how many people travel for healthcare and which kinds of procedures are most often performed. Cosmetic and plastic surgeries are extremely popular–the so-called Thailand tuck–because those are the procedures that are not covered by U.S. insurance. However, Williams reports that major organ transplants and heart surgeries performed in India are growing in popularity, not simply because of their low cost, but because the quality of service is so high.

Williams has prepared an industry white paper that he hopes will wake up the major U.S. healthcare providers to the opportunities available overseas. He writes:

“Increasingly, patients are traveling for ‘serious’ surgeries, including cardiac and orthopedic procedures. This builds on the established phenomenon of medical tourism for cosmetic and dental surgeries. Employers, health plans and benefits consultants are taking notice and in some cases are launching pilot programs. The media have drawn attention to medical tourism, while medical travel facilitators have sprung up to help patients and companies go abroad.”

He hopes his research will encourage major insurance companies to cover patients willing to travel. In turn, that will inspire more careful numbers reporting and better research about who’s a good doctor and who isn’t.

“If you compare the auto industry, which, like healthcare, has been shielded from foreign competition like Honda and Toyota, you see that the prices have continued to rise, reliability is lower. Healthcare is like that in the U.S. Service isn’t particularly good, costs have skyrocketed. It’s protectionism, a lack of exposure to competition. If you look anywhere else, the costs are lower and the quality is often higher. A healthy medical economy has more competition.”

Mainstream healthcare institutions have made attempts–if meager ones–to address this growing trend.

The International Society of Aesthetic Plastic Surgery (ISAPS) released a set of guidelines for patients considering plastic surgery travel.

The list recommends patients “Ask for certification information and who the certifying body is,” and to ensure that the operating physicians speak English. “If you cannot be understood properly, be prepared for complications.”

Additionally, (and perhaps confusingly), the American Society of Aesthetic Plastic Surgeons (ASAPS) has its own set of guidelines for overseas surgery-seekers, recommending specifically that patients forge a relationship with an American doctor before they travel.

“If you are thinking about having surgery overseas, consider establishing a relationship with a local board certified plastic surgeon before going on your trip. Then, if complications arise when you return home, a qualified surgeon will be familiar with your goals and procedures.”

A new class of healthcare consumer

Medical tourism is a case of Internet savvy early-adopters who accept some degree of health and financial risk in order to embrace a new set of opportunities. Becki Bozard, 49, a Portland-area social worker, underwent bariatric “duodenal switch” surgery in the U.S. and lost 190 pounds. Afterward, she was plagued by health problems and needed to get the muscles of her torso repaired and have the loose skin trimmed off.

“I’d had seven hernias—count ‘em—around the mesh they put in my stomach and my doctor told me I would continue to get hernias if I didn’t get reconstructive surgery on the muscle walls in my gut,” she said.

After her weight loss surgery, the muscles of her abdomen were so weak and disconnected in several places that they could not hold her internal organs in place. They were popping out of her mid-section like bulges in a tire with worn-out sidewalls.

Her insurance company, which paid for the original gastric Lap-Band, refused pay for the reconstructive abdominoplasty to fix her body afterwards. She worried that her muscles would continue to atrophy and that she would be doomed to walking around with a heavy kilt of excess skin. “They said they wouldn’t pay for plastic surgery, and offered to continue to fix my hernias for the rest of my life.”

A U.S. doctor quoted her $22,500 for the procedure she needed. She didn’t make enough money to afford the procedure out of pocket. And so Becki began looking for answers on the world wide web.

“Getting surgery in another country was already in the back of my mind, but I hadn’t thought of it for reconstructive plastic surgery. I went back online to the websites I knew, asked who else was facing this problem. The outpouring was ‘Yeah, go overseas.’”

Bozard found a vibrant online community of informed healthcare consumers sharing information, via websites like www.tlcmedicaltravel.com, a travel agency and “medical tourism concierge service.” Med tourism would not be in existence without the Internet, she said.

“Weight loss people are the most determined to get what they want,” she said. “You do your research on the Internet. We’re using our heads when it costs us money. When you’re a medical tourist, you want a single surgery and you don’t want it screwed up. You’re going to find somewhere that will do the best possible job for the best possible price.”

These days, Bozard describes herself as a weight loss “mentor,” helping others find overseas healthcare and Web resources. “People that don’t have the Internet, I tell them, ‘Can you get online?’ because it’s going to be a lot harder if you’re not online. I don’t want someone I know to go without doing their own research.”

Bozard and others like her are part of a new class of self-educated healthcare consumers who, faced with situations where prohibitive costs or a lack of services, no longer rely on their general practiticioner to act as “the captain of the ship” guiding them through the murky waters of specialists, insurance and referral, said Dr. David Goldman, M.D., an ethics expert and surgeon at USC’s Keck School of Medicine.

As the American healthcare system grows more costly and more complex, a new class of healthcare consumers like Bozard is on the rise. They want real information about overseas opportunites and want to cut out the middlemen. Information providers like David Williams of MedTripInfo have begun to answer that demand. Whether or not this free-market healthcare model will prove to significantly impact the way American doctors, insurance companies and patients do business remains to be seen. But none of it would be possible without the Thomas Friedman Earth-flattening potential of the Internet to bring Brazilian doctors and Oregonian patients together.

[Editor’s note: One of the (many) great things about having OJR at USC is the information we get from our students about what is happening in media today, under the radar of media executives and mid-career news reporters. This story is one such example. It deals with the music business, but the business model practiced here offers intriguing possibilities for other content businesses, including news. — Robert]

Has the light gone out for you?
Because the light’s gone out for me
It is the 21st century
It is the 21st century
–“Bodysnatchers” by Thom Yorke/Radiohead [In Rainbows, 2007.]

Can a major rock band turn out a profitable album without a major label to back it? Can said band sell the album as a legal DRM-free mp3 download? Can said download still make money even if users themselves are allowed to choose how much they are willing to pay? (No really, zero bucks is okay.)

Well, if the band is Radiohead and the album is In Rainbows, the Magic 8 Ball says ‘Yes.’

As has been widely reported and blogged about, the album logged 1.2 million downloads on its first day. How much did people pay? I paid £3 (about $6). (Hey, I’m a grad student.)

Rumors, polls and inside sources circulating indicate that the average buyer paid £4, or about $8, which would mean that Radiohead has made about $10 million or more since the record’s release on Oct. 10.

With numbers like that, and self-released digital downloads in the works from Madonna and Trent Reznor/Nine Inch Nails, some are claiming that the major labels are hearing their deathknell.

This so-called “anti-marketing” has lead Pitchfork Media reviewer Matt Solarski to wryly suggest that “they’ve turned this into a moral question of sorts, by giving us the freedom to pay actual money for what amounts to an album leak. Only a band in Radiohead’s position could pull a trick like this. Well played, gentlemen.”

Nonetheless, the entire experiment may have been a simple ploy to raise sales of the actual CD release, coming in January of 2008. The mp3s are 160kbps–middling quality–so perhaps Radiohead hopes that fans of the album will shell out for the disc.

Radiohead is among the last big-name bands that has resisted releasing their material for paid download from Apple’s iTunes store.

Radiohead’s Jonny Greenwood told the Gothamist blog: “We talked about it and we just wanted to make it a bit better than iTunes, which it is, so that’s kind of good enough, really. It’s never going to be CD quality, because that’s what CD does.”

All this after another strange online event, the appearance of a phony countdown site to the album that turned out to be the world’s most epic rickroll. (If you just clicked that, you really need to use the Interwebs more. Here’s what a ‘rickroll’ is.)

Amazon.com and PayPal, among others, for years have been offering publishers the ability to put out online “tip jars.” PBS long ago established a reasonably successful business model that relies in part on consumer’s donations. And services like Priceline have applied the “name your price” model to online travel sales. But Radiohead’s apparent success with its In Rainbows release might tempt other content publishers to consider voluntary pricing models. (Of course, not even making the album free can stop piracy; In Rainbows is Piratebay‘s 25th-most popular audio torrent right now.)

In any case, the record is hugely popular, cheap or free online, and creating tons of free buzz for the band. Radiohead guilts us into paying for something that we could have for free, and then slams us with a higher quality CD release a few months later, will inevitably sell out their tour dates… and (most of us) love them for it. I still think Amnesiac is their post-OK Computer high point, but that’s another debate… until then, enjoy the new profit model, the newly romantic balladry mixed in with Radiohead’s typical post-pop existential dread and the fact that you gots it all for cheap.

(In Rainbows reviews, from MetaCritic.)