When patients jump the border

July 14, 2009 | dentalproductsreport.com
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When patients jump the border

Photo: Anna Moller/Getty Images

An in-depth look at dental tourism and why its affordability could mean trouble for practices state-side.

by Lauren Bryant, Associate Web Editor

With only half the U.S. population covered by dental insurance, many Americans are jumping the border and flying overseas for high-quality, low cost care, according to a BuisnessWeek 2008 special report. Compared to the 85% of the population that receives medical insurance, the 50% of Americans without dental coverage will continue to travel abroad to take care of their smiles. The problem is aggravated further by the fact that people who do have dental coverage aren’t covered very well. Most policies have a low annual cap, estimated at $1500, an amount that BusinessWeek reports hasn’t changed since the 1970’s despite an increase in premiums.

Thus the birth of dental tourism, where citizens from wealthier countries travel abroad to not only receive affordable dental care but to also enjoy a vacation. Most of these dental destinations are found in areas of Budapest, Prague, Tijuana and Bangkok where dental clinics advertising their services line the streets.1 European patients also seek affordable care in neighboring countries, with British patients traveling to Eastern Europe for care for years. One survey estimated as many as 30% of the population along the Texas side of the Rio Grande crosses the border into Mexico for cheaper dental services.1 Savings racked up by patients often more than compensate for travel costs.

“Teeth caps that range from $750 to $1000 in the U.S. cost $150 in Mexico. In Hungary, a top-quality crown costs $780, compared with $1,200 to $2,000 in the U.S.,” reported the BusinessWeek article.

USA Today also gives an example of savings as it reported on the experience of a Nancy Corathers, an American who took a dental vacation to Mosonmagyarovar, Hungary with fantastic results. Throughout her ten-day stay in Hungary, Corathers was able to visit Budapest and Vienna, countries she had never seen before, while only paying $2,900 for her dental work, a quarter of the $11,150 she estimated she would have paid had she had the work done at home. USA Today reported that in total, Corathers spent just under $4,300 for her dental care, travel, hotel and last-minute airfare.2

Dental care abroad

If you go abroad for dental care:

• Check with the appropriate government agency in the destination country about its national dentistry guidelines.

• Find out what recourse is available if something goes wrong.

• At the dental office, look for infection-control procedures, including instrument sterilization and use of protective gloves, mask and eyewear.

• A traveler’s guide to dental care is available through the Organization for Safety and Asepsis Procedures at www.osap.org.

Source: American Dental Association

So, how do these countries keep the costs down? Coathers’ Hungarian dentist Dr. Frank Kannmann, explained that the manpower is much cheaper. Using the same materials, Kannmann still manages to pay his staff better-than-average wages while making a bigger profit. Moving his practice to Hungary five years ago from his native country of Germany, Dr. Kannmann says he averages about two to three U.S. patients a month, with the majority of his patients hailing from Germany and Austria. Like Corathers, many of the other visiting patients come for shopping and travel and the perks of lower-priced goods.2

Similar experiences are happening closer to home as well, with an influx of patients traveling south of the border to Mexico for more affordable care. The Washington Post claims that Mexican dentists often charge one-fifth to one-fourth the cost of U.S. dentists. Helping keep costs low is Mexico’s legal system. Making it almost impossible for patients to sue, dentists don’t have to worry about the high malpractice insurance premiums.3

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According to the Washington Post, Nuria Homedes, public health expert at the University of Texas said that such differentials have allowed some El Paso residents to decline dental insurance to avoid paying even modest premiums for employer plans. Unsettling to U.S. based dentists, who tell horror stories of infections, undetected cases of oral cancer and lousy work south of the border, many Americans are still taking a leap of faith.3

And a convenient leap at that, with the Mexican dental empire coming into view the moment an American steps off the footbridge that leads from downtown El Paso to Ciudad Juarez. Once they make it downtown, on Juarez Avenue, they will find taxi drivers offering trips to dentists and pitching local practices. For those that travel to Mexico by plane, many dentists even offer airport pick-up services.3

In another Washington Post article, Palomas, Mexico a town built around destination dentistry was examined in light of current health, political and immigration concerns. Lined with storefront clinics, dentists had no trouble keeping their chairs full, morning, noon and night, serving almost all American clientele. Dr. Oscar Quiñones, one such dentist, claims that patients are afraid to come back. The Post article sited Quiñones saying that with the global swine flue pandemic emerging from Mexico in April, people didn’t want somebody else’s hands in their mouth, especially someone from Mexico. But a shift was happening even before the flu.4 In light of the economic crisis, the government began requiring papers to enter the country.

According to the Post, “On June 1, the U.S. Customs and Border Protection agency began to require travelers entering the United States from Mexico or Canada to have passports or special high-tech driver’s licenses. A U.S. passport costs $100.”4

With dental tourists in Palomos under the pretence of saving money, spending $100 on a passport to drive a short distance into Mexico for a routine check up and the advice to floss more, suddenly didn’t seem like such a bargain. Knowing this, the clinic where Quiñones works began offering clients with a new passport a $100 rebate on any dental work of equal or greater value.4

“Although there have been dentists in Palomas for more than 40 years, business boomed as health insurers in the United States demanded ever higher co-payments. Suddenly it made sense to drive four hours from Tucson to get a crown for $125 or a cavity filled for $60.”4

What can you do?
According to the American Dental Association, Dr. Kathleen Roth, president-elect, visited the Texas border region to be educated on the issues through the eyes of local dentists. The key, she said, is educating patients to understand that the best dental health is not comprised of a one-time visit, but a lifetime of joint effort between the patient and the dental team.5 Educate your patients on risks that could occur abroad as well as the possibility that follow up care and repairs may not be as easy to accomplish. Ask that they find out what kind of dental licensing and accreditation programs are required in their destination country and compare them with U.S. standards. Establishing strong relationships with patients and providing high quality and unique experiences to everyone will keep them in your chair for years to come.

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References
1. Arnst, Catherine. (2008, November 9). BuisnessWeek. Lack of Insurance Drives Dental Tourism. Retrieved July 9, 2009 from http://www.businessweek.com/globalbiz/content/nov2008/gb2008119_541944.htm

2. Marklein, Mary Beth.(2005, July 28). USA Today. The inciDENTAL tourist. Retrieved July 9, 2009 from http://www.usatoday.com/travel/news/2005-07-28-dental-tourism_x.htm

3.Roig-Franzia, Manuel. (2007, June 18). Washington Post. Discount Dentistry South of the Border. Retrieved July 9, 2009 from http://pqasb.pqarchiver.com/washingtonpost/access/1289966531.html?dids=...

4. Booth, William. (2009, June 18). Washington Post. Mexican Dentists Now Fill Only Time. Retrieved July 10, 2009 from http://www.washingtonpost.com/wp-dyn/content/article/2009/06/17/AR2009061703780.html

5. Berry, Jerry. (2006, August 23). ADA.org. The phenomenon of ‘dental tourism’. Retrieved July 10, 2009 from http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2064