HOUSTON -- Mexican businessman Juan Payan and his wife, Martha, arrived in Houston almost three months ago and have accrued about $300,000 in expenses to ensure they have the best Houston has to offer.
About $8,000 per month goes toward a furnished, two-bedroom apartment at Camden Post Oak Apartments, a 33-story luxury high-rise near the Galleria where they plan to reside at least two more months. But by far the biggest expense incurred by the 67-year-old San Luis Potosi shopping center owner and former importer is the estimated $200,000 for his kidney transplant, performed June 24 at Houston Methodist Hospital, and related treatment. Payan is uninsured and pays cash for everything, including expenses for Payan's kidney donor, a family friend who traveled with them from Mexico.
"Health doesn't have a price," Payan said through interpreter Javier Paredes, the patient liaison assigned to assist him.
The Texas Medical Center is becoming more focused on patients like Payan and the estimated 20,000 other foreign visitors who travel to Houston annually for medical care. It's part of a renewed effort to capture a bigger share of the multibillion-dollar global medical tourism industry.
Payan and many others tell the Houston Chronicle (http://bit.ly/1pJTnOI) that Houston is the best choice.
"People with money come here. I feel safe with the physicians," he said. "... Here, they perform the surgery every eight days. They don't do it in Mexico that often. I trust Houston."
Globally, cross-border health care travel, known as medical tourism, generates $38.5 billion to $55 billion annually, industry experts say.
Officials at the Medical Center recently initiated a study of how much of that business currently comes to Houston, research that center president and CEO Dr. Robert Robbins hopes will lead to a plan to further build its name recognition abroad.
After arriving two years ago, Robbins decided to do more than oversee the Medical Center's parking garages. He wants to transform the 1,345-acre complex into the world's health care destination, rebuilding its international patient base.
"There has been a reluctance for the (Medical Center) to brand itself," Robbins said. "Anything we can do to promote its entities is a good thing."
The focus comes as the Texas Medical Center increasingly finds itself competing with other countries that have invested heavily in medical infrastructure to draw from that same pool of wealthy patients. Meanwhile, the number of visitors is half what it was before Sept. 11-related travel restrictions.
Before the 2001 terror attacks, about 40,000 international patients, mostly from Mexico and the Middle East, sought treatment at one of the Medical Center's research and health care institutions every year. The attacks led to stricter medical visa policies, and international patients began to seek care elsewhere.
At the same time, countries like Germany, Thailand, Japan, Costa Rica, Brazil, India, South Korea and Mexico became more competitive in attracting them, offering care comparable in quality with that provided in the United States at lower costs.
"There was a lot of change with our government," said Rosanna Moreno, a Houston attorney and partner of McMains & Moreno Global Consultants, as she recalled the visa changes following the attacks. "Homeland Security was created. It wasn't very friendly. It discouraged people from coming."
In response, Medical Center hospitals sought affiliations with foreign hospitals, medical schools and private companies, setting up offices abroad to build name recognition and lure patients.
They rely on those relationships for patient referrals instead of advertising.
Here in Houston, hospitals created concierge service centers and hotel-like luxury hospital suites to further appeal to international patients.
While it's unclear exactly how much these travelers contribute to the Medical Center's estimated $20 billion economy, economic development officials say the effects are felt beyond the hospitals. These patients sometimes bring their families, lease apartments and hotel rooms and stay in the Houston area several months for surgeries, treatments and follow-up care.
Like Payan, many pay cash for their care - usually at a higher rate than that set for Medicare, Medicaid and private insurers.
Medical Center leaders and the University of Houston began discussions about an economic study a couple of years ago, but the process stalled. Robbins said he hopes the nascent research effort will yield results that will help the center do a better job of attracting patients like Payan.
Lack of hard data isn't unique to Houston. Renee-Marie Stephano, president of the Washington, D.C.-based Medical Tourism Association, said information about the number of international patients who come to Houston, the treatments they seek and the money they spend isn't available.
"Hospitals don't collect it, and if they have it, they don't want to share it because the numbers are lower than they want people to know," she wrote in an email. "The industry, as a developing industry, is too new. Our Customs forms don't even ask the info like that."
A 2009 report by the Washington-based Deloitte Center for Health Solutions predicted up to 561,000 international patients annually would travel to the U.S. by 2017.
Patients Beyond Borders, a Chapel Hill, N.C.-based provider of international medical and health travel information, states on its website about 11 million cross-border patients worldwide spend an annual average of $3,500 to $5,000 per trip, including medical and travel costs.
The most popular services sought include cosmetic surgery and dentistry; cancer and reproductive treatments; organ transplants; cardiovascular, orthopedic and weight-loss surgeries; and scans, tests, screenings and second opinions.
Although people worldwide have crossed borders for years in search of treatments, the Internet and the accessibility of information have further globalized health care.
The Texas Medical Center is considered a health care leader because it offers expertise in cancer treatment, transplants, orthopedics and neurosurgery, said David Vequist, founder and director of the center for medical tourism research at San Antonio's University of the Incarnate Word.
But some of Houston's main competitors are gaining ground by investing heavily in health care, offering financial incentives to companies that can develop quality services and recruit highly skilled doctors.
"They are stealing ideas from the U.S.," Vequist said. "Health care is only going to get better."
With 17 international airlines now flying to Houston, the Medical Center is a convenient destination for patients too sick to wait hours for layovers, said Patrick Jankowski, economist at the Greater Houston Partnership. Each new route will make Houston's hospitals more accessible to the world, he said.
"Medical tourism is a way to offset losses at a time when hospitals are all concerned about medical care and controlling costs," he said. "Medical tourists have the wherewithal to spend money where Houstonians don't."
Jankowski estimates that every $1 a Houston medical tourist spends on medical care, accommodations, travel, food, entertainment and the like has at least a $2 effect on the economy by generating business and jobs.
"So, a procedure costing $100,000 is going to have over a $200,000 impact on the economy," he said. "A 21-day hotel stay totaling $4,200 will have an $8,000 impact on the economy."
Payan is among about 3,000 international patients who seek treatment at Houston Methodist annually. Half have international insurance coverage. The rest pay cash or have coverage through their embassies. They typically seek oncology, neurosurgery and heart and vascular treatment, said Cathy Easter, president and CEO of Houston Methodist Global Health Care Services,
While other countries improve the medical care they deliver, Easter said, the Texas Medical Center will maintain an edge because of its international reputation for innovative, quality care provided by some of the world's leading doctors.
Citizens of Mexico and Saudi Arabia make up the majority of Medical Center's international patients. In part, this is because of medical and business connections established by Houston Methodist Hospital, University of Texas M.D. Anderson Cancer Center and Memorial Hermann Health System in those countries.
The hospitals' international centers assist with medical appointments, travel arrangements and hotel and apartment leasing. Houston Methodist and Memorial Hermann also offer luxury patient rooms in their Medical Center hospitals.
"We understand it's a big undertaking for our international patients to leave home," said Martha Coleman, nurse manager of M.D. Anderson's international center. "We try to be very available before they arrive and while they're here. We make this as smooth as a transition as possible."
An estimated 1,800 international patients come to the hospital annually seeking second opinions and treatment options. Half pay cash. Twenty-five percent are insured. The rest carry embassy- or employer-sponsored coverage. M.D. Anderson's reputation for groundbreaking treatments and research has spread mainly because of the cancer center's relationships with facilities in Turkey, Spain and most recently Brazil. The center advertises in Mexico.
"They want the latest thing," Coleman said. "We might not always be talking about a cure. We might be able to get their pain under control."
Caio and Cristiane de Matos traveled from Sao Paulo, Brazil, to have their 5-year-old son Benicio treated at M.D. Anderson, no matter the cost, the language barrier or their unfamiliarity with Houston. Earlier this year, the child was diagnosed with right orbital rhabdomyosarcoma, a rare eye socket tumor.
The couple, Benicio and 8-year-old Bianca arrived about a month ago at the recommendation of Benicio's home doctor.
The daily proton therapy treatment, during which a beam of protons is used to more precisely radiate diseased tissue, is unavailable in Sao Paulo. It is estimated to cost $200,000, which Caio de Matos said his insurance won't pay.
"We looked at all the options," he said through interpreter Andrea Barbosa. "We would do anything to make sure he gets the best."
After a recent 30-minute therapy session, the de Matoses, both information technology consultants, discussed the family's plight as Benicio and his sister played in a treatment center playroom. The energetic boy wore a NASA spacesuit his parents bought at Space Center Houston when they first arrived.
De Matos, frequently switching from English to his native Portuguese, sobbed as he recalled how friends and relatives urged him and his wife to bring Benicio to Houston, even though his son's treatment costs almost double than what he expected.
"You go do what's needed," he said they told him. "We'll take care of it."
He and his wife rent an apartment near the Medical Center and they cook meals to save on expenses. De Matos rents a car, not just to make doctor appointments but also for trips to museums, the Kemah Boardwalk Aquarium and the Galleria to go ice skating. He and his wife want to make the trip as enjoyable as they can for their children.
"When it comes to your children, you need to do the best you can," Cristiane de Matos said, as she began to cry. "Worry about the finances later. You never want to have the doubt or ask 'what if.' There's the financial burden and we will deal with it. Coming here has strengthened us. We have a lot of belief."
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Information from: Houston Chronicle, http://bit.ly/NIjdEf
Editor's note: This is an AP Member Exchange shared by the Houston Chronicle.
