Flying to the Doctor 

The lack of insurance coupled with skyrocketing medical costs has led many Korean Americans to seek cheaper care in their homeland.

Sudok Choi has lived in the United States since 1982 and has long had private health insurance, but when she wants to see a doctor, she often boards a plane. The 58-year-old owner of Koryo BBQ in Oakland says she's traveled to South Korea about five times to see a doctor because the cost to do so in her homeland is much cheaper. Speaking through the translation of her nineteen-year-old son, Tae Kim, Choi says she usually pays a one-time fee of about $3,000 to get everything checked out, "from head to toe."

And she's not the only one. Korean Americans are increasingly seeking care in South Korea, where a universal health-care system means it's cheaper to buy a $1,000 plane ticket to fly thousands of miles away to see a doctor than it is to see a physician down the street. While it's known that many US residents travel outside of the country for expensive medical treatments, many Korean Americans appear to be seeking care for everyday procedures such as filling cavities or getting routine checkups.

That's because Korean Americans have one of the highest — if not the highest — rates of uninsurance in the United States, at about 34 percent. It's primarily due to the fact that so many are self-employed or work at small businesses. And those, like Choi, who are insured still face high deductibles and out-of-pocket expenses. She currently shells out about $1,600 a month to cover herself, and her husband, son, and mother.

In fact, many Korean Americans fall into an in-between bracket — they make too much money to qualify for government subsidies but too little to afford private insurance. Language barriers and inadequate translation services also impede the ability of American doctors to effectively communicate with non-English-speaking patients. "I know very well they go back to Korea and then they come back with a report," said Stella Han of Oakland's Asian Health Services, which serves low-income Asian patients in Alameda County. "They kind of want to get follow-up — because they go there and find out the main problem, then come here and say, 'This is what I need.'"

At the same time, the growing number of Korean Americans who now fly overseas to see a doctor also reveals a gap in the health reform plan that President Obama hopes to sign into law soon. Although some Korean Americans may receive subsidies under the reform initiative that will help offset their health insurance premiums, the bill is not expected to rein in skyrocketing medical costs. As a result, the president's plan may do little to stem the tide of Korean Americans jetting home for health care.

Locally, the trend of Korean Americans taking a plane to see a doctor appears to be fairly common. In a recent door-to-door survey of five businesses in Oakland's Koreatown, every employee said they have traveled to South Korea for health care or knows someone who has.

Thirty-year-old Ryan Yoo, who works at his father's restaurant, Sahn Maru, said his younger sister was currently in South Korea getting dental implants. Though his sister had dental insurance, Yoo said it wouldn't cover implants, which were estimated to cost between $6,000 and $7,000. During a family visit to Korea, she found out it would only cost $2,500. She had initial work done, then made a return trip for a follow-up procedure months later. The total cost was about $4,300 — still thousands of dollars cheaper than if she had the procedure done here.

Once, while visiting Korea, Yoo's daughter developed an ear infection. He said he paid $8 to get it taken care of, and that was without being on the nation's government insurance plan. With the government insurance, he said, it would have cost just $2. Foreigners who can prove Korean ancestry are eligible for the national health insurance. But non-Korean foreigners can still receive care.

Yoo said his father, who does not have health insurance, also plans to travel to Korea in the spring for knee surgery. "I see a lot of people who go to Korea for medical reasons," said Yoo, who has lived in the United States for fifteen years. "They rather go to Korea than here because medical cost is tremendously high."

Because of the low cost and high quality of its medical services, South Korea has emerged as a hub for so-called medical tourism. "Korea medical care is very high class," said Mike Lee, a native of South Korea who runs Mike Lee Tours in Oakland. "Doctors is top class. Medical program is very good. Only one-third expense than in USA."

Three years ago, Lee expanded his nearly thirty-year-old travel agency to include medical tours to South Korea, citing increased demand. "It's hard to go to hospital in the US — language problem, expense very high, they're most used to Korean doctors," he explained.

Last year, 300 of his 1,000 clients — who are mostly Korean American but also other ethnicities — booked such tours, whose costs vary depending on the services rendered. A full-body checkup, including airfare, three nights of lodging, sightseeing tour, and meals, costs about $2,500, he said.

Lee said South Korea is competing with countries like Singapore and Thailand as a medical destination in Asia. Yet statistics vary on just how many medical tourists the country is attracting. According to the market research consultancy group RNCOS, South Korea saw about 25,000 foreign medical tourists in 2008, a 56 percent increase from the year prior. The Korea Times, however, reported the number for the year closer to 40,000, representing about $48 million.

Whichever the case, it's clear that medical tourism there is on the rise. The South Korean government is trying to encourage the industry, and last year enacted a law to allow its hospitals to directly seek foreign patients. A joint venture between the government and private investment is in the process of creating a sprawling "Healthcare Town" on the island of Jeju, a resort-like medical facility designed to attract foreigners.

Even US health-insurance companies are recognizing the value in medical tourism. According to the consultancy group Deloitte Center for Health Solutions, several insurers, including Blue Shield, Health Net, and Anthem WellPoint have launched medical-tourism pilot programs, sending some group members for certain elective procedures to hospitals in India, Thailand, and Mexico because they're cheaper. In addition, states such as West Virginia and Colorado have introduced legislation to encourage public employees to seek medical treatment overseas, also in order to reduce costs. However both bills failed to pass, likely because they provided financial incentives for patients and employers

With US health-care costs among the world's highest, and predicted to rise 6 percent per year for the next decade, more and more Americans will likely seek care beyond our borders — and not just for major surgeries. The consultancy group Deloitte Center for Health Solutions recently released a report stating that 750,000 Americans traveled abroad for medical care in 2007. And that number is expected to grow to 1.6 million by 2012. Lee said initially his clients were older, first-generation Korean Americans. "Now all generations," he said, "because they find out cheaper, more convenient, good treatment."

Though Lee, who came to this country 38 years ago, has health insurance in the United States, he also sought medical treatment in Korea last year for the first time. "They are more kind, more friendly," he enthused in his Grand Avenue office, adding that the hospitals have new, state-of-the-art equipment and the doctors are well educated. "I sent all my family to go there," he said. "It's very common."

Nineteen-year-old Sunjmin Hur, a nursing student at Laney and Berkeley City College who works at Cyber Cafe on Telegraph Avenue, said he returned to his homeland in 2007 because of a cavity and to get his wisdom teeth removed. He paid less than $50, including prescriptions. This year, he's planning to return to get Lasik surgery. All of his friends, he says, do the same.

Suk Lee, owner of Casserole House in Oakland, said she always gets dental work done when she travels to Korea, about once a year, even though she has dental insurance in the United States. The 69-year-old, who has lived in this country for 35 years, says she has been getting her dental work done in Korea for the last ten years. "They clean everything — if they find [she motions to a cavity], they fill it up for me," she said, adding that it cost $200. "They have fantastic equipment and doctors." Lee said she goes with her friends. "It's fun," she said. "One hospital — you walk in, you complain, they do everything. I wish they have here."

But the fact that it's cheaper to buy a plane ticket to fly to Korea and see a doctor than it is to get care in the US is "absolutely absurd," said Ricky Choi, who heads the pediatric department at Asian Health Services and resides on the board of the National Council of API Physicians. Choi, no relation to Sudok Choi, has been a vocal advocate in the health-care reform debate, and is in favor of adding a public option and eliminating the five-year ban on new legal immigrants from becoming eligible for Medicaid, Medicare, or other insurance subsidies. "Having a public option will add competition to the health insurance market, help bring cost down, and therefore allow more people to have access to the health-care system," he said. "Korean Americans, for example, would benefit from a cheaper health insurance program and would allow them to buy into it."

Yet many Koreans continue to be largely uninformed of how America's health-care system works. Mrs. Choi, who had recently been in a car accident and was taken to the hospital, said she was confused as to which of her insurance companies — car, life, or health — would be paying her hospital bills. Navigating such complex bureaucracy would be difficult for anyone, let alone someone with limited English-speaking ability.

And she wasn't any clearer on health-care reform. Choi admitted she didn't really understand what reform would mean for her or how it would work, but said she didn't think it would be fair if that meant her taxes would be raised. However, when told it might mean cheaper insurance for her, Choi said she'd "jump at the chance" — even if the quality wasn't as good as her private insurance.

With care being so much cheaper in South Korea, Yoo finds it difficult to comprehend why services are so much more expensive in the United States. "Make copayment $5 or $10 — and the rest covered by government like Korean system," he suggested. "We don't understand why health care is so controversial. ... Medical cost should be reasonable so everyone can be treated equally."

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