If you’re anticipating a trip overseas for medical treatment, or even just an overseas vacation, it pays to know before hand that there is a big variation in the fees you may pay on foreign purchases and money changing. It’s easy to get burned by fees that U.S. banks and credit card companies tack on to your overseas purchases.

You probably know all about the ATM fees your bank charges. But you may be in for a surprise if your bank adds an additional 3% “foreign exchange” fee on top of that. That’s pretty common so it pays to check the list first and go with the bank that has competitive rates. The same applies to your credit card. Some credit card companies charge as much as a 3% adder for overseas purchases while there is at least one company that charges a 0% adder and gives the best available exchange rate on the day of purchase.

In many countries using your ATM card is convenient, safe and you receive a better exchange rate than cash or travelers checks. In Thailand, for example. ATMs are plentiful throughout the country, even in small cities, and there is no local ATM fee charged. Changing cash or travelers checks is convenient only in heart of the major tourist destinations and only during opening hours of the exchange windows. Elsewhere you’ll need to visit a bank branch during normal banking hours. So use your ATM. But check this list first:

The fees charged by the first three banks in this list are from my own recent personal experience. I got burned by the Citibank 3% fee when they changed their fee structure in late 2006. When you make a sizable withdrawal that 3% fee ends up being far more than any normal ATM fees. WaMu (that’s the online banking division of Washington Mutual) has a competitive 1% foreign exchange fee. I call this the “standard” fee because it is the fee that Visa international charges on foreign money transactions and the banks charge this fee to recoup that cost. Interestingly, although the Fidelity representative I spoke with said that this 1% fee is included for ATM withdrawals from a Fidelity core account I have made many withdrawals and there is no fee. Is this a mistake? Probably not. Perhaps it is related to the type of account, such as a Premium Services account. The other notable point is that many ATM withdrawals from Fidelity and WaMu within a few minutes of one another always show a 0.3% better exchange rate from Fidelity. So somebody seems to be “skimming” on the WaMu withdrawals, although it’s pretty small.

Note that most banks list the “foreign exchange fee” as a separate item on your statement so it’s easy to see how much they are charging. If your bank doesn’t then it’s probably buried in a reduced exchange rate so check the rate they are giving you carefully. Since exchange rates fluctuate it is sometimes it is difficult to confirm the exact amount of the fee.

Ok, so when you are traveling use your ATM card but be sure to pick the right bank to avoid getting burned on those fees. Remember, there are two types of fees your bank might charge, “ATM fees” and “foreign exchange fees”. They both can add up so check it out.

Now for credit cards the story is similar. Different issuers charge different fees on overseas purchases made with your credit card. But the fees on credit card purchases are lumped in with the purchase price so it’s more difficult to determine exactly what they are. Here’s what my research has uncovered:

Again, the fees for the first three credit card issuers in that list are from my personal experience. What seems sort of amazing is that CapitalOne somehow absorbs the 1% Visa money exchange fee. So purchases I have made on the same day with my Chase Visa and my CapitalOne Visa show a 3% difference in the exchange rate.

There is another little trick that you need to watch out for when you make credit card purchases. Some merchants will offer to charge your purchase in your home country currency rather than the local currency. From what I have experienced and read this is always a rip off. They’ll give you a much lower exchange rate than Visa will when the transaction books. You’ll usually get this offer from large merchants who have many foreign tourists, including the large private hospitals. It’s easy to avoid. Just be aware of it, decline the offer, and be sure the purchase is charged in the local currency.

Offshore versus Onshore Exchange Rates

Here’s one more important tip about exchanging money. This definitely applies to Thailand and may apply to some other countries. There are really two exchange rates. The so-called “offshore rate” is what you will get if you purchase Thai money outside of Thailand. This rate is about 10% lower than the “onshore rate”. That’s huge, a 10% difference. So wait until you arrive in Thailand to exchange money. You are getting ripped if you do it at your departure airport. There are exchange booths and ATMs all over the airport in Bangkok so you’ll have no trouble changing money when you arrive no matter what time it is.

This issue can be particularly important if you are transferring money by bank wire from a U.S. bank to a bank in Thailand. A lot of expats who are purchasing retirement homes in Thailand are finding this out the hard way. Typically the U.S. bank is going to give you the offshore rate and you are going to get ripped off big time. But the picture is a little fuzzy now because there have been reports of people doing bank wires from U.S. banks to Thai banks and receiving the onshore rate. In particular, a recent bank wire from WaMu to Bangkok Bank was completed at the full onshore rate, and on top of that there were no fees on either end. That’s worth investigating if you are in that situation.

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Thailand’s Board of Investment (BOI) has approved the Israeli-Thai stem cell therapy company TheraVitae for special investor privileges under the BOI’s foreign investment program. Mr Narin Apichairuk, president of TheraVitae, says this will allow them to open a laboratory near Bangkok. Currently adult stem cells are extracted from patients’ blood and then sent to a laboratory in Israel for multiplication, then sent back to Bangkok for use in treatment. The treatment, called VesCell, involves injection of stem cells directly into the heart tissue to treat conditions untreatable by any other means. Two hundred patients have so far received the TheraVitae treatment in Bangkok with 75% reporting significant improvement in heart function within a few months.

With the BOI approval TheraVitae anticipates building the world’s largest stem cell laboratory near Bangkok. The result will be greater efficiency in treatments and greater capacity which will lead to lower costs that will make the treatment available to more patients. Currently TheraVitae is working with partner hospitals that include Bangkok Heart Hospital, Chaophya Hospital, Phaya Hospital group and Praram 9 Hospital as well Singapore’s Parkway Hospital group which uses VesCell throughout it’s group.

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This story is from October 2006 but worth mentioning for completeness in the assessment of Thailand’s top healthcare facilities. Newsweek, in an article titled Medical Meccas, features Bumrungrad International Hospital in Bangkok and lavishes the usual praises upon it such as “world-class medicine at developing-world prices”, and “velvet-glove treatment redolent of a five-star hotel”. The article also mentions the move by some U.S. insurance companies to cover procedures performed at overseas hospitals. The leader in this healthcare outsourcing is United Group Programs, previously mentioned here. The Newsweek article lists the 10 world leaders of medical destinations; Bumrungrad is listed first among those 10 prestigious institutions.

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The online news site NBC-2.com had a story about several patients, 10 actually, who came from Florida to Bangkok to receive adult stem cell therapy for their untreatable heart conditions. One of the interesting points from that story is that this therapy is “illegal” in America. So these 10 men from southwest Florida were condemned to death by their American doctors. They did not accept that prognosis, however, and travelled to Thailand to be treated by Dr. Fupachai who uses adult stem cells extracted from the patients own blood to regenerate heart tissue in otherwise untreatable cases. One patient, David Foege, had the treatment three months ago. He was quoted as saying before the treatment he couldn’t take ten steps, but now, after only three months he can walk for 30 minutes.

Another interesting point from the story is that Dr. Fupachai made a “housecall” all the way from Thailand to Florida to check up on his patients. Talk about service. A local doctor in Florida named Dr. Zannos Geckos was instrumental in connecting the Florida patients with Dr. Fupachai in Thailand. Regarding the efficacy of the procedure Dr. Geckos was quoted as saying “You can’t fake new heart tissue starting to work again.”

The procedure is currently being performed in three countries, Thailand, Germany and Brazil. Despite it being illegal in the U.S. about 60% of the 2,000 patients who have had it performed are from the U.S.

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The UK’s National Institute for Health and Clinical Excellence is considering proposals to offer free stomach surgery for obese teens. The rationale is that it will reduce costs in the long term due to health issues arising from obesity such as diabetes and heart disease. That’s good, because at around 8,000 pounds the cost of the surgery is substantial. Of course they could consider off-shoring it since the cost of gastric banding surgery at Yanhee Hospital is about half that.

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The Bangkok Post has a story today about the rise in the number of Japanese coming to Thailand for medical treatment. Kasikorn Research Centre published a survey that states the number of Japanese who came to Thailand for medical treatment in 2006 was 185,616 or 14.9 percent of all foreign patients. And they expect that number to rise in 2007 to around 200,000. The total number of foreign patients is expected to be around 1.54 million in 2007. Kasikorn credits the recently signed trade agreement between Japan and Thailand with having a positive effect on medical tourism to the country. The attractive features of Thai healthcare are the high quality care at lower prices plus spa and Thai traditional medicine which are often combined with moden medical care.

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The website NewsTarget.com has as it’s tagline “Information that Empowers”. And information about healthcare alternatives abroad fits well with their philosophy. They have an article from April 2005 that challenges the commonly held assumption that medicine in the U.S. is the best in the world. The author asserts that the U.S. ranks near the bottom of all industrialized nations, with Americans getting far less actual health care per dollar spent than almost anywhere else in the world. He discusses some of the factors that are causing this, and the resulting trend in medical tourism. As he concludes he warns that one day the powerful special interest groups of the U.S. medical and pharmaceutical industries may be successful in getting legislation passed that will make it nearly impossible, perhaps illegal, for Americans to seek medical treatment abroad, a sobering thought.

Back in September 2005 60 minutes did a story on medical tourism with the focus on Thailand. This is when Bumrungrad really got introduced to the American public. The story is still up on the CBS News website, including a video of the segment.

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That’s the title of a story on medical tourism over at news.com.au. Funny thing is, the entire story is a glowing account of medical tourism in Thailand, Singapore and India - no warts. It’s another good snapshot of the state of medical tourism and the preeminent position of hospitals like Thailand’s Bumrungrand International in this industry. They have a few good up-to-date data points as well, such as the cost of an elective coronary artery bypass operation that would typically cost $70,000 is about one-quarter of that fee at Bumrungrad, and the number of international patients Bumrungrad treated last year which tallied 435,000. The article also has a good summary of the top international hospitals in Singapore and India.

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Hyatt has developed something they call the “residential spa” concept that incorporates spa and business facilities into individual rooms. The concept is designed to offer guests wellness and comfort with added amenities such as wet and dry in-room treatments, luxurious oversized soaking bathtubs, and steam showers. The features of the residential spa are customized to each location, taking into consideration local environment and culture. The concept has recently been implemented in The Barai, which is the brand new Hyatt Regency hotel in Hua Hin, the beachside resort town approximately two hours drive south of Bangkok.

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