Consumers increasingly are trying alternatives to their local hospitals and doctors, from going abroad for less-costly surgery to seeking quick, basic care at new clinics in drugstores and discounters, experts say.

The number of people heading abroad for “medical tourism” could jump tenfold in the next decade, to nearly 16 million Americans a year seeking cheaper knee and hip replacements, nose jobs, prostate and shoulder surgery, and even heart bypasses, according to a forecast by health care consultants at the Deloitte Center for Health Solutions.

Meanwhile, the number of “retail clinics” operating in pharmacies, big-box and discount stores and supermarkets has jumped from about 200 in October 2006 to nearly 1,000 this month, according to a second report from the Deloitte center. While growth is slowing and some early players funded by venture capitalists have folded or been bought out, major retailers such as Wal-Mart Stores Inc., CVS Caremark Corp. and Walgreen Co. have announced plans to open hundreds more clinics in their stores in the next few years.

The two reports, released exclusively to The Associated Press, show potential big savings for U.S. consumers — and likely their health insurers — would come at the cost of American hospitals and doctors losing billions of dollars a year in revenue.

Surgery in some of the countries that have become hubs for medical tourism, from Thailand and Singapore to Mexico and Brazil, can cost less than half the U.S. price tag, even when including outlays for airfare, hotel and meals abroad. In a few cases, procedures overseas can cost one-tenth as much, Keckley said.

Many of these countries actively market their programs in wealthier nations and have new, 21st-century hospitals. Most of their physicians are U.S.-trained and know all the latest techniques, according to Keckley and Michael Taylor, a global health consultant at Towers Perrin.

But in the event of botched surgery or complications later, who takes care of the patient?

“That’s one of the two big question marks about this, and the other is liability,” said Keckley.

When patients work with specialized brokers who arange the surgery, travel and hotel, contracts sometimes provide for a doctor or hospital back home to handle follow-up care and spell out who is liable if a lawsuit follows, he said, but that’s very inconsistent.

“In many ways, it’s still the Wild West,” Keckley said.

Problems come up most often when patients make arrangements themselves, such as for cosmetic and dental surgery not covered by insurance.

About 750,000 Americans headed abroad for major health care last year and an estimated 1.5 million will do so this year, according to the report. Based on several years of data from sources including the Medical Tourism Association trade group, top brokers arranging such trips and economic development agencies in countries doing the surgeries, the Deloitte report projects the number could jump to anywhere from 10.4 million to 23.2 million in 2017, with 15.8 million the most likely number.

“I think that’s very optimistic,” said Towers Perrin’s Taylor, who thinks host countries likely are inflating their reported numbers of American patients. He thinks the trend is growing, but not that quickly.

Deloitte’s projections would equate to U.S. medical tourists spending roughly $50 billion abroad in 2017, with U.S. providers losing about $373 billion that year, given the difference in costs.

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