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SAN FRANCISCO—Turn a quiet corner of the U.S. health care system and bump into a medical niche unknown — and unavailable — to most patients.  

While many Americans are traveling to India and Singapore for affordable lifesaving or cosmetic procedures, affluent foreign patients are paying cash upfront for stateside surgery and routine checkups in large medical centers with concierge services that cater to traveling families’ banking, dining and shopping desires.  

Call it medical tourism, American style.  

Bouncing back from a post-9/11 setback in Middle Eastern patients by reaching out to Europe, Latin America and the Caribbean, this market is competitive and lucrative. Neither the American Hospital Association nor the federal government knows the total number of foreign patients who received care at U.S. international medicine centers last year, or how much revenue U.S. hospitals and local economies reaped for treating them and hosting their families. According to “The Healthcare Business Market Research Handbook,” by Richard K. Miller and Associates, annual revenue to U.S. hospitals for treating foreign patients who return home afterward totals more than $1 billion.  

Mayo Clinic. Johns Hopkins. Cleveland Clinic. Texas Medical Center. Together with nine medical facilities in Philadelphia, these domestic drivers of medical tourism alone report welcoming more than 30,000 patients from more than 100 countries last year.  

Philadelphia International Medicine (PIM) is the only U.S. medical consortium formed specifically to attract foreign patients to one metropolitan area, according to Leonard Karp, executive vice president and chief operations officer. Among its members are University of Pennsylvania Medical Center, Temple University Hospital and Children’s Hospital of Philadelphia. Founded six years ago, PIM is also building a hospital in Korea at an estimated cost of $860 million.  

“Originally, our hope was to generate $200 million a year for the Philadelphia region, with about 6,000 patients generating $60 million in revenue,” Karp says. “Since 9/11, we have restructured to be in a better position to withstand world events. This year, we attracted between 4,000 and 5,000 patients, mostly from the Caribbean, Middle East and Brazil, who generated more than $60 million in economic activity in Philadelphia.”  

Like his competitors, who attract at least double the number of overseas patients, Karp is secretive about total revenue and profit figures. Middle Eastern embassies regularly arrange payments for their patients, he says. Other patients pay cash or use insurance from companies with PIM contracts. Foreign patients can pay as much as 100 percent more than domestic patients.  

Most health care observers consider marketing these centers a savvy way to make money in a broken health care system. But because doctor-patient communication in every major language is at the core of these programs, their interpretation services are the envy of health professionals serving as many as 20 million U.S. residents who barely speak English. These immigrants would be lucky to find a full-time, trained medical interpreter in a major metropolitan area emergency room.  

Patients who speak limited English risk misdiagnosis, medical errors and poor quality of care, according to widespread research on language access in health care. These patients are more likely than others to report being in fair or poor health, defer needed medical care and experience drug complications. Guaranteed by Title VI of the Civil Rights Act as a protection against discrimination based on national origin, medical interpreting is often called health care’s biggest “unfunded mandate.” But failure to afford an interpreter will not prevent a malpractice lawsuit or civil rights investigation when mistakes from lack of communication result in injury or death.  

In some cases, immigrants with a limited grasp of English who live and work near international medical centers can benefit from these facilities’ commitment to hiring full-time interpreters. For instance, Johns Hopkins Medicine International reports having 40 full-time and 45 on-call interpreters; Mayo Clinic in Minnesota, 38 fulltime interpreters and 25 on-call employees; Cleveland Clinic, 35 staff interpreters; and Texas Medical Center, 10 full-time interpreters and 25 bilingual staffers.  

“When our international patient coordinators have time to assist domestic patients who are limited-English-proficient, they do so,” says Mika Dulay, project analyst for the Johns Hopkins International Call Center in Baltimore, Md. “Domestic patients who speak unusual languages might have to wait 60 or 90 minutes to get an in-person interpreter, and we also use telephonic interpreting.”  

In the Philadelphia international consortium, however, “there is a difference between use of medical interpreting for domestic patients who barely speak English and foreign patients,” Karp says. “It’s daunting for U.S. patients who speak English. You can imagine how it is for a person from a foreign country who doesn’t speak English... We wouldn’t want to use a telephonic interpreting service for the foreign patient unfamiliar with our culture and not speaking English. It’s pretty impersonal. But telephonic works well in emergencies in hospitals for domestic patients who may not speak English.”  

It’s the nature of the world that “crazy amounts of money buy good health care like trained medical interpreters,” says Heng Foong, program director of PALS for Health, a community-based organization offering free, professional health care interpreting in Los Angeles and Orange County. “Do I think it’s fair to someone who’s living in this country and can’t afford it? No. But this is a hard nut to crack. Very few people are willing to talk about it.”