Such services typically include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available. As a practical matter, providers and customers commonly use informal channels of communication-connection-contract, and in such cases this tends to mean less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed. A specialized subset of medical tourism is reproductive tourism and reproductive outsourcing, which is the practice of traveling abroad to undergo in-vitro fertilization, surrogate pregnancy and other assisted reproductive technology treatments including freezing embryos for retro-production.
Over 50 countries have identified medical tourism as a national industry. However, accreditation and other measures of quality vary widely across the globe, and there are risks and ethical issues that make this method of accessing medical care controversial.
Spa towns and sanitariums may be considered an early form of medical tourism. In eighteenth century England, for example, medtrotters visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.
Medical tourists can come from anywhere in the world, including Europe, the UK, Middle East, Japan, the United States, and Canada. This is because of their large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care. An authority at the Harvard Business School recently stated that "medical tourism is promoted much more heavily in the United Kingdom than in the United States".
A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that a million and a half would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
A large draw to medical travel is convenience and speed. Countries that operate public health-care systems are often so taxed that it can take considerable time to get non-urgent medical care. The time spent waiting for a procedure such as a hip replacement can be a year or more in Britain and Canada; however, in Costa Rica, Singapore, Hong Kong, Thailand, Cuba, Colombia, Philippines or India, a patient could feasibly have an operation the day after their arrival. In Canada, the number of procedures in 2005 for which people were waiting was 782,936.
Additionally, patients are finding that insurance either does not cover orthopedic surgery (such as knee/hip replacement) or imposes unreasonable restrictions on the choice of the facility, surgeon, or prosthetics to be used. Medical tourism for knee/hip replacements has emerged as one of the more widely accepted procedures because of the lower cost and minimal difficulties associated with the traveling to/from the surgery. Colombia provides a knee replacement for about $5,000 USD, including all associated fees, such as FDA-approved prosthetics and hospital stay-over expenses. However, many clinics quote prices that are not all inclusive and include only the surgeon fees associated with the procedure.
According to an article by the University of Delaware publication, UDaily:
The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the US, for example, goes for $10,000 in India--and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the US costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the US runs about $1,250 in South Africa.
Popular medical travel worldwide destinations include: Brunei, Cuba, Colombia, Costa Rica, Hong Kong, Hungary, India,Jordan, Lithuania, Malaysia, The Philippines, Singapore, South Africa, Thailand, and recently, Saudi Arabia, UAE, Tunisia and New Zealand. Popular cosmetic surgery travel destinations include: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Mexico and Turkey. In South America, countries such as Argentina, Bolivia, Brazil and Colombia lead on plastic surgery medical skills relying on their experienced plastic surgeons. In Bolivia and Colombia, plastic surgery has also become quite common. According to the "Sociedad Boliviana de Cirugia Plastica y Reconstructiva", more than 70% of middle and upper class women in the country have had some form of plastic surgery. Colombia also provides advanced care in cardiovascular and transplant surgery.
However, perceptions of medical tourism are not always positive. In places like the US, which has high standards of quality, medical tourism is viewed as risky. Nonetheless, the number of Americans who are going abroad for health care is increasing. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care.
Health tourism providers have developed as intermediaries to unite potential medical tourists with provider hospitals and other organisations. Companies are beginning to offer global health care options that will enable North American and European patients to access world health care at a fraction of the cost of domestic care. Companies that focus on medical value travel typically provide nurse case managers to assist patients with pre- and post-travel medical issues. They also help provide resources for follow-up care upon the patient's return.
The typical process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified medical doctors or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.
In the United States, Joint Commission International (JCI) fulfills an accreditation role, while in the UK and Hong Kong, the Trent International Accreditation Scheme is a key player. The different international healthcare accreditation schemes vary in quality, size, cost, intent and the skill and intensity of their marketing. They also vary in terms of cost to hospitals and healthcare institutions making use of them.
Many international hospitals today see obtaining JCI accreditation as a way to attract American patients. Increasingly, some hospitals are looking towards dual international accreditation, perhaps having both JCI to cover potential US clientele and Trent for potential British and European clientele. As a result of competition between clinics for American medical tourists, there have been initiatives to rank hospitals based on patient-reported metrics.
Other relevant organizations include:
The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. However, JCI and Trent fulfill the role of accreditation by assessing the standards in the healthcare in the countries like India, China and Thailand. Also, travelling long distances soon after surgery can increase the risk of complications. Long flights can be bad for those with heart (thrombosis) or breathing-related problems. Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they sunburn while healing. To minimise these problems, medical tourism patients often combine their medical trips with vacation time set aside for rest and recovery in the destination country.
Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients.
Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.
Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system. In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care".
Medical travel packages can integrate with all types of health insurance, including limited benefit plans, preferred provider organizations and high deductible health plans. Insurers are beginning to establish partnerships with overseas health providers to treat their insureds. The article cites a BlueCross BlueShield of South Carolina representative who had a colonoscopy at Bumrungrad International Medical Center in Bangkok.
According to a recent case study interview in The Health Care Globalization Report, a major employee benefits management company, Plan Benefit Services, accompanied a group of employers to Bangkok and Singapore to visit facilities. This is seen as significant since up to this point, most visitors to foreign hospitals were patients, health plans and medical travel companies. According to the report, the employers attending were very close to making benefit changes that would incentivize employees to seek care overseas.
In another publication, Fast Company Magazine, a much lengthier story discusses the globalization of healthcare and how an employee benefits decision-maker for the City of Myrtle Beach fully supports overseas care, having been a patient himself for a colonoscopy.
Colombia has many surgeons that have either trained and/or practiced in other countries such as the US and Europe. Salaries for doctors, nurses, and supporting personnel in Colombia are about 20% of US salaries for similar occupations even though they are required to have the same level of education and job skills. Real estate costs related to medical care facilities are also a fraction of what they are in the US
Like Brazil, ease of travel and relative proximity from the US and Canada is an advantage. Colombia offers cheaper airfares from the US and Canada (and some European countries) than other more-distant destinations, and does not have the visa restrictions of other countries currently in the medical tourism market.
This trend has alarmed American healthcare providers who, fearing a loss of business, warn patients away from Mexico. "The phenomenon has unsettled US-based dentists who tell horror stories of rampant infections, undetected cases of oral cancer and shoddy work south of the border", claims hotly disputed by Mexican dentists. "In Texas, legislators explored the possibility of allowing health maintenance organizations to operate on both sides of the border. However, physicians in south Texas lobbied against the changes, arguing that local doctors could not compete with the lower costs in Mexico". US doctors point out that the Mexican legal system makes it almost impossible to sue Mexican doctors for malpractice.
However, many who travel to Mexico for care report that they are satisfied. According to a report commissioned by Families U.S.A., a Washington advocacy group for health-care issues, "About 90 percent [feel] the care they had received in Mexico had been good or excellent. About 80 percent rated the care they had received in the United States as good or excellent".
Indeed "some U.S. dentists ... have conceded to the competition and begun a 'reverse migration' opening offices in Mexico to take advantage of lower costs". More American insurers are providing coverage for travelers, as the out-of-pocket costs to them are much lower. "With healthcare costs in the United States continuing to rise, many employers in Southern California are turning to insurance plans that send their workers to Mexico for routine care, plans that are growing by nearly 3,000 people a year".
In addition to dental and plastic surgery, Mexican hospitals are popular for bariatric surgery for weight loss, considered an elective procedure that is not covered by some US insurers. A popular bariatric procedure, lap band surgery, which was approved by the FDA in the US in 2001, has been performed for longer by Mexican surgeons.
While much attention has been given to the growing trend of U.S. citizens seeking health care in other countries, other evidence points out that the largest segment of medical travelers are headed stateside. The availability of advanced medical technology and sophisticated training of physicians are cited as driving motivators for growth in foreigners traveling to the U.S. for medical care. Also, it has been noted that the decline in value of the U.S. dollar is offering additional incentive for foreign travel to the U.S.
Several major medical centers and teaching hospitals offer international patient centers that cater to patients from foreign countries who seek medical treatment in the U.S. Many of these organizations offer service coordinators to assist international patients with arrangements for medical care, accommodations, finances and transportation including air ambulance services.
Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012. The Indian government is taking steps to address infrastructure issues that hinder the country's growth in medical tourism.
The south Indian city of Chennai has been declared India's Health Capital, as it nets in 45% of health tourists from abroad and 30-40% of domestic health tourists.
Medical centers in Metro Manila have complied to ISO standards, and are periodically and regularly undergo accreditations from Philippine's Department of Health. Others have already accredited by the American accreditation group Joint Commission International (JCI), while some have appied to join the UK-sourced Thailand's tourism and health-care sectors. In 2005, one Bangkok hospital took in 150,000 treatment seekers from abroad. In 2006, medical tourism was projected to earn the country 36.4 billion baht.
Treatments for medical tourists in Thailand range from cosmetic, organ transplants and orthopaedic treatments to dental and cardiac surgeries. Treatments also include spa, physical and mental therapies. Thailand offers everything from cardiac surgery to organ transplants at a price much lower than the US or Europe. Thai medicine also features a higher, more personalized level of nursing care than westerners are accustomed to receiving in hospitals at home. One patient who received a coronary artery bypass surgery at Bumrungrad International hospital in Bangkok said the operation cost him US$12,000 (8,200 euros), as opposed to the $100,000 (68,000 euros) he estimated the operation would have cost him at home. Bumrungrad treated approximately 55,000 American patients in 2005 alone, a 30% increase from the previous year. Hospitals in Thailand are a popular destination for other Asians. Bangkok Hospital, which caters to medical tourists, has a Japanese wing, and Phyathai Hospitals Group has interpreters for over 22 languages, besides the English-speaking medical staff. When Nepal Prime Minister Girija Prasad Koirala needed medical care in 2006, he went to Bangkok.
Today many Thai physicians hold US or UK professional certification. Several Thai hospitals have relationships with educational facilities in the US and UK (for example, Sheffield Hallam University has links with Bangkok}. One Thai hospital, Bumrungrad International, states that many of its doctors and staff are trained in the UK, Europe and the US. Bumrungrad International was accredited most recently in 2005 by an American group in order to ensure an international standard of medical services. Some of the country’s major hospitals also have achieved other accreditations, and some have achieved certification by the International Organization for Standardization’s ISO 9001:2000 (However, ISO not an accreditation scheme).
The US consular information sheet gives the Thai health care system high marks for quality, particularly facilities in Bangkok, although the World Health Organization ranks the Thai healthcare system at number 47, below the USA's ranking at 37 and the United Kingdom's ranking at 18. The UK's Foreign and Commonwealth Office web site states "There are excellent international hospitals in Bangkok but they can be expensive".
Hospitals in Dubai and other emirates have expressed an intent to develop in medical tourism. Some have American-sourced international healthcare accreditation, while other are looking towards the UK, Australia and Canada for accreditation services.
German Hospital in Istanbul operates the country's first ISO certified IVF center, while Memorial Hospital was the first private hospital to receive American JCI accreditation. According to Visit and Care, a medical tourism agency in Istanbul, average medical costs are 50%-75% lower than those in the United States.
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