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Medical Tourism - Part 1 - Who, Why and Where?

medtourDeloitte Consulting published a report1 in August 2008 that estimated that a million and a half would seek health care outside the United States in 2008 and that the number could jump by a factor of ten in the next decade. “Over fifty countries have identified medical tourism as a national industry.” – Wikipedia.

Patients turn to medical tourism because it costs less than at home or provides faster access to treatment. In a few cases they can also receive treatments, such as abortions, that aren’t available in their home country. This is common in Ireland, for instance, with women making the short trip to the United Kingdom for legal treatment. Medical tourism is very popular in countries with socialized (free) health care because waiting times for some procedures can amount to months, so some people decide that it is worth paying for a procedure abroad rather than waiting. They may even have been advised against a procedure by their physician, but then decide to go ahead anyway.

In the United States the prime motivator is cost. With health care costing more than twice as much as in any other developed country it makes sense for Americans to seek a less expensive, but safe, alternative. If there were a free, competitive market, you’d expect many more people to be taking this option, forcing down the cost of treatment at home. Indeed, parts of the health sector now regard this eventuality as a serious threat. The Big Pharmas maintain a constant pressure on politicians and the FDA to make it illegal for individuals to import drugs from other countries. However, as we’ll see, other parts of the health sector are taking a different approach.

From hope to hype
People have been traveling to foreign lands for promised cures for thousands of years. Health spas, often centered around mineral springs, became very popular in Europe during the eighteenth century. The English town of Bath, with its hot mineral springs, has been a spa since Roman times and is still a popular tourist destination. Lourdes, a small market town in South-West France, has been a popular destination for pilgrims seeking miraculous treatments since the mid-nineteenth century.

Affordable international air travel plus high standards in developed countries and greatly improved care in developing countries have made medical tourism even more attractive to people who want to save money or be treated sooner. It didn’t take long for the travel industry, particularly in Europe, where travel packages are a way of life, to develop tours that combine travel, pleasure and treatment. The total cost can often be less than for the same procedure carried out in a patient’s home country.

As with any booming industry, it also didn’t take long for frauds and other criminals to start exploiting the opportunity. Scams can range from non-delivery of services, sometimes leaving a patient stranded in a foreign country, to illegal trading in human organs. The medical services may also be delivered by unqualified, or under-qualified, practitioners. Would you like to be operated on by a first year medical student? It happens, particularly in countries that have lax regulations. Even worse, the victim of a scam may have little or no legal protection in many countries.

The medical service providers2
Just about every form of elective procedure and specialized surgery is available to travelers, including: alternative treatments; cardiac surgery, convalescent care; cosmetic surgeries, dental surgery, joint replacement and psychiatry. 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.

Most providers are private companies, but in some countries the government has expanded socialized care facilities to make money from medical tourists. Here are some of the main providers:

  • Popular medical travel destinations: Argentina, Brunei, Cuba, Colombia, Costa Rica, Hong Kong, Hungary, India, Jordan, Lithuania, Malaysia, The Philippines, Singapore, South Africa, Thailand, and recently, Saudi Arabia, UAE, South Korea, Tunisia and New Zealand.
  • Belgium, Poland and Slovakia are also breaking into the business.
  • South Africa is taking the term “medical tourism” very literally by promoting “medical safaris“.
  • Popular cosmetic surgery travel destinations: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Mexico and Turkey.
  • Colombia also provides advanced care in cardiovascular and transplant surgery.

The package dealers2
Medical tourism providers unite potential medical tourists with provider hospitals and other organizations. Many such companies can offer global health care options that allow North American and European patients to access world health care at a fraction of the cost of domestic care. The best, specialist companies typically provide nurse case managers to assist patients with pre- and post-travel medical issues. They can also help provide resources for follow-up care upon the patient’s return.

The typical medical tourism 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. They may also 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.

As we mentioned above, the conventional health sector isn’t just standing by. In 2000 Blue Shield of California began the United States’ first cross-border health plan. It allows patients in California to travel to one of three certified hospitals in Mexico for treatment under California Blue Shield plans. In 2007, a subsidiary of BlueCross BlueShield of South Carolina teamed up with hospitals in Costa Rica, India, Ireland, Singapore, Thailand and Turkey to support similar plans.

Caution!
We must emphasize that scammers are thriving in this business and that regulations, standards, laws and prices vary widely across countries and providers. Patients should exercise extreme caution before deciding to use this option. Tomorrow we’ll talk about the pros and cons of medical tourism.

1 “Medical Tourism: Emerging Phenomenon in Health Care Industry” – 2008 Report – Deloitte.
2 Source: Wikipedia.org

Related Articles: Part 2 – Pros and Cons.

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