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Medical Tourism - Part 2 - Pros and Cons

medtourYesterday we described the reasons that medical tourism is becoming popular, particularly in Europe and the United States, the kinds of treatment available (almost every type) and who is involved. Today we’ll talk about the advantages and disadvantages of choosing this optional form of health care.

Remember that we’re not advocating medical tourism as it is still largely unregulated and there are far too many scams and downright illegal schemes out there. However, as health insurers and some employers have started to use medical tourism as a way to reduce health care costs (a novel form of outsourcing), it’s important to understand the issues. A reader of yesterday’s article commented that he’d had medical treatment done in India in 2009 and saved $1200. That’s at the low end of the savings that can be made by obtaining treatment overseas. Given the high costs of health care in this country (twice what people in other developed countries pay), it’s well worth looking at this option.

The prime reasons that people are considering medical tourism are lower prices and reducing wait times. The latter really only applies in countries with socialized medicine, so we’ll look at some other advantages.

Significantly lower prices
Wikipedia1 and Medicaltourism.com cite these examples:

  • Surgery in India, Thailand or South Africa can cost as little as 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, including the round-trip airfare and a brief vacation package.
  • Heart Bypass surgery that costs up to $144,000 in the US ranges from $10,000 in India to $26,000 in Costa Rica, Korea and Thailand.
  • Angioplasty that costs $57,000 in the US ranges from $9,000 in Thailand to $22,000 in Korea.
  • A metal-free dental bridge worth $5,500 in the US costs $500 in India.
  • A dental implant costing $2,000-$10,000 in the US costs $1,000 in Cost Rica, India, Mexico or Thailand.
  • A knee replacement that costs around $50,000 in the US costs $14,000 in Thailand with six days of physical therapy.
  • Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730.
  • Hip resurfacing that costs $30,000 or more in the US ranges from $10,000 in India to $23,000 in Korea.
  • Hip replacements that cost up to $43,000 in the US range from $10,000 in India to $19,000 in Korea.
  • Cosmetic surgery savings are even greater. A full facelift that would cost $20,000 in the US runs about $1,250 in South Africa.
Better Accreditation
Standards are obviously critical in any legitimate health care environment, so medical tourism has increased the importance of international health care accreditation. Some of the most significant organizations in this area include:

  • Joint Commission International (JCI) is probably the best known accreditation group in the United States . They have been inspecting and accrediting health care facilities and hospitals outside of the United States since 1999. It is related to the Joint Commission in the United States. Both are independent private sector not-for-profit organizations that develop nationally and internationally recognized procedures and standards to help improve patient care and safety. They work with hospitals to help them meet Joint Commission standards for patient care and then accredit those hospitals meeting the standards.
  • Trent International Accreditation Scheme is a key player in the UK and Hong Kong. Many hospitals are trying to achieve dual international accreditation, perhaps having both JCI to cover potential US clientele and Trent for potential British and European clientele.
  • Accreditation Canada is a “Not-for-profit, independent organization accredited by the International Society for Quality in Healthcare (ISQua). We provide national and international health care organizations with an external peer review process to assess and improve the services they provide to their patients and clients based on standards of excellence. Accreditation Canada’s programs and guidance have helped organizations promote quality health care for over 50 years.”
  • The Australian Council on Healthcare Standards (ACHS) was established in 1974. ACHS “is an independent, not-for-profit organisation, dedicated to improving the quality of health care in Australia through continual review of performance, assessment and accreditation.”
  • The International Society for Quality in Health Care (ISQua) is – “A non-profit, independent organisation with members in over 70 countries. ISQua works to provide services to guide health professionals, providers, researchers, agencies, policy makers and consumers, to achieve excellence in healthcare delivery to all people, and to continuously improve the quality and safety of care.”
  • The Society for International Healthcare Accreditation (SOFIHA) is a free-to-join group providing a forum for discussion and for the sharing of ideas and good practice by providers of international healthcare accreditation and users of the same. The primary role of this organisation is to promote a safe hospital environment for patients.
  • Medical Tourism Association is “The first international non-profit association made up of the top international hospitals, healthcare providers, medical travel facilitators, insurance companies, and other affiliated companies and members with the common goal of promoting the highest level of quality of healthcare to patients in a global environment.”
  • United Kingdom Accreditation Forum (UKAF) is – “An established network of accreditation organisations with the intention of sharing experience good practice and new ideas around the methodology for accreditation programs.”

It’s worth noting that – “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. An August 2008 forecast by Deloitte Consulting regarding medical tourism noted the value of accreditation in ensuring quality of healthcare. It specifically mentioned JCI, ISQuA and Trent. As a result of competition between clinics for American medical tourists, there have been initiatives to rank hospitals based on patient-reported metrics.” – Wikipedia.

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.

Obviously, patients should only consider facilities with excellent accreditation and deal with a well established medical tour provider. Internet sites can’t be relied upon unless their independence can be very clearly established. Many scams rely on fake sites to plant glowing references and lure victims in. Word of mouth references from friends are probably the most reliable right now. Packages arranged by your regular health insurer or a large employer should be even better.

Even when dealing with experienced organizers and accredited providers, medical tourism still carries some risks that locally-provided medical care does not, such as:

Additional Risks

  • Risk of exposure to different infectious diseases: Some countries, such as India, Malaysia, or Thailand harbor very different infectious diseases to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery and paratyphoid) which could weaken progress, mosquito-transmitted diseases, influenza, and tuberculosis. There have been cases where patients were consistently misdiagnosed for years because such diseases are perceived to be “rare” in the West.
  • The quality of post-operative care: This 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.
  • Traveling long distances soon after surgery can increase the risk of complications: Long flights and decreased mobility in a cramped airline cabin are a known risk factor for developing blood clots in the legs such as Deep Vein Thrombosis (DVT) or pulmonary embolus economy class syndrome. 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.
  • Vacation activities can introduce new problems: For example, scars may become darker and more noticeable if they sunburn while healing.
  • Corrective action is more difficult: Health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients. It may also be inconvenient, or too costly, to return to an overseas facility if any corrective action is required.
  • Inadequate access to medical history: It’s essential that the physicians providing treatment be as well informed about your medical history as possible. Have them work with your regular physician and health care facilities to ensure that they have all pertinent information.
Legal issues
As regular tourists may have discovered for themselves, receiving medical care abroad may subject medical tourists to unfamiliar legal issues. It’s worth noting that the limited nature of litigation in various countries is one reason for the lower cost of care overseas. Medical tourists should be aware that:

  • Legal recourse may be inadequate: While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist.
  • Standard insurance may be inadequate: Should problems arise, patients might not be covered by adequate personal insurance. it is important to seek out adequate coverage from a well established, large insurance company with experience in this area.
  • Local laws may not cover all situations: Patients who receive less than they paid for, or who suffer complications or damage, might be unable to seek compensation via malpractice lawsuits.
  • Inadequate compensation funds: Hospitals, doctors and other health care facilities in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, often because they don’t have appropriate insurance cover and/or medical indemnity.
Ethical issues
There can be major ethical issues around medical tourism. Patients should carefully research the issues connected with some procedures and let their conscience help them come to a decision. For example:

  • Illegal organ dealing: There have been many allegations and evidence of the illegal purchase of organs and tissues for transplantation in countries such as China, India and ex-Soviet bloc countries.
  • Impact on local medical 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”.
  • Questionable treatments: Medical tourism centred on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. This is a gray area that borders on scams and crimes.
All boom industries breed scams and medical tourism is no exception. Patients considering this option should be very alert for scams. Remember our Golden Rule – “Never respond to an unsolicited offer.” Unfortunately, the “looks too good to be true” rule is harder to apply in this area, because, as we’ve seen above, many of the medical tourism discounts are legitimately huge. However, you can cross-check at least some of the components of a package. For instance, what proportion is for travel costs? If the cost of your treatment plus vacation is less than a tour operator would charge for the same destination, dates and accommodation, there’s obviously something wrong. So, you should be on the lookout for:

  • Internet scam artists: These range from phishing (stealing financial or other personal information) to stealing deposits for fake services. Victims often don’t realize they’ve been scammed until an airline refuses to honor a ticket.
  • Local scams: Every traveler, especially those who aren’t feeling well, can fall prey to local scam artists. In many countries you have to be very careful if you use ATMs. If your card gets stuck it is probably soon going to be in the hands of scam artists who will sell your card number and PIN on the Internet. Report the loss immediately. Leon met an American in Argentina who had taken a cab from the airport to his hotel. The cab stopped and the driver explained that he’d run out of gas. He waved down a cab driver coming the other way. They transferred luggage from one cab to the other, then they both drove off. Always arrange for a hotel/pre-arranged limo to meet you in Third World companies. They’ll be in the airport “Arrivals” area with your name on a placard and they’ll know which hotel you’re going to.
  • Inferior services or care: Scammers may arrange treatment with shady providers and truly awful recovery accommodation. Unaccredited facilities may employ students instead of licensed physicians, or allow surgeons to undertake operations that they are not qualified to perform. They may use inferior artificial parts or donated organs of dubious quality.

Medical tourism is here to stay, certainly as long as health costs are outrageously high in the United States and impatient people exist in countries with socialized medicine. It has to be considered as a serious option, but patients should be very careful to work with their regular physicians, reputable intermediaries and accredited overseas facilities. We’ve added some resources that will provide you with further information on the issues and choices to our Useful Sites page.

1 “Medical tourism growing worldwide” by Becca Hutchinson – UDaily – July 25, 2005.

Related Articles: Part 1 – Who, Why and Where?

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7 comments to Medical Tourism – Part 2 – Pros and Cons

  • This article discusses accreditation, legal, ethical issies, it is so true that all the accreditations differ in standards. All of these issues are very important. While Medical Tourism is an attractive option for health care needs, one must read articles like these to make an informed decision.
    Dha Kur
    On line Medical Tourist Community

  • Brian West

    I agree entirely with the article and the points made.
    None more important than the advice to beware of scammers.
    Use a reputable company to help you with all the arrangements.
    I needed to operate my ACL and had no insurance here in the US. My out of pocket cost would have been insurmountable.
    So , I decided to check oversees options. Tried to do it myself and was quickly overwhelmed with the abundance of information out there.
    Three months later I was no closer to fixing my problem than when I started.
    At this time I decided I need help and started looking around for a reputable and diverse company to help me with my arrangements.
    Came across a lot of “wanna be’s” pushy and incompetent when it comes to healthcare and medicine in general.
    Finally ran into Worldwide Medical Partners and Dr. Ves Gitchev in Miami, Florida.
    The only company I found, ran and operated by team of doctors. Their only focus was my safety and on the positive outcome of my surgery.
    Moreover, they had been in business for over 7 years.
    The rest was handled by their own travel agency.
    Dr. Ves personally walked me through the process and the surgery, discussed all my options from India and Norway to Panama and Colombia.
    He and his team had visited and inspected all places, so he was able to really point the pros and cons of each destination.
    On his recommendation I picked Panama and two weeks later I was ready to go. As their patient I got preferential scheduling and reduced price.
    I saved over $6000 including all travel and hotel expenses, enjoyed VIP-like treatment from the moment I set foot at the airport, and could not be happier with the outcome of the surgery.

  • Because some of these comments mention a specific company, Worldwide Medical Partners LLC, we checked the local and national Better Business Bureau online database. There are no complaints on file.

  • Enjoyed the practical information, both pro and con, on healthcare tourism.

  • Thanks. We’re looking forward to your new site.

  • there are lots of vacation packages out there but choose the ones coming from reputable companies,”`

  • Russ Saupe

    The concept of Medical Tourism may be quite legitimate and a great idea in the current economic climate. But be advised there are already internet fraud specialists who have devised ways to victimize people under the guise of this industry.

    Out of the Fort Pierce / Port St Lucie area of Florida come a husband/wife team named Fred Siller (aka Frederico Gustavo) and Lorena Siller (aka Lorena Ortiz aka Lorena Ortiz-Siller aka Lorena Kay aka Lori Burns) who have devised various websites claiming that they run a group known as the New Life Medical Tourism Group. They attempt to hire people as agents to recruit potential patients to have medical and dental procedures performed in Colombia or Panama at a fraction of the normal cost that they would incur in the USA. For only $595 these new agents are provided with all the brochures, training materials, business cards, a company email address and more. They are all set to earn a whopping 8% commission. The only catch is Fred (Frederico) and Lorena aren’t affiliated with any doctors, dentists or hospitals in either Colombia or Panama and they can provide no real leads to potential patients. They’ve never worked in the medical field. They are scam artists working out of a Goin Postal PO Box in Fort Pierce. It probably costs them $10 to print the materials they send for a tidy $585 profit.

    This is just one of about 5 or 6 internet scams they have in the works. The others include:
    Profit with Fred
    Roadway to Riches
    Hand of Heaven
    Frelo Latin Wear

    Most are internet pyramid schemes, one (Hand of Heaven) has a religious twist to it. Frelo Latin Wear is an internet clothing line they are trying to get off the ground. Clothing that will never arrive. Anyone who sends these people money will never see it again. Simply do a Google search on their names and aliases for more details of their scams.

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