Medical Tourism Helps Desperate Patients & Raises Ethical Issues

Dr. Kris Gopal. M.D.,F.A.C.S.      e-mail:

Wealthy patients and politicians from developing countries have always traveled, and continue to go to developed countries or to neighboring countries for medical treatment not available in their own countries. Now, a growing number of less-affluent patients from developed countries (North America and Western Europe), in what is called Medical Tourism, travel to regions once pejoratively called the “Third World” for medical treatment. These patients seek, often desperately, medical care that they cannot afford in their own countries.

Americans are among the estimated 250,000 foreign patients who sought care in Singapore, 500,000 in India and as many as 1 million in Thailand. The cost savings for patients, particularly when the money comes from their own pockets, is huge. See the table below:

Cost of Medical Procedures (in US dollars)

Procedure                  US             US            India*      Thailand*      Singapore*

                                                     Retail     Insurance

Angioplasty               99.000       44,000       11,000      13,000          13,000

Heart Bypass         210,000       94,000       10,000      12,000          20,000

                   Heart Valve

Replace (single)  274,000      123,000         9.500      10,500          13,000

                  Hip Replacement       76,000       31,500          9,000      12,000          12,000

* International rates include airfare, hospital, and hotel.  Source:  Time, May 21, 2006

In 2006, McKinsey & Co. reported the medical tourism would gross  $100 billion by 2012. For most medical tourists, including those from the United States, the reasons for travel are primarily financial. Ease of international travel and improvements in both technology and standards of care in host countries are the other drivers. Services typically sought by travelers include elective procedures as well as complex specialized surgery such as knee and hip replacements, and cardiac, dental, and cosmetic surgery.

Over 50 countries have identified medical tourism as a national industry. Popular medical travel destinations include Argentina, Brunei,

Cuba, Costa Rica, Hong Kong, Hungary, India, Jordan, Lithuania, Malaysia, the Philippines, Singapore, South Africa, Thailand, and recently Saudi Arabia, UAE, South Korea, Tunisia, Ukraine and New Zealand.

Patients unfamiliar with specific medical facilities abroad often coordinate their treatment through medical travel intermediaries who use the Internet to recruit patients. These services work like specialized travel agents. Clients of MedRetreat, for example, can choose from a menu of 183 medical procedures from seven different countries. California based PlanetHospital is a well-known name in this business.

However, perceptions of medical tourism are not always positive. In the US, the medical establishment, which boasts of high quality of care, self-servingly views medical tourism as risky; but offers no alternatives to desperate patients with limited resources.

Till recently it was very difficult to compare the quality of care rendered at various hospitals worldwide. But with the recent accreditation process in Canada and the US, it has become easier to compare results. The accreditation agencies work with hospitals to help them meet standards for patient care and then certify those hospitals meeting the standards.

Companies are beginning to offer global health care options for their employees that will enable North American and European patients to access world health care towards reducing their health care costs. In 2000 Blue Shield of California began the United States’ first cross-border health plan. Patients in California could travel to one of the three certified hospitals in Mexico for treatment under California Blue Shield.

India’s medical tourism sector is expected grow at 30% annually.  Foreigners are not likely to face a language barrier in India. India is known for heart surgery, hip resurfacing and other areas of advanced medicine. Surrogate pregnancy in India, which raises lots of ethical issues, is becoming increasingly a popular service.

Medical tourism is not without risks. Potential risks are:

1. Exposure to diseases without having built up natural immunity can be a hazard, as with hepatitis-A, amoebic dysentery, paratyphoid, mosquito-transmitted diseases, influenza, tuberculosis, and others.

2.  The quality of post-operative care can vary dramatically.

3.  Traveling long distances soon after surgery can increase the risk of developing blood clots in the legs and in the lungs.

4.  After returning home, delayed infection is resistant to antibiotics.

5.  Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to patients suing them.

There are other serious ethical/legal issues, too:  a) Illegal purchase of organs like kidneys and tissues for transplants from gullible, and often poor patients; b) Medical tourism for the classes and health missions for the masses has further deepened the already abysmal inequities, creating two-tier health care in host countries — poor quality care for its own poorer citizens, and better ones for medical tourists. India is a prime example. c) This also creates ethical issues to developed countries. They pretty much abandon their less affluent citizens to fend for themselves while taking care of their affluent/resourceful ones.

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