Medical tourism (also called medical travel or health tourism) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling to another country to obtain health care.
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. The provider and customer use informal channels of communication-connection-contract, with less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed.
Leisure aspects typically associated with travel and tourism may be included on such medical travel trips.
History
The concept of medical tourism is not a new one. The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios. Epidauria became the original travel destination for medical tourism.
Spa towns may be considered an early form of medical tourism.
Description
Factors that have led to the recent increase in popularity of medical travel include the high cost of health care or wait times for procedures in industrialized nations, the ease and affordability of international travel, and improvements in technology and standards of care in many countries of the world.
Medical tourists can come from anywhere in the world, including Europe, the UK, Middle East, Japan, U.S. 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.
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 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.
Medical tourists may seek essential health care services such as cancer treatment and brain and transplant surgery as well as complementary or 'elective' services such as aesthetic treatments (cosmetic surgery).
According to research found in an article by the University of Delaware publication, UDaily:
Popular medical travel worldwide destinations include: Brunei, Cuba, Colombia,Hong Kong, Hungary, India, Israel, Jordan, Lithuania, Malaysia, The Philippines, Singapore, South Africa, Thailand, and recently, UAE and New Zealand.
In Europe Belgium, Poland and Slovakia are also breaking into the business. South Africa is taking the term "medical tourism" very literally by promoting their "medical safaris": Come to see African wildlife and get a facelift in the same trip
However, perceptions of medical tourism are not always positive. In places like the U.S., which has high standards of quality, medical tourism is viewed as risky. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care; for example, in late 2006, some patients from the Middle East were choosing to travel to Singapore or Hong Kong for health care rather than to the U.S. because of international tensions.
While the tourism component might be a big draw for some Southeast Asia countries that focus on simple procedures, India is positioning itself the primary medical destination for the most complex medical procedures in the world. India's commitment to this is demonstrated with a growing number of hospitals that are attaining the U.S. Joint Commission International accreditation to help to capture the US medical tourism market, while others looking beyond just the US market to potential clients from the United Kingdom, Europe and Australia may also look towards other international healthcare accreditation schemes for brand advantage.
Singapore positions itself as a medical hub for health care services, medicine, biomedical research and pharmaceutical manufacturing converge. Singapore has made international
news for many complex surgeries in specialties such as neurology, oncology, and organ transplants procedures. Currently Singapore boasts the largest number of U.S. Joint Commission accredited hospitals in the region.
In South America, countries such as Argentina, Bolivia, Brazil and Colombia lead on plastic surgery medical skills relying on the vast experience their surgeons have in treating the style-obsessed. It is estimated that 1 in 30 Argentineans have had plastic surgery procedures, making this population the most operated in the world after the U.S. and Mexico. In Bolivia and Colombia, plastic surgery has 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.
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 experienced 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. While these services will initially be of interest to the self-insured patient, several studies indicate that the rapid growth of Health Savings Accounts in the U.S. will also drive interest to health care in other countries.
International healthcare accreditation
Because standards are everything when it comes to health care, there are parallel issues around medical tourism, international healthcare accreditation, evidence-based medicine and quality assurance.
Those people considering becoming medical tourists may be assisted in making rational choices by whether hospitals providing such services have been assessed and accredited by reputable and independent external accreditation bodies. In the USA, JCI (Joint Commission International) fulfills such a 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, intent and the skill of their marketing. They also vary in terms of cost to hospitals and healthcare institutions using them. They all have web sites.
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.
The Society for International Healthcare Accreditation, or 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, wherever they travel to in the world for health care.
HealthCare Tourism International, or HTI, is the first U.S.- based non-profit organization to accredit the non-clinical aspects of health tourism such as language issues, business practices and false or misleading advertising prevention. The group has accreditation for all the major groups involved in the health tourism industry from hotels, to recover facilities to medical tourism booking agencies, etc.
India
India is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine. The government and private hospital groups are committed to the goal of making India a world leader in the industry. The industry's main appeal is low-cost treatment. Most estimates claim treatment costs in India start at around a tenth of the price of comparable treatment in America or Britain.
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 other infrastructure issues that can serve as a deterrant to 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.
Risks and rewards
Medical tourism carries some risks that local medical procedures do not. Should complications arise, patients might not be covered by insurance or able to seek compensation via malpractice lawsuits. However new insurance products are available that do protect the patient should a medical malpractice occur overseas. The most outspoken critics of medical tourism are U.S. malpractice lawyers who see this emerging trend as a threat to their livelihood. Some countries currently sought after as medical tourism destinations provide some form of legal remedies for medical malpractice. However, this legal avenue is unappealing to the medical tourist. Advocates of medical tourism advise prospective tourists to evaluate the unlikely legal challenges against the benefits of such a trip before undergoing any surgery abroad.
Some countries, such as India, Malaysia, Costa Rica, or Thailand have different infectious diseases than Europe and North America, and different prevalences of the same diseases compared to nations such as the U.S., Canada, and the UK. Exposure to disease without having built up natural immunity can be a hazard for weakened individuals, specifically for gastrointestinal diseases (e.g Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress, mosquito-transmitted diseases, influenza, and tuberculosis (e.g., 75% of South Africans have latent TB). International hospital accreditation with Trent or JCI, mentioned earlier, may be of value here when people are trying to choose a destination for their procedure
Also, travel soon after surgery can increase the risk of complications, as can vacation activities. For example, scars will be darker and more noticeable if they sunburn while healing. Long flights can be bad for those with heart (thrombosis) or breathing-related problems.
However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of any infectious disease, including HIV, TB, and typhoid, there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West.
For hospitals and doctors seeking to provide medical tourism services, there is the risk of being sued by a disgruntled patient, so medical indemnity services such as those provided by the Medical Protection Society are essential. There is also, unfortunately, great potential for adverse publicity for an organisation if things go wrong, or are perceived to have gone wrong.
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