Medical Tourism and Global Healthcare – Where Are You Going?

The American Medical Association (AMA) defines medical tourism as “the organized travel outside of one’s health care jurisdiction, usually one’s country, to enhance or restore health through medical intervention.” A less technical definition comes from Harvard Business School, which defines medical tourism as the act of “traveling far and wide for health care that is often better and certainly cheaper than at home.” The practice is also known as health tourism, medtrotting, or cross-border health tourism.

Medical tourism is booming and has now become a billion dollar industry. An estimated 10,000 Americans engage in medical tourism annually, not including cosmetic surgery and dental procedures. Other estimates range from 50,000 to 500,000, including all procedures. In 2005, about 150,000 people worldwide were medical tourists. Singapore, Thailand, Malaysia and India are the leading countries in the medical tourism industry.

Though it has become very popular only in recent years, medical tourism is not a new phenomenon. Indeed, hundreds, even thousands of years ago, people have been to known to visit areas known for their healing powers. In England, the World Heritage City of Bath got its name from the numerous heated mineral springs and roman baths that became quite popular with the rich and famous of Europe of the 17th and 18th century. The word “Spa” is taken from a little Belgian town of that name, famous for its thermal springs. The French Riviera has also a history as a wellness getaway for English and Russian nobilities escaping the cold winters of northern Europe,

In more recent history, medical tourism followed advances in medicine as rich people from developing countries travelled to more developed countries such as the US and the UK. Other countries (e.g. Switzerland) specialized in boutique health services, such as cosmetic surgery and rehabilitation clinics.

Globalization and widespread air travel have triggered the rise in medical tourism, bringing about two major trends in health tourism.

(1) Medical tourism has gone mainstream. Whereas before, only the rich and the famous could afford to be medical tourists, medical tourism is now accessible to everybody. Hundreds of travel agencies have specialized in this rather lucrative niche. In Europe, where crossing national borders now have fewer restrictions with the inclusion of eastern European countries to the European Union, medical tourism has become widespread. This is aided by the short distances and the fact that the health care destinations are reachable by car, by train or a short flight. For Americans, medical tourism may entail travelling long distances but with cheaper flights, Central American countries have become favorite destinations.

(2) Medical tourism has changed directions. Medical tourism of 50 years ago mainly consisted of trips from a less developed country to a more developed and medically advanced country. Nowadays medical tourism goes in both directions, but mainly in the direction of developing countries where good quality but affordable healthcare can be found.

The current trends in medical tourism may be due to the following factors:

(1) Rising health care costs. Rising health care costs in developed countries especially the US are forcing their citizens to seek affordable health care elsewhere. Charges for common procedures such as heart bypass can be ,000 in Thailand compared to 0,000 in the United States. Knee replacement can cost ,000 compared to ,000 in Singapore. This is even encouraged by health insurance companies and employers offering coverage of medical tourism expenses. One case is that of the insurer WellPoint Inc. and a self-funded, Wisconsin-based specialty graphics business called Serigraph. According to reports, “Serigraph will waive co-pays and coinsurance for any of their 650 employees to fly to India for certain non-emergency medical procedures such as major joint replacement and upper and lower back fusion. In addition, Serigraph will pay for all travel expenses for the employee as well as a companion”.

(2) Cross-border medical training. More and more doctors from developing countries have studied and specialized abroad. India, for example, has many doctors trained in the US and the UK who speak excellent English and fully understand the medical needs of medical tourists from Western countries. The same is true for Mexico in relation to the US and Australia in relation to Thailand.

(3) Holistic approach to medicine. The last decade also witnessed the popularity of alternative medicine. More and more people seek out alternative health care such as traditional Chinese medicine, Ayurveda (India), Unani (Arabic), homeopathy, and herbal medicine, among others. Many countries in Asia offer these types of medicine for Western tourists.

(4) Accreditation. To overcome the scepticism of patients, many medical tourism facilities apply for accreditation. Several American organizations conduct inspections, evaluations of and grant accreditation to medical facilities outside the US. One of these is the Joint Commission International (JCI). More encompassing is accreditation by the International Society for Quality in Healthcare which is the umbrella organization for accreditation agencies in many countries including Australia, New Zealand, Japan, Canada and Ireland.

The most popular destinations are in Asia and Latin America. However, it is estimated that about 50 countries in all continents engage in the industry.

India is on top of the list of favorite medical tourism destinations. According a University of Delaware article “India has top-notch centers for open-heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy, and virtually all of India’s clinics are equipped with the latest electronic and medical diagnostic equipment”. “For example, hip surgery patients in India can opt for a hip-resurfacing procedure, in which damaged bone is scraped away and replaced with chrome alloy–an operation that costs less and causes less post-operative trauma than the traditional replacement procedure performed in the U.S”. Heart bypass goes for ,000 and a hip replacement for ,000, compared with 0,000 and ,000 respectively in the United States”.

Aside from the additional attraction of its holiday destination facilities the beaches of Phuket, Thailand is actually well-known for sex-change surgery, which “is one of the top 10 procedures for which patients visit Thailand”.

For Americans, Mexico and Costa Rica are appealing because of their proximity. Arizona retirement communities now organize regular bus tours for Mexican dental work and inexpensive drugs. And tiny border communities, some about an hour from Ciudad Juarez, are becoming dentistry boomtowns to handle an ever-growing flow of American patients flying in from as far away as Alaska”.

Despite the boom in medical tourism and global healthcare the industry remains controversial in several respects.

(1) Health care disparities. A main objection by those who are opposed to medical tourism is the disparities of care delivered by private facilities catering to medical tourists and public health care for local residents. It is estimated more than half of India’s primary health care facilities are not equipped with a labor room, laboratory, or a telephone or stocked with essential medications.

(2) In Vitro Fertilization. In January 2009, a Canadian woman made headlines when she delivered twins at the age of 60. Under Canadian law, the age limit for a woman to have in vitro fertilization (IVF) is 45 to years old. India is the home of the world’s oldest first-time mother who delivered a baby girl last November at the age of 70. Laws governing fertility treatments are almost nonexistent in India, and unlike in many countries, there are no regulations limiting the age of the mother or the number of embryos implanted.

(3) Commercial surrogacy or reproductive outsourcing. This is another form of assisted reproduction connected with medical tourism and again India is in the front line. Women whose uteri are not capable of carrying a baby resort to paying other women to be surrogate mothers. In India, women consider this as a respectable way of making money and at the same time help childless women. Commercial surrogacy has been legal in India since 2002, as it is in many other countries, including the United States. But India is the leader in making it a viable industry rather than a rare fertility treatment.

(4) Organ transplantation. One of the shady dealings of medical tourism is organ transplantation. People who are not willing to wait and can afford to pay a lot of money may find other means of getting an organ in developing countries. “Transplant tourism” as it is sometimes called, is thriving in developing countries. In 2006, The Guardian reported that British patients travelled to China to have transplants with organs taken from executed prisoners, “without the prior consent of either the prisoner or their family”.

Medical tourism is on the rise and is expected to become more popular and acceptable in the future. According to the American Medical Association, “the global economy and changing rules of trade provide opportunities and challenges for the medical profession and public health”. Like in any industry, medical tourism is ruled by supply and demand. There is definitely a lot of demand in developed countries that developing countries willingly supply. However, limits and regulations need to be set in place in order to protect the patients as well as the labor force of the service providers. Only then can the industry be worthy of the term “global healthcare”.

Source: ArticlesBase.com

What Is Medical Tourism

(also called , or global healthcare) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling across international borders to obtain health care. It also refers pejoratively to the practice of healthcare providers traveling internationally to deliver healthcare[1][2].

Services typically sought by travelers 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[citation needed].

Over 50 countries have identified medical tourism as a national industry.[3] 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[citation needed]. Also, some destinations may become hazardous or even dangerous for medical tourists to contemplate.

In the context of global health, “medical tourism” is a pejorative because during such trips health care providers often practice outside of their areas of expertise or hold different (i.e., lower) standards of care[4][5]. Greater numbers than ever before of student volunteers, health professions trainees, and researchers from resource-rich countries are working temporarily and anticipating future work in resource-starved areas[5][6]. This emphasizes the importance of understanding this other definition.

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 and sanitariums may be considered an early form of medical tourism. In eighteenth century England, for example, patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.[3]

Description

Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries.[7]

Medical tourists can come from anywhere in the First World, including Europe, the 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”.[8]

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.[9]

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. Using Canada as an example, an estimated 782,936 Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks.[10] Canada has set waiting-time benchmarks, e. g. 26 weeks for a hip replacement and 16 weeks for cataract surgery, for non-urgent medical procedures.[11]

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 ,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.[12]

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 0,000 or more in the US, for example, goes for ,000 in India–and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth ,500 in the US costs 0 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 ,700 in the US is available in many other countries for only 0. Cosmetic surgery savings are even greater: A full facelift that would cost ,000 in the US runs about ,250 in South Africa.[12]
”

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Popular medical travel worldwide destinations include: 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.[3]

Popular 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.

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”.[13]

A specialized subset of medical tourism is and ,[14] 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.[15]

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. 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.

Process

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.

International healthcare accreditation

Because standards are important when it comes to health care, there are parallel issues around medical tourism, international healthcare accreditation, evidence-based medicine and quality assurance.

The oldest international accrediting body is Accreditation Canada, formerly known as the Canadian Council on Health Services Accreditation, which accredited the Bermuda Hospital Board as soon as 1968. Since then, it has accredited hospitals and health service organizations in ten other countries.

In the United States, the best known accreditation group is the Joint Commission International (JCI). They have been inspecting and accrediting health care facilities and hospitals outside of the United States since 1999.[16] Many international hospitals today see obtaining international accreditation as a way to attract American patients.[17]

Joint Commission International is a relative of 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.[18]

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.[19] A forecast by Deloitte Consulting regarding medical tourism published in August 2008 noted the value of accreditation in ensuring quality of healthcare and specifically mentioned JCI, ISQUA and Trent.[8]

Increasingly, some hospitals are looking towards dual international accreditation, perhaps having both JCI to cover potential US clientele, Trent for potential British and European clientele and Accreditation Canada. As a result of competition between clinics for American medical tourists, there have been initiatives to rank hospitals based on patient-reported metrics.[20]

Other organizations providing contributions to quality practices include:

The Society for International Healthcare Accreditation (SOFIHA), 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.[21]
The 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 programmes, covering issues such as developing healthcare quality standards, implementation of standards within healthcare organisations, assessment by peer review and exploration of the peer review techniques to include the recruitment, training, monitoring and evaluation of peer reviewers and the mechanisms for awards of accredited status to organisations.[22]
References
Shaywitz, D.A., & Ausiello, D.A. (2002). Global Health: A Chance for Western Physicians to Give – and Receive. The American Journal of Medicine, 113, 354-357.
Bezruchka, S. (2000). Medical Tourism as Medical Harm to the Third World: Why? For Whom? Wilderness and Environmental Medicine, 11, 77-78.
^ Gahlinger, PM. The Medical Tourism Travel Guide: Your Complete Reference to Top-Quality, Low-Cost Dental, Cosmetic, Medical Care & Surgery Overseas. Sunrise River Press, 2008
Roberts, M. (2006). Duffle Bag Medicine. Journal of the American Medical Association, 295, 1491-1492.
^ Pinto, A.D., & Upshur, R.E.G. (2009). Global Health Ethics for Students. Developing World Bioethics, 9, 1-10.
James, D. (1999). Going Global. The New Physician, 48, online. Accessed 7 May 2009. [1].
^ Laurie Goering, “For big surgery, Delhi is dealing,” The Chicago Tribune, March 28, 2008
Lagace, Martha “The Rise of Medical Tourism”, Harvard Business School Working Knowledge, December 17, 2007. Accessed July 1, 2008.
Linda A. Johnson, “Americans look abroad to save on health care: Medical tourism could jump tenfold in next decade,” The San Francisco Chronicle, August 3, 2008
The Private Cost of Public Queues in 2005, Fraser Institute
Wait times shorter for some medical procedures: report., Canwest News Service
^ “Medical tourism growing worldwide” by Becca Hutchinson, UDaily, July 25, 2005, retrieved September 5, 2006
“Medical tourism: Need surgery, will travel” CBC News Online, June 18, 2004, retrieved September 5, 2006
Jones CA, Keith LG. Medical tourism and reproductive outsourcing: the dawning of a new paradigm for healthcare. Int J Fertil Womens Med, 2006;51:251-255
Jones C, “Ethical and legal conundrums of post-modern procreation” Int J Gynaecol Obstet Dec 4, 2007
“Medical Tourism Industry Certifications and Information”
“Medical Tourism Magazine”, Medical Tourism Association, February 2008

http://www.jointcommission.org/AboutUs/Fact_Sheets/jci_facts.htm

“INDIA: Accreditation a must”, International Medical Travel Journal

http://www.worldhospitalmonitor.com

SOFIHA – Welcome to SOFIHA
United Kingdom Accreditation Forum

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