You may have heard about medical tourism, as it is a concept that has recently taken flight in the media. Hundreds of thousands of Americans now travel overseas for medical procedures each year, which sounds exotic — but may not provide such a great outcome. Health experts urge extreme caution to those considering medical travel.
For insight into the medical tourism trend, I contacted Ann Marie Kimball, MD, a professor of epidemiology and health services at the University of Washington School of Public Health in Seattle and author of Risky Trade: Infectious Disease in the Era of Global Trade (Ashgate). She told me there are several reasons behind the growth of medical tourism, including the fact that surgery often costs far less overseas. Other factors may include privacy (for elective cosmetic surgeries, for example) and accessibility to operations, such as transplants, that are harder to get or not available at all in the US.
Patients fly to exotic destinations such as India for coronary bypass surgery, heart valve replacement and cancer therapy… Thailand for knee and hip replacement surgery and eye surgery… and Costa Rica, South Africa or Malaysia for plastic surgery, usually because it is far less expensive. Procedures people can have overseas but that are not available in the United States include stem-cell-infusion therapy for myocardial ischemia (end-stage heart disease) in Thailand and, believe it or not, pancreatic transplants from pigs in India.
Specialized medical tourism companies help travelers find the overseas doctors and facilities for the procedures they are seeking, and often assign “case managers” to serve as patient liaisons. These tourism companies advertise directly to consumers over the Internet and through promotional campaigns that tout state-of-the-art medical care at bargain prices. Public Citizen, a national, nonprofit consumer advocacy organization, warns that the reason alternative treatments may not be offered in the US is because of our more stringent safety or efficacy standards.
So just how much money are medical tourists saving? It’s hard to know for sure, as most information on cost savings is supplied by organizations with a vested interest. However, according to some reports, costs can be as little as one-tenth or less of what such procedures cost in the United States. For instance, heart-valve replacement surgery that may cost $160,000 or more here could be as little as $10,000 in India. A knee replacement in Thailand costs about 75% of the price here. A facelift that would cost $20,000 can be had for $1,250 in South Africa. Some packages may also include travel and vacation expenses.
Cheap, yes, but many health experts in our country call medical tourism a risky venture. The United States Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) warns that the quality of health care in overseas facilities may not be on par with what is available in the United States, and that foreign facilities are not always subject to the same health standards and regulations. Few overseas health facilities are accredited by the Joint Commission International (JCI), an organization that accredits overseas hospitals according to quality and safety standards similar to those in the United States. Additionally, surgery abroad can put patients at risk of infection or other complications when they return home. In fact, the CDC has received several reports of nontuberculous mycobacterial infections after people received elective cosmetic surgery abroad. There are also concerns about the quality of post-operative care and, of course, medical errors. Such problems can happen in the US too, of course — but the fact that your local physician may be unfamiliar with your case may pose additional challenges.
Dr. Kimball concurs. “My priority is from the point of view of infectious disease and infection control,” she said. “People are the best vectors for disease. When you go to a hospital overseas, you run the risk of bringing new microbial agents into the United States. The problem is that your own health care provider may not be aware of them or how to treat them.”
Dr. Kimball voiced special concerns about organ transplant surgery and most specifically from animal sources, such as those pancreatic transplants from pigs mentioned above. There’s a frightening risk with xenotransplant (the transfer of organs or tissue from animals to humans), she told me. “We fear that transmission of infectious agents or a retrovirus could emerge. It’s a theoretical but scientific possibility.”
Unfortunately, there is little reliable data regarding the efficacy, safety and outcomes of overseas health care. This is because most information about the safety of medical tourism has been generated by the medical tourism industry. “Medical tourism businesses are much more similar to travel businesses than to medical businesses,” said Dr. Kimball. “It’s not in their interest to do surveillance or track outcomes.”
If you are considering having a procedure done overseas, keep the following in mind:
Involve your US doctor with all medical travel decisions. Don’t view this as a travel decision, warns Dr. Kimball: “It’s an important medical decision to be made only with professional advice.” Your doctor at home should be in communication with your foreign doctor and should also be aware of any potential complications that may arise, and how to deal with them.
Get a second opinion at home before you travel. “Be really sure of the procedure that you need, because once you get to a far-away destination, it’s hard to get a second opinion,” said Dr. Kimball. “For instance, if your own doctor or cardiologist says you need a stent placed in your coronary artery, and you decide to go overseas for this, the doctors there may look at your films and suggest that you need bypass surgery instead. At that point you won’t have the chance to go back and say, ‘wait a minute’ because you’ve just spent thousands of dollars traveling, and you can’t get a second opinion. This is why communication with your own doctor about what you need is very, very key.”
Find the best surgeon and hospital for your procedure. Research the surgeon’s education, training, credentials and experience with your particular procedure. Learn as much as you can about where the surgery will be performed, and whether or not the facility is JCI-accredited, which means it meets quality and safety standards. (A list of accredited international health-care facilities is available at jointcommissioninternational.org.)
Determine whether or not your health insurance will cover the procedure and any complications. “Most insurance companies have non-portability, meaning medical insurance doesn’t work outside of the country,” said Dr. Kimball. “If you are considering medical travel, you may want to check whether or not your insurance company is not only covering the service, but would cover complications that arise.”
Understand everything about your procedure, and what may happen after it — before you leave home. Remember, there may be a language barrier between you and those who know the answers to questions that arise, so be sure to know everything about your procedure before you leave home. Learn about the benefits and the risks involved, whether or not travel is compatible with your procedure, what to expect during recovery time, what kind of follow-up care you may need during your recovery, and what would happen if there were any complications.
It is understandable that at times, desperate situations call for desperate measures — and so there are terminally ill individuals who will try anything in their effort to regain health. Be careful and do your homework. As for those procedures of convenience or bargain hunting, let the buyer beware.
