Friday, May 28, 2010

Health Tourism A Boon or Curse?

What is it?

Medical tourism (also called medical travel, health tourism or global health care) 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. 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. 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. Over 50 countries have identified medical tourism as a national industry.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. Also, some destinations may become hazardous or even dangerous for medical tourists to contemplate.

History of health tourism

The concept of medical tourism is almost as old as medicine itself. Long before the first American cardiac patient stepped onto Indian soil, the country enjoyed a rich history of providing Yoga instruction, spiritual enlightenment, and Ayurvedic healing to seekers from around the world. The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrimstraveled 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.

Health tourism: An overview

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.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".

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. A large draw to medical travel is convenience and speed. Countries that operate public healthcare 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.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.[6] In Costa Rica, Singapore, Hong Kong, Thailand, Cuba, Colombia, Philippines or India, a wealthy patient could feasibly have an operation the day after their arrival, while the poor may die before they receive help. 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.[7]

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 theUnited 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--and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the US costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about onefifth of what it would in the States, and Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the US runs about $1,250 in South Africa.[7] ”

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. Popular cosmetic surgery travel 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 Plasticay Re constructiva", 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".

A specialized subset of medical tourism is reproductive tourism and reproductive outsourcing,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.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. While most medical tourism providers are independent companies, some hospitals have developed their own departments to help attract medical tourists. For example, the company Medical Value Travel is a subsidiary of the CIMA hospitals in Mexico and Costa Rica and the VITA hospitals in Brazil. There are several advantages to using a medical tourism coordinator embedded in a hospital. Since they work together all the time, the coordinator will be more familiar with the procedures of the specific hospitals, the cities where the hospitals are, and all the people involved in the process. Therefore, there is a lower likelihood of non-medical complications.

India in Health tourism

India’s medical tourism sector is expected to experience an annual growth rate of 30%, making it a Rs.9,500-crore industry by 2015.[64] Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012.[65] Advantages for medical tourists include reduced costs, the availability of latest medical technologies and a growing compliance on international quality standards, as well as the fact that foreigners are less likely to face a language barrier in India. The Indian government is taking steps to address infrastructure issues that hinder the country's growth in medical tourism. Most estimates claim treatment costs in India start at around a tenth of the price of comparable treatment in America or Britain.[2][66] The most popular treatments sought in India by medical tourists are alternative medicine, bone-marrow transplant, cardiac bypass surgery, eye surgery and orthopedic surgery. India is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine . Ministry of Tourism India(MoT) is planning to extend its Market Development Assistance (MDA) scheme to cover Joint Commission INternational (JCI) and National Accreditation Board of Hospitals (NABH) certified hospitals. A policy announcement of this effect is likely soon.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.[68] Other major cities where medical tourists are catered to include New Delhi and Mumbai.

Kerala in health tourism

Kerala, or God’s Own Country as its corporate slogan goes, has pioneered health and medical tourism in India. They have made a concerted effort to promote health tourism in a big way, which has resulted in a substantial increase of visitor arrivals into the state. Kerala and Ayurveda have virtually become synonymous with each other. However, though Kerala has strongly focussed on Ayurveda and its wide array of treatments and medications, good facilities are also available in the other traditional forms of medicine as well as in modern medical treatment. The bias towards health tourism in Kerala is so strong that Kerala Ayurveda Centres have been established at multiple locations in various metro cities, thus highlighting the advantages of Ayurveda in health management. The health tourism focus has seen Kerala participate in various trade shows and expos wherein the advantages of this traditional form of medicine are showcased.Kerala,India has one of the best qualified professionals in each and every field,Allopathi,Dental,Ayurveda etc and this fact has now been realized the world over. Regarding Medical facilities Kerala has the most competent doctors and world class medical facilities. With most competitive charges for treatment, Kerala is a very lucrative destination for people wanting to undergo treatment of certain medical problems who do not need immediate emergency treatment. Kerala offers World Class Medical Facilities, comparable with any of the western countries.Kerala, India has state of the art Hospitals and the best qualified doctors. With the best infrastructure, the best possible Medical facilities, accompanied with the most competitive prices, you can get the treatment done in Kerala ,India at the lowest charges. A patient will come to Kerala India where he will undergo medical treatment and along with that we will show him the Kerala tourist and pilgrim destinations, as and when advised by the Doctors. The whole thing would save him a lot of money and he will get to discover Kerala ,India at the same time.

Health tourism as a boon

You might be wondering why anyone would travel to a foreign country in order to receive medical care? Why place your health in the hands of a total stranger in a country you've never visited? Why pay for extra airfare and hotel accommodations? Why expose yourself to the potential dangers of treatment abroad? There are actually many reasons for medical tourism's increasing popularity:

1. Medical Vacations Can Be Affordable

For many procedures, it's often more expensive to receive treatment at home than it is to purchase a plane ticket, book a hotel, and pay for all medical expenses out of pocket in a foreign country. This is especially true in popular medical tourism destinations such as India, Thailand, and Singapore. The New England Journal of Medicine recently detailed an account of a self-employed carpenter who had an acute mitral-valve prolapse that required surgery. Estimated fees at the nearest hospital approached $200,000, half of which needed to be paid in advance. After some more digging around, this patient was able to find a hospital in Texas that could perform the procedure for $40,000. After some more research, the patient decided to fly to New Delhi, India where he had the procedure performed for less than $7,000. Shortly after returning to North Carolina, the patient went back to work with a healthy heart.

2. Medical Tourism Provides You with Options

Some countries heavily regulate (or even ban) certain elective procedures or complicated surgeries.Hip resurfacing, for example, was only recently approved by the US Food and Drug Administration, despite its widespread use and success rate at many popular medical tourism destinations around the world. In other cases, treatments are so prohibitively expensive that they are impossible to afford in your home country. A coronary bypass, for example, might cost almost $80,000 in the United States. That same procedure costs just over $10,000 in India. With medical tourism, you can travel to parts of the world where hospitals specialize in the aforementioned procedures. And you won't necessarily have to break the bank either. Equally important, wait times tend to be considerably less if you plan your medical vacation accordingly. Because popular medical destinations actively recruit patients from abroad, they do everything they can to eliminate wait times, provide patients with options, and ensure optimal care. In 2005, for example, luxury medical facility, Bumrungrad International Hospital in Thailand, treated 55,000 patients from the United States alone.

3. Medical Vacations Can Be Fun

Imagine recuperating after surgery on a white sand beach while sipping island drinks and receiving full body massages. Think about all the exotic foods, tourist attractions, and shopping you could enjoy. The fact of the matter is, most of us need medical treatment from time to time, and most of us plan vacations every year or so. Why not combine the two into an all-out medical vacation that provides you with everything you need, want, and desire?

The other important advantages are:

Ayurveda becomes popular

Ayurveda regains it lost name and prestige

Can attract more touristors

Employment (1 emp/1000 tourist) (labor intensive, few administrative positions, little upward mobility.)

Infrastructure development (roads, water, electricity, telecom and cybercom, but not necessarily local priorities.)

Cultural preservation (economic incentives to preserve food, fashion, festivals and physical history, but these tend to be superficial elements of a culture.)

Environmental protection (econ incentives to preserve nature, wildlife and urban cleanliness)

Foreign exchange (generates resources to import food, pharmaceuticals, technology, consumer goods.)

Development of health care services (those these aren't always available to local people.)

Health tourism as a curse

Although there are countless advantages and benefits to medical tourism, there are also a few disadvantages, dangers, and concerns of which you should be aware. Medical tourism is a trade-off, pure and simple. Although you might receive personalized attention, quality health care, convenience, affordable pricing, and a chance to experience a new culture, you occasionally sacrifice familiarity and certain legal guarantees.

1. Medical Malpractice Suits

Although most medical tourism facilities (hospitals, dental clinics, etc.) will have medical malpractice insurance to cover any unforeseen events, seeking damages can sometimes be difficult in cases of negligence, misdiagnoses, or incompetence. This is not to say that medical tourists have absolutely no legal recourse, but if you're looking for large cash settlements, you should probably stay in your home country. The laws of your country might not be any easier to decipher, but you will probably enjoy greater access to more transparent guidelines and regulations. For a more detailed discussion on legal issues surrounding health travel, please visit our Medical Tourism Malpractice & Liability section.

2. Insurance Laws May Vary

Depending on the type of insurance you have, and depending on the type of procedure you need, you might not be fully covered if you travel abroad. You'll want to check with your insurance carrier and see what portion of the final bill they're willing to cover. In the past, medical tourism was largely relegated to the cosmetic surgery industry, and thus, insurance usually wasn't a major factor since elective procedures aren't normally covered. But increasingly, hospitals in medical tourism destinations like Thailand and India have begun offering life-saving medical procedures that your insurance company would probably cover back home. Make sure you have the facts first. To get started, please consult our Medical Tourism Insurance section.

3. Postoperative Treatments

For many procedures, it's customary to check in with your physician or dentist from time to time as you recuperate. However, by receiving treatment abroad, it becomes prohibitively expensive to consult with whatever doctor or dentist provided you with primary care. This is one reason why many medical tourists decide to recuperate while they are still abroad. Fortunately, many medical tourism destinations have excellent facilities to care for and entertain recovering patients. It's not uncommon to find medical tourists relaxing on the beaches of Phuket or Goa as they recuperate. But for procedures requiring longer recovery periods, you'll need to make postoperative arrangements on your own. This usually requires consulting a local physician or dentist in your hometown, in addition to whatever foreign health care provider supervised the original treatment.

4. It's Best Not to Travel Alone

Anytime you have major surgery done, it's always good to have a friend or family member present both during and after the procedure. When flying abroad to receive medical treatment, it's strongly recommended that you take someone with you. However, this necessarily drives up the total price of your medical vacation since you'll have to book flights and hotel reservations for at least two people.

5. Finding the Best Medical Facility Possible

When you shop around for hospitals and dental clinics in your neighborhood, you can easily visit them in person, check out the facilities, and meet with hospital staff. But with medical tourism, this type of in-person reconnaissance becomes a little harder to manage. We have tried our very best to provide contact information and background info for all of the medical facilities listed throughout this Web site, but the ultimate decision rests solely with you. By following the steps outlined in Planning a Medical Vacation, you can minimize the chances of selecting a medical facility that fails to meet your standards.

Legal issues

By traveling outside their home country for medical care, medical tourists may encounter unfamiliar legal issues.[26] The limited nature of litigation in non-US countries is one reason for the lower cost of care overseas. 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. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity.

Ethical issues

There can be major ethical issues around medical tourism.[26] For example, the illegal purchase of organs and tissues for transplantation has been alleged in countries such as India and China prior to 2007. 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".

The other disadvantages are:

Cultural destruction, (modernization (world mono-culture), freezes culture as performers, loss: language, religion, rituals, material culture.)

Primary products (sun, sand, surf, safari, suds, ski, sex) (little value added, neo-colonialism)

Environmental destruction (game drives, resorts: golf, ski, beach, desert, world as play ground,SUV.)

Earginal employment (low skill, low wage, menial services, prostitution, drug trade, gambling, hustlers.)

Low benefits (no job security, no health care, no organizing, no work safety rules or environmentstandards.)

Development of illegal and/or destructive economic activities (markets for drugs, endangered species, etc.)

Outside hiring (skilled middle and senior management recruited out of the area and transferred in.)

Concentration employment (walled resort enclaves.)

Seasonal employment

Outside decision making (decisions made outside of the area, corporate dollars corrupt government .)

Unrealistic expectations (divert young people from school and brighter futures.)

Anti-democratic collusion (industry support of repressive governments)

Land controlled by the elite (people relocated, agriculture eliminated, prohibited from N.P.)

Negative lifestyle's (STD's, substance abuse, begging, hustling)

Diverted and concentrated development (airport, roads, water, electricity to tourist destinations,development not accessible to locals),

Little for ex stays in country (airplanes, vehicles, booze, hot air balloons, generally have foreign owners) ,

• Package programs

Cruises (eat and sleep on board so the economic benefits to the ports-of-call is very thin and limited.)

Unstable market (fickle, affected by local and world events, generally highly elastic)

Health tourism (traveling to get medical procedure at lower cost) has it own set of unique challenges, which include: Determining the credential, skills and quality of the facility and personnel. Language communication challenges on topics requiring a lot of details, sometimes even when both parties seemingly speak the same language. Different cultural issues and expectations around health care and the body. Post-treatment complications, after the "tourist" has left the facility.

Environmental Impact

Most people going for medical treatment abroad tend to combine travel and tourism along with the medical procedure. This means that the country where you go for the treatment has to build more hotels to accommodate the ever growing number of patients cum tourists. The government resorts to deforestation to build more hotels and provide better civil amenities because medical tourism is a way of earning revenue and foreign exchange. In addition, medical tourism is also responsible for contributing to increased air emissions, noise, solid waste and littering, releases of sewage, oil and chemicals, even architectural/visual pollution; all which has negative impact on the environment.

Medical tourism creates great pressure on local resources like energy, food and other raw material, which could be already in short supply in that country. Even natural resources like water, especially fresh water, is affected as medical tourism like any other tourism generally tends to overuse water resources for hotels, swimming pools, and personal use of water by the tourists. This results in shortage of water and degradation of water supplies as well as generating large volumes of waste water. From fiscal aspect, medical tourism is good for a country but the environmental impacts of medical tourism are always negative.


v Act to support cultural diversity

v Engage in activities that add value to the community

v Don’t do activities that deteriorate the environment

v Don’t engage in illegal activities

v Act to disperse the benefits

v Patronize locally (community) owned enterprises.

v Support the traditional cultural legacy

v Training and education in local culture, history, natural science, etc.

v Select development and activities that draw from local traditions and add value to the community

v Don’t promote activities that deteriorate the environment

v Don’t engage in illegal activities

v Adopt a program to disperse the benefits

v Patronize locally produced products and locally (community) owned enterprises.

v Make business and foreign exchange transactions transparent and efficient.

The result largely depend upon how the business is conducted: Are visitors coming and supporting what the community prides itself in and in a way that perpetuates and sustains (or improves) the quality of life in the community)? Are are the activities of the tourist detrimental to the values, environment and culture of the community in the long run?


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