The real cost of medical tourism

The real cost of medical tourism


Dr Mark Duncan-Smith
AMA (WA) Vice President

Friday 8 November 2019

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As a plastic surgeon, it has always fascinated me why a patient would consider going overseas to undertake a breast augmentation and then sit by a pool they can’t swim in (due to the risk of infection) while looking longingly at that pina colada (which may not rest well with the Endone).

 

I have often asked why people would consider elective surgery in a country where they’d be hesitant to drink the water.

 

The answer of, course, is reduced cost. While there is clearly an increased risk, it is considered worth the cost, or not considered at all. Cosmetic surgery for example is serious, invasive and should not be entered into lightly.

 

While cosmetic surgery and dentistry remain the most common reasons for patients to undergo surgery/ procedures overseas, the list is growing. In a 2014 review, medical tourism included:[1]

 

  • Cosmetic surgery (breast, face, liposuction)
  • Dentistry (cosmetic and reconstruction)
  • Cardiology/cardiac surgery (by-pass, valve replacement)
  • Orthopaedic surgery (hip replacement, resurfacing, knee replacement, joint surgery)
  • Bariatric surgery (gastric by-pass, gastric banding)
  • Fertility/reproductive system (IVF, gender reassignment)
  • Organ, cell and tissue transplantation (organ transplantation; stem cell)
  • Eye surgery
  • Diagnostics and check-ups.

 

The same paper estimated that 15,000 Australians travelled overseas every year for medical services worth $300 million. At that time, medical tourism was estimated to be increasing at 20-30 per cent per year.[2]

 

The patients typically go through a medical tourism company or travel agent with no medical experience. The business receives either a direct fee or a commission and is therefore intrinsically conflicted.

 

Some surgeons travel from the destination country to the patient’s home country to present at seminars and provide initial consultations, typically in CBD hotels. This despite the fact they do not have a medical licence to practise in the home country. The industry is completely unregulated – all this is in direct contrast to the primary care physician referral to an appropriate specialist where needed.

 

Medical tourism, in fact, undermines the patient’s relationship with their GP/primary care specialist as most clients don’t seek advice from their GP prior to embarkation.

 

The internet plays a major role in medical tourism, providing information on the hospitals, services, doctors and surgeons. You often find patient testimonials in direct contrast to Australian standards. Social media networks and often, paid local networks (commission-based) provide support for clients.

 

According to the 2014 review, 17 per cent of patients experienced complications and 9 per cent received treatment via the NHS or Medicare when they returned to their home country.[1]

 

Some businesses and clinics offer ‘lifetime’ guarantees as part of their sales pitch, but clinics often close after a few years. Overseas clinics and doctors often don’t have medico-legal insurance and it is extremely difficult to initiate an action across international borders.

 

The medical tourism company or travel agent simply put their hands up and claim they did not provide the medical service, only facilitated it and therefore are not responsible.

 

In general terms, there is no legal recourse if and when something goes wrong.

 

One patient came to me after having an abdominoplasty in South East Asia. Her wounds became infected in the early post-operative period but little was done to rectify this in that country.

 

The patient’s mother travelled from Perth to the destination country to retrieve her, adding she was relieved to get her daughter on the plane especially since very quickly “she stank out the plane” from her wounds. As soon as they landed in Perth, they went directly to an emergency department where she was admitted and treated.

 

I saw another patient who had a breast augmentation in South East Asia with a terrible result. I asked if she had attempted to get assistance from the medical tourism company located in the northern suburbs of Perth. She told of how she’d gone to their office only to be asked by the male receptionist (the only person there) to come out the back where he’d take clinical photos and send these to the surgeon for feedback. She declined the offer and left.

 

The patient also said that the surgeon who operated on her wasn’t the same doctor with whom she’d had the initial consultation in a Perth hotel room. There was no continuity of care, and no follow-up on her return to Perth.

 

Patients need to consider that if their surgery goes wrong and complications arise, the cost of repair may be considerably more than the original surgery. Interestingly, patients who have gone overseas and encounter problems often feel ashamed and self-conscious when they then seek medical assistance in their home country.

 

Most believe costs are generally less expensive than in Australia. That is not always the case. One patient I saw went to South East Asia for a breast reduction not realising it would have been covered, in part, by private health insurance here in Australia. That surgery cost her $3000 more overseas.

 

Death is a risk and does occur. In 2015, a patient from Queensland went overseas for a buttock lift and died on the table. In 2014, a patient from Sydney went to Malaysia for cosmetic plastic surgery post massive weight loss. He had two surgeries, each 10 hours long, and then flew home. Despite being short of breath with an increased heart rate and dizziness, he was cleared to fly by the local doctors. The patient died the day after returning to Sydney from a massive pulmonary embolus.

 

A typical surgical patient flies to the destination country, has surgery, then returns back to their home country all within a week – hardly surprising when they develop a DVT.

 

Medical tourism is not going away and carries significant risk. Patients considering medical tourism should be encouraged to seek advice from their GP/primary care specialist. A public health awareness campaign could assist with this.

 

Dr Mark Duncan-Smith is a specialist burns and plastic surgeon. He is also a Vice-President of the AMA (WA).

 

References

[1] Lunt N, Smith R, Exworthy M, et al. Medical tourism: treatments, markets and health system implications: a scoping review. OECD, Directorate for Employment, labour and Social Affairs, 2011. Available at www.oecd.org/ els/health-systems/48723982.pdf

[2] Bartold PM. Editorial: Medical tourism – an established problem. Aust Dent J 2014;59:279.

 

 

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