Sun, sea and — surgery?

Need surgery? How about a little adventure safari or a discounted tropical vacation on the side?

Medical tourism — where patients go to another country for urgent or elective medical procedures — has become a worldwide, multibillion-dollar industry.

And while medical tourists from Canada often seek treatment abroad because they’re frustrated by long waiting times, the idea has worldwide appeal. US citizens are lured by drastic cost-savings for most medical procedures, sometimes paying less than a quarter or even as little as a tenth as what they’d pay at home. Yet other patients seek medical treatments that are not available to them locally. For instance, some Canadians are heading abroad for the controversial MS Liberation treatment — which hasn’t been studied or approved in Canada yet.

And in the case of elective or plastic surgery, some tourists view a medical holiday as an opportunity to combine treatments with an adventure safari or a discounted stay in the tropics.

It’s not difficult to understand the appeal. Most doctors in foreign care centres are trained in top medical schools in the developed world, yet charge comparatively inexpensive prices. For example, a hip replacement in India costs about $14,000 including airfare, accommodation and recovery in a resort. And in some cases, hospital booking agents even help patients arrange for visas, translators, flights and ground transportation. (By comparison, the cost for hip replacement surgery in the US can run as high as $40,000.)

Further, the clinics are clean, friendly and state-of-the-art — and, significant for many Canadians, fast.

Worldwide appeal

According to a CBC report, countries that actively promote medical tourism include: Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and Singapore have also recently entered the field.

And for those seeking something a little exotic, South Africa offers medical safari packages where the patient can visit the country for a safari, with a stopover for a facelift or other plastic surgery.

India, however, is still considered the leading country promoting medical tourism, with reports estimating industry growth at 30 per cent a year. The country’s top-rated education system churns out not only computer programmers and engineers, but also approximately 20,000 to 30,000 doctors and nurses each year.

Western patients traveling to India usually opt for a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation.

Medical tourism is also booming in Thailand. Cheap prices, pampered care and short waiting lists draw foreigners to this Southeast Asian country. Bangkok’s International Medical Centre offers services in 26 languages and recognizes cultural and religious dietary restrictions.

Medical tour companies servicing Thailand often put emphasis on the vacation aspects and post-recovery resort stays.

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Specialty care

Many countries are now offering medical care to specific markets. Cuba, for example, originally targeted its services at well-off patients from Central and South America, but is now attracting people from Canada, Germany and Italy.

Malaysia attracts patients from surrounding Southeast Asian countries while Jordan serves patients from the Middle East. One Israeli hospital advertises worldwide services, specializing in male and female infertility, in-vitro fertilization and high-risk pregnancies.

The trend also extends to alternative medicine, according to Lonely Planet’s Best in Travel 2010 guide. Travelers and foreign doctors alike are flocking to Beijing, China in search of new therapies. Doctors can learn at the country’s Acupuncture Training Centre, and patients can find treatment throughout the city.

Another fast-growing niche of medical tourism is dentistry, where costs aren’t usually covered by basic insurance and by only some extended insurance policies. India, Thailand and Hungary attract patients who want to combine a filling, extraction or root canal with a holiday.

The downsides of medical tourism

Sounds too good to be true? Medical tourism has been the subject of much controversy, the most recent involving the death of an Ontario man following MS treatment in Costa Rica. While not all cases have such extreme outcomes, experts have identified a number of problems with medical tourism, according to the CBC:

– Government and basic medical insurance, and some extended medical insurance, often does not pay for the medical procedure — which means the patient has to pay cash.

– There is little follow-up care. Typically, the patient is in hospital for only a few days, and then goes on the vacation portion of the trip or returns home. Complications, side effects and post-operative care then become the responsibility of the medical care system in the patients’ home country.

– Most of the countries that offer medical tourism have weak malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.

– There is growing criticism that profitable, private-sector medical tourism is drawing medical resources and personnel away from the local population, although some medical organizations that market to outside tourists are taking steps to improve local service.

– In some places, safety concerns can be an issue. For example, Iran is becoming known for plastic surgery, but it’s on the “avoid all non-essential travel” list for Canadians.

Know before you go…

Every surgery has its risks, but combining travel and healthcare isn’t for everyone. If you or someone you know is considering surgery abroad, here’s what experts say you should know:

– Talk to your doctor about your current health. Not everyone is up to the combined stresses of long distance travel and surgery. Everyone heals at a different rate, so a longer stay may be required depending on individual needs.

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– Find out as much as you can about the hospital and local healthcare facilities. What are the qualifications and experience of medical staff? What is the operation’s success rate? How common are infections, and what is being done to prevent them? What measures — like the safer surgery checklist — are they using to prevent medical errors? What level of service and care can you expect?

– Get everything in writing. It isn’t just the travel arrangements you should be worried about. Make sure you know what is and isn’t included in the cost of your operation and care. There may be fees and costs you don’t know about — like the price of bandages, sheets and towels.

– If you’re working with a medical tourism company, be sure to do your homework as you would with any company or agent. Check out their qualifications and expertise, and thoroughly read through any paperwork and agreements.

– Make sure your entire care is covered. Is nursing care available, or are friends and family expected to look after you? What additional costs can you expect for help?

What kind of follow up care do you need once you’re home, and who will provide it? In some cases, patients have required additional care and corrective surgery in their own country.

– Have a back-up plan. What happens if there are complications and you need additional care? How will you get home if you can’t take a regular flight, and who will pay for medical evacuation? Experts recommend having an additional stash of cash to cover any emergencies before and after your surgery.

Also, find out what recourse (if any) you have for less-than-satisfactory results. As previously mentioned, malpractice compensation is often out of the question, but many doctors will provide corrective surgery to fix mistakes — but that could require a second trip or longer stay.

Is it worth the trip — or the risk? Medical tourism may be an option for some people, but it’s one that experts warn should be carefully weighed beforehand.

Additional sources: medical tourism company websites, travel advice from the UK Foreign and Commonwealth Office.

Updated December 2010.

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