Sunday, January 31, 2010

Medical Tourism is On The Rise

Angioplasty in Argentina ? A mastectomy in Malaysia ? Plastic surgery in Paraguay? Or a cosmetic cut-n-paste in Costa Rica ? You've probably already heard about it, but what you may not know is that in recent years, medical tourism has grown into a multi-billion dollar business. And more growth is expected.

According to an article published in 2005 from the University of Delaware publication, UDaily:

"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 one-fifth of what it would in the States

Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730."

An estimated 750,000 Americans went abroad for health care in 2007 and consulting firm Deloitte published a report in 2008 that projected a tenfold increase in medical tourism over the next decade. The growth in medical tourism results in billions of dollars in savings to patients, and in even more in lost revenue to U.S. health providers.

Overseas surgery costs less, but why ? For one, there is a more favorable malpractice system in many countries, plus a lower cost of building, staffing, and maintaining facilities. Overseas hospitals and surgeons are also not burdened by insurance paperwork and billing because their patients typically pay cash up-front. Follow-up care, which consumes a large amount of a doctor's time, is also virtually non-existent.

Medical tourism is not without it's risks and pitfalls, however.

Patients travelling are often recruited or channelled trough a "booking agency" that receives payment for the referrals. This bypasses the usual doctor's referral and recommendation process, and patient's are largely left to word-of-mouth recommendations or the internet. Both of these processes can be influenced at various levels, and are generally a poor substitute for physician-to-physician referral.

Checking credentials on doctors and facilities in various countries is often difficult, as there is no standard that is uniformly accepted. Board-certification, for example, requires continuing medical education in the U.S. and in fact is a law to maintain licensure in all states. This varies widely in other countries.

Patients also do not enjoy the same degree of consumer protection due to the lack of an aggressive malpractice system in most other countries.

In the U.S., the Joint Commission is an independent, not-for-profit organization that develops nationally recognized standards to improve patient care and safety. They work with hospitals to help them meet standards for patient care, and then accredit those hospitals who achieve those standards.

Joint Commission Internationalis a relative of the Joint Commission in the United States that has been accrediting hospitals since 1999. Overseas institutions, mindful that American consumers value accreditation, are increasingly looking towards this international accreditation. Competition between overseas hospitals for American medical tourists will likely result in a move towards accreditation.

Unfortunately, in the plastic surgery arena, where most surgery is done in clinics, there are no international regulatory agencies in place. The highly publicized deaths of celebrities such as Donda West and Argentinian beauty queen Solange Magnano have heightened public awareness about the safety of plastic surgery procedures being done in clinics without adequate personnel and equipment for aftercare.

Likewise, the media is replete with patients who have returned from plastic surgery overseas with complications or unfavorable results. Finding care domestically is difficult or impossible for these individuals. Plastic surgery complications, usually minor, are a simple fact of life. But their treatment and outcome vary significantly, depending on whether they occur at home or abroad. Dr Jospeh Capella, a pioneer in post-weight loss plastic surgery, reported a complication rate of 50% after large procedures such as body lift, whereas Dr. Dennis Hurwitz, founder of the total body lift procedure, reposted a complication rate of 76%.

Medical devices used overseas also vary in terms of their quality warranty support. Breast implants placed outside of the U.S. by either of the 2
major manufacturers are not warrantied in the U.S. Replacement surgery, if needed due to rupture or leak, must be done in the country of origin.

Capella JF. Body Lift Clin Plast Surg. 2008 Jan;35(1):27-51.

Hurwitz DJ, Agha-Mohammadi S, Ota K, Unadkat J. A clinical review of total body lift surgery. Aesthet Surg J.2008 May-Jun;28(3):294-303; discussion 304-5.

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