Medical Tourism: Risks and Benefits of Treatment in a Foreign Country

Surgeon tying his mask
Preparing For Surgery. Miquel Llonch/Stocksy United

Medical tourism, also known as international surgery or surgery abroad, is the process of leaving your home country in order to have treatment in another country. This should not be confused with having an unplanned surgery in a foreign country due to an unexpected illness or injury. Medical tourism means intentionally going to another country for the purpose of having healthcare or surgery.

At this time, it is estimated that 750,000 or more Americans will seek healthcare outside of the United States in the next year.

Many of those will be seeking surgery at a lower cost, or a procedure that they are unable to have at home.

Why Medical Tourism Is So Popular

Medical tourism is appealing for a wide variety of reasons, ranging from the cost of surgery at home, to being an immigrant who prefers to have surgery in their country of origin.

  • Lower Costs of Medical Tourism: The cost of surgery is considerably lower in foreign countries when compared to the cost of the same surgery in the United States. For someone having a procedure that is not covered by insurance, such as cosmetic surgery, or someone who doesn’t have insurance, the difference can be enormous.

    In fact, the cost of some procedures can be 90 percent less in foreign countries than it would be in the United States. Surgery in India is particularly inexpensive, and patients are flocking to Malaysia, Brazil, Singapore, Costa Rica, Mexico, Thailand, and Vietnam.

    We know why surgery in the United States is so expensive, but why is medical and surgical care overseas much cheaper? The cost of labor, whether it is nurses, aides, surgeons or pharmacists, is often dramatically lower. Also, malpractice insurance, which can top $250,000 for some specialties, is significantly lower abroad. When the cost of labor is low, everything is less expensive, from the building where care is provided to the cost of meals provided in the hospital.
  • Insurance Incentives: Some insurance companies have started promoting medical tourism due to the dramatic savings. Blue Cross and Blue Shield has started a program where the patient has an assigned case manager who will arrange for travel and accommodations for both the patient and a companion of their choosing. The case manager makes arrangements for their medical care, and even arranges for postoperative care, if necessary, at home.  Savings for the insurer means savings for the insured.

    Some insurance companies offer financial incentives for surgery abroad, discounting or eliminating the percentage of the cost that the patient is expected to pay.
  • Luxury and Private Nursing:  Some patients are drawn to the spa-like luxury that some foreign hospitals offer, seeing the opportunity to be pampered as an additional benefit of inexpensive surgery. Some facilities offer hospital rooms that are more like a hotel suite than a traditional hospital room. Other hospitals offer one on one private nursing care, which is far more generous and attentive than the staffing ratios that most hospitals allow.
  • Vacation in a Foreign Country: It sounds wonderful, doesn't it? Your insurance company flying you to an exotic location on the other side of the world? Why not experience a vacation in a foreign country along with surgery?

    A vacation is often scheduled immediately before or after surgery, taking advantage of the stay in a foreign country to travel for pleasure. This is an especially inexpensive way to travel to a foreign country if the insurance company is paying for the flight and the cost of staying is low. It seems logical to recover on a beach or at a beautiful location, especially when the cost of staying is often inexpensive when compared to staying home. Just remember, swimming isn't recommended until your incisions are completely closed, and you may not feel up to doing much more than napping in the days following your procedure.
  • Bypassing Rules and Regulations: Some travelers seek surgery abroad to bypass rules that are set in place by their own government, insurance company, or hospital. These rules are typically in place to protect the patient from harm, so getting around them isn't always the best idea.

    For example, a patient may be told that their weight is too low (healthy) to qualify for weight loss surgery. A surgeon in a foreign country may have a different standard for who qualifies for weight loss surgery, so the patient may qualify overseas for the procedure they want. This is especially true with transplant tourism (more on that later).
  • Talented Surgeons: Surgeons in certain countries are often known for their talent in a specific area of surgery. Brazilian surgeons are often touted for their strong plastic surgery skills, and they have ample practice, as Brazilians are rumored to be more likely to have plastic surgery than people from almost any other country. Thailand is reported to be the primary medical tourism destination for individuals seeking gender reassignment. It is often easier to qualify for surgery and the cost is significantly reduced, and the surgeons are performing the procedures frequently, which can lead to improved skill.

    It is often surprising to many medical tourists that their physician was trained in the United States. Not all physicians are, of course, but a surprisingly high percentage of them working in surgery abroad are trained in English-speaking medical schools and residency programs and then return to their home country. These physicians often speak multiple languages and may be board certified in their home country and a foreign country, such as the United States.

Remember, medical tourism isn’t limited to countries outside of the United States. Many individuals seek care in different areas of the United States because of the cutting edge technology that is available, as well as the safety of the healthcare and prescription medicine supply.

Medical Tourism Sounds Wonderful, So What’s the Catch?

As wonderful as medical tourism sounds, there are some issues that should be considered prior to signing up to have your medical or surgical treatment in a foreign country. The financial benefits are well known, but the downsides can be significant, even deadly in some cases.  

  • Poor Quality Surgery Is a Possibility: Just as there are great surgeons abroad, there are also some surgeons that are far less talented. It is often hard to obtain information about physicians and the quality of their work from afar. In the United States, it is often easy to obtain information about malpractice lawsuits, sanctions by medical boards, and other disciplinary actions against a physician. This information may not be as readily available with foreign providers and may make choosing a great surgeon more difficult. 

    A physician should be trained in the specific area of medicine that is appropriate for your medical and surgical needs. You should not be having plastic surgery from a surgeon who was trained to be a heart doctor, nor should you be having surgery performed by someone who isn’t trained as a surgeon. It isn’t good enough to be a physician, the physician must be trained in the specialty.

    Prior to agreeing to surgery, you should know your surgeon’s credentials: where they studied, where they trained, and in what specialty(s) they are board certified. Do not rely on testimonials from previous patients, these are easily made up for a website and even if they are correct, one good surgery doesn’t mean they will all be good.

    Many American plastic surgeons have spent countless hours repairing the scars and disfiguring surgical damage done by a surgeon in a foreign country. A quick search on the internet will quickly provide hundreds of photos and stories of individuals who were permanently harmed by a foreign surgeon. Poorly trained surgeons, or even well-trained surgeons using poor quality materials, can lead to a terrible final outcome.
  • Quality of Staff: Nurses are a very important part of healthcare, and the care they provide can mean the difference between a great outcome and a terrible one. A well-trained nurse can identify a potential problem and fix it before it truly becomes an issue. A poorly trained nurse may not identify a problem until it is too late. The quality of the nursing staff will have a direct impact on your care.

  • Quality of the Facility: Is the facility where your surgery will be performed state of the art, or is it dirty, with old equipment, outdated technology, and minimal resources? Is the hospital prepared to help you if you are very ill after surgery or will you need to be sent to a different facility for a higher level of care? Will the surgery be performed in a hospital or a surgical center that is isolated and far away from a major hospital?

    These questions are important and should be answered before choosing a facility for surgery. The facility you use should either be a hospital with ICU level care (in case there is a problem during your surgery or recovery) or it should be near a major hospital with the ability to transfer you quickly.

    Look for a facility that has an international accreditation, such as Joint Commission International. The Joint Commission is the certifying body of hospitals in the United States, determining if hospitals are providing adequate care or if there are deficiencies.  The international division does the same for hospitals outside the United States, and to be certified is a mark of quality.

  • Flying Home After Surgery: There is a risk of blood clots after surgery, and flying home, especially on a long haul flight, increases the risk of clots. If the flight home is a long one, plan on getting up and walking up and down the aisles each hour. Try to avoid flying home in the days immediately after surgery; waiting a week will decrease the chances of developing a blood clot or another serious complication during the flight.

  • Different Food: If you have a sensitive stomach, you may want to think long and hard about having surgery abroad. The food is often very different in foreign hospitals, and in some areas there is a risk that even the water will be upsetting to your body. Having diarrhea or postoperative nausea and vomiting can be terrible after surgery, especially if it is made worse by the food you are eating on a daily basis.

  • Language Barrier: If you are having surgery in a country where English is not the primary language, you will need to make preparations in order to be able to communicate with the staff. You may be pleasantly surprised to learn that the staff speaks your primary language beautifully. If not, then you will need to consider how you will make your wishes and needs known to the surgeon, the staff and others you will meet.

Hope For the Best, Prepare For the Worst

Imagine you go abroad for surgery and during the surgery there is a mistake. For example, the surgeon accidentally cuts a small area of your bowel during your procedure. It may not seem like a big deal, but two days later you are critically ill with an infection that is barely being controlled by IV antibiotics. You need to return to surgery to repair the mistake. If you do not get better, you will need to be moved to the ICU, and you may need to be on a ventilator until your condition improves.

In a hospital in the United States, this level of care is widely available. Most hospitals have an intensive care unit, and patients who need to be transferred to a larger hospital can be. Imagine this happening during your treatment overseas. Does the facility have an ICU? Does the fee you are paying cover unexpected events like this or will there be an additional cost? Can you afford to get home if your life depends on it? Does your trip include medical travel insurance, which is a type of malpractice coverage that helps with the costs associated with medical mistakes? Does your trip include repatriation insurance, a type of insurance that pays for medical staff to pick you up in a foreign country and return you to your home country with medical care while in flight?

Finding out the answers to these questions, and making sure a high level of care is readily available, will lead to a safer tourism experience, knowing that you will be cared for in the event of an emergency.

Follow-Up Care

It is important to arrange for your follow-up care prior to leaving your home country. Many physicians and surgeons are hesitant to take care of a patient who received care outside the country, as they are often unfamiliar with medical tourism and have concerns about the quality of care overseas. Arranging for follow-up care before you leave will make it easier to transition to care at home with the stress of trying to find a physician after surgery.

A Few Words About Organ Transplant Tourism

Transplant tourism is one area of medical tourism that is strongly discouraged by transplant professionals in multiple countries. Most international transplants are considered “black market” surgeries that are not only poor in quality, but ethically and morally wrong. There are significant health-related issues along with  more philosophical issues with international transplants.

China, the country that is believed to perform more international kidney transplants than any other country, is widely believed to take organs from political prisoners after their execution. In India, living donors are often promised large sums of money for their kidney donation, only to find out they have been scammed and never receive payment. Selling an organ in India is illegal, as it is in most areas of the world, so there is little recourse for the donor.

Then there is the final outcome, how well the organ works after the surgery is complete. With black market transplants, less care is often taken with matching the donor and recipient, which leads to high levels of rejection. Researchers in Canada found that transplant tourists were three to four times more likely to die or reject a transplanted organ than those who received an organ after being on the waiting list.

Many individuals feel that they are doing the necessary thing and that they will not survive if they are forced to remain on the waiting list for a transplant. The opposite may be true, as some recipients come home with a new organ and a new disease. Cytomegalovirus, tuberculosis, hepatitis B and hepatitis C are common. It is often the new disease that leads to death, rather than the loss of the organ to rejection.

Transplant surgeons are often reluctant to care for a patient after transplant surgery with an unknown physician, a patient who intentionally circumvented the donor process in the United States. Ethics aside, the low quality of surgical skill found in black market transplant surgeons, compounded by the high risk of infection, complication, and rejection makes the transplant tourist a difficult patient to treat. Knowing that someone may have been murdered to obtain the organ is a complicating factor that many surgeons refuse to look past.

Before you finalize your decision, make sure to consider all of these factors and ask the right questions so that you can seamlessly receive the care you deserve.

Sources:

Medical Tourism. Centers For Disease Control. http://www.cdc.gov/features/medicaltourism/

Transplant Tourism: How Dangerous Is It? American Association of Kidney Patients. https://www.aakp.org/education/resourcelibrary/transplantation-resources/item/transplant-tourism-how-dangerous-is-it.html

Transplant Tourism: Treating Patients When They Return to the US. AMA Journal of Ethics. http://journalofethics.ama-assn.org/2008/05/ccas2-0805.html

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