Healthcare has become a global concern. In a competitive global market where information is shared instantly, consumers have all the knowledge and choices at their disposal. The internet enables the patients to seek out the best service providers, to make comparisons by themselves or to find out brokers and specialist services.
But it’s not only all about providing better health care. It’s about business and commerce. There is a huge amount of commercial interest driving this trend, rather than health care interests.
We come from a culture of people expecting the government to provide health care, as we transition from a country where the private sector is playing such an important role.
Thus, there is a risk that if we lose sight of the practice of medicine as in part a humane discipline, a morally driven discipline, and if we look at the practice of medicine only as another market opportunity, then there will be values that will be lost.
There will also be a change in the nature of the doctor-patient relationship. If the doctor simply becomes somebody who says “Right, you’ve done all your internet research, you know all the options, what do you want me to do?”, adopts that sort of stand-back role and lays out the array of goods, rather than acts in the traditional protective, almost paternalistic relationship with the patient, guiding and showing care for the patient, then there is a real change about in the nature of the doctor-patient relationship. We could wonder whether it will be the patient who gains the most from that.
Personal Health Risks
The medical treatment is carried out and after a usually brief period of recuperation the patient, having recovered, travels home. This may be acceptable for cosmetic surgery or basic dental treatment but not in the case of illnesses where recovery is dependent upon long term medical attention and extensive after-care. In many cases it is advisable for the after-care to be in the hands of doctors and assistants who have been well acquainted with the patient’s history for some time.
There is little follow-up care. The patient usually 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 are then the responsibility of the medical care system in the patients’ home country.
Another prerequisite is that the costs should be shared between the health insurance scheme in the home country and by other comparable institutions. This is not always the case, because the health schemes only give their approval if they can be sure that the services provided are of an equivalent standard. Another requirement is that invoices must be clear and in accordance with the health insurance organisations’ rules, and capable of withstanding close scrutiny. And finally, as the contractual partners of professional medical organisations and hospital associations, the health insurance schemes in the patient’s home country sometimes find themselves under considerable pressure.
The American Society for Aesthetic Plastic Surgery lists half a dozen reasons why “you may want to think twice about traveling for your cosmetic surgery,” ranging from the inadvisability of sunbathing during post-surgical recovery to the potential difficulty of finding a doctor back home who is willing to handle complications of a surgery he or she did not perform.
All of which is to say that medical tourism — indeed, any surgery or other invasive medical procedure — is not to be undertaken lightly. If you want or need a medical procedure that might be performed less expensively or more quickly overseas, do your homework — especially when it comes to the accreditation and quality standards of hospitals you are considering and the training and certification of doctors who would treat you.
Before planning a trip, there are several things to keep in mind: — Realize that you may not feel up to doing much after the procedure. Although some packages include activities, doctors say many patients should refrain from exercising or participating in other activities for days afterward:
–Forget sunbathing by the pool. After many plastic surgeries, you’ll have to avoid the sun until your skin has healed.
–Find out when it’s safe to fly home afterward. Many doctors discourage air travel after surgery for fear of health risks that include deep-vein thrombosis on long-haul flights.
–Have a plan for follow-up care. You may want to ask the surgeon to refer you to a colleague near your home who can treat you.
Otherwise, if post-surgical problems arise, many U.S. doctors may be reluctant to take on the consequences of a surgery they did not perform.
Medical Insurance and Legal Issues
Many of the countries involved in this business have weak malpractice laws so there’s little opportunity for recourse should anything go wrong. Since follow-up care is minimal, patients must deal with any complications or side effects on their return home.
Critics also argue that it’s very difficult for patients to evaluate the credentials of doctors or the quality of surgical facilities in other countries. And they warn that patients may struggle to find follow-up care if problems arise after they return home. They also pint that the administration and services in developing countries sometimes do not fulfill the necessary conditions and that the implications could be detrimental to the health insurance schemes responsible for meeting the costs of treatment. In many cases the amounts available to meet these costs are somewhat opaque and not standardized, and private clinics charge a variety of rates without adequate substantiation. In both a medical and an economic sense, health insurers and clinics see problems in relying on short-term treatment abroad, which may necessitate preliminary and after-care in the patient’s home country, possibly at considerable expense.
People who travel across borders for surgery must be protected from negligence or malpractice or false advertising concerns brokers and insurance agents. So far, the industry of facilitating patients to other hospitals around the world, without giving medical advice, isn’t still very regulated at this time. This issue will probably be addressed in a near future.
There are large regulatory issues involved. Part of the problem is the unwillingness of health insurance companies (and politicians) to take it seriously. Legal issues abound: what happens if there are complications, what happens with extended stays in the hospitals, what happens if you die? If something goes wrong, can you sue? Many countries don’t have the protective legal systems westerners are used to yet. There is no international regulationconcerning this area of international trade. What is the legal status? is, we don’t really know.
Complications do arise in any potential operation that is undertaken. You can’t guarantee that health care and the sequelle to operations are always going to run smoothly, there will always be issues about problems that arise. And how one deals with those on a patient who, let’s say, has made a contract with a company or a broker in London to travel to Johannesburg for surgery, to travel on to another country for recuperative holiday and such like, and something goes wrong in the operation itself? Trying to resolve these legal issues really is going to become a quite fundamental issue over the next 10 or 15 years
And of course it’s going to differ from jurisdiction to jurisdiction. It may even differ from where the patient comes from. You can have a hip replacement in India, or heart surgery in Dubai, or dental work in Malaysia, but you may find it hard to get insurance, or a legal comeback if you’re badly treated.
One way of overcoming such problems would be in the form of joint ventures involving physicians and hospitals in various countries, in order to facilitate the coordination between health insurers, medical needs and the possibilities offered by medical tourism. In this way some of the current objections could be eliminated.
Such collaboration could enable the provision of long-term medical care in accordance with the same performance standards, provided that this is preceded by an accurate exchange of data. Independent monitoring of performance and success eliminates the risk of disputes about the cost of treatment and the settlement of liability issues. Joint ventures between companies would provide an accurate division of labour and reduced costs. This is in the interests of all concerned. Moreover such long-term forms of collaboration enable suppliers in developing countries to unlock commercial possibilities in the industrialied nations which could not be replicated in any other way.
While promoters of medical tourism focus on the attractive costs, prepaid pampering, and glamorous side trips that accompany overseas surgeries, opting for foreign medical care is not without its risks. In the event of complications after the trip, uninsured patients are on their own and those covered by national health systems fall back on the systems in place in their native lands. One factor lowering the cost of foreign medical care is often weak malpractice laws, leaving patients who suffer bad results with little recourse.
An obvious answer to all this is accreditation. This only will ensure transparency in the way a hospital performs, and everything from the operating to the cleaning procedures will be monitored, audited and recorded. With an aim to boost the much talked about medical tourism, many corporate hospitals in India are looking to international agencies such as JCAHO/JCI for accreditation. Accreditation will even make tie ups with overseas health insurance agenciessuch as BUPA and CHUBS easier to route patients to India.
As the medical tourism industry is growing exponentially and with public health systems near collapse, governments and private players will need anyway to join hands in order to act as a catalyst to build infrastructure for hospitals, create specialty tourist packages to include medical treatment, promote accreditation and standardisation, enable access and tie-ups with insurance companies, provide state of art facilities and improve quality of in-patient care and service to meet the requirements of foreign patients and to attain sustainable competitive advantage.
Though the benefits that medical tourism has to offer both patients and host countries may seem highly appealing, many disagree with a number of the fundamental and economical merits of the idea. Critics argue that medical and healthcare services should not be something that is simply sold off the shelf to the lowest bidder.