Tuesday, 6 January 2009

medical tourism-disadvantages

DISADVANTAGES OF MEDICAL TOURISM

Medical tourism is the practice of travelling to another country in order to receive medical attention, be it heart surgery, breast implants, a hip replacement, or dental work. Depending on the location and procedure, a medical vacation can cost 50%, 30%, or even 10% of what you would pay at home. Medical tourism (also called medical travel, health tourism or global healthcare) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care. Such services typically include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. Medical tourism can be broadly defined as the provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. The process of healthcare tourism is jointly facilitated by the corporate sector involved in medical and healthcare as well as the tourism industry - both private and public.

Over 50 countries have identified medical tourism as a national industry.[1] heart valve operation that might require $100,000 in the States could cost well under $10,000 in a country like India where lower labour costs help drive down the price considerably. The same is true in popular medical tourism destinations like Thailand, Argentina, Singapore, and Hungary. The key selling points of the Indian medical tourism industry are the combination of high quality facilities, competent, English-speaking medical professionals, “cost effectiveness” and the attractions of tourism. The cost differential is huge: Open-heart surgery costs up to $70,000 in Britain and $150,000 in the US; in India's best hospitals it could cost between $3,000 and $10,000. Knee surgery costs Rs. 3.5 lakh ($7,700) in India; in Britain it costs $16,950 (2) Public expenditure on health in India has hovered around 0.9 per cent of gross domestic product (GDP) in the past decade, down from 1.3 per cent (also meagre) in 1991 (3)

Indian medical care: a study in contrasts

Medical care in India is today a study in contrasts, typical of countries that have promoted segmentation in healthcare: expensive private care catering to the elite and poor quality public-funded care for the poor. When the poor are forced to seek private medical services they face pauperisation: more than 40 per cent of patients admitted to hospitals borrow money or sell assets and 25 per cent of peasant families with a member needing in-patient care are driven below the poverty line (4). According to industry estimates, the medical tourism market in India was valued at over $310 million in 2005-06 with 1 million foreign medical tourists visiting the country every year. The market is predicted to grow to $2 billion by 2012. These figures are significant when seen in the context of the total healthcare expenditure in the country today - $10 billion in the public sector and $50 billion in the private sector (calculated as approximately one per cent and five per cent of the country's current GDP respectively). Visitors from 55 countries come to India for treatment but the biggest growth in business is from the UK and the US. The Taj Medical Group receives 200 inquiries a day from around the world and arranges packages for 20-40 Britons a month to have operations in India. It also offers follow-up appointments with a consultant in the UK. Apollo Hospital Enterprises treated an estimated 60,000 patients between 2001 and 2004. Apollo now has 46 hospitals with over 7,000 beds and is in partnership with hospitals in Kuwait, Sri Lanka and Nigeria. The government predicts that India's healthcare industry could grow 13 per cent in each of the next six years, boosted by medical tourism which, industry watchers say, is growing at 30 per cent annually (5). Since 2006, the government has also started issuing M (medical) visas to patients and MX visas to the accompanying spouse.

Medical practices in Thailand practices i are changing and causing ethical dilemmas for Thai medical practitioners. Traditionally, Thais ascribed to Asia-based medical models, which were influenced by Buddhist, Chinese Taoist and animist beliefs. These medical models were accessible to the predominantly rural Thais and were practised by Buddhist monks, Thai and Chinese practitioners and shamans or healing specialists.

The western medical model was an appendage of western colonisation of Asian countries in the 19th century. Thailand was prompted to modernise its society as a way of thwarting western imperialism (
6). It was mainly Christian missionaries who brought western medicine to Thailand (7). By the mid-20th century western medicine had become the predominant medical model. Perhaps nowhere is the market-oriented ideology more evident than in the area of medical tourism, which Thailand leads in the Asian-Pacific region. Medical tourism accounts for more than US$2.3 billion in Thailand, with an annual rise of 40 per cent in the last few years (8). Estimates of medical tourists entering Thailand vary from 400,000 to 1.1 million annually (9). The government hopes to promote Thailand as a favoured tourist place in south-east Asia due to its accessibility from major cities such as Kuala Lumpur, Jakarta, Sydney, Tokyo, Shanghai, Beijing, and Singapore. The focus on big business has lead to the privatisation of many Thai hospitals in four major collaborations: Bumrungrad, Bangkok, Thon Buri, and Phyathai are now the leading medical tourist centres (10). The Bangkok Dusit Medical Services is a major collaborative group. It owns the chain of 14 hospitals of the Bangkok Hospital Group (10). The chain offers a range of deluxe services and amenities on par with five star hotels.


ADVANTAGES

A. The New England Journal of Medicine recently detailed an account of a self-employed carpenter who had an acute mitral-valve prolapse that required surgery. Estimated fees at the nearest hospital approached $200,000, half of which needed to be paid in advance. After some more digging around, this patient was able to find a hospital in Texas that could perform the procedure for $40,000. After some more research, the patient decided to fly to New Delhi, India where he had the procedure performed for less than $7,000. Shortly after returning to North Carolina, the patient went back to work with a healthy heart.

B. In other cases, treatments are so prohibitively expensive that they are impossible to afford in your home country. A coronary bypass, for example, might cost almost $80,000 in the United States. That same procedure costs just over $10,000 in India.

C. With medical tourism, you can travel to parts of the world where hospitals specialize in the aforementioned procedures. And you won't necessarily have to break the bank either. Equally important, wait times tend to be considerably less if you plan your medical vacation accordingly.

Because popular medical destinations actively recruit patients from abroad, they do everything they can to eliminate wait times, provide patients with options, and ensure optimal care. In 2005, for example, luxury medical facility, Bumrungrad International Hospital in Thailand, treated 55,000 patients from the United States alone. (11) There is no waiting period for the treatment. In the US, sometimes the waiting period for surgeries can be months together, and those required treatment more urgently are benefitted from medical tourism. The most surprising advantage of medical tourism is getting better and more personal care at a foreign hospital than you would get back at the United States. In order to attract customer, many hospitals that specialize in medical tourism provide outstanding quality and service. Equipment and facilities in these hospitals are comparable to the United States and patients invariably figure out that they can afford a more luxurious hospital stay than home.

D. Medical Vacations Can Be Fun

For many people, a medical vacation is exactly that... a medical "vacation."

Imagine recuperating after surgery on a white sand beach while sipping island drinks and receiving full-body massages. Think about all the exotic foods, tourist attractions, and shopping you could enjoy. The fact of the matter is, most of us need medical treatment from time to time, and most of us plan vacations every year or so. Why not combine the two into an all-out medical vacation that provides you with everything you need, want, and desire?(12)

E. A specialized subset of medical tourism is reproductive tourism and reproductive outsourcing,[13] which is the practice of traveling abroad to undergo in-vitro fertilization, surrogate pregnancy and other assisted reproductive technology treatments including freezing embryos for retro-production.[14]

DISADVANTAGES OF MEDICAL TOURISM

* Going to foreign country for medical treatment has its own risks as the country you go to may not regulate professional licensing and certification of the medical professionals.

* If something goes wrong during the medical procedure you will have very little legal recourse.

* You might end up traveling too soon after a surgery and this can cause serious complications like blood clots or pulmonary embolism. In addition, you can suffer from swelling and/or infections.

* Usually post-operative care is minimum and limited as most hospitals believe in getting in patients and then releasing them quickly and there will be hardly any post-operative care.

* Going to a foreign country for treatment means that you will not have immunity prevalent in that country and this can pose the risk of catching an infection.(24)

A. Medical tourism carries some risks that locally-provided medical care does not. Some countries, such as India, Malaysia, Costa Rica, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress, mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West.[15]

B. The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. However, JCI and Trent fulfill the role of accreditation by assessing the standards in the healthcare in the countries like India, China and Thailand. Also, traveling long distances soon after surgery can increase the risk of complications. Long flights and decreased mobility in a cramped airline cabin are a known risk factor for developing blood clots in the legs such as venous thrombosis or pulmonary embolus economy class syndrome. Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they sunburn while healing.16

C. By traveling outside their home country for medical care, medical tourists may encounter unfamiliar ethical and legal issues.[17] The limited nature of litigation in non-US countries is one reason for the lower cost of care overseas. While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity.[18] However new insurance products are available that protect the patient should an alleged medical malpractice occur overseas.[19]

D Ethical issues

There can be major ethical issues around medical tourism. For example, the illegal purchase of organs and tissues for transplantation has been alleged in countries such as India[20][21] and China.[22]

Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system.[23] In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care"

SO If we make it in a nut shell.......(1) Medical Malpractice Suits

Although most medical tourism facilities (hospitals, dental clinics, etc.) will have medical malpractice insurance to cover any unforeseen events, seeking damages can sometimes be difficult in cases of negligence, misdiagnoses, or incompetence. This is not to say that medical tourists have absolutely no legal recourse, but if you're looking for large cash settlements, you should probably stay in your home country. The laws of your country might not be any easier to decipher, but you will probably enjoy greater access to more transparent guidelines and regulations. For a more detailed discussion on legal issues surrounding health travel, please visit our Medical Tourism Malpractice & Liability section.
( 25 )

(2) Insurance Laws

In the past, medical tourism was largely relegated to the cosmetic surgery industry, and thus, insurance usually wasn't a major factor since elective procedures aren't normally covered. But increasingly, hospitals in medical tourism destinations like Thailand and India have begun offering life-saving medical procedures that your insurance company would probably cover back home. Make sure you have the facts first. To get started, please consult our Medical Tourism Insurance section.

(3) Postoperative Treatments

After finishing treatment still patient should be in contact with the doctors rather enjoying there. It is costly, need time and expensive for being in check up or being in routine

(4) It's Best Not to Travel Alone

Anytime you have major surgery done, it's always good to have a friend or family member present both during and after the procedure. When flying abroad to receive medical treatment, it's strongly recommended that you take someone with you. However, this necessarily drives up the total price of your medical vacation since you'll have to book flights and hotel reservations for at least two people.

patient can easily visit doctors in person, check out the facilities, and meet with hospital staff in own space. But in medical tourism, this type of in-person reconnaissance becomes a little harder to manage. So 1)It make health sector highly commercial and the common man in the country will be hard pressed for medical care;
2) All the resources of health sector will be thrown open for the international tourist so much so that even the so called middle class will be able to ill afford the medical care.
3) Patients from overseas, if they come in droves, may bring in new types of diseases and the risks of infection.
4) In the name of medical tourism, many people who want to enjoy themselves in this country, with the ostensible intention for treatment in this country, may turn the hospitals into merry making resorts and convert the hotels into hospitals.
5) The health workers like nurses etc will be compelled to pander to all the needs of the foreign visitors. There is a risk of the hospitals being converted into brothel houses.

REFERENCES

Gahlinger, PM. The Medical Tourism Travel Guide: Your Complete Reference to Top-Quality, Low-Cost Dental, Cosmetic, Medical Care & Surgery Overseas. Sunrise River Press, 2008

2. Medical Trips India. About medical tourism. [cited 2007 Dec 24]. Available from: http://www.medicaltripsindia.com/about-medical-tourism.html

3 Ministry of Health and Family Welfare. National Health Policy, 2002. [cited 2007 Dec 24]. Available from: http://mohfw.nic.in/np2002.htm

4 Health, Nutrition, Population Sector Unit India South Asia Region. Raising the sights: better health systems for India's poor. Washington: World Bank; 2001.

5 health-tourism-india.com. Growth of the medical tourism industry. [cited 2007 Dec 24].Available from: http://www.health-tourism-india.com/growth-of-the-medical-tourism-industry.html

6 Ratanakul P. Bioethics in Thailand. In: Norio Fujiki and Darryl R J Macer, editors. Bioethics in Asia. 1998. p 98-99. [cited 2006 May 4]. Available at: http://www2.unescobkk.org/eubios/asiae/biae98.htm

7 Winkelmann A, G?ldner F H. Cadavers as teachers: the dissecting room experience in Thailand. BMJ 2004 Dec; 329: 1455-1457.

8 Indepth Healthcare Medical Tourism. Need surgery, will travel. CBC News Online. 2004 June 18. [cited 2006 May 4]. Available at: http://www.cbc.ca/news/background/healthcare/medicaltourism.html

9 Ivy The, I, Chu C. Supplementing growth with medical tourism: special report. [cited 2006 May 4]. Available at: http://www.marketinfo.sg/articles/Synovate/(Synovate)%20Medical%20Tourism.pdf

10 Saniotis A. Medical bioethics and medical tourism in Thailand. Paper to be published in 2007 in the Journal of the Thailand Medical Association.

11 http://www.healism.com/Medical_Tourism/Overview/Advantages_of_Medical_Tourism/

12 http://www.healism.com/Medical_Tourism/Overview/Advantages_of_Medical_Tourism/

13 ^ Jones CA, Keith LG. Medical tourism and reproductive outsourcing: the dawning of a new paradigm for healthcare. Int J Fertil Womens Med, 2006;51:251-255

14 ^ Jones C, "Ethical and legal conundrums of post-modern procreation" Int J Gynaecol Obstet Dec 4, 2007

15 ^ "TB Often Misdiagnosed". American Lung Association of Illinois. Retrieved on 2007-03-10.

16 # ^ "Incision Care", American Academy of Family Physicians, July, 2005, retrieved September 18, 2006

17 # ^ Ahc | Hot Topics

18 # ^ Medical Protection Society | MPS UK

19 # ^ "eworld press release- Aos Assurance Company limited"

20 # ^ IFTF's Future Now: The dark side of medical tourism

21 # ^ Organ-transplant black market thrives in India

22 # ^ The Epoch Times | Transplants and Ethics in San Francisco

23 # ^ Indian Journal of Medical Ethics

24 http://www.scumdoctor.com/medical-tourism/Advantages-And-Disadvantages-Of-Medical-Tourism.html

25 http://www.healism.com/medical_tourism/overview/disadvantages_of_medical_tourism/

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