Medical tourism
Medical Tourism is a growing concept worldwide where people travel to another country for medical treatment at lower cost or to enjoy a vacation along with their treatment.
Typically, medical tourism involves residents of high-income countries seeking medical treatment in low-income countries; often the costs are much lower. Residents of countries with national health care schemes – such as Canada and Great Britain – may travel to avoid the long waiting times such schemes sometimes bring. Others may travel for work not covered by insurance; many insurance schemes do not cover cosmetic surgery or sex change operations, Canadian health care does not include dental, and so on. Also, couples are increasingly seeking fertility treatments abroad. Others have sought more sophisticated surgery, such as cardiology treatments, overseas.
Availability of good low-cost medical services can also be a major factor in selecting a destination for retiring abroad.
Possible benefits
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This is not medical advice The goal of this article is to provide an overview of the possibilities of medical tourism. We do not even pretend to have all the answers. Almost any medical procedure has some risk, as does travel. Before going abroad for treatment, you should at least consult your doctor at home and do some web searching to find comments from previous travellers, preferably including some who have had the treatment you need. |
The most obvious benefit is lower cost of treatment. All the professional services — doctors, dentists, optometrists, physiotherapy, lab tests, hospitals, etc. — are generally cheaper in low-income countries. Many related items, such as eyeglasses, dentures or common drugs, are also usually cheaper. However items that have to be imported, such as dental implants or certain drugs, may actually be more expensive.
Many travelers incorporate a holiday along with the treatment as they may need time to recover after surgery or have their progress monitored through other treatment and vacations also tend to be cheaper than vacations in their home country. Some even retire abroad in an area where they can get good cheap treatment.
Medical tourists sometimes can avail themselves of the best doctors and hospitals of a foreign country. The hospitals/clinics in medical tourist destinations may also be credentialed in first world countries and doctors are sometimes graduates of first-world medical schools.
Waiting lists are sometimes shorter in another country, for those with the means to pay. For example well-heeled Canadians may jump the queue at home by buying treatment in US private hospitals, where specialised care can be had quickly – if money is no object.
Residents of nations which criminalise abortion may find their options less restricted elsewhere; for instance, Irish patients often travel to Great Britain for treatment.
Birth tourism may allow a way around immigration laws or circumvention of mainland China's one-child or two-child policies; jus soli countries (where anyone born in the country without diplomatic immunity is entitled to birthright citizenship) are the preferred destinations. The number of countries offering jus soli , let alone unconditional ius soli, is dropping. Australia for example abandoned unconditional jus soli in 1986, Ireland and France similarly abandoned it. Outside the Americas, jus sanguinis (citizenship by "blood" or descent) is most common.
In some cases, the foreign hospital or medical facility is actually geographically closer. This can have unintended consequences; many Campobello Island, New Brunswick kids have Maine birth certificates as it's the only point reachable year-round by bridge, but that dual citizenship leaves these "border babies" liable for United States of America income taxes for life while living as Canadian citizens in Canada. A few decades back when the US military used conscription, these kids could be drafted.
Medical tourism also gives people a chance to incorporate local therapies — India's yoga and Ayruvedic medicine, Thai massage, traditional Chinese medicine, ... — with their ongoing treatments.
Generic drugs
Another reason for seeking treatment abroad can be the lower cost or better availability of some drugs.
As a general rule the more common drugs, e.g. most things on the WHO list of essential medicines, will be considerably cheaper in low-income countries. On the other hand, imported items such as dental implants and newer or more unusual drugs are often more expensive. There may also be differences in prescription rules; for example in China Viagra (or a Chinese copy?) and many antibiotics are available over-the-counter. In the Philippines, Viagra and Cialis are often sold by vendors walking around tourist areas; like their Rolex and Rayban products these are likely not authentic, so they may be quite risky, but they are cheap (under a dollar a pill if you bargain well) and they do work.
The most blatant example of an enormous price difference is Harvoni for treating Hepatitis C. Previous treatments involved injections, often had quite nasty side effects, and gave only about a 60% chance of curing the disease; Harvoni was the first (about 2011) of a new generation of drugs that are taken by mouth, have fewer side effects, and cure well over 90% of patients. Unfortunately, in the US it is patented and sells for about $1000 a pill, over $80,000 for the usual treatment of 12 weeks at one pill a day. At least two other drugs with similar properties are now on the market and cost less, but still in the tens of thousands. Many insurance schemes — including the British National Health, Canadian provinces, and many insurers in the US — will not pay for these treatments unless you are very ill, so some patients go untreated and may spread the disease.
India refused to grant the Harvoni patent on grounds it contained no significant original work — the key part of the research was done at a British university — and in India the whole 12-week course of treatment costs about $1000. This is not some dubious knock-off from a 'pirate' vendor; the Indian companies involved are large and reputable, and are licensed by the original developer. A 12-week vacation in India, including air fare, good hotels, and Harvoni treatment would quite likely cost less than Harvoni in the US or Europe, and other countries such as Egypt and Bangladesh also have Harvoni at low cost.
For other things, the issue may be availability rather than cost. It can take years for a new or experimental treatment to prove its worth and obtain regulatory approval, and it may be approved in some countries long before others. The dengue fever vaccine, for example, was approved in Mexico, Brazil and the Philippines in late 2015 but as of mid-2017 there are many countries where it is not yet approved. Cuba has a lung cancer treatment called CimaVax that (as of mid-2017) is available only there and in a few other Latin American countries; other countries are running tests but are unlikely to approve it soon.
Destinations
The most popular medical tourism destinations worldwide currently are:
- Costa Rica : Joint Commission International accredited private hospitals, state-of-the-art-equipment, proximity to the United States and Canada, English-speaking medical personnel, highly trained doctors, dentists, oral surgeons, and cosmetic surgeons with costs generally up to 70% of what would be paid in the United States.
- Greece : Greece is becoming increasingly popular as destination for high quality cosmetic surgery especially for patients from United Kingdom. Because Greece is a member of the European Union, its health industry is kept to a good standard and under thorough checks and safety regulations. In private sector the Metropolitan Hospital in Athens is regarded as being the best in Greece, and the plastic surgeons associated with that hospital are among the best. Greece is also traditionally regarded as a popular tourist destination and therefore its tourism and service sectors are well developed. The widespread knowledge of English language among the general population is also an advantage.
- India : Specially for heart surgery, hip resurfacing, dental, cosmetic surgery and high end surgeries. English as a primary language is also an advantage.
- Singapore : Has highly accredited hospitals and a very high quality infrastructure
- Thailand : Low labour costs resulting in lower treatment costs. Some Thai hospitals have a lot of experience with sex-change surgery.
- Hong Kong : High quality infrastructure and good quality doctors
- Mexico: Dental care is the best deal here. Because Mexico borders the United States, Americans in border states visit for dental care and minor checks out of convenience. The quality in Private Clinics and Hospitals is just about the same.
- Turkey: Istanbul is inexpensive by US and European standards for in vitro fertilization, optometry, cardiology and cosmetic procedures such as hair transplants.
- South Korea: Known for being the world leader in cosmetic surgery.
- United States: By far the world's leading nation in medical research, with the most cutting edge treatment methods and infrastructure available to those who can afford it. The downside is that consultation and treatment costs are the highest in the world. Also a popular birth tourism destination due to the fact that all people born in the U.S. other than those whose parents are on diplomatic posting are automatically granted citizenship.
– and more recently, Brazil, Brunei, Colombia, Cuba, Malaysia, Philippines, South Africa and the United Arab Emirates
Important considerations
Be sure you are allowing enough time in your travel to receive follow up care. You may need to stay days or weeks beyond the date of the medical procedure itself. Be realistic about the finances of medical tourism. Sure the medical treatment itself may be cheap. But when you add on airfare, hotels, taxis, restaurants – all in an unfamiliar city – the actual cost may be close to what you would pay at home.
Next, involve your home doctor in your plans! Having major surgery in a faraway country is not a decision you should take lightly. Research – what sort of questions should you ask your doctor about this procedure? How is the procedure typically performed, and will it be done this way where you travel? Who credentials doctors and hospitals in your destination country, and what credentials do your intended providers have? You should also determine what level of follow up care your procedure may require – in the days, weeks, and even years after the procedure. Who will provide this follow up care?
If a specialised procedure entails possible medical complications, your budget should permit a follow-up trip to your distant specialist. For instance, if gender reassignment surgery in Canada is done only in Montréal, a British Columbia patient might incur an unexpected 4600km road trip to revisit the original surgeon.
Not all medical tourism is enjoyed by patients travelling away from their home country, or travelling to a third world region. For instance, migraine surgery is performed only in the US, and attracts patients from the Middle East and Africa, since their surgeons aren't able to perform this. If you are considering travel from within your country or outside of it, be sure to explore all of your options. Seek assistance from many sources in locating the right doctor and the right country.
Don't be surprised if insurance which would have fully paid for a medical procedure at home refuses to cover (or only partially covers) the same treatment abroad. Even within the same country, some provincial health insurance plans only reimburse what they would have paid in-province, leaving the traveller out-of-pocket. Insurers are also likely to refuse to cover transportation. Border crossing can also be complicated by the need to carry prescribed medicines; a prescription validly issued by a practitioner in one country may be meaningless in another.
Patients seeking treatment for mental health conditions, communicable disease or street drug addiction may encounter issues with immigration authorities if travelling internationally. "I'm Toronto mayor Rob Ford and I'd like to see a Chicago doctor about my crack cocaine problem" is the wrong thing to tell the US border patrol, unless the intention is to immediately turn back to seek medical treatment in-province. Gravenhurst is charming this time of year?
Consider the languages you speak and what is spoken in your country. In some countries, such as Singapore, Malaysia, India, the Philippines and South Africa, most educated people speak English. This can be an important consideration. Having a common language is not necessarily enough, though, if it is not the native tongue for both of you ("fluently" can mean different things), or you or the personnel speak it with a strong accent or with a strange jargon. There may be subtle nuances you'd better be able to convey and understand.
Lastly confirm, and double check, your plans. How can you contact family members while abroad? Do you need a special visa or proof of ability to afford treatment in order to enter your destination country?
Stay safe
In the past, some discredited or bogus doctors set up shop outside US borders to promote dubious or dangerous treatments or outright scams (alleged cures for cancer, lengthening body parts, etc.). Medical tourism today is far removed from these scammers but one must still be vigilant. At the very least, see a trusted doctor in your home country and discuss your plans for overseas treatment.
Reputation counts in medical treatment overseas. Look for top quality hospitals and clinics with well known doctors.
If anything goes wrong, don't be surprised if your local doctor is reticent to do anything to attempt to "fix" the work done by your foreign practitioner. This is a medical liability issue; local doctors fear lawsuits if an attempt to repair another surgeon's bungled procedure makes things worse.
Realize that, should a worst-case scenario occur, your legal avenues for making a malpractice claim or filing a lawsuit will be greatly reduced and often nonexistent. Freedom from frivolous lawsuits and huge insurance premiums are one reason why some doctors choose to practice overseas and can offer low cost treatments. On the other hand, this type of legal environment makes seeking doctors of good reputation all the more important.
Travellers might be impaired during recovery; see travellers with disabilities.