A list of international destinations where patients travel to obtain a wide array of procedures is growing, and they range from low to high risk according to possible complications or other negative outcomes. Hence it is vital to speak openly with the international physician about potential complications and how to minimize them prior to any medical procedure.
Diverse standards with regards to hospitals and physicians can be a problem, as each country usually has its own licensing and certification protocols. Increased familiarity with destination country protocols is necessary, and all potential risks should be taken into account before making a final decision to travel abroad.
Medical tourism increases the risk of nosocomial infections, also referred to as healthcare or hospital acquired infections. For example, if needles are reused between patients or other unsafe injection practices are occurring, serious infections such as hepatitis and HIV can be transmitted.
Infections with multiresistant organisms, the spread of noroviruses (common cause of acute gastroenteritis) and mycobacterial infections after cosmetic surgery are well documented cases of medical risks. Patients who cross borders in seek of a medical care are also potentially exposed to infections that they would not normally encounter, thus posing a public health risk when they return home.
An apparent increase in so called “transplant tourism” in the last twenty years is also followed with a higher incidence of tissue rejection after the operation and critical infectious complications among transplant medical tourists, when compared to other transplant patients. Furthermore, blood supply in some countries comes predominately from paid donors and may not be adequately screened, which can additionally endanger patients.
Traveling long distances after surgical procedures can also pose certain risks such as deep vein thrombosis and pulmonary embolism. The risk of these adverse events can be reduced by drinking plenty of water, exercising legs while seated and taking a walk every 2 to 3 hours on a long plane trip. Medical compression stockings and anti-clotting medications can also be prescribed for high-risk patients.
Ethical and legal risks
Patient autonomy and informed consent both represent a cornerstone of bioethics, which can sometimes mean a concerning issue for medical tourists. In the context of medical tourism, informed consent can be influenced by ambiguous or incomplete information on websites, problems in obtaining veracious information about success rates and the quality of care in destination facilities.
Even under optimal circumstances it is often difficult to obtain informed consent for medical procedures; the international dimension raises those concerns even more. Limited health literacy (coupled with aforementioned inadequate access to accurate information) can result in patients’ inability to make a thoroughly informed decision about medical tourism and to eventually accept the risks of seeking healthcare in another country.
Countries may also have different standards of medical ethics. For example, a therapy that is considered experimental in one country (like stem cell therapy) can be commonly used in the private care institutions for medical tourists in other countries. Similarly, the medical ethics related to organ transplantation often differ from country to country.
If problems arise, patients might be left without the opportunity to seek damages in malpractice lawsuits, due to the multiple jurisdictions involved and the lack of clarity in terms of which law should apply. Valid legal solutions to these issues are difficult to establish, thereby transferring pressure on patients’ healthcare systems at home – including health and safety professionals – to address them in a makeshift fashion.
The role of the travel and tourism sector
The “traditional” tourism operators and travel agents have shown little interest in medical tourism. It’s viewed as a niche sector requiring specialist expertise to make it work and deliver a return.
Noel Josephides, Chairman, Association of British Travel Agents, has strong views on the role of travel agents in medical tourism and of the activities of some medical tourism facilitators who are operating as medical travel agents in ignorance of the regulations that bind a travel agency business.
But there are significant opportunities for travel and tourism operators to get involved and reap a reward in the softer areas of medical travel such as health and wellness tourism that do not involve the significant risks of surgical interventions. Peter Nash, Strategic Chairman of the European Travel Commission will consider the opportunities to build a destination brand in this sector.
Where is the growth coming from?
In recent years, we’ve heard the stories of “exponential growth” which have attracted numerous entrants to the sector, both destinations and providers. But many have remained disappointed when the market has failed to deliver to their expectations. Irving Stackpole of Stackpole and Associates will be looking at why this is so and where some of the newer entrants have got it wrong, and some have got it right. Mature destinations providing high value services to the international patient (e.g. USA, UK, Germany) continue to thrive but the development of domestic healthcare services in their traditional source markets in the Middle East pose a threat. Leonard Karp, President and CEO, will be looking at how Philadelphia International Medicine is building a sustainable international patient practice. Chris Canning from Moorfields Eye Hospital in London and Dubai will examine the potential to create an “overseas footprint” to develop a market presence.
What do buyers and customers actually want?
There is little independent research carried out in the medical travel sector about what buyers (those who commission medical travel on behalf of governments and organisations) actually want, and what our customers think of their medical tourism experience. Dr Mussaad M. Al-Razouki, Chief Business Development Officer of the Kuwait Life Sciences Company will give his buyer’s perspective. Elizabeth Ziemba of Medical Tourism Training Inc will be interviewing some real patients who have jumped on planes to seek treatment abroad.
What do we call it? And how do we count it?
Two people talking about medical tourism could be talking about two completely different things! The language of the sector is confused. Is it medical travel? Medical tourism? Health tourism? What is wellness travel? Where do spas fit in? Is cross border healthcare medical tourism? What fits where and what should we call it?
The hotel and tourism sector has standard ways of measuring success and comparing destinations and providers. The hospital sector has standard measures and indicators. But when it comes to medical travel everyone counts things differently! In the UK, an international patient is someone who specifically comes to the UK for treatment. In Malaysia, an international patient is anyone with a foreign passport whether they live locally, have travelled there on holiday or for business, or specifically for treatment. In Thailand, one visit to a hospital department by a foreign patient counts as one medical tourist. Hence one individual undergoing treatment may be counted ten times over when medical tourist numbers are totted up.