Medical tourism will flourish when the destination country matches the home country in terms of fit and feel, but over delivers in terms of service and patient experience, all at a significant cost reduction to the home country.

Hence destinations that share cultural similarity to the USA, speak English as the first language, are safe and politically stable, with a recognized history of providing high quality health care that is also cost efficient, will be the long term winners.

Medical tourism is disruptive technology and hence is a long term play. It is also a reasonably complex offer with the buying decision needing to be aligned to a selling cycle, both of which are unique compared to the traditional health care model.

Hence destination countries and enablers based in the USA need to build credibility and confidence in the industry and at all costs avoid trying to make a quick buck. A low cost strategy as being the sole differentiator vs the US health care system may being appealing to some of the market. However the offer needs to be far more than that.

From what the US and Canadian patients who come to New Zealand comment; excellent service, in a world class health care system which puts the patient first (patient centric) at an affordable price (and not a Hobbit or Ork in sight) certainly is different to what they usually experience when accessing health care.

Now that has universal appeal.

I recently read with interest Jennifer Wolff’s article in Good Housekeeping ‘Passport to Cheaper Healthcare’ about Medical Tourism.

Whilst I think that it is great that mainstream America is sitting up and taking notice of the medical tourism phenomenon, I find it frustrating that this article perpetuated the myth that Medical Tourism is a ‘third world’ offer only.

Comments such as:

You can have surgery for less than half the price, but only in countries where you wouldn’t drink the water.

are frustrating in that they ignore the reality that there are Medical Tourism options in first world countries.

Countries such as India, Thailand and Mexico have a large share of the ‘voice’ but also attract some harsh criticism with stories of sub-par providers who sully the whole industry. This makes it hard for the average consumer to sort the good from the bad. Don’t get me wrong, there are some great providers in these countries, but they suffer by association.

For those that don’t feel confident in this sorting process there are other options. First world Medical Tourism destinations such as New Zealand, Belgium and other Western countries take a slightly more boutique approach. While they may not shout quite as loud, they have some advantages at the forefront of which is the regulations in these societies.

Quoting Wolff’s article…

“The level of standardization we have in the U.S. doesn’t exist in most of the world,” says Anmol S. Mahal, M.D., president of the California Medical Association. “Currently, there is no good system in place to help guide people through the maze of interpreting what is good medical care abroad.”

I beg to differ. The level of standardization in the U.S. exists in most first-world countries, and there is a good system in place to guide people in their decisions, that is, by looking at countries that have a high degree of regulation and rigor, not only in healthcare, but in law, society and government in general.

Interestingly in the Transparency International’s Corruption Perceptions Index the USA ranked only 19th. Countries promoting Medical Tourism that rank higher on this index include:

1 – New Zealand
3 – Singapore
8 – Iceland
14 – Germany

Maybe the world just got a little bigger for Dr Mahal?

Related posts:

1. Healthcare for the Uninsured – a third world problem in a first world nation
2. Veoivis Inside Business Video clip
3. Polar Vision and Socialized Healthcare

I’m sitting here in New Zealand feeling frustrated after reading Kinsey Gidick’s article True Tales about Healthcare Abroad. Nothing against Gidick, the article makes for an interesting read.

While the article does a great job of proving a point regarding the exorbitant cost of healthcare in the USA and the Medical Tourism alternatives available, Gidick, along with the vast majority of US media, polarizes the concept of socialized healthcare.

I’m referring to the section entitled “United Kingdom or Magic Kingdom”:

Dr. Evans disagrees. “I had a good friend of mine who lived on the west coast of England who was in his 80s and suffered from terrible chronic neuropathic pain,” he says. “After months of waiting, he was at last able to see a neurosurgeon who confirmed that he needed surgery to correct his problem. They put him down on the books for surgery 11 months out. Granted the surgery and all his care was free, but had he been in this country I could have picked up the phone and had him in a surgical suite in a week.”

Why is it that, regardless of whether they are ‘for’ or ‘against’ socialized healthcare, the US media insist on packaging a nations healthcare up in a nice tidy box that either has ‘socialized’ or ‘not socialized’ (or more correctly ‘American system’ or ‘Canadian system’) written on the front. The reality is that it is not this black and white.

Having lived and worked in the UK for a period of time, I’m in a fairly safe position to say that, much like New Zealand’s system, the chap Dr. Evans refers to had options, something that neither the US or the Canadian system would provide.

A quick Google of “private neurosurgeons UK” gives an abundance of competent surgeons. So had this patient been willing to pay he could have avoided the long wait he experienced.

or

Again through the powers of google it is pretty easy to confirm that there are elective insurance options available that would have covered this man for private surgery, again avoiding the wait lists.

or

He could have gone with the option he did…. Suffer the wait and receive free treatment.

Safe to say that even if Dr. Evan’s friend had chosen to pay, it would have been significantly cheaper than paying for the same care in the USA.

So why, when there are systems around that can offer so much choice, do the US media focus on perhaps the two least flexible systems around?

When considering travelling abroad for medical care a fundamental question is why is the destination I am travelling to able to provide healthcare at significantly less cost than America? The answer is two fold.

Firstly from a historical perspective most of the destinations offered in the past have been third world countries which have built hospitals not to service their own population , who in many cases can not afford them. but to cater for the local wealthy and overseas patients, yet leverage a local economy offering cheaper labour and materials.

However with the advent of first world countries like New Zealand, Belgium, Ireland and Germany offering their themselves as destinations one asks how can they provide such high quality care at significantly less cost than the US system? How can cardiac surgery in New Zealand cost 25% of the same surgery in the USA, even though both sets of surgeons are US trained?

One fundamental difference is the widespread practice of defensive medicine throughout the US system, illustrated in the recent article Costs of Defensive Medicine

A 2005 study of 824 doctors in Pennsylvania by Havard School of Public Health and Columbia Law School found 93% reported practicing defensive medicine

Driven by the financial need not to be wrong doctors in America it seems over treat and over diagnose. Operations it seems are performed that are both unnecessary and wasteful, let alone an unnecessary risk to the patient. Screeds of CTs and MRIs are done because the punishment of missing something is far greater than the satisfaction of having the confidence to say to the patient ”Even though we could do this test in my opinion you don’t need it”.

In other first world countries it is perceived that doing that unnecessary test is a risk to the patient. In America it is perceived that not doing the test is a significant risk to the doctor.

In Atul Gawande’s erudite commentary of the state of the US  healthCare system- The Cost Conundrum we hear that

Spending on doctors, hospitals, drugs and the like now consumes more than one of every six dollars we earn, The financial burden has damaged the global competitiveness of American businesses and banrupted millions of families, even those with insurance

Well to use a wellknown American saying ” Houston we have a problem….” and to an outside observer…it seems to be a big one.

The issue is that other first world healthcare sytems are not really cheap; its just that Americas healthcare system is really and truly massively expensive. The dramatically high prices American consumers are paying is for not higher quality procedures but for a wasteful system.

Other English speaking first world countries offer just as good quality healthcare as the USA; in some instances due to the co-ordination of aftercare, the access to the surgeon for the patient, they offer a better more personalized healthcare experience.

Its just at a cheaper price.

Related posts:

1. Boutique Medicine – American style or New Zealand?
2. The Great Unknown – Is leaving home for healthcare really that scary?

As traveling overseas is becoming a more widely accepted way of receiving medical treatment, here are a few key questions to tick off your list when considering an overseas destination.

How far do I need to travel?, Is it a direct flight or multiple stop overs?

Where possible try to book direct international flights rather than flights with 1 or 2 stopovers. You might not notice it so much traveling to the destination, but returning home after surgery could prove to be far more taxing than it needs to be with lengthy stopovers included in your travel plans.

How easy is communication with the doctors and nursing staff of the destination Hospital?

When dealing with issues about your health it’s vital that you are not in the position of not being understood, or not understanding what the doctors and nurses are saying. For example if you are an English speaker, consider countries where English is spoken as the primary language first.

What is the total cost of the package

Most destinations advertise medical procedure costs only and compare them to similar US based medical procedure costs. This is meaningless as you need to factor in the cost of travel, accommodation, aftercare and transport costs within the destination country. Always compare the total package cost of the destination to the procedure cost in the US for a true savings comparison.

What are the Potential hidden costs in the packages?

You don’t want any surprise costs when you travel to the destination country. Never assume, always confirm what additional out of pocket expenses you can expect.

What happens after discharge from Hospital, does the destination country provide comprehensive aftercare?

This plays a critical part in aiding your recovery after a medical procedure. Some destinations provide daily physical therapy, excercise routines and nursing programs in your Hotel to aid in getting you back to full health as quickly as possible. Some destinations also provide domiciliary aids to help with shopping and even dressing if required. Not having comprehensive aftercare can impact on the success of your procedure and recovery time. Make sure you fully understand what you will be receiving in the way of aftercare post surgery.

How transparent is the medical destination?

Will the destination hospital share surgical outcome data concerning their hospital and the procedure that you are traveling for? How many operations has the surgeon you are seeing performed and what training has the surgeon undergone? Can you talk your procedure over with the surgeon prior to leaving home? Can you talk to other patients that have already been there? All important points to help build both your understanding and confidence in the overall process.

What happens when things go wrong?

In the majority of western hospitals, the risk of complications is minimal but never zero. Adverse events happen even to healthy people. Find out what contingencies the destination hospital has in place to ensure you are looked after if you have a complication, and what it will cost. Some Destinations include contingency insurance to protect you against additional costs incurred as a result of an adverse event. It’s an important point to check before you agree to travel.

Will you feel safe and comfortable traveling to the destination?

Traveling and having a medial procedure will make you feel considerably more vulnerable than usual, so you must feel you can trust the destination you have chosen to make you feel comfortable and safe. Complete culture shock can be avoided by selecting a safe and culturally similar destination to your own, consider destinations that are safe, friendly and conducive to aiding your recovery.

What is the main purpose of my travel?

While beautiful beaches and scenery might sound enticing, they shouldn’t outweigh the quality of care factor when deciding on the destination. The time you spend at the destination may involve some must see tourist sites and experiences before the operation. However, after the operation you are more likely to be solely interested in getting better and getting home, so plan carefully.

These are just a few things to consider when traveling for medical treatment. A professional well focused medical destination will have anticipated many of these issues and questions, making the process of traveling there is as simple and risk free as possible.