The recent outbreak of the superbug NDM-1 as reported in the latest edition of the Lancet is a wake up call for all people involved in the globalisation of health. While there is a focus on the positives of access to high quality but more affordable care that medical tourism can deliver the negative connotation of bringing back to your native country something distinctly unpleasant from the country that you just visited makes us all stop and think.

It highlights very clearly that when considering an overseas destination for surgery, while the quality of the surgeon and the hospital is important, one aspect that is difficult to assess as to its quality is the medical environment in which the service takes place.

The medical environment includes all things that you can not see and take on trust. Like for example the blood supply, the ability of the nurses to understand and communicate with you, the practices of sterilisation of surgical instruments and so forth. Its the culture and practices under which medical treatment is delivered. It encompasses much more than the individual hospital or doctor; indeed they may have little control of it.

Hence in India the widespread unfettered use of antibiotics has created a medical environment in which a type of (gram -negative) bacterium has developed resistance to all known antibiotics. The only sure way not to have it colonize you and hitch a ride home is not to subject yourself to the medical surroundings where such a bug is endemic.

Thus if the medical environment to where you are heading is not aligned with or better to where you live, dont go even at if huge savings are on offer: the risk of going is very difficult to quantify.

I just watched the following video…

Veiovis inside business

These are some great examples of how medical tourism can work well.

It’s great to see insurance companies evolving and including global options in their health plans.

Also of note, is that Veiovis has recently added New Zealand to its network.

Related posts:

1. The Wider World of Global Healthcare

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

One of the issues in being involved in an unregulated global industry is the untruths and exaggerations that abound. While they possibly exist in many areas, medical or otherwise, the number of medical patients travelling overseas illustrates the struggle of indiviudal countries wanting recognition.

A much used quote is that in any war the first casualty is the truth seems to hold true as these countries fight for recognition and legitimacy.  The Lemmings Theory seems to be that by overstating the number of patient travellers to your facility you some how encourage more patients to visit. The more lemmings you say you treat , the more lemmings will follow.

A recent article Medical tourism statistics.Comparing Apples with apples…. hightlighted this by illustrating how some  hospitals count their  patients. It seems in some countries who indicate large numbers of medical tourists, the hospital administrators count each event as a separate patient. hence having an xray is one, the actual operation is two etc. This ends up with one patient having undergone a routine inpatient procedure as having been recorded as 15 patient episodes and (for sake of brevity) this is further shortened by marketing  to 15 patients.

Even well known global consultant agencies seem to fall for the same trick. Deloitte for example published a report in 2008- Medical tourism conumers in search of value, we hear that 400,000 medical tourists went to India and over 1.2 million medical tourists went to Thailand. Unbelivable numbers that appear, well…. unbelievable.

Until therefore there is a global agency such as the WHO that can verify overseas medical tourists numbers, patients contemplating travelling overseas for medical care should do their own research. If you want developed first world and English speaking then your choice is UK, Canada, Ireland, Australia, New Zealand and Singapore. If you want cheap well thats another story. Although there does seem to be a connection between the claim of very large  numbers of medical travelling patients and the third world. While it may be true that they treat many regional Asian patients, the actual number of North Americans who travel to Asia (or indeed anywhere else) for medical treatment , is yet to be verified.

Related posts:

1. What will make Medical Tourism grow?

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?

Last week as I was seeing off yet another satisfied customer back home to relay the amazing experience to his friends, family and generally anyone who will listen, I thought back over our patient experiences to the common theme that “wows” each and every one of them… The Medical Tourism Care Factor.

While much is out there on Medical Tourism accreditation, quality outcomes, medical training etc, the importance of ‘care’ seems somewhat swept under the carpet. Don’t get me wrong, quality assurance markers are extremely important; but in my experience, in patient testimonials, they are not saying “Wow, the hospital is internationally accredited” or “The surgeon has one of the lowest post-op infection rates out”. However, it is pretty common to hear “the surgeon made me feel so comfortable”,  “I felt like I was more than a number” or “The nurses were so attentive and caring”.

My suspicion as to why the care factor is not broadcast more widely is that it is beyond most Medical Tourists imagination. Remembering, that in many cases the starting point to seek treatment abroad is the disillusionment that they have experienced trying to access affordable care within their own health system. To tell someone in this situation that, not only will they receive excellent medical treatment at a lower cost, but they will also feel important and cared for while they are doing so, is like trying to explain Filet Mignon to someone who has only ever had burgers. While they know it is special, they can only really know the difference by experiencing it themselves.

This ‘Care Factor’ goes beyond one person to the whole experience; the call and guidance their facilitator gives them while they are deciding, the pre-operative experience with the surgeon, the hospital and nursing care, recuperative care, right through to the follow up once they return home. Get it right, and it is a recipe for health care success.

Related posts:

1. The Great Unknown – Is leaving home for healthcare really that scary?

Recent articles such as Transplant tourism poses ethical dilemma for US doctors and Majority of doctors skeptical of organ transplantation practices in China bring the issue of “Transplant Tourism” under the microscope.

At risk of quibbling over semantics, the name “Transplant Tourism” makes me shudder. When you are talking about surgery as major as a vital organ transplant, to trivialize it by the mere suggestion of beaches and palm trees is near criminal. I prefer the term Medical Travel over Medical Tourism, yet, I guess, Transplant Travel is not quite as catchy or sensationalist.

The process of traveling overseas for transplants is driven by desperation, let’s face it, for something like this, the ideal is to have it in an environment where you feel comfortable and can be assured that you have top-notch surgeons and facilities at your disposal, yet the sheer idea of “buying” an organ suggests that the regulations that you would normally desire around healthcare are absent in that “transplant tourism” destination. However, through inaccessibility of treatment, due to cost or wait times, patient’s are compelled to lower their standards of ethics, quality or both in order to regain their failing health.

Much is written about the evils of Medical Tourism and the impact on developing nation’s healthcare for its natives, this practice is yet another fine example of this. Who is missing out on an organ because someone wealthier from another nation can afford one?

It is these factors that would lead you to dust off your placards and join a movement to place a blanket ban on this phenomenon, however in many cases there is still room for Medical Travel in relation to transplants… well some of them anyway.

Live Donor Renal Transplant’s when carried out ethically are an option for those who have access to a live donor and can be more affordable when performed out of the USA. It is important for institutions and facilitators to screen donor’s, to avoid the “paid donor” trap however.

For example it is possible for patient’s to receive live donor renal transplants in leading New Zealand private hospitals for around one third of the cost in the US, including flights, accommodation (around 6 week stay) surgery and hospitalization for donor and recipient, drugs, aftercare and contingency insurance. Strict regulations around health care provision in New Zealand ensure that the procedure is carried out to a high standard and ethically, including checks to ensure that the live donor’s are known to the recipient and sourced ethically.

So, while the unscrupulous processes will no doubt continue with Transplant Tourism it is comforting to know that there are options for those who can’t access care at home, where they do not have to lower their standards in terms of quality and ethics.

Much has been written about the ebb and flow of opportunities around Medical Tourism as an attractive option for Americans seeking cheaper health care outside their own borders. From predictions of stellar growth by Deloitte in its 2008 report on the Medical Tourism market in the US, to significant downward revisions of forecasts due to the economic environment; authored by Deloitte in the 2009 installment.

Opinion generally around the fortunes of Medical Tourism are polarized, ranging from examples like; USA Today picking medical tourism in the USA to be one of the top 10 trends during 2010, to an article by Keith Pollard “Treatment Abroad” that points to medical tourism remaining in the margins for the foreseeable future. http://www.imtjonline.com/articles/2010/the-outlook-for-medical-tourism-30034/

Apart from feeling the need to reach for a bottle of Prozac and a stiff Gin after reading parts of Keith Pollard’s article, the issue I have with his opinion, is that it implies that Medical Tourism was originally prophesied as a Holy Grail, mainstream, overnight solution to the current issues facing the US health care landscape. In reality, Medical Tourism is a channel option within the business mix and will always be so. As such, being in the margins is probably a sound footing from which to continue to build on a beachhead industry, moving it towards a longer term goal of wider understanding and acceptance within the US health care landscape. As trite as it may sound, Rome wasn’t built in a day, or for that matter, a year.

Of greater interest, and proving that a week can be a long time in politics, was the election of Republican candidate Scott Brown to the US Senate. In doing so ending the 47 year stronghold by the Democrats in Massachusetts by the late Senator Kennedy, and preventing the Democrats from passing major reforms through the Senate unimpeded. A key reform Health care now appears stalled as the Republicans, with new found power, push back in response to, what appears to be, resounding public opinion. Watch this space, as it now appears that the already watered down health care reforms will be further watered down and in the process perhaps further opening the way for opportunities in Medical Tourism… watch this space.

Related posts:

1. Boutique Medicine – American style or New Zealand?

Philip Wrights recent article in the Verde Independent explains the experience of Ben Wordinger, a self insured man from Arizona, and the difficulty he had accessing medical care in the USA.

This shows one of many drivers behind people accessing Medical Tourism out of the USA.

Of interesting note is his comment on his preference for an English speaking destination. When accessing medical care overseas many people find that cultural similarities such as this are an important factor in their decision on a destination.

Related posts:

1. 10 Handy Tips for Hip Replacement Surgery Overseas
2. What will make Medical Tourism grow?