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.

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.

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?

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?

A few tips for those heading abroad for Hip Replacement surgery (THJR). These are a combination of what I tell our clients coming to New Zealand for surgery, what they tell me, and what our surgeons and physical therapists advise.

1. Choosing accommodation

If you are not using a medical travel facilitator to book your accommodation (or even if you are in some cases) make sure that your accommodation is suitable for someone who is having hip replacement surgery. You need to make sure that you don’t have to navigate flights of stairs on crutches or that you don’t have to step into a bathtub to have a shower. Also bear in mind that low seating is not appropriate for people with recent hip replacements – especially if you are tall.

2. Airports

Ask your facilitator or travel agent to request wheelchair transfers for you in transit. While you may not think you need a wheelchair, sometimes it is a long walk between terminals and you may need some assistance with luggage etc.

3. Bring a knapsack

It makes life on crutches so much easier.

4. Bring slip on shoes

Unless you have a very patient traveling companion, you may struggle with laces.

5. Bring Skirts or loose fitting trousers

It will make life easier and be more comfortable than tight fitting clothing after surgery.

6. Talk to your surgeon

Arrange a telephone call before traveling to your destination. Find out what you can expect afterward in terms of recovery and mobility. Find out how long before you can get your wound wet (different surgeons have different perspectives on this). Then plan any additional travel with this in mind.

7. In flight DVT prevention.

This is important both before and after surgery. Drink plenty of water, avoid alcohol, make sure to get up and walk regularly on the flight. Talk to your surgeon about preventative measures for the flight home.

8. Recuperative Care.

This is VERY important. For our New Zealand clients we provide exercise equipment in the hotel rooms so that our physical therapists can work out a regime that gives you optimum results for your surgery and recovery. Be concerned if your overseas provider makes no mention of it.

9. Don’t skimp on the pain medication.

While you don’t want to overdo it either, being in pain can interfere with your post operative recuperation and physical therapy regime. Make sure your doctor explains clearly when and how you should take any prescribed pain medication.

10. Find out what sort of implant.

Will be used in your surgery. Implants can vary greatly in both price and quality. The general rule is you get what you pay for. Make sure you are comfortable and confident that you are getting a reputable brand of implant and that it is appropriate to your needs. Talk to your surgeon about the different types and what is best for you.

Note that these are suggestions only and should not replace any advice given to you by your health professional

Have you had or are you considering having hip replacement surgery either at home or abroad?

How do you decide on a hospital or surgeon?

Do you have any questions?

Do you have any tips for others?

Please leave a comment below. I’d love to hear from you.

Related posts:

1. Medical travel food for thought.

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?

Jorgensens article How Companies are Changing Healthcare Costs certainly raises some questions.

I applaud Hannaford on leading the way in giving their employees an affordable option for elective surgery. By doing this they not only managed to save themselves some pennies, save their employees many pennies, but have also called the local providers bluff in regards to pricing.

The big question is…  if a hospital can reduce its prices from 50,000 to 18,000 for a hip replacement, then where was the other 32,000 coming from in the beginning. That is one mightily hefty margin!!

You have to ask:

If they can do this for the masses who is paying for it?

What would be the cost for an uninsured patient?

Why are other large companies so slow to catch on?

It is a story heard all too often in Medical Travel stories – The patient who needed surgery 5 years ago and has sacrificed quality of life because they can’t afford surgery. Desperation pushes them to seek out other options and that is when they pack their bags and head for foreign shores. The only regret when they are headed back home pain-free… waiting for so long to do it.

So why are people waiting? Three reasons I can think of:

1. Financial – Yes it is much cheaper, but what if it I still don’t have the cash?

2. Lack of knowledge – I didn’t even know that these options were available?

3. Fear – I have never been outside of the USA, I don’t know what to expect, it’s too hard.

The first 2 are easy. Financial assistance is available for medical care and some options will extend to offering assistance to medical travelers. One such option is mymedicalloans.com who offer assistance to New Zealand bound medical tourists.

The industry as a whole is doing a fine job at raising the profile of Medical Tourism and the PR surrounding it, means that the message is slowly but surely getting through. One of the most effective means of education is through word of mouth and the more happy patients going back to the USA, the more that seek out offshore options.

So coming back to fear – I certainly understand it. Medical treatment is scary and confusing enough on its own without adding the distance factor to it. But there are many ways that you can make your journey a whole lot less daunting with a few simple steps:

1. Research your destination

Find out all you can before you go about the country and customs you are going to so you know what to expect. Look at travel forums to get insider tips. Know how you are going to get from A to B.

Research the medical care at the hospital as well. Find out outcome information, number of surgeries the surgeon has performed. Nurse to patient ratio’s. Number of english speaking staff.

2. Talk to previous patients

Most good facilitators or international patient departments will be able to arrange for you to contact a patient who has agreed to talk to prospective patients. They will also be able to give you insider tips and reassurance of the quality and ease once you get there.

If you can’t talk to a patient then seek out credible testimonials. Good facilitators or treatment centres will have them readily available on their website.

3. Select an appropriate destination

There are so many Medical Travel destinations out there these days that you can pick and choose based on factors that are important to you. Do you want to choose a very safe destination? Is an English speaking destination important to you? Make a checklist of things you want in a destination and then start matching the available destinations to your wishlist.  If you are a fussy eater, you don’t want to go to somewhere that has food tastes vastly removed to what you are used to.

4. Find a facilitator you can trust

You should feel comfortable with the facilitator you are using. These are the people that you are entrusting with your healthcare, if you can’t trust them then find a new one! You should be able to ask them anything, if they don’t know the answer right off, then they should be finding out for you. Some patients actually find that traveling abroad for healthcare using a good facilitator is easier than staying at home, after all the facilitator knows the system inside out and takes care of everything for you. How many people can say that about using facilities at home?

5. Take a companion

Medical Travel is much easier with somebody to share the experience with you, but choose carefully. Someone who is off shopping or playing golf the entire time is not helpful. It is common to feel a little blue after surgery no matter where you have it and having someone on hand who can sympathize and help cheer you up is incredibly helpful. If you can’t take a companion then talk to your facilitator about home care assistants, it is amazing how much difference a friendly face makes when you are recovering.

There are many more tricks of the trade that make the medical travel experience a whole lot easier but the underlying factor is that a GOOD facilitator can make the process easy and familiar. Never underestimate how valuable being greeted by someone you trust and 24 hour assistance can make to the ease of your journey. Even at home haven’t you ever wished that someone would just figure it all out for you? That is the Medical Travel difference… They do!

Related posts:

1. 10 Handy Tips for Hip Replacement Surgery Overseas

Is access to safe blood transfusions a consideration for you when selecting a medical tourism destination? Information from the WHO suggests it should be…

“Evidence-based strategies for blood safety and availability have been successfully implemented in most developed countries and some transitional and developing nations. However, despite the proven effectiveness of these strategies, many countries are making slow progress towards their implementation.”

Infection is a risk with any blood transfusion. Diseases such as HIV, Hepatitis B & C, Malaria and Syphilis can be acquired through receiving contaminated blood products. This fact has lead to strict regulation and screening of blood products in developed countries.

The WHO Aide-Memoir for national blood programmes indicate that the risk of infection through blood product transfusion can be substantially reduced through the following measures:

• Establishment of a nationally-coordinated blood transfusion service
• Collection of blood only from voluntary non-remunerated blood donors from low-risk populations
• Testing of all donated blood, including screening for transfusion transmissible infections, blood grouping and compatibility testingReduction in unnecessary transfusions through the effective clinical use of blood, including the use of simple alternatives to transfusion (crystalloids and colloids), wherever possible.

But wait, before you unpack your suitcase and sell the house to have your surgery at home, there are many Medical Tourism destinations with equally as safe, or even safer, blood supplies than the USA’s. For example New Zealand has one of the safest blood supplies in the world with no reported cases of HIV transmission from blood transfusion since they began screening for it in 1985 (NZBS).

You should be able to obtain reliable information on screening and outcomes from the hospital or facilitator you choose. An example of such information is the New Zealand Blood Services Hemovigilance Report.

While giving blood prior to your surgery (Autologous Transfusion) is an option it is usually not appropriate for Medical Tourists for the following reasons:

• Most reputable blood organizations will only take around 4 units of blood. In the case of an emergency this may not be sufficient and you may still require donor blood as a ‘top up’.
• Ideally you should allow around 1 week between donations. With the final donation a bare minimum of 48 hours prior to your surgery. This leads to a long visit to your chosen destination!
• There is a cost involved in the collection and storage process.
• Not all people or procedures are suitable for autologous donations eg. Cardiac surgery.

All it takes is a little research to find out which destinations are safe. Any facilitator worth their salt should be able to provide you with some statistics on your preferred destinations. Failing that a simple Google search with “blood transfusions [country]” should give you an abundance of information.

Related posts:

1. 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.