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.

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.

Apart from the cost one of the major differences between the majority of US healthcare and medical tourism destinations appears to be the personalized service one receives.

For example, the private healthcare offered in places such as New Zealand is the boutique option. You can choose your hospital, doctor and the day of treatment but you have to pay. In contrast, the public healthcare system in New Zealand is government funded and hence there is no charge for its use by individuals. Indeed the same doctors work in both systems. The real difference is in the waiting time, and choice of doctors.

Contrasting this with the US health system where a recent article cites an example of the same medical clinic having two entrances: one for the insured clients and one for the self- pay. The self pay got the boutique service; to see a doctor and the higher charge. The insured patient got the diagnostic test but very little more and their insurance paid (a reduced rate).

It appears more and more Americans are walking away from insurance and wanting to make their own decisions with added benefits that feel to them that they are receiving fair value for their own non-insured, self pay health dollar. In this environment of consumer driven healthcare, medical travel must be an option.

Americans now have a boutique option of medical care in their own country where increasingly the customer not the insurer pays. Since the customer can not negotiate substantial discounts, (like the insurers) they pay … a lot.

Hence to travel overseas for easy access to the same level of service, a single invoice (if not more personalized), for 25% the cost of the boutique service in the US, with no bureaucratic minefield or unexpected bills starts to sound attractive.

Related posts:

1. Defensive Medicine – Why Americans Pay More

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?

Every year, more than 44,000 Americans die simply because they have no health insurance. Congressman Grayson recently launched a website http://www.namesofthedead.com/ to honor but a few of the unfortunate masses.

Reading the stories on the site dispels the common misconception that the uninsured population is largely comprised of illegal immigrants and societies parasites. These people are just “Joe Average Americans” that are victims of the US health care system.

As a New Zealander I find this hard to fathom, as do most other people I discuss this with… a first world country similar to ours, with people dying unnecessarily because they cannot afford healthcare… Surely not! This is a third world problem they say – you must be mistaken.

What ever happened to the American Dream?
Are all men created equal except for those who cannot access medical insurance??

Where does Medical Travel fit into this?
It is not and will not ever be a panacea for the US Health system, but it can certainly help.
Medical Travel is not for everyone. There are some people that travelling for treatment is simply unsuitable for and some procedures which do not fit the criteria, for example, treatment that requires multiple visits over a long period of time.

However there are people living with pain and illness that may benefit from affordable treatment offshore. As I read the names of the dead, I tick off many that we could have helped, particularly in the early stages. The big question is, how do we get the message through?

Related posts:

1. The Wider World of Global Healthcare

The Towers Perrin’s latests survey that US employers who insure their employees will shortly face an average annual per employee cost for healthcare coverage of US$10,000 must come at a time when companies must wish they had only to focus on increasing profits not reigning in healthcare costs.

One is somewhat surprised therefore in the slowness of the uptake of a product that if chosen and implemented correctly, will not only be desirable for employees, maintain high standards of healthcare but deliver significant cost savings, namely medical travel.

Nothing in the healthcare reforms to date has talked about addressing cost; its all about coverage. The question will therefore be will reigning in the costs of healthcare be left in the hands of the hospitals and insurers with the self -insured companies left to either pay higher costs or lay off staff? Spending time considering medical travel looks like a viable and progressive third option

Related posts:

1. How Companies are Changing Healthcare Costs

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