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’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?

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?

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.

This recent article in the New York Times clearly highlights the disconnect between consumers and the US health system. These individual stories not only highlight the personal issues that these people face, but the economic concern that these people should be recognized as presenting to the US economy. These are stories about people in their economic prime who instead of being able live life and focus the contributions they can make to their families, communities and the wider economy through their work, worry more about the risks and complications of  living with or without Health Insurance, knowing that they are probably quite literally one medical incident away from potential financial disaster.

The New York Times introduces the story as follows and I quote.

“Much of the debate about health care reform focuses on people who don’t have insurance. But as Karen Barrow explores during the latest Patient Voices series, even people with insurance coverage are struggling with bills, confusing policies and red tape.

Six men and women share their experiences with health coverage and insurance issues. You’ll meet Tasha Huebner, 41, who found dealing with the insurance company worse than dealing with breast cancer. “With insurance, it was always a big surprise, what are they going to deny next?” she says.

Once she called her insurance company to find out why a $5,000 surgery bill had been denied. She was told it was because she had one too many nurses in the operating room during her surgery. “At that point I hung up on my insurance representative that I was talking to,” she says. “I didn’t even know what to do with that.”

Zoraida Reyes, 46, is a small business owner who was forced to cut health insurance, including her own. “I work six days a week, and I can’t afford insurance,” she says. “You can imagine the people who have a lot less than me, they’re probably worse off.”

And there’s Carl Arrington, 58, who lost his health insurance after his Internet company closed. Instead of paying for health insurance, he decided to invest in his health, changing his diet and exercising more. “If you’re in your 50s or 60s and you don’t have medical insurance and you don’t get it through your employer, it’s going to cost you two or three thousand dollars a month. With that kind of money I could see a doctor every week.”

Adrienne Schroeder, 31, has high-deductible health insurance through her husband’s job but is saddled with medical debt as a result of four pregnancies in six years, including two that ended in miscarriages. “Since we have insurance we should not be worried about having a baby or having a miscarriage and be stressed about how long it takes to pay it off,” she says. “Our daughter is near 18 months, and we’re nowhere near paying off these hospital bills.

The majority of the people in this story are representative of a Medical Traveler demographic that are coming to New Zealand in gradually increasing numbers for non-urgent or elective medical procedures as an alternative to the high cost of care in the US.

It’s nothing new that the adventures of everyday people’s lives make great reality TV viewing for audiences all over the world, and now it’s the turn of Medical Tourism playing host to the fascination of TV viewers in the United States as they watch fellow citizens seek medical treatment overseas. Surely a measure of the growing interest in Medical Tourism in North America, this show should prove to not only entertain, but enlighten and perhaps inspire American television viewers about the options and opportunities that exist in various parts of the world to receive cost effective, safe and quality medical treatment.

The recent announcement indicated that Merv Griffin Entertainment has teamed with a medical tourism agency to produce a televised reality-style series on medical tourism.
It was reported that the show will follow medical tourists as they travel to other countries in search of healthcare that they either can’t afford or can’t obtain in the United States.

The article reported that patients will be followed through the various stages of their journey, including their initial research, arrival in a foreign country and talks with doctors at hospitals where they will be treated.

The subject matter certainly has all the makings of powerful and inspirational Television.