Travel plan idea blog

Medical tourism creating difficulties in Thailand - is medical tourism responsible tourism or exploitation?

I wrote a while back (almost 3 years ago actually) I wrote about how a friend of mine ended up with a nasty infection after visiting a dirty hospital in rural Thailand. Her arm is permanently disfigured as a result so it must have been serious.

Several people replied that healthcare in Thailand is actually excellent and my friend's experience must have been the exception rather than the norm. It seems that we need to differentiate between private hospitals and public ones in Thailand. Since my friend was nowhere near a city I'm guessing she ended up in a public hospital, probably the only one anywhere nearby.

This article explains that public hospitals don't have enough doctors because private hospitals near expensive hotels pay much better than public hospitals. In one day at a private hospital a doctor might make three times more than she would working 5 days in a public hospital.

The result is that while some hospitals in Thailand provide excellent care, public hospitals even in major cities like Bangkok (and you can imagine it would be even worse the further you get from a city especially since people are willing to travel hours to get tot he public hospital in Bangkok) are a bit more trying:

The outpatient waiting room looks a bit like Grand Central Station. On a very hot day. With no air conditioning.

Hundreds of patients are squeezed onto old wooden benches. Many more are slumped in wheelchairs or lying on gurneys.

Malai says she has come in from the district of Phetchaburi because she feels sick and her legs hurt. She also has hepatitis. She left her home at 3 a.m. to travel three hours to the hospital.

It reminds me of this story from a while back - I linked to one article about Canadians getting transplants in India from poor people willing to sell their organs. It seems that medical tourism is great for the tourists but there's definitely some controversy over how good it is for the locals.

What do you think? Is medical tourism responsible tourism or exploitation?

And no, if I needed a kidney or whatever, I wouldn't really care about the answer to my question.

Medical tourism FAQ, the travel biz, and downtime

First, if anyone visited while this blog was offline, let me assure you that all is now well. Apparently the hosting company (who I pay $225/month to keep this site online) had some problems. Overall, they've been pretty good about keeping us online even though we get a lot of traffic so I'm forgiving them.

Speaking of traffic, here's a business that gets 1,000-2,000 visits a day to their web site about traveling with kids. They decided to turn it into a business and so they became a travel agency. Apparently they do enough business to have 4 full-time workers and plans to expand. I get about twice as much traffic so I wonder if I should start my own travel agency...

In fact, a friend of mine and I are trying to get a business started where we take people on tours of some of Brazil's lesser know carnaval festivals. Surely there must be a few people who want to get away from the touristy one in Rio and see the real ones. Also, my wife and I are talking about doing tours in Italy when we finally retire there. Although I guess that means we'd be working and not really retired.

Anyway, I found this medical tourism FAQ and realized it has been a while since we covered that topic. Naturally you'd want to do more than read a single web page before going to Thailand for heart transplant or whatever - the only book I know of for you is Patients Beyond Borders.

Well there you go. I've explained why we were offline for a while, thought about selling out and making this blog some sort of business, and covered medical tourism briefly.

Medical tourism makes the news again

Here's a story about a woman who saved 20,000 on some facial cosmetic surgery by getting it done in Mexico.

We know that medical tourism is a growing trend and we know that sometimes it is risky (not that it isn't risky in the US as well). Naturally, US doctors say that it is riskier to travel abroad:

But Dr. Carl Lentz, a Daytona Beach plastic surgeon, said he is skeptical of the quality of care in operations that cater to overseas patients. He said he treated a patient who went to Costa Rica for surgery and came back with a saliva gland draining down her face.

In this case the woman had a personal recommendation from a friend who had used the same Mexican doctor which removes some concern. Doing your research would help relieve some concerns as well. But here are other issues.

The article I'm linking to here says that you can't sue for malpractice when you get work done overseas. They also say many doctors in the US refuse to give patients follow-up treatment. Supposedly there are liability issues but it seems to me that US doctors are refusing to treat sick people - it just seems wrong.

One scary thing the article mentions is that insurance companies might start sending people abroad to save money:

The lower charges for medical service outside the United States could present a new wrinkle in the relationship between U.S. medical providers and insurance companies as companies look for cheaper ways to pay for their employees' health care. It could mean your insurance company puts you on a plane to Thailand for the next heart valve replacement or you leave your gall bladder in India.

I don't like this, but now the insurance companies seem to try to avoid paying at all, basically leaving people to die if their treatment costs too much. I'm reminded of the cancer patient who was denied treatment and pain killers.

I'm not sure how exactly, but I guess this will tie in somehow with the whole problem of unemployment and health insurance we have in America.

300,000 to 400,000 Americans seeking healthcare abroad in 2007?

Here's a Forbes article explaining medical tourism's rise in popularity in the US. With so many people uninsured and healthcare so expensive, it's really no surprise:

Almost 45 million Americans, or slightly more than 15 percent of the population, are currently uninsured, according to U.S. Census Bureau statistics from 2005, the latest available.

Woodman estimated that more than 150,000 Americans traveled abroad for health care in 2006. The number is projected to double in 2007, he said.

"That 150,000 number is conservative," he said. "Some experts say 400,000." Among the top destinations: Southeast Asia and Mexico, with many other countries, such as Costa Rica, expected to be the next popular destinations for medical care.

That article has some advice, a few quotes from doctors, but if you're considering medical tourism, you'll need more. I recommend Patients Beyond Borders.

Does the fact that Americans are traveling to Thailand, India, Singapore, Mexico, etc. for healthcare mean that the US system is broken?

Patients Beyond Borders: book review

Patients Beyond Borders is a book written for US citizens who are considering traveling abroad to save money on healthcare. It is written by Josef Woodman and published by Healthy Travel Media. The official website is patientsbeyondborders.com.

In addition to Americans, citizens in countries where certain procedures are very expensive (hard to imagine anyplace being more expensive than the US) or difficult to get in a timely fashion (transplants come to mind although that can raise ethical questions for some) will also find this book useful. People who don’t want to be convinced that medical tourism is safe and cost-effective shouldn’t bother with this book. However, if you want to be convinced that traveling abroad for surgery, dental work, or what have you is a good decision, Patients Beyond Borders makes a strong case.

The author, Josef Woodman, argues that you can find healthcare specialists and hospitals abroad that are as good or better than those in the US. He writes that if you’re considering a procedure that will cost over $6,000 in the US, you will probably save money by traveling abroad. He does note that you need to keep your American doctors in the loop and heed their advice (see the Jude Jarvis story).

Woodman spends the rest of the book proving his claim by covering JCI accredited hospitals and health travel agents that help medical travelers plan their trips. The hospitals and health travel agents are organized by country and the major medical tourism destinations are covered. These include a few that have been mentioned in this blog such as Thailand, Singapore, and India (be sure to read the comment here).

Patients beyond Borders also covers Brazil, Caribbean countries, Costa Rica, Czech Republic, Hungary, Malaysia, Mexico, South Africa, and UAE. For each country, Woodman gives an overview of treatments popular with medical tourists visiting the country, lists well-known clinics and hospitals, gives contact information and brief overviews of health travel planners, and names a few hotels at which travelers can rest and recover.

I’m not sure that I would use the lists of hotels. For example in the chapter on Budapest, Hungary two hotels are mentioned (one deluxe and one moderate). Clearly there are more options in Budapest so the limited information in Patients Beyond Borders will be of very limited use. I wouldn't use it all. The best bet might be to have the health travel agent find something near whichever hospital the medical tourist ends up choosing.

One point that Woodman stresses is that patients, not health travel agents, are responsible for choosing the hospital and physician. One very useful section in Patients Beyond Borders is the 10 "must-ask" questions designed to begin a dialogue with potential doctors abroad. Another useful section helps readers choose health travel agents.

All in all, if you want to travel abroad for healthcare or are willing to be convinced to travel abroad for healthcare, Patients Beyond Borders is for you. The book can help you get to know which procedures are common in which countries, locate reputable hospitals, contact health travel agents, and help you communicate with doctors and health travel agents.

If you want to travel without using a health travel agent, you’ll need more than Woodman's general and limited travel advice in order to find flights and hotels but if you don’t know how to book these things on your own, you probably don’t want to start when you need an important and expensive medical procedure.

If you're looking for details on the dangers of medical travel abroad or if you want a book that will give you reasons not to visit countries outside the US for healthcare, you need to look elsewhere.

Travel for health care in Poland, Malta, Spain

Here's a very intersting article on how budget airlines are changing Europe. One the important changes is easy access to inexpensive health care:

No-frills airlines also let Europeans seek cut-rate health care in Malta, Poland and Spain.

An implant and crown that cost 2,500 euros in the U.K. go for 1,400 euros in a Polish dentist's office, says Marcin Gaborski, a board member of Dental Clinic HAHS in Szczecin.

Has anyone here ever experienced healthcare in Spain, Poland, or Malta? If so, please share your experiences because many people think of India, Thailand, and Singapore when they think of traveling for low cost health care.

Holistic health resort in the Philippines

The Farm at San Benito recently won the Medi-Spa of the Year and Spa Cuisine of the Year awards from the 2006 Baccarat AsiaSpa Awards. Sounds luxurious and healthy but I'm not so sure about the cuisine of raw foods:

Guests can enjoy a range of programs designed to suit each one’s needs. These include medical consultation, live blood cell analysis, colon detoxification therapy, psycho-emotional therapy, among many others. Doctors and nurses work on site tailoring treatment plans for guests' conditions. The Farm's proven curative approach is based on the consumption of raw foods and the detoxification of the body and the mind.

Medical tourism in India: sun and surgery packages pros and cons

Here's an article on medical tourism in India that discusses some of the conditions that keep people away from India for healthcare:

1. garbage, pollution and waste matter remains
2. murderous driving of ill-disciplined traffic
3. regular outbreaks of dengue fever (numerous cases in 2006 actually originated within the prestigious All India Institute of Medical Sciences in Delhi itself)
4. the appearance of chikungunya, the presence of drug-resistant malaria and tuberculosis
5. the appalling state of health care for the majority of the people of India, particularly those who cannot afford the "Third World prices" which are supposed to be such an attraction to the modestly affluent Westerner.

The article also mentions why some people travel to India anyway with a pretty strong example:

The Washington Post recently reported the case of a carpenter, one of the 40 million Americans without healthcare insurance, the remedy for whose heart condition would have cost $200,000 in the USA. He made his own arrangements with the Escorts Heart Institute in New Delhi, where for $10,000, his faulty heart valve was replaced by one harvested from a pig. Included in the price was a sightseeing trip to the Taj Mahal. This is described by the Indian health care companies as "First World Health Care at Third World prices".

Some related blog entries: the Jude Jarvis tummy tuck tragedy, medical tourism in India, and more medical tourism blog entries.

Phuket, Thailand: Health tourism destination

Here's an article on health tourism in Thailand, specifically Phuket. I'm not surprised that Americans travel to find affordable healthcare, but it seems to be an issue in Australia as well:

The increase in demand for Health Tourism in Phuket is linked to rising healthcare costs and long waiting lists for surgery in the tourists own country. In Australia for example, some patients are waiting over a year to have hip surgery, a wait that is often both painful and impacts considerably on their quality of life.

An alternative is to immediately book into one of Phuket’s private hospitals, have the surgery, recover beside a five-star resort’s pool sipping a favourite cocktail and then return home a new person, all at a cost far less than private hospital care in Australia.

But it’s not just surgery that is attracting the health tourist. Dental work, health checkups, acupuncture, spa and wellness programs are all experiencing increasing demand.

As some of you may recall, Thailand has been recommended over other possible destinations (like India or the Philippines) by at least one commenter who seems to know his stuff. And remember, if your domestic doctors won't perform a surgery for medical reasons, having the same surgery in another country is a huge risk.

Medical Tourism in the Philippines

The Philippines is competing with other Asian countries for medical tourism dollars. They are creating packages that include golf and other vacation activities in places like Palawan, Boracay and Cebu. They're combining these famous vacation spots with medical treatments in the following packages:

Wellness and health holidays: laboratory tests (urinalysis, fecalysis, CBC with platelet), blood chem, Hepa B screening, thyroid screening, pap smears (for women), prostate check-up, chest X-ray, and ECG.

Beauty holidays: Eyelid surgery, Rhinoplasty, breast surgery (augmentation, reduction, lift), Liposuction, tummy tuck and Botox.

Vision Plus holidays: phacoemulsification with IOL (a kind of cataract extraction surgery), LASIK or laser-assisted in Situ Keratomileusis, routine pterygium removal, eye muscle correction, entropion, ectropion, and ptosis correction.

Smile holidays: Dental implants, crowns, and veneers.

In the past I've blogged about medical tourism (or medical value travel) in India, including the death of Jude Jarvis. One commenter suggested Thailand as a better alternative. Singapore is superior to both, but more expensive.

Jude Jarvis: Tragic story about cosmetic surgery in India

I haven't said anything about medical tourism recently but Neal Yerkes who sometimes leaves very insightful comments on this blog recently wrote me about an article in a Rhode Island newspaper - Here's what he said:

The article is about a young woman (young to me at least) who traveled to India for liposuction (not mentioned in the article but you generally get liposuction and a tummy tuck), breast reduction and a tummy tuck. She had been told by US surgeons they would not operate until she reduced her weight to one hundred forty pounds. The doctors and the hospital in India decided to push the envelope and operate anyway. The article says she died of a pulmonary embolism caused by a blood clot. It is more likely she died of a pulmonary embolism caused by fat entering her blood stream during the operation, a known risk factor in liposuction made greater by her obesity. We will ever know.

The autopsy was performed by the same hospital where she received the operation. Her sister, a non-medical person, called it a freak accident. In fact the outcome was predictable due to the woman being a high-risk patient. She was a single mother and left three children.

I don't understand risking your life for a tummy tuck but the fact that this would have cost 20,000 in the USA but only 5,000 in India tells me that some people will take the risk and have the surgery done abroad. What Neal has recommended in the past is that medical tourists go to Thaliand or Singapore rather than India. I wonder if they have statistics so that we can see if surgery in India (at one of the tourist hospitals - not the rural ones) really is more dangerous than in the US.

India as a destination for medical tourism

This article on medical tourism in India claims that shorter waiting lists and lower prices are attracting foreigners to come to India for healthcare. Another article tells us that "top hospitals like Apollo and Sir Ganga Ram here are providing travel facilities akin to the best offered by the hotel industry."

At least one nurse recommended against India as a healthcare destination in the comments section of my Nov. 17, 2005 post on medical value travel in India.

In Canada medical tourism has stirred some controversy: there's a company that arranges medical tourism visits in Pakistan and India. The company can "arrange a kidney transplant from a live donor for about $32,000 US." The controversy, of course, comes from the "exploitation of the individuals in the Third World." The counter argument is that one life is saved (the wealthier medical tourist) and another life is improved (the person selling their kidney escapes abject poverty).

Medical tourism in Singapore

Thank you to Neal, both for his interesting comments on India's medical value travel marketing campaign and for emailing me this article on medical tourism in Singapore (the article also mentions Malaysia, Thailand and India as countries who will see increased medical tourism). However, the fact that some Indians travel to Singapore for transplants is telling.

The Living Donor Liver Transplant program at Gleneagles is popular with foreigners, partly due to excellent medical care (it's headed by "world renowned transplant and hepatobiliary surgeon Dr KC Tan"), and because "unlike India, Singapore law allows transplants in situations where there is an emotional link between the donor and recipient."

The article also goes on to discuss stem cell transplant and stem cell treatment for patients with advanced cancer tumors at Mount Elizabeth Hospital. One big attraction: "cost of treatment here ranges from USD 72,000 to USD 90,000 per person, compared to USD 235,000 for similar treatment in the US."

The article also discusses health care in other Asian countries and is certainly worth reading.

Medical Value Travel

Certain prties in India want to replace the term medical tourism with the term medical value travel to better position India in the world marketplace. They feel the distance from countries that do medical tourism will highlight that India does more complex procedures including organ transplants.

"We need to position ourselves differently. We are not doing just low-end medical jobs. We have world-class facilities in expert areas such as heart care and even liver transplant. Countries in south-east Asia region which have done good in medical tourism most of the times do simple procedures. We don't want to dilute our medical expertise by the term medical tourism."