Medical Tourism: The Big Picture

You’ve probably heard about “medical tourism,” the traveling of patients to foreign countries in order to receive care. But what you may not know is just how popular medical tourism has become: according to Deloitte LLP, an international consulting firm, an estimated 750,000 Americans traveled abroad for medical care in 2007. Aggressive projections put this number somewhere around 6 million by 2010.

As interest in medical tourism increases it’s important to understand the nuts and bolts behind its allure, and the risks that it poses—both for patients and health care systems at home and abroad.

Saving Money

Over the past few years insurers and employers have warmed up to medical tourism as a way to save money: its cheaper for insurance plans to help fund patients’ trips to foreign doctors who charge much less for procedures than their U.S. counterparts.

The price differentials  are stunning. According to a recent Deloitte report, Thailand, the world’s leading medical tourism hub, saw 1.2 million medical tourists from around the world in 2006. On average, medical procedures in Thailand cost a mere 30 percent of American prices. India, another destination that sees more than 400,000 medical tourists each year, charges just an average of just 20 percent as much as the U.S. Thousands of Americans also flock to Mexico and South America every year for cosmetic and dental surgery, where procedures cost anywhere from 75 to 50 percent less than they do in the U.S.

Data from the University of Delaware offers
more specific numbers: “A heart-valve replacement that would cost
$200,000 or more in the U.S., for example, goes for $10,000 in
India—and that includes round-trip airfare and a brief vacation
package. Similarly, a metal-free dental bridge worth $5,500 in the U.S.
costs $500 in India, a knee replacement in Thailand with six days of
physical therapy costs about one-fifth of what it would in the States,
and Lasik eye surgery worth $3,700 in the U.S. is available in many
other countries for only $730. Cosmetic surgery savings are even
greater: A full facelift that would cost $20,000 in the U.S. runs about
$1,250 in South Africa.”

Sine insurance doesn’t cover cosmetic procedures insurers and employers
don’t care too much about cheaper facelifts (though patients do, of
course). But medical tourism isn’t all about vanity. According
to the National Business Group on Health, some of the most popular
procedures pursued by medical tourists include heart procedures (e.g.
coronary artery bypass graft, heart valve replacement, pacemakers,
etc), orthopedic procedures (e.g. hip and knee replacement),
laparoscopic surgery for gall bladder and hysterectomy, and many kinds
of transplants. Given this, the consulting firm McKinsey and Co.
aggressively estimates that increased medical tourism over the next few
years can save health care purchasers as much as $20 billion in benefit

Catching On

Insurers and employers are quickly catching on to the savings opportunity represented by medical tourism. In June, MSNBC reported
that  “CIGNA, Aetna and Blue Cross/Blue Shield…have begun or are
considering pilot programs that provide limited coverage for foreign
care.” Last month CNN reported on an Albuquerque construction firm that
has included a medical tourism component in its health coverage that
encourages employees to seek care in countries like Costa Rica,
Singapore, and India. In South Carolina, BlueCross BlueShield and
BlueChoice recently formed an alliance with one of Thailand’s premier
hospitals to promote medical tourism to its 1.3 million members. United
Group Programs, a smaller insurer in Florida, also has begun to offer a
plan that sends patients to Thailand for expensive procedures. Insurers
Blue Shield and Health Net of California also both offer low-cost
policies that allow members to receive medical treatments in Mexico.

It would be wrong to say that providing coverage for medical tourism is common practice amongst employers. A January survey
by the International Foundation of Employee Benefit Plans found that
just 11 percent of employers cover medical tourism under their plans.
Nevertheless, according
to the National Business Group on Health, another 9 percent of large
U.S. employers are interested or very interested in sending employees
off shore for major surgeries over the next five years.

Still, these proportions are noteworthy given that (a) medical tourism
was a non-issue a few years ago and (b) these employers are willing to
pay to send their employees halfway around the world for
medical care. All things considered, this is a pretty drastic
measure—the fact that it’s gaining traction, however slowly, means

Patients also are warming to the idea of going abroad for medical care: Deloitte’s 2008 Survey of Health Care Consumers found that
almost 40 percent of the 3,000 Americans aged 18-75 that the company
interviewed said they would go abroad for medical care, provided the
procedure was half the cost and of comparable to quality to what they’d
get in the U.S.

Personal Risks

Yet for all the appeal that medical tourism holds, it’s not without its
downsides, which are in fact considerable. The first big problem is
that medical tourists have little legal recourse if things go wrong. In
2007, one patient wrote the U.S. embassy in Bangkok, describing her horror story after undergoing botched plastic surgery.

“…I have been scared, mutilated, and disfigured by offshore plastic
surgery in Thailand,” she began. After surgery, the patient removed her
facial bandages and was appalled at what she saw, but could do little
about it: “After the doctor refused to refund my money, or pay to have
the damage he had done to my face fixed by another doctor, or do the
surgery over again himself, I attempted to report the doctor to
government and professional medical associations to no avail. I was
completely ignored by the Thailand Medical Council, the Thailand
College of Surgeons, and the Medical Association of Thailand. I wrote a
formal complaint to the hospital where the surgery was performed…and it
was ignored.

“Even the attorney I attempted to hire just gave me a run around for
several weeks promising to take action against the doctor and never
doing so. He initially was very eager to take my case, but shortly
after doing so, he not only lost interest in the case, but became an
apologist for the doctor. This appeared to have everything to do with
me being a foreigner, attempting to take legal action against a wealthy
and influential Thai plastic surgeon.

“I later discovered that there are extremely few successful medical
malpractice cases against medical doctors in Thailand that result in a
cash award. Currently, there are only about 60 outstanding medical
malpractice cases on file with the Medical Council of Thailand for the
entire country, and this number of cases is being pointed to by Thai
Medical Council authorities as being unacceptably large.”

This is just one story, of course, but it illustrates an important fact, best summed
up by Miami plastic surgeon James Stuzin in a 2006 Fox news segment:
"The liability and the responsibility that physicians have to their
patients in America is very high, and that doesn’t necessarily exist in
foreign countries if you have a problem."

Another barrier to patient satisfaction is culture. The same news story
presented the case of Amie Goldberg, a patient who went to South
America for surgery and almost bled out on the table. Her doctors tried
to talk to her about performing another surgery to help her, but she
couldn’t understand them. "When you don’t know what someone is trying
to tell you, and your life is at stake, it’s really scary,” she said.

If a surgery is botched abroad, the options for getting a ‘fix’ here in
the states are few: most surgeons aren’t thrilled at the prospect of
trying to mess with a surgery that they themselves did not perform. And
even if things go perfectly in Bangkok, patients don’t get much by way
of follow-up—after all, their doctors are 9,000 miles away and speak
another language.

Policy Concerns

But the problems with turning to medical tourism as an answer to health
care problems goes beyond personal stories and into to the realm of
hard policy. There are a lot of stakeholders that are eager to trump up
medical tourism as a silver bullet for health care costs. Firms like
GlobalChoice, IndUShealth, and PlanetHospital exist to connect
employers and patients with medical tourism opportunities—and like any
other business they want to convince consumers that their services are
essential. The claim here is that, since insurers and employers can pay
less to cover procedures, the U.S. health care system will benefit
greatly from medical tourism. It will “help drive costs down in the
U.S.,” the CEO of GlobalChoice said in an interview last year. Other advocates say
its time for “the U.S. Marketplace to seriously step outside the box
and look at medical tourism as a real solution to the rising costs of

This isn’t the case. According to a 2007 article in Health Affairs,
medical tourism is unlikely to reduce total U.S. health spending by
more than 1-2 percent. Why such a small impact? First, because most of
our health care costs are related to supply-side factors, not to
patients demanding care—so even if you reduce demand by shunting
patients to Thailand you won’t make a huge dent in the system’s overall
spending. Second, medical tourism carries with it its own extra costs.
A 2006 piece in
Health Affairs, authored by a lead economist from the World Bank,
points out that if patients get bad care abroad and come back to the
U.S. in bad health, insurers might have “to cover the costs of
subsequent treatment,” resulting in little savings. Monitoring the
quality of care received overseas—something that insurers will have to
do if they want to institute medical tourism programs—can also become
costly since it’s administratively cumbersome. 

Another important consideration is this: as more people get care from
abroad, what happens to those who are left behind? As medical tourism
catches on, people may grow more open to the prospect of cheaper care
abroad; as more people hop to India for care when they need it,
attachment to U.S. public health care systems would likely diminish.

Why does this this matter? Because, according to Deloitte’s consumer
survey, the people most willing to consider going abroad for care are
young and healthy—the very people who cross-subsidize care for the old
and sick by paying into our health care system. And traveling to India
is expensive, meaning medical tourists are also more likely to be
relatively well-off. When our system loses contributions from those who
can pay into the system but don’t need that much care, it “could again
increase costs for those” who are too poor, frail, or scared to travel.

Inequality is also a problem for medical tourism hub countries. Slowly
but surely, it’s becoming clear that an influx of wealthy foreign
patients siphons the attention, resources, and medical labor force of
developing countries. The result is a two-tiered system of posh,
concierge care for foreigners and sub-par leftovers for citizens.  In
Thailand, one newspaper
recently opined that “most of the benefits of the $6.4 billion Medical
Tourism Promotion in Thailand over the past five years have gone to
private hospitals, while the public health system has shouldered much
of the cost in terms of the ‘brain drain’ and deteriorating working
conditions for government-employed doctors and nurses. The country’s
public health system is still a long way from meeting its target of
providing one doctor per 1,800 people…thousands of vacancies remain
unfilled due to an exodus of government-employed doctors to the
lucrative private healthcare industry.”

The WHO has expressed
a similar concern with regards to India, where “medical tourism could
worsen the internal brain drain and lure professionals from the public
sector and rural areas to take jobs in urban centres.” Last year, Dr
Manuel Dayrit, director of WHO’s Human Resources for Health department,
noted that emerging data on medical tourism “does not augur well for
the health care of patients who depend largely on the public sector for
their services.” Dayrit pointed out that revenues from medical tourism
are unlikely to be fed back into public health systems “unless national
laws or regulations are set up so that these revenues are taxed
explicitly and channeled to the public sector.”

In the end, medical tourism might reduce our national health care bill
by 1 percent to 2 percent—not enough to solve our problem. For
insurers, medical tourism means taking on extra duties that they may or
may not be able to perform. Finally, the patients who need the most
care—both in the U.S. and in destination countries—end up getting the
short end of the stick.

Undoubtedly, medical tourism will become more popular as time goes on.
To a certain extent, it’s a reality of globalization, and no doubt it’s
here to stay. But that doesn’t mean it’s a viable solution to the
United State’s health care crisis.

44 thoughts on “Medical Tourism: The Big Picture

  1. Wow, lots of weak, anecdotal arguments against medical tourism.
    Especially that the ‘poor’ will pay more, since I know of at least one Medicaid agency that already sends patients overseas. So they’re not paying anything anyway.
    The same arguments you see against retail mini-clinics, drug re-importation, etc. etc. Gloom and doom and worthless economists saying “it might do this-then again it might not”.
    Meanwhile most Americans can’t afford the system we have, and even those that do have insurance can still be bankrupted by ferocious costs and a bloated system.
    It was entertaining to see a physician promote that ‘liability and responsability’ is a plus of our system. Never thought I’d see that in my lifetime…

  2. Maggie: Excellent reporting as usual. Interesting ramp up projection by Deloitte from 750k to 6 mil. When you couple the forecasted growth with the return of high single to double digit premium increases, with marginal tinkering, by payors, with international services as covered health benefits, I’d say the trend is alive and well.
    What part of the diminishing returns cost vs. benefit of employer sponsored health insurance does the industry not get?
    This drip, drip, drip or service area out migration, could turn into a flood. Don’t forget new Zealand, a late entry into the medical travel/tourism industry.

  3. Medical tourism is very popular, which is also why JCAHO is so dangerous. We already have at least one advocate whose child died in a JCAHO-accredited foreign facility. Like that’s supposed to mean something. We don’t know which hospitals are safe in our own country.

  4. Why not go to a dental clinic that is owned and run by an American, such as Mexican Dental Vacation? You are at least assured that the quality is as good as, or better than in the US and Canada.

  5. Lisa makes a good point safety. Nobody knows even here. I can tell you this however, it can be nothing but bad to take an 18 hour flight 1 week after a knee replacement. Someone is going to die from a Pulmonary Embolus. It’s going to happen. Is it worth it? Or is it worth it to have a complication such as malaligned component or infection that no surgeon will touch because he doesn’t want to fix someone else’s mess( rightfully so). I don’t see massive growth for these reasons. My Grandmother won’t go to Mount Pilot to see a Doc, she sure as heck won’t go to Bangkok.

  6. “Olive Healthcare is proud of being attached with four JCCI Accredited Hospitals in India.”
    You see what I mean!?!? I guess Olive Healthcare didn’t actually bother to read this blog. To Olive Healthcare: Nobody on this blog is impressed with any Joint Commission accrediation.

  7. Thanks for the comments all.
    Frustrated consumer–thanks for commenting, though I’m not sure why you think my post is anecdotal (save for the example of botched cosmetic surgery, which is less a scare tactic than it is a way to illustrate systemic difficulties patients encounter). If its data you’re looking for, I think the real bottom line is that medical tourism would shave 1-2 percent of our health care bill, which means its not a viable health care solution.
    Brad, thanks for posting the AMA document–they’re right, this is uncharted waters, and it is very much in need of some institutional guidance. As i said, medical tourism is likely not going to go anywhere. But it seems to me a poor decision to think of it as some sort of magic solution to our health care woes.
    Gregg–thanks for your comment, and again, the trend is indeed alive and well. And it’s likely to grow–which is why its so important that we take a critical eye to it.
    Lisa and Jenga—accreditation is something to keep an eye on….not because its not necessary or inherently bad, but because, as Lisa pointed out, it’s no guarantee of quality care. Going abroad for care just brings too many variables into the situation for an institutional stamp of approval to represent a sort of silver bullet for quality.

  8. I have been to India for my hip replacement treatment. I did a lot of research and found out about , a leader in medical tourism. ValueMedicare gave me excellent services. Though this company is a little expensive compare to other medical tourism companies(though it is still very cheap compare to US) but then you get treated by the best doctors in the best hospitals.

  9. For the 47 million uninsured people medical tourism does provide a viable solution. If you are faced with the possibility of bankruptcy paying for your $100K surgery you are most likely to choose the 90% discount and fly to India.
    BTW, flying to India isn’t as expensive as the author thinks. A round trip air ticket from US to India costs about $1500 (economy class). I suggest upgrading to business class if you need extra room to move about or choosing a destination that’s geographically closer to you.
    Medical tourism may not be a panacea in all cases but you can’t ignore its financial benefits in most situations.

  10. To the viewwers
    From Olive Health Care please go through
    I thank you very much for raising up an enquery related “why we are associated with JCI Acredated Hosptials”. Since my Introductory Post was not found quite impressive to some of respected viewers, I would like to apologise In the begening of letter. We are not only aiming to bring modern and sophesticated Health care within the reach of people, but we are thriving to bring comfort to the ill-health residents who are not in position afford for treatment.
    Now question is Why Acredation: ?
    The traditional process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified medical doctors or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient’s accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.] International healthcare accreditation
    Because standards are important when it comes to health care, there are parallel issues around medical tourism, international healthcare accreditation, evidence-based medicine and quality assurance.
    In the United States, Joint Commission International (JCI) fulfills an accreditation role, while in the UK and Hong Kong, the Trent International Accreditation Scheme is a key player. The different international healthcare accreditation schemes vary in quality, size, cost, intent and the skill and intensity of their marketing. They also vary in terms of cost to hospitals and healthcare institutions making use of them.
    Many international hospitals today see obtaining JCI accreditation as a way to attract American patients. Increasingly, some hospitals are looking towards dual international accreditation, perhaps having both JCI to cover potential US clientele and Trent for potential British and European clientele.
    Other relevant organizations include:
    The Society for International Healthcare Accreditation (SOFIHA), a free-to-join group providing a forum for discussion and for the sharing of ideas and good practice by providers of international healthcare accreditation and users of the same. The primary role of this organisation is to promote a safe hospital environment for patients.]
    HealthCare Tourism International, the first US-based non-profit to accredit the non-clinical aspects of health tourism, such as language issues, business practices, and false or misleading advertising prevention.The group provides accreditation for all major groups involved in the health tourism industry including hotels, recovery facilities, and medical tourism booking agencies.
    The United Kingdom Accreditation Forum (UKAF) is an established network of accreditation organisations with the intention of sharing experience good practice and new ideas around the methodology for accreditation programmes, covering issues such as developing healthcare quality standards, implementation of standards within healthcare organisations, assessment by peer review and exploration of the peer review techniques to include the recruitment, training, monitoring and evaluation of peer reviewers and the mechanisms for awards of accredited status to organisations.
    Medical tourism carries some risks that locally-provided medical care does not. Some countries, such as India, Malaysia, Costa Rica, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress, mosquito-transmitted diseases, influenza, and tuberculosis (e.g., 75% of South Africans have latent TB). However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be “rare” in the West.
    The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. However, JCI and Trent fulfill the role of accreditation by assessing the standards in the healthcare in the countries like India, China and Thailand. Also, travelling long distances soon after surgery can increase the risk of complications. Long flights can be bad for those with heart (thrombosis) or breathing-related problems. Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they sunburn while healing.To minimise these problems, medical tourism patients often combine their medical trips with vacation time set aside for rest and recovery in the destination country.
    Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients.
    Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.
    I think above inoformation is quite impressive and depict a clear picture Why we are associated with “JCI Acredeted” or Internation certified (recognized) Hospitals. I would like to request you to go through few of Website and Blogs to realize, it is always better to get treated from JCI or Internationaly certified Hospitals. I also sugest few of our Blogs to go through, where we have furnished all necessary article. I would also recomond, in my recent search I have found an Interview with JCI CEO Brian Gooch, JCI consultant Karen H. Timmons, president and chief executive officer of Joint Commission Resources, Inc. (JCR) and Joint Commission International (JCI)., which would be strategic information for your interest. Go through take the copy from attachment.
    thank you
    Reagards K.Adhikari

  11. I found the article interesting in sections and absurd at other parts. I run a medical travel and all my clients have been lower middle class. To assert that the rich are utilizing medical tourism is more than absurd-it is dead wrong. I myself was cut off from insurance without a reason after making 0 claims in ten years. I have travelled extensively (one month to three) throughout the world for the past 35 years. I am a house painter and know that many people in the trades have no insurance. These are the demographics that medical travel speaks to. I have had my broken shoulder fixed while in Thailand and last year had a stent implanted which probably saved my life. I get all my medical tests and dental work there.
    The absurd assertion about medical travel leading to the demise and deterioration of general medical care is totally unfounded. Actually, quite the opposite happens when a highly technical and educated sector gets more popular. More people can get into the business, in this case the healthcare industry. It encourages more of the indigenous people to get an education knowing that there is work out there for them that pays better than working behind a hotel desk or on a construction site. Buying clothing and jewelry made in these countries does nothing but increase the number of people working in sweatshops. Going there for medical tourism is actually great for the economy and education system.
    Your fear mongering section about not being able to sue a doctor is typically American- a lottery for the poor. If you truly want to get involved in expensive litigation (and all lawyers pray for this) make sure to get the worst doctor you can find at the worst hospital you can find in the USA. We have plenty of them. My experiences and those of all our clients are exactly the opposite. The healthcare we found and experienced in Thailand was so far superior to what is available in America that all said they would never seek care here if they could help it. As far as the woman who had botched cosmetic surgery, I will bet she didn’t use a respected medical travel company. If you are going to go overseas than you need to do the same research that you should do if you were having the surgery done here. She failed on that end. This is your body so do all the footwork.
    To be blunt the JCI accreditation is a scam to increase the coffers of the JCI (a privately owned and operated organization). Almost all hospitals in the USA would not pass the absurdly strict guidelines that they demand of the international hospitals. Most all the hospitals that we at Patient Vacation use have JCI accreditation, but the local accreditation agencies are just as stringent as those in force in the US. Just know that the cost for JCI accreditation is more than $300,000. The problem is that as long as the news media runs the same story about medical travel with the same inaccuracies, the hospitals are in a bind. They can be the greatest medical facilities with the best doctors and the best staff but can not get international patients without the JCI stamp. Thus, they get it and are now considered validated in the minds of the American public. Is Bumrungrad better than Vejthani or Nonthavej or Phaya Thai? Let us debate this with facts and not suppositions.
    Medical tourism is a personal choice and not meant to impact the system but rather the individual. I have saved money, but the most important aspect of medical care is the quality. All I have seen and experienced in Thailand’s medical care leads me to know that it is far superior to what is available and practiced in the USA. I travel for quality at a cost that allows me to keep my house and not head to the poor house.

  12. We can put forth couple of example like an incident of Maria Hernandez, a working-class American woman who travels to Delhi to get a hip replacement she could not afford back home.
    There are many who come across several hazards, when they travel overseas for treatment. The main point behind of problem is that they are not being catered appropriate logistic support by management of Medical Tourism Company. Since, there is prominent growth of this Industry, it easily attract people from various other walk of life to join inn. Apart from that, we follow a trend that, once a retired ill-health traveler comes to a new destination and think of himself familiar with the place, he or she start provides medical travel guidance to others. Thinking of himself educated about whole lot about Global Health Care Industry. Just about six months back Olive Health Care rendered facilitation services to a cardiac Patient of Randolph, who came India and received treatment by one of the most stalwart Hospital. Now, we have found, he also started running his own Medical Travel Company in USA. We think this job is catchy and seems easy, but I would like to request to all new commers that a simple mistake and a bit carelessness would react lot not only to the Patient but entire Industry.
    There is big diference in between Professionaly groomed management office who is experinced in the Industry for long time and the layman who is experinced simply by coming to the overseas destination once or twice. The basic factor is, A forign Medical facilitator dosent negotiate with the Service provider or not able to judge quality of practicing Hospitals more than an inbound Medical Travel Professional knows about it. Since, Forign Partnering represntative (Brokers) individual for the Hospital as well as patients generated by them, both are huge revenue resource for Hospitals. In comparision, if the case is being dealt by Inbound Medical Travel Management then, customer can enjoy much more benefits.
    Olive Health Care has been established by one of the most respected Hospitals Mangement Professional with 15 years of rich experience in the Hospitals Indutry as a Global Patietns Facilitator. In adition to this we would like to inform to all, In recent past we have partnered with one of the most eminent Health Care Professional who is most senior and chief of Medical practicing community of India. Today Olive has develoed an unique synergy between icon Doctor and most experienced Health Care Management Professional. The prime ambition of Olive is to lead a Patients to a parfect service provider and letting Patient enjoy best of facilities from the Hospitals. Because requirement of Patietns is on our prime focus.
    We are the one Medical travel company, dedicatedly focusing on paitents of within India as well as Outside India. We have opened chain of clinics in several places across the country, and facilitate patients for advance treatment. Apart from that, we are aware of cost of treatmetn and facilities provided by the Hospitals. I would like to request Patietns who are planning to Come India for treatment, they must reaserch and study before they take initiative. We know because of valued curency Global Patietns is a chunk revenue source for every service providers, start from cab to Hospitals. we never want Mrs. Hernandez’s tragedy would replicate again.

  13. The concerns raised in Niko’s post are far from foolish.
    I would note that those who suggest that there are no (or very few) problems with medical tourism are making a living in the industry. Some no doubt are very conscientious and do a good job. Nevertheless, their view is inevitably biased.
    For an unbiased view, Medscape did a good piece which raises many of the questions Niko raises here:
    ” How will patients choose the right facility and provider? How will we measure quality in outcomes? For example, should there be pretreatment screening for such medical travel? Does the patient actually need his or her hip replaced in the first place? How will one ensure adequate short- and long-term follow-up? Who is liable for mistakes? How is continuity of care provided across geographic boundaries? Overall, one critical issue will be to develop a service that will provide higher-end benchmarking, one which will truly compare quality and outcomes from institution to institution.”
    In terms of the effect on the U.S. Health care system Medscape writes: “Another consequence of the rise in quality and competitiveness in emerging nations may be an exacerbation of the already-serious shortage of doctors and nurses in the United States. The American Association of Colleges of Nursing estimates that the United States will need one million new and replacement nurses by 2012.[9] But consider that during the current nursing shortage in the United States, influxes of foreign-born nurses have represented a third of the increase in U.S. hospital nurse employment (with the hiring of older nurses making up the majority of the increase).[10] The shortage will be increased if those nurses return home or don’t come in the first place.The same holds for physicians . . ”
    Niko also stresses concerns about what happens to patients in the U.S. who can’t travel abroad. He doesn’t say that all medical tourists are rich. He says they tend to be younger and healither than many other patients. And typically they are not truly poor.
    For example, R. Cooper says he is a house painter who makes enough to travel extensively through the world, one to three months a year. He is in a very different situation from a underinsured mother of two living on $19,000 a year–or a frail uninsured 59 -year-old suffering from congestive heart failure.
    People with family responsibilities are not nearly as free to travel.
    Then there is the question–which Niko raises–as to what happens to the poor in India or Thailand. Medscape reports ” Any discussion of the rising health care systems of the Middle East, South and Southeast Asia, and other emerging economic regions inevitably raises the question of access for the poor and underserved. Certainly, the high-quality cardiac care offered at Wockhardt-although representing a cost-efficient alternative for many Americans-remains out of reach for the majority of India’s poorest. Yet, similarly, the doors of Massachusetts General Hospital or the Cleveland Clinic remain closed to millions of Americans who lack adequate health coverage even while living in the wealthiest country in the world.
    “The question of access is as relevant in Des Moines as it is in New Delhi because disparities continue to exist at all levels and in all locations.”
    So while medical tourism may be a temporary solution for the individual who is healthy enough to travel for that particular procedure, from a collective point of view, medical tourism doesn seem to be distributing resources in a way that contributes to world health.
    We really don’t need more doctors and nurses devoting their talents to doing cosmetic surgery somewhere in the Dominican Republic or India.
    And even for the individual who can’t afford an operation here that he can afford abroad–
    he still faces the questions about lack of follow-up, and the fact that he has no recourse under the law.
    I’m afraid the risks are real. Here’s an article form the journal Clinical Infectious Diseases (U. of Chicago) about women winding up with infected wounds and absceses after traveling abroad for liposuction.
    Finally, we would all be better off if young, relatively healthy Americans bought health insurance so that if they needed medical treatment it would be covered here.
    In that way, as Niko points out,
    they would contribute to the pool that also covers poor, singel mothers and those who are too frail to travel, thus making insurance more affordable for everyone.
    When it comes to healthcare, we need to think collectively, not individually.

  14. All of Maggie’s assertions and questions come from her inherent belief system that has little to do with the factual reality. If facts are available to back up her ideas it would be useful. Maggie seems more ready to attack the messenger (medical travel operators) than to recognize the personal reality of many uninsured and underinsured Americans. First, I must state that Ms. Mahar knows nothing of my personal finances and absolutely less about my traveling styles. I am a “child of the 60’s”, 57 years old, and I live very frugally to make my blue collar income last (yes, I have made less than 19,000 for most years). I have travelled, hitched and walked in many poverty stricken nations for most of those thirty years, staying in guesthouses, pensions, tents, and homes. I eat at street stalls and working class cafes. I am an uninsured 57 -year-old suffering from chronic heart disease. I was successfully treated in one of those state of the art foreign hospitals you don’t trust unless they are approved by the JCI, a private American corporation. Perhaps a private Thai corporation should inspect American hospitals to make sure they are up to snuff. Believe it or not some nations are even stricter in their guidelines than America is. Until you know all the facts the argument is moot.
    Those of us who are in the medical tourist industry may not be money grubbing leaches but actually concerned individuals with knowledge that we wish to share with those in need of medical care. Those same Americans ignored by this country. The fact that we charge for this is called reality. Who gives away their labor and intellectual property in the USA. If you want to talk about “making a living” off people’s health needs look no further than the profits registered my medical insurance and pharmaceutical corporations in the USA . The obscene salaries of the executives are available online. Your assertion that “we would all be better off if young, relatively healthy Americans bought health insurance” is refuted by all the data available. Start with any report of the WHO and The Commonwealth Fund and you can see how the current profit driven corporate system is literally killing Americans. Just take a look at Michael Moore’s film “Sicko” to see some real American medical failures. Believing that the medical insurance/pharamaceutical conglomerate cares about your well being is akin to believing that fast food restaurants care about your nutrition. It is money that matters. The only solution that will work is nationalized health care. Yes, I am in the medical tourist industry and I want free healthcare for all. It would end my business, but I and all my American brothers and sisters would be healthier.
    If you are so concerned with the health care of Thailand where we send our clients, just know that since nationalized health care was enacted the numbers prove that people are better off. The life expectancy numbers do not lie. The folks who are using the argument that medical travel is bad for any country are simply wrong. How bad was it forty years ago when many foreigners came to the US for treatment? I never heard any talk that they were taking treatment away from the poor Americans who had no insurance. As I said before, advanced technological businesses (medicine for example) is a lot better for the lasting growth of an economy than sweat shops to make more clothes for the box stores back in the US.
    To answer Ms. Mahar’s questions, I offer the following:
    “How will patients choose the right facility and provider?” The answer is simple-through research, on the internet and, if they choose, with a medical travel specialist. It is the same process they should follow when looking in the USA.
    “How will we measure quality in outcomes?” If they were many bad results from medical travel you would know immediately as the internet would be overrun with testimonials. The obvious answer is that there are fewer mistakes in medical travel than in those who go to American facilities. To quote from The Commonwealth Fund’s 2007 study, “One-third of U.S. patients (32%) with chronic conditions reported a medical, medication, or lab test error in the past two years.” That is a fact.
    “Does the patient actually need his or her hip replaced in the first place?” Actually most people who head off to another country for serious surgery visit a doctor in the US first for their prognosis. We highly encourage this in the medical travel sector. One of my client’s last year was told by an orthopedist in the US that he needed surgery on his knee. When he arrived in Thailand the orthopedist told him that he would recommend against surgery. The doctor in Thailand spent more than an hour with him in consultation. The doctor in the US spent less than five minutes with him.
    “How will one ensure adequate short- and long-term follow-up?” This is another false warning trotted out by the anti-medical travel society. First of all, all the medical travel companies make sure that their clients return to the US with the proper medical papers. In Thailand, all the hospitals and clinics that we utilize make cd-roms of all operations to be carried back to the US. It is a bit graphic but insures that the physician will have no problem with follow up. It is essentially no different than if you had an operation in New York and had to see a doctor in California of Alaska. The doctors who did follow up on me after my shoulder and heart surgery both were very interested in my experience and were quite satisfied and impressed with the quality of care I received.
    “Who is liable for mistakes?” You go into all medical procedures believing that it will improve your condition. There are no guarantees in this world of results. Any doctor will tell you the same. Through research and due diligence you can make an informed decision. If you want to hit the lottery get a bad doctor in the worst hospital in the US and you can maximize your profits when they cut the wrong leg off. A recent study found the biggest factor in medical malpractice cases stem from personality differences between the patient, his family, and the physician.
    This is my question. Shouldn’t great medical care be available to all citizens without taking all their savings? Why shouldn’t an adult be able to seek consultation from those who know better? Talk to my clients and thousands of others who are thrilled with the healthcare found in other countries. Who are you to tell them not to go when the fact is that they, as individuals, made the right decisions. I guarantee that if you come to Thailand with Patient Vacation as your aid and consultant you will see the light. Every one of my clients can’t be wrong. After all, they have seen it with their own eyes. I even put my heart into it as well as my good name.

  15. I think there is little doubt that independent survey and accreditation by a reputable international group is of value, as it is really the only practical way that someone living in the USA, the UK, Australia, Canada, France, Germany or the like can get some realistic information as to whether or not a hospital is fit for purpose, not just in terms of equipment and staff credentialing etc but (vitally) in terms of whether or not the systems which keep the hospital working properly are up to scratch.
    I certainly do agree that JCI is outrageously expensive, and is often taking cash out of parts of the world (such as the Philippines and India) which need it badly and transporting it to the USA! However, JCI is a superb marketer, and it is this talent of theirs which leads to apparently well-informed people putting out a stream of uncritical statements, such as “Olive Healthcare is proud of being attached with four JCI Accredited Hospitals in India.”
    What are the options here? In terms of international accreditation, there are certainly other reputable accreditation groups which are less expensive (sometimes considerably so) and which are just as capable of establishing if a hospital is fit for purpose, even for demanding US citizens! For example the Trent Scheme from the UK, mentioned elsewhere in this blog, is vastly cheaper for participating hospitals, while the Australian ACHSI is also cheaper than JCI. As for local accreditation groups, there are excellent options such as MSQH and NABH, although the international medical tourist may find it more difficult to readily accept the findings of a local group than an international group (perhaps unreasonable, but there may be concerns about conflicts of interests etc.).
    Hospitals wishing to offer medical tourism services, medical tourism facilitators, and intending patients all need to bone up more on hospital accreditation if they are going to be travelling to unfamiliar countries for reasons of acquiring healthcare. It is a bit pathetic for people in 2008 to keep assuming that JCI is the be-all and end-all of hospital accreditation, and as long as things stay this way the JCI offices in Chicago, Dubai and Singapore will continue to be decked out with the very plushest of decors!
    There is a lot of information out there – read it!

  16. Medical tourism is becoming the magic mantra of sorts, primarily because a lot of Americans and Brits find it not only inexpensive to get their elective treatments done abroad, but also exciting since they get to take a vacation while they are at it. The growing trend of attracting international patients around the world has virtually evened the playing field. Patients around the world have more choices when it comes to choosing surgeons and physicians to treat them and their conditions. In the medical field, borders are dissolving.
    Today, people travel to distant locales like Singapore, Thailand and India for cosmetic, heart and orthopedic surgeries. They choose Brazil, Argentina, Mexico or South Africa for dental or cosmetic treatments. Many countries in the Far East are also beginning to tap the potential of this business proposition and are jumping onto the medical tourism bandwagon.
    To cut a long story short, medical tourism is the in thing today. And it’s a win-win situation for the patients as well as for two industries in the host countries, namely, the health industry and the tourism industry.

  17. Okay. So, I’m not part of this forum, but I googled this.
    Turns out that I actually know him:
    he is my best friends sisters lesbian lovers son.
    follow that?
    Basically, Maria’s sister is Sue. Sue is dating Karin. Karin is John’s mother.
    I’ve met him on several occasions, and trust me, a Bruce Willis look will severly .. enhance his physical appearance.
    However, all the way to India? And his sister (Christy is her name) and mother are going now too.
    Its weird.

  18. In the business of Medical Tourism there are a number of risks that come along with going under the knife. Along with its many benefits, medical tourism can create some additional risks that anyone considering it should keep in traveling too soon after your surgery. Flying immediately after or within a few days of a surgery can cause some very serious complications. The combination of high altitude and sitting for long periods of time can cause blood clots and pulmonary embolisms, both potentially fatal conditions. Less seriously, you also put yourself at risk of swelling and infections.
    Medical Escort Services commends the contribution that Medical Tourism Companies have by providing affordable medical care and our modest job is bridging the gap between the American consumer and medical providers abroad. By suggesting some of the Medical Tourism Companies to integrated travel companion packages that add a sense of reliability and peace of mind for those with ailing, traveling relatives.
    Going abroad for surgery can be a great way to potentially save thousands but it’s certainly not without its risks. You should spend time researching and planning your trip. Risks can be managed if you’re careful and educate yourself and can help you make your experience a rewarding and healthy one. for more Info about what our company can do for you go to

  19. As with any big decision, the key to a good outcome is to do your research. Medical tourism is no exception, and in many ways is an area in which increased research and assistance in the process are tools to be utilized.
    I find it interesting how medical tourism facilitators are disparaged in forums over and over. Just because one is in business does not mean they value making a buck over doing what is right. In fact, considering the development of medical tourism as an industry, reputation is more important here than in many other arenas and generally leads to even better outcomes due to the desire to ensure a good experience for the patient.
    With this being said, I do believe greater transparency is needed in medical tourism. Many players are focused on the facility and not enough discussion and focus is placed on the surgeon. Think about how you make a healthcare decision in the states. Do you choose a hospital, or do you choose a surgeon? One of the biggest factors determining the quality of a surgical outcome is the experience of the surgeon. I choose the hands that operate on me, not where that person works.
    People of high quality and skill only work at legitimate facilities, and therefore this is where the industry needs to go. Unfortunately, hospitals are hesitant to focus on one surgeon over another so as not to play favorites. And, most facilitators do not want to give out surgeon information so as not to lose their role in the transaction. Ultimately this hurts the quality of the process and the reputation of medical tourism in general.
    There are a few people out there who are working to change this. My company, Medical Tourism Solutions is one of these players. I don’t claim that we are the only quality option out there. But, I can assure anybody who contacts us that we will be completely transparent in the process and our ultimate goal is a good outcome for a patient. Without good outcomes, this industry will collapse before it gets on its feet.
    Good luck to all who go abroad. And, remember to do your research.

  20. It’s true that medical tourism has its risks, but no one said you could do it blindfolded. Someone looking to go abroad for medical treatment must be doubly sure of the hospital and the doctor chosen for the procedure. Also, it is best to talk to patients treated by that doctor.

  21. Traveling patients may help them feel that they are being cared that possibly can make their recovery more easier. So, those in the mood to go for travel and a vacation with your patients, an exotic locale on the cheap might look into Iceland. Iceland took an enormous hit in the credit collapse. It is tourism that brings home the fermented shark for a lot of people. (Fermented shark or hakarl is a delicacy there, mentioned in lieu of bacon.) The currency value has diminished noticeably; the kronur, their currency, is not about 50% of its former value. So trips via Icelandair are a lot cheaper, for those wishing to visit the mysterious land of rock, ice, and Bjork. For a payday loan, you could almost pay for a trip to Iceland.

  22. There is big diference in between Professionaly groomed management office who is experinced in the Industry for long time and the layman who is experinced simply by coming to the overseas destination once or twice. The basic factor is, A forign Medical facilitator dosent negotiate with the Service provider or not able to judge quality of practicing Hospitals more than an inbound Medical Travel Professional knows about it. Since, Forign Partnering represntative (Brokers) individual for the Hospital as well as patients generated by them, both are huge revenue resource for Hospitals. really great. wow what a commentar

  23. The concept of medical tourism is indeed catching up in the present time. This is quite an interesting and informative article on the pros and cons of medical tourism.

  24. Enlarged Prostate??? Don’t worry because Avodart is an unbeaten weapon for you problem. Yes with 100% assurance this can solve your disease reducing the need of any hazardous surgery. So why are you waiting to get this drug?

  25. Nice blog.There is big diference in between Professionaly groomed management office who is experinced in the Industry for long time and the layman who is experinced simply by coming to the overseas destination once or twice.

  26. This is a well-researched analysis, Niko. One thing worth addressing, however, is the success rates of some of these medical tourism destinations. You speak of overseas medical tourism as if it is more likely to cause complications and malpractice than domestic care – however, the statistics show that this is not necessarily the case. Taiwan, for example, has higher success rates and lower infection rates than the United States – and I’m sure many other countries have similar stories. To say that the increase in medical tourism will only force US healthcare to foot the bill for corrective procedures, therefore, is misleading. Indeed, perhaps the globalization of medical care would make it so fewer – rather than more – people will have to seek follow up care in the United States.

  27. I think that we dont have to look in the poket for something that is for us health!!!
    For a good work we dont have to look on money or sometimes we have to spend it double, 1 for the first work that was bad and 1 for the second work to fix the first one.