australiandoctor.com.au

Archive

Earn CPD Points

Sun, surf and sutures

3-Mar-2009

With medical tourism booming worldwide, can Australian providers get in on the game?By Bianca Nogrady

IT should have been a routine operation: a knee arthroplasty for an elderly man that would have cost about $15,000 and kept the patient off his feet for perhaps a few weeks. There would have been some small risks of complications, but in a high- standard health care environ ment such as Australia, it should have been simple.

But the patient — perhaps frustrated by the prospect of being put on a waiting list or unwilling to face the full cost of undergoing the procedure at a private facility — decided to travel to India for the oper ation. It was a decision both he, and his doctors, would come to regret.

Instead of enjoying a quick trip up the waiting lists, spending just $8600 on his procedure and getting a holi day in exotic India, the patient developed a post-oper ative infection with Mycobac terium fortuitum. Four opera tions, countless doses of antibiotics and $140,000 later, the sad story of this oth erwise straightforward proce dure came to a close.

Toowoomba orthopaedic surgeon Dr Anthony Wilson was one of those charged with the unenviable task of cleaning up the mess — a task made even more frus trating given the patient was originally his.

“People take it upon them selves to go overseas, but the problem is if they have com plications,” Dr Wilson says. “We’re stuck with it and we don’t know what they did, what antibiotics they used; we’re completely in the dark about how to treat this person.”

It’s not the first case of med ical tourism gone wrong, and it certainly won’t be the last. As more countries, including Australia, realise the dollar potential of touting their med ical services to overseas clients; as more individuals decide they can get their procedure done cheaper, faster or better in another country; and as international travel becomes ever easier and cheaper, med ical tourism is on the rise.

Medical tourism is most often associated with cosmetic surgery procedures but increasingly, patients are trav elling overseas for more seri ous procedures, from knee replacements to major cardiac surgery.

A 2007 report by the National Center for Policy Analysis — a conservative US think-tank — says the global medical tourism industry grossed about $US60 billion (about $94 billion) in 2006, a figure forecast to rise to $US100 billion (about $153 billion) by 2012.

Another forecast by the Deloitte Center for Health Solutions, published in August last year, projected that medical tourism originat ing in the US could jump 10- fold over the next decade. About 750,000 Americans went overseas for health care in 2007, and the report esti mated that 1.5 million would have sought health care out side the US last year.

The global financial crisis may lead to belt-tightening in many areas of the economy, but can only increase the demand for discount medical services, especially when packaged with a holiday in an attractive and cheap desti nation. Even the health insur ance industry is acknowledg ing the inevitable, and many insurance companies in the US now cover the cost of their customers undergoing elective surgery overseas.

Medical tourism is big busi ness, particularly for develop ing countries such as India and Thailand. Thailand was something of an early pioneer in the industry, and now boasts the largest private hos pital in South-East Asia, serv icing more than one million patients annually, 400,000 of whom are international.

DR Peta Cook, an asso ciate lecturer in sociol ogy at the Queensland University of Technology, says there are various reasons why medical tourism is so appeal ing. “One of the motivating factors is that, yes, it can be cheaper to go and get some kind of medical therapy over seas,” Dr Cook says.

For example, a 2005 con ference paper she co-authored says a bone-marrow transplant in the US would set a patient back $US250,000 (about $384,000). That procedure can cost roughly 10% of that in India.

Time is also a factor. “For Australians it seems that a lot of the flow has to do with not being able to access the sur gery quick enough,” Dr Cook says. “But it’s also a motivat ing factor when someone can go overseas and get world- class treatment and a holiday.”

It’s for this reason that developed nations, including the US, Singapore and Aus tralia, are now jumping on the medical tourism bandwagon.

“What we will see from more developed nations such as Australia and the US is that they’ll sell their medical serv ices but also sell-on local attractions,” Dr Cook says. While medical procedures may not be cheap in the US or Australia compared with India or Thailand, they will most likely be safer and of a higher quality — something that private health operators are turning to their advantage.

AustAsia Pacific Health Ser vices is one company taking advantage of the downturn in conventional tourism by mar keting Australia as a destina tion not just for a holiday, but for a quality of medical service not easily accessible in the rest of the region.

“I think tourism on the Gold Coast has been quite depleted over the last 12 months,” says the managing director of AustAsia Pacific Health Services, Mrs Julie Webb. “Australia has all the ingredients that are required to support medical tourism. The Gold Coast in particular has a lot of specialists, it’s close to Brisbane, it can offer a whole heap of medical pro cedures and tourists can have a nice holiday.”

The company specialises in what it calls “executive med ical checkups”, which combine a two- to three-week holiday to the Gold Coast, Brisbane or Cairns, with an all-over med ical checkup including chest X-ray, ECG, spirometry, full blood count, hepatitis A and B screen, Pap smear or PSA test, and urinalysis.

Many of the clients are Aus tralians working in the Asia- Pacific Region, Mrs Webb says. “They come back to Australia and while they’re here having their holiday, I arrange for them to have a medical checkup because it’s not offered in those countries.”

The company has now started marketing its services in areas such as the United Arab Emirates. “We tried to offer this in the Emirates because we know a lot come to the Gold Coast,” she says.

Mrs Webb says the private health sector in Australia is also starting to get in on the act, albeit slowly. “The pri vate sector is quite happy to participate but it is more ‘you go get the patients and we’ll look after them’,” she says. “They’re happy to go along with it providing I find the patients.”

Some are becoming a little more active. Mrs Webb says a consortium of eight private hospitals in Melbourne recently collaborated in an effort to attract cardiac patients from Indonesia. A noble effort, but one Mrs Webb suggests is perhaps missing the point of medical tourism. “The trouble with Victoria is they don’t really have the beaches, they don’t have the sun and the sand.”

It’s still early days for the Australian medical tourism sector, so there are no figures available on how much the industry is bringing into the country and how many insti tutions are involved. How ever, the acting CEO of the Australian Private Hospitals Association, Mr Paul Mackay, believes it’s still a niche market for Australia.

“I think Australia certainly does have a high standard of health care, but it’s a compet itive market,” Mr Mackay says. And it is becoming even more competitive, with a new private hospital catering for medical tourists recently opening in Singapore.

One factor that may limit Australia’s ability to grab a significant market share is availability, he says. The issue of public waiting lists is rarely off the media agenda and unfortunately that also affects the private sector, which Mr Mackay says has very high occupancy. “We would have limited capacity to be able to look in any large way to over seas patients.”

AMA president, Dr Rosanna Capolingua, sees medical tourism in Australia as a positive development.

“It showcases Australian medicine to the world and that’s a good thing,” Dr Capolingua says. “Overseas dollars injected into our health economy are always welcome.”

She is also confident that the private sector would not prioritise overseas patients at the expense of locals.

“It’s not an issue of putting any strain on the public market,” she says. “The pri vate sector market will only take the overseas market on if they have capacity; if [they] haven’t [they will] just con tinue to do the work they need to provide for local market.”

However, Dr Capolingua is slightly less enthusiastic about the notion of Australians trav elling overseas seeking medical services. “If you have surgery or treatment in Australia, we have regulatory authorities, we’ve got medical boards and medical indemnity providers, you’ve got protection,” she says. “If you have something done overseas and something goes wrong, there might not be any of those avenues for protection or recourse.”

NOT all overseas medical procedures end as dis astrously as that per formed on Dr Wilson’s patient. In most situations, the procedure will go smoothly and the patient return happy.

But Dr Wilson says the diffi culty is that patients don’t nec essarily have access to the same information about a pro cedure, surgeon or medical facility as they might do if they were undergoing treatment at home.

“Here the patients want to know how many of these have you done, what’s the infection rate and so on,” Dr Wilson says. “The [infection] rate over here is about 1-2% for knee replacement, but it could be higher than that in those coun tries and these people, they don’t know.”

Going overseas for cosmetic surgery or a knee replacement also tends to forfeit an impor tant relationship with the doctor or surgeon. “The rela tionship with a surgeon is potentially a lifelong one,” Dr Wilson says — or at least a relationship for the lifespan of the prosthesis. “They’re forgo ing a long relationship with the surgeon who understands them quite well and will look after them, not just their joints but other things.”

Medical tourism also has bigger implications for society in general, says Professor Jane Hall, professor of health eco nomics at the University of Technology, Sydney.

“The thing that it threatens is the sense of social solidar ity.

“There has been a sense of a focus on equity both in financ ing and access to services,” says Professor Hall, who is also director of UTS’ centre for health economics research and evaluation. “The whole idea of medical tourism is com modifying those services and making them much more responsive not to the needs of individuals but the individual ist.”

Not that this will stop Aus tralians travelling overseas for a cheaper procedure or pros thesis. The call of the cut-price nose job can only get stronger as budgets get tighter. The best the AMA can hope for is that patients consult their GP before they go and carefully weigh the risks.

“Go and talk to your own GP about it, what you’re thinking of having done and look at the options in Aus tralia or at home so you can really do the value judgment about going overseas,” Dr Capolingua says.

“If you’ve got enough money, you could buy [what you need] in Australia. You don’t sit on a public waiting list.”

THERAPY UPDATE: What GPs need to know medical tourism

Submit your feedback here:

Actions

Email to a friend/colleague

Print this article