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A worldwide market

What's called medical tourism – patients going to a different country for either urgent or elective medical procedures – is fast becoming a worldwide, multibillion-dollar industry.

The reasons patients travel for treatment vary. Many medical tourists from the United States are seeking treatment at a quarter or sometimes even a 10th of the cost at home. From Canada, it is often people who are frustrated by long waiting times. From Great Britain, the patient can't wait for treatment by the National Health Service but also can't afford to see a physician in private practice. For others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery.

And more patients are coming from poorer countries such as Bangladesh where treatment may not be available.

Medical tourism is actually thousands of years old. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios, at Epidaurus. In Roman Britain, patients took the waters at a shrine at Bath, a practice that continued for 2,000 years. From the 18th century wealthy Europeans travelled to spas from Germany to the Nile. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate.

Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and Singapore are now entering the field. South Africa specializes in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants.
 

India

India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries.

India's National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion US into the country by 2012. The reports estimate that medical tourism to India is growing by 30 per cent a year.

India's top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year.

The largest of the estimated half-dozen medical corporations in India serving medical tourists is Apollo Hospital Enterprises, which treated an estimated 60,000 patients between 2001 and spring 2004. It is Apollo that is aggressively moving into medical outsourcing. Apollo already provides overnight computer services for U.S. insurance companies and hospitals as well as working with big pharmaceutical corporations with drug trials. Dr. Prathap C. Reddy, the chairman of the company, began negotiations in the spring of 2004 with Britain's National Health Service to work as a subcontractor, to do operations and medical tests for patients at a fraction of the cost in Britain for either government or private care.

Apollo's business began to grow in the 1990s, with the deregulation of the Indian economy, which drastically cut the bureaucratic barriers to expansion and made it easier to import the most modern medical equipment. The first patients were Indian expatriates who returned home for treatment; major investment houses followed with money and then patients from Europe, the Middle East and Canada began to arrive. Apollo now has 37 hospitals, with about 7,000 beds. The company is in partnership in hospitals in Kuwait, Sri Lanka and Nigeria.

Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation.

Apollo has also reacted to criticism by Indian politicians by expanding its services to India's millions of poor. It has set aside free beds for those who can't afford care, has set up a trust fund and is pioneering remote, satellite-linked telemedicine across India.
 

Thailand

While, so far, India has attracted patients from Europe, the Middle East and Canada, Thailand has been the goal for Americans.

India initially attracted people who had left that country for the West; Thailand treated western expatriates across Southeast Asia. Many of them worked for western companies and had the advantage of flexible, worldwide medical insurance plans geared specifically at the expatriate and overseas corporate markets.

With the growth of medical-related travel and aggressive marketing, Bangkok became a centre for medical tourism. Bangkok's International Medical Centre offers services in 26 languages, recognizes cultural and religious dietary restrictions and has a special wing for Japanese patients.

The medical tour companies that serve Thailand often put emphasis on the vacation aspects, offering post-recovery resort stays.

Specialty care

Other countries interested in medical tourism tended to start offering care to specific markets but have expanded their services as the demand grows around the world. Cuba, for example, first aimed its services at well-off patients from Central and South America and now attracts patients from Canada, Germany and Italy. Malaysia attracts patients from surrounding Southeast Asian countries; Jordan serves patients from the Middle East. Israel caters to both Jewish patients and people from some nearby countries. One Israeli hospital advertises worldwide services, specializing in both male and female infertility, in-vitro fertilization and high-risk pregnancies. South Africa offers package medical holiday deals with stays at either luxury hotels or safaris.
 

Visiting the dentist

The newest and fastest-growing area of medical tourism is a visit to the dentist, where costs are often not covered by basic insurance and by only some extended insurance policies. India, Thailand and Hungary attract patients who want to combine a filling, extraction or root canal with a vacation.

The downsides of medical tourism

Experts have identified a number of problems with medical tourism

Government and basic medical insurance, and sometimes extended medical insurance, often does not pay for the medical procedure, meaning the patient has to pay cash.

There is little follow-up care. The patient usually is in hospital for only a few days, and then goes on the vacation portion of the trip or returns home. Complications, side-effects and post-operative care are then the responsibility of the medical care system in the patients' home country.
Most of the countries that offer medical tourism have weak malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.

There are growing accusations that profitable, private-sector medical tourism is drawing medical resources and personnel away from the local population, although some medical organizations that market to outside tourists are taking steps to improve local service.

Across Canada, thousands are on waiting lists for surgeries. In some cases those waits can last for years.

 

Aruna Thurairajan

A year ago, Aruna Thurairajan of Calgary was becoming resigned to the idea of living in pain. At the age of 50, a spinal condition was making tasks like reaching over her head impossible.

"I had almost 20 to 40 painkillers a day," she says.

Her doctors in Alberta said there would be a three-year wait for corrective surgery.

"I went over to India... and I had the surgery, " Thurairajan says.

Six weeks later not only could she lift her arm, she could also endorse this cheque from the province of Alberta, reimbursing her for almost the entire cost of the surgery despite the fact it was done in a foreign private hospital.

"I had a legitimate claim, I processed it just the way they wanted, I didn't make any unreasonable demands," she says,

An out of country health services claim is little known, little used. Alberta only had 45 cases last year. It's an option for patients who simply can't get into a hospital quick enough.

"The basic criteria are [that] it be an insured medically necessary service unavailable in Alberta or elsewhere in Canada," says Howard May of Alberta Health. "After that we look at each case on a case-to-case basis."

It's not just Alberta; each province has a similar process. The catch is patients often pay up front.

Enter the great Canadian health dilemma. Are Canadians "jumping the queue" for free?

Sharon Sholzberg-Gray speaks for the Canadian Healthcare Association.

"Certainly it's a form of 'queue-jumping,' but if someone went and got the treatment and it was medically necessary, and they can show it was, one could argue it was just to reimburse them," she says

"There is no thing called queue-jumping when it comes to your own health. You don't want to end up paralysed or dead," Thurairajan says.

She'd rather have had the surgery at home, around family and friends, but on the end she's living pain-free.

All she had to do was write a cheque... that she'd gladly write again.