Apr 9, 2012

Canada - British Columbians go abroad for medical treatment to avoid long lineups at home


VANCOUVER — When Robert Stuart Smith’s left knee gave out, the busy realtor, avid golfer and occasional Scottish singer had no time to wait a year or two for surgery to replace the 72-year-old joint.

Rather than putting his active life on hold and adding his name to a wait list, the White Rock resident took his business abroad and outsourced the surgery to India.

He contracted a Kelowna-based medical tourism company to book the trip, travelled with his wife to Kerala and for $20,000 he had his knee replaced in less than a month. After the surgery, he spent two weeks recovering in hospital with a private nurse, then moved to a five-star hotel while his wife went sightseeing.

Their every need was attended to, right down to a “get well” message written in rose petals on his bed.

“We were concerned [about going abroad for surgery], but we were treated first class,” says Smith, now 79.

“To me, they had a better system there than they did here.”

“The knee’s still good today. To me, instead of having to wait a year and a half to get something done, if you could afford it, why wouldn’t you?”

When he signed up for his surgery, in 2005, Smith became one of a rapidly growing number of international health consumers who are fuelling the global medical tourism boom.

The U.S. research firm Frost & Sullivan expects the industry to pull in $100 billion this year, and to increase by 20 per cent a year across 50 countries.

For some patients, the cost of surgery is cheaper than in their home country. Others don’t want to wait, or they may be seeking procedures not available where they live.

A growing number of developing countries now have top-notch doctors, facilities and equipment to reassure Westerners. The Internet allows them to heavily market their services and makes it easy to book overseas clients.

But there are concerns about the medical tourism industry. In 2010, the World Bank reported the sector has “considerable implications for public health.” There is potential for abuse. Hospital accreditation with the U.S.-based Joint Commission International is voluntary, and medical tourism “facilitators” — brokers — are unregulated and often work on commission.

Then there’s the impact on countries where health resources are being funnelled into private hospitals, possibly depriving local patients of expertise. Some governments give tax breaks to for-profit health centres in countries that lack basic care for their poor.

There is little or no research about how many Canadians travel abroad for medical procedures, the impact of medical tourism on our health-care system, or the effect on destination countries, says Simon Fraser University associate professor of geography Valorie Crooks.

Crooks has spent four years trying to determine the real cost of medical tourism through her SFU Medical Tourism Research Group.

“I think people would be surprised to know that people are choosing to go abroad for medical care more often than they’d think,” said Crooks, who won the first Canadian Institutes of Health Research grant in 2008 to study the issue.

“There’s a lot of public discussion of wait times as the reason people go abroad for surgery, but from our research we know the things prompting Canadians to go abroad are much more diverse.”

The government doesn’t track medical tourists, which leaves researchers and policy-makers in the dark. And although shopping abroad for medical care is perfectly legal, Crooks is concerned with its consequences.

“There’s no international regulation scheme for the industry that assesses things like surgical outcomes and safety,” said Crooks, a health geographer.

“There are a lot of health and safety risks involved . . . the industry is growing so rapidly and there is such a need to know more about what is happening.”

She cites concerns about the safety of blood supplies, incomplete medical records and the risk of flight following surgeries. There can also be pressure on the health system in patients’ home countries to provide follow-up care, especially in the case of organ transplants, and some patients have returned to Canada with hospital-acquired superbugs.

Crooks and her team will visit Mongolia this month and will conduct studies in Mexico, Guatemala, Barbados and India to examine the role of caregivers and the impact of medical tourism on local health care in developing countries.

Crooks hopes more data will lead to ethical buying guidelines for medical consumers to help them minimize their risk. At the moment, Canadians have to fend for themselves or turn to unregulated brokers to arrange surgeries for a fee.

One of the biggest medical facilitators in B.C. is Vancouver’s Surgical Tourism Canada, which has arranged to send more than 1,500 clients abroad since it was founded in 2005. Most of the clients are Canadian; 30 per cent are British Columbians.

“Many people need and want the option of medical specialists to get treatment faster than waiting in line here,” said the company’s spokesman, Glenn Sergius.

“People want to go to a place where they get the best medical treatment immediately, if they can afford it.”

Sergius argued patients are as safe abroad as when they undergo procedures at their local hospital.

“The risks faced for those needing medical treatment and surgery — with or without travel — are much the same, perhaps less, because the hospitals have more trained staff per patient,” Sergius said, adding that by using a medical facilitator, the risks are reduced “because an experienced expert ... is looking after the details relating to choice of physicians and hospitals, travel and accommodations.”

Kelowna’s Shaz Pendharkar is the first to admit he isn’t a trained medical professional. He is a retired school principal who connects patients to doctors he knows in India and works part-time as a facilitator. His business, Meditours, is small; he said he’s arranged 60 surgeries since he started the company in 2003.

“I’m not a medical broker,” Pendharkar said. “I really know the doctors well that I send my clients to. I’m more of a niche marketer.”

He arranges all travel details, exchanging medical information with doctors and organizing accommodations. He says can get a patient into a hospital bed in India in as little as two weeks. Patients generally pay $10,000 to $12,000 for the package, depending on the surgery and not including airfare, and Pendharkar charges a fee of 10 to 15 per cent.

He stresses he doesn’t offer medical advice — just logistical support — and that he’s never had a patient who had a surgery go wrong, save a Vancouver woman who wasn’t entirely happy with her butt-lift.

Pendharkar doesn’t see the need for regulation, but admits patients do take risks, especially dealing directly with foreign hospitals.

“My biggest problem with that sort of system is not knowing the doctors,” he said. “You don’t know what you are getting.”

MEDICAL TOURISTS SEEK EXPERIMENTAL SERVICES

Linda Stewart is one of the unknown number of Canadians using medical tourism to obtain experimental treatments not offered in Canada.

The 57-year-old was diagnosed with multiple sclerosis at age 38 and was using a wheelchair when she saw a news report in 2009 on a controversial MS treatment known as a “liberation procedure” which removes blockages in veins to address a condition known as chronic cerebrospinal venous insufficiency.

Stewart arranged her surgery in May 2010 with Meditours and paid $15,000 US for treatment in India. To her it was well worth it.

“Before, I was very handicapped. I had no feeling in my hands and most of my legs and feet and extreme cramping . . . I’d lost pretty much all my voice,” she said.

“I have feeling now in my feet, the cramping is almost totally gone, my voice is back.”

Stewart said she did her research and had few reservations.

“I was a travel agent so I have no fear of travelling at all, and I did look into the hospital and the doctor — he was more qualified than most people in Canada.”

Indian hospitals, she said, were “absolutely immaculate,” with leading-edge technology and staff who spoke English. Her doctors even followed up by email.

Perhaps because her experience was ideal, Stewart doesn’t support regulation, but cautions patients to “do the research.”

“If you can go there and get it done with good doctors and good facilities and for so much cheaper and have a vacation included, why not do it?” she said.

“I really would do it again tomorrow. I was on the fastest track to a nursing home you ever saw. This made my life more bearable.”

Top spots for medical tourism:

-       Asia has established destinations in India, Thailand, Singapore and Malaysia. Emerging centres include South Korea, Philippines and Indonesia.

-       The Caribbean is trying to draw the North American market with Barbados, Cayman Islands, and Jamaica building capacity.

-       Eastern European countries such as Poland, are also hot spots, particularly for MS treatments.

-       Mexico and Latin American countries are popular destinations for cosmetic and dental surgery, notably Brazil and Costa Rica.

ELAINE O'CONNOR
The Victoria Times Colonist



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