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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