Inside Medical Tourism: Pros & Cons of Surgery Abroad

A low-cost gastric bypass in sunny Mexico, a tummy tuck in Brazil or fertility and cancer treatment in India—it’s all part of medical tourism, the umbrella term for traveling abroad to obtain inexpensive health care, for both medically necessary and cosmetic treatment. While the concept has been around for years, recent stories in the media have pointed out the risks involved, but medical tourism is an estimated $24-40 billion-dollar industry, says Patients Without Borders.

The UMHS Endeavour looks at the pros and cons of medical tourism for various procedures, and the benefits and risks involved for Americans and students at Caribbean medical schools, and what the U.S. government and the American Medical Association (AMA) say about the phenomenon. Medical tourism is big business because, according to Patients Without Borders, an estimated 900,000 Americans traveled abroad in 2013 for medical procedures.

CDC Warning About Cosmetic Surgery in the Dominican Republic

A 29-year-old Bronx, NY woman traveled to Santo Domingo, Dominican Republic this winter for a simple cosmetic surgical procedure, with tragic results.

Beverly Brignoni went to the Dominican clinic Vista del Jardin on February 19, 2014 for a tummy tuck by Dr. Guillermo Lorenzo upon the recommendation of friends. She suffered a pulmonary embolism and died on the operating table.

The New York Daily News reports the woman’s family hired a lawyer and is suing Dr. Lorenzo and the clinic. The clinic was shut down “when Health Ministry officials inspected it and found bacteria and violations of bio-sanitary regulations,” the newspaper says.

The Daily News says the U.S. Centers for Disease Control (CDC) issued an alert about cosmetic surgery in the island nation because “at least 19 women in five states developed serious wound infections involving a virulent from of bacteria over the previous year following cosmetic procedures in the Dominican Republic.”

Surgery South of the Border

Unlike the Dominican Republic, suing a doctor in Mexico for malpractice is not an option because Mexican law prohibits lawsuits. However, the inability to sue for malpractice keeps health-care costs down in Mexico and makes the country attractive to medical tourists. Plus, many of the procedures are state of the art. Hospitals in Mexican resort cities are just as modern and advanced as those back in the States. Everything from dental work to cosmetic surgery is popular in Mexico, catering both to Latinos in border states and English-speaking Americans.

Medical tourism is promoted extensively on tourism websites. According to Bloomberg News, Mexico is the #2 destination for medical tourism worldwide, attracting nearly one million tourists annually for health care.

On the official tourism website for Puerto Vallarta , a whole section is devoted to medical tourism for North Americans. Puerto Vallarta, a city that heavily promotes itself in the USA on Facebook and Twitter, is hosting the V Summit on Medical Tourism and Wellness in November 2014.

Costs for care and medication are kept low in Mexico because malpractice lawsuits are nonexistent. Such costs “make up a large portion of the medical costs ‘back home,’’ the Visit Puerto Vallarta website says.

Top Specialties for Medical Tourists (from Patients Without Borders):

• Cosmetic surgery
• Dentistry (general, restorative, cosmetic)
• Cardiovascular (angioplasty, CABG, transplants)
• Orthopedics (joint and spine; sports medicine)
• Cancer (often high-acuity or last resort)
• Reproductive (fertility, women's health)
• Weight loss (LAP-BAND, gastric bypass)
• Scans, tests, health screenings and second opinions.

Top Countries for Medical Tourism

CNBC lists the top countries for medical tourism and the most popular procedures.

• Mexico, (Dental work; cosmetic surgery)
• India, (Fertility treatments; orthopedic and cardiac care; oncology)
• Thailand, (Cosmetic surgery)
• Brazil, (Cosmetic surgery)

CDC on Risks of Medical Tourism

The CDC’s website  has a long list of risks associated with medical tourism, and necessary precautions. The CDC says risks “depend on the area being visited and the procedures,” but outlines general concerns.

• Communication may be a problem. Receiving care at a facility where you do not speak the language fluently increases the chance that misunderstandings will arise about the care.
• Doctors may reuse needles between patients or have other unsafe injection practices, which can transmit diseases such as hepatitis and HIV.
• Medication may be counterfeit or of poor quality in some countries.
• Antibiotic resistance is a global problem, and resistant bacteria may be more common in other countries than in the United States.
• The blood supply in some countries comes primarily from paid donors and may not be screened, which puts patients at risk of HIV and other infections spread through blood.
• Flying after surgery increases the risk for blood clots.

For more information, please visit http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/medical-tourism

AMA Guidelines on Medical Tourism

The American Medical Association says "employers, insurance companies, and other entities that facilitate or incentivize medical care outside the U.S." must adhere to the following:

• Medical care outside of the U.S. must be voluntary.
• Financial incentives to travel outside the U.S. for medical care should not inappropriately limit the diagnostic and therapeutic alternatives that are offered to patients, or restrict treatment or referral options.
• Patients should only be referred for medical care to institutions that have been accredited by recognized international accrediting bodies (e.g., the Joint Commission International or the International Society for Quality in Health Care).
• Prior to travel, local follow-up care should be coordinated and financing should be arranged to ensure continuity of care when patients return from medical care outside the U.S.
• Coverage for travel outside the U.S. for medical care must include the costs of necessary follow-up care upon return to the U.S.
• Patients should be informed of their rights and legal recourse prior to agreeing to travel outside the U.S. for medical care.
• Access to physician licensing and outcome data, as well as facility accreditation and outcomes data, should be arranged for patients seeking medical care outside the U.S.
• The transfer of patient medical records to and from facilities outside the U.S. should be consistent with HIPAA guidelines.
• Patients choosing to travel outside the US for medical care should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities.

For more information, please visit http://www.ama-assn.org/ama1/pub/upload/mm/31/medicaltourism.pdf

(Top photo) Photo: Deposit Photos

About UMHS:

Built in the tradition of the best US universities, the University of Medicine and Health Sciencesfocuses on individual student attention, maintaining small class sizes and recruiting high-quality faculty. We call this unique approach, “personalized medical education,” and it’s what has led to our unprecedented 96% student retention rate, and outstanding residency placements across the US and Canada. UMHS is challenging everything you thought you knew about Caribbean medical schools.