Medical tourism:
implications for
general practice
Assoc. Prof. Brent Lovelock
Department of Tourism
Dr Kirsten Lovelock
Department of Public Health, Wgtn
Definition
• Medical tourism is the practice whereby
individuals travel across national borders
with the intention of receiving medical care
Scope
• Cosmetic surgery (breast, face, liposuction)
• Dentistry (cosmetic and reconstruction)
• Cardiology/cardiac surgery (by-pass, valve replacement)
• Orthopaedic surgery (hip replacement, resurfacing, knee
replacement, joint surgery)
• Bariatric surgery (gastric by-pass, gastric banding)
• Fertility/reproductive system (IVF, gender reassignment)
• Organ, cell and tissue transplantation (organ
transplantation; stem cell)
• Eye surgery
• Diagnostics and check-ups.
Destinations
Costs
USA India Thailand Singapore
Heart bypass 113,000 10,000 13,000 20,000
Hip replacement 47,000 9,000 12,000 11,000
Spinal fusion 43,000 5,500 7,000 9,000
Gastric bypass 35,000 11,000 15,000 20,000
Rhinoplasty 4,500 2,000 2,500 4,375
Breast implants 6,000 2,200 2,600 8,000
US dollars; Lunt et al 2011
Scale
• Somewhere between 60,000 and 50
million medical tourists!
• US$60B industry (Deloitte 2007)
Demand side drivers
• Changes to domestic health systems
• Familiarity
• Availability
• Cost
• Quality
• Bioethical legislation (Glinos et al 2006)
• Privacy
• Tourism
Why people ‘do’ medical tourism
40
32
15
13
Most advanced technology
Better quality care
Quicker access
Lower cost
McKinsey 2008
Quality of information
• Direct-to-Consumer sales model
• A study using the search term “breast
augmentation” located 130 sites and
concluded that 34% of these sites
contained information that was either false
or misleading (Jejurikar et al., 2002).
Quality of care, clinical outcomes
• lack of comparative quality and safety data
• lack of information on infection rates for
overseas institutions
• lack of reporting of adverse events
• evidence of clinical outcomes is limited
• Travel component poses additional risk
Continuity of care
• patient follow-up by providers is rare
Liability and redress
• Differences in standards and regulations abroad
• Difference in legal liability
• Lack of knowledge of how to pursue a complaint
• Jurisdiction
• legal disclaimers
Implications for health systems
at home• Costs of emergency or remedial treatment
• Infection outbreaks
– E.g. ‘Superbug’ NDM-1 [New Delhi metallo-beta-
lactamase]
• Impact on private health sector
• Exacerbating two-tier system? (Lunt et al 2011)
• But….savings for public health systems- from
‘outsourcing’? (Smith et al 2011)
• And….potentially drive down costs in domestic
health systems? (Herrick 2007)
Ethical issues
• Some procedures illegal in home country
• Or experimental
• E.g. rewarded kidney donation
Cases from our study
• Qualitative study of New Zealanders who had
travelled abroad for medical treatment.
‘Suzanne’: 61 yrs, Auckland
• Procedure: Full face lift
• Destination: Malaysia
• Chose Malaysia because had never been to Kuala
Lumpur
• Booked procedure through ‘Beautiful You Holidays’
• Cost was $7000 c.f. $30,000 in Australia.
• Could have recovery time while away and not have
to go through the “why I’ve been away” questions
• Chose provider on basis that they had worked on
the Malaysian Royal Family
• Didn’t tell GP
‘Alan’ 28yrs Auckland
• Procedure: Blepharoplasty
• Destination: Thailand
• Alan walked in off the street to a clinic in Phuket
• Has had three rounds of revision
surgery/treatment in Australia (all failed)
• Currently having more corrective work done in
NZ
• “Complete disaster. .. Cost thousands, and not
covered by ACC”
• “Lost all confidence, emotionally devastating,..”
‘Bob’ 75yrs, Central NI
• Procedures: Cardiac ablation
• Destination: France
• Searched internet, leading expert in France
• Procedure (at the time) was not available in NZ
• Specialist (Auckland) said there is no procedure,
“you’ve got it for life, fella”
• Specialist: “Why do you want to have a froggy
poking around in your heart for?”
• GP pushed the idea and acted as liaison with
France
‘Paul’, 59yrs, Auckland
• Procedure: cardiac ablation
• Destinations: Italy, France
• At the time there was only one person in NZ, who
was just starting to do the procedure
• Paul wanted the best, and undertook an internet,
finding a provider in Milan. But the procedure didn’t
work, and his condition returned on arrival back in
NZ
• “Claimed a success rate of 80% but that turned out
to be only 12%... Xxxxx was a charlatan…No
evidence that he had actually done anything”
‘Karmel’ 44 yrs, Wellington
• Procedure: IVF
• Destination: India
• Grew up in India. Married again at 40yrs, premature
menopause
• Did not meet criteria for public funded IVF in NZ
• Couldn’t afford private $12,000 per treatment
• In India- cost $7000 incl airfares, travel around India,
treatment and medication
• Needed a donor egg- availability and strict criteria NZ
• GP “didn’t want to know anything about it”
‘Jack’ 58 yrs Dunedin
• Procedure: mitral valve replacement
• Destination: India
• Prognosis 2 yrs to live, could get public funded
surgery in NZ, but internet search revealed that
in Dunedin they “cut you open” c.f. overseas you
can have microsurgery
• Internet search: US $100,000; Singapore
$40,000; India $10,000 (final cost was $12,000)
• Google: 5 hospitals in Delhi; 4 in Chennai; 3 in
Mumbai.
• Infection in wound- 3 days in hospital in NZ
Critical questions for
GPs
• Should I support my patient’s medical tourism?
• How much should I be involved?
• Will my involvement implicate me if anything
goes wrong?
• Shouldn’t the specialist play a role rather than
me?
• If something goes wrong, how can I best support
my patient?
GPs’ potential roles
• decision-making stage
• strategies for minimizing health risks
• medical records
• follow-up care
Where do GPs fit?
Medical tourism:
implications for
general practice
Assoc. Prof. Brent Lovelock
Department of Tourism
University of Otago Business School