dr vinay rane - medico-legal society of victoria - controversies in obstetric and reproductive...
DESCRIPTION
Vinay Rane delivered this presentation at the 2014 Medical Tourism Summit. The Summit examines the implications of recent changes within the medical tourism industry and the impact on the Australian market. Find out more at http://bit.ly/1zgqUTXTRANSCRIPT
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DR VINAY S. RANE
MBBS, LLB, LLM, BMEDSCI(HONS), PDLP, FACLM, MFFLM, RCP(UK), MHSM, MRANZCOG
FORENSIC PHYSICIAN
OBSTETRIC REGISTRAR
BARRISTER AND SOLICITOR (VIC)
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“Medical Tourism”
• Is this really a thing?
• Is it really a holiday?
• Is it safe?
• Is it cheaper?
• Why?
• What‟s on the menu?
• What happens if?
• Ethical Considerations
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Is this really a thing?
• $100 billion industry
• 20-30% growth per year
• Australian spend is $350 million per year
• 300,000 people travel to India alone each year for medical treatment
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Top Countries by Spend
• 5. India
• 4. Singapore
• 3. USA
• 2. Mexico
• 1. THAILAND
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Why Thailand?
• Location
• Experience of friends
• Perceived Safety
• Excellent Marketing
• Hospitality
• Cost
• Not so much because it‟s a holiday
• Access to services
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Reasons for Medical Travel
• Cost
• “get a holiday on the beach” – Not really
• Volume / Safety
• Self Esteem Issues for some procedures
– “Escape”
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What Kind of Procedures
• Cosmetic
– Breast, Tummy Tucks, Face Lifts, rhinoplasty
• Dental
• Is that all?
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What Kind of Procedures
• Bariatric
– Types
– Follow up
– Comps
– Prosthesis
– Escape
– Wait List
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What Kind of Procedures
• Orthopaedic
– Infection
– Medicare
– Prosthetic Cost
– Wait List
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What Kind of Procedures
• Coronary Artery Bypass Grafts
– Cost in USA
– Cost in India
– Volume
– Indian Genes
– Indian Doctors
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What Kind of Procedures
• Infertility – Cost
– Access
– Emotional and
Psychological Factors
– Laws : • surrogacy,
• sex selection,
• multiple pregnancy
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What Kind of Procedures
• Organ Transplant
– Access
– Laws
– Safety?
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Safety
• Regulation of doctors in Australia
• Varied regulation overseas
• Cheaper must
mean worse
• Case Volume
• Local Perceptions
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Complications
• Incidence
• Impact on initial rationale
• Impact on Medicare
• Impact on private health funds
• No audit data
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When it goes wrong
• Often no recourse
• NIB “12 month guarantee”
• Local laws
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Baby Gammy
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Baby Gammy
• Dec 2013 Thai commercial surrogate gives birth to twins
• Baby Girl Pipah and a boy Gammy (T21)
• Australian biological parents returned to Australia with Pipah leaving Gammy behind.
• Suggested TOP at ~k28; Thai laws
• Became news in mid 2014
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Baby Gammy
• Recourse for the Australian Couple – Thai law – birth mother is the legal mother
– Comodification of medicine
• Confounders – PHx, TOP, Age
• Fallout – Other families stopped from leaving Bangkok
– Approval of draft law banning surrogacy
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Other ethical considerations
• Exploitation
• “Brain Drain” Reversal
• Impact on local medicos
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What can we learn?
• “Can‟t beat „em join „em”
• Australia as a destination – Quality Health Care
– Falling Australian Dollar
– Safety
– We too have great beaches and
resorts and drinks
with little umbrellas in them!