Health Professionals

Health Information sheets

Medical tourism

Last updated: August 2011

Introduction

Health care abroad

Costs of health care abroad

Health facilities accreditation schemes

Guidance from organisations and professional bodies

Risks of Medical Tourism

Advice for travellers

References

Links

Introduction

The term medical tourism is used when the primary purpose of travel is to voluntarily seek health care abroad. In 2008, estimates of the amount of medical tourism occurring worldwide relied on tourism industry sources and varied from 600,000 to 5 million worldwide [1, 2]

A survey in 2007 of 27,200 European Union (EU) citizens from 27 EU member states indicated that 4% had sought medical treatment in another member state [3].

The 2005 to 2009 International Passenger Surveys indicated that in recent years, the annual number of travellers leaving the UK for health care abroad was more than 50,000 (Figure) [4].

  

Annual Number of Travellers Leaving the UK for Medical Treatment Abroad

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Data from Office for National Statistics, Internal Passenger Survey

The most frequent destinations visited by UK residents in 2009 were Poland, Pakistan, Iceland, Republic of Ireland, India, Gibraltar and Hungary, accounting for 69% of the total number seeking healthcare abroad [4]. A consumer survey of 300 UK medical tourists in 2007 indicated that 48% had undergone dental procedures, 28% cosmetic surgery, 8% orthopaedic, 4% fertility and 11% other treatments [5].

Health care abroad

There are many reasons for seeking healthcare abroad including shorter waiting times for treatment, reduced cost, the perception that the treatment is better, and the ability to access treatment not available in the home country e.g. unapproved treatments such as stem cell therapies [6].

Health services for medical tourists are worldwide including India, Singapore, Thailand, Malaysia, Dubai, South Africa, and countries in South and Central America, and Europe. The close proximity of European countries and ease of movement between nations allows transfer of services both outbound and inbound to the UK.

Costs of health care abroad

Most medical tourism is funded by the traveller. Private tourism agencies or facilitators can be used; linking individuals to hospitals and booking travel and accommodation are part of the service provided [7-9]. Occasionally, National Health Service (NHS) funding for those seeking healthcare in European Economic Area (EEA) countries is available. In some circumstances, such as undue delays in treatment in the UK, local commissioners can consider individual applications for NHS funded treatment outside the UK, based on patient needs [10].

Travellers returning to the UK with failed procedures or complications will usually require the NHS to treat them [11]. In 2008, a survey of UK dentists showed that 60% had treated complications due to poor quality or clinically inappropriate (33%) treatment received outside the UK [12]. A survey of women with ‘high order’ multiple pregnancies (e.g. triplets. quadruplets) indicated that 25% had received fertility treatment abroad with multiple embryo implantation not permitted in the UK [13]. This results in an increased risk to the mother and the need for additional antenatal and postnatal care.

Health facilities accreditation schemes

There are a number of international accreditation schemes that visit healthcare facilities nationally and internationally to assess the standards and quality of providers. Organisations are:

  •  Joint Commission International (JCI). USA-based, accrediting facilities worldwide [14].
  •  Quality Healthcare advice (QHA) Trent Accreditation. UK-based, evaluating standards of healthcare worldwide [15]
  •  Accreditation Canada International [16]
  •  Australian Council on Healthcare Standards [17]
  •  Indian National Accreditation Board for Hospitals and Healthcare Providers [18]

Most accreditation schemes produce directories of accreditated facilities in different countries. These can be used to measure the standards of care based on each organisation’s criteria.

Guidance from organisations and professional bodies

Several organisations and medical specialities have developed specific guidance for plastic surgery [19, 20], general surgery [21, 22], dentistry [23], transplantation [24, 25] and fertility treatments [26].

General advice:

  •  check the credentials of the health professional including:

° specialist registration or qualifications of the practitioner in their own or another country

° membership of specialist professional bodies, e.g. International Society of Plastic Surgeons certifies surgeons who meet US standards of practice [19]

  •  consider if there are language differences and how you will communicate with your healthcare provider
  •  know the success or complication rates for the health professional performing your chosen health procedure
  •  ask to contact other patients who have undergone similar procedures

Risks of Medical Tourism

Although many patients will be satisfied with their decision to seek care abroad others are not. Quantifying the risk of medical tourism is difficult and is dependent on several factors: most importantly the individual health provider and facilities. However, there are other recognised risks:

  •  lack of health insurance if there are complications whilst abroad [27]
  •  medical procedure failures, e.g. transplants [28], dental procedures[12]
  •  inadequate infection control resulting in wound infections and other serious post surgical complications [29-34]
  •  failure to adequately screen blood products resulting in blood borne virus transmission [35]
  •  risks of flying after surgery, e.g. deep vein thrombosis (DVT) and pulmonary embolus [36]
  •  no legal recourse when the treatment outcome is not satisfactory or as expected
  •  poor continuity of care on return to the home country

Advice to travellers

1. Discuss your plans with your general practitioner or specialist in the UK.

2. See a travel health advisor to obtain country-specific health advice including necessary vaccinations and malaria prevention for your chosen destination.

3. Assess the quality and standards of health care organisations abroad.

4. Assess the health professional who is caring for you abroad. Advice from a UK-based specialist should be sought.

5. If travelling within EEA countries consider whether NHS funding is available.

6. Traveller’s holiday insurance and the European Health Insurance Card (EHIC) do not cover medical care that is planned in advance and sought voluntarily.

7. Consider the care you may require after a procedure, the local follow up arrangements, and costs involved.

8. Consider your rights of legal recourse in the event of a post operative complication, e.g. infection or procedure failure.

9. Consider who is to care for you on return to your home country and ensure you have a copy of all your clinical records.

10. Be aware of the potential risks of combining surgical procedures with long flights, e.g. DVT risk and the need to be fit to fly home.

 

References

1. Ehrbeck T, Guevara C, Mango PD. Mapping the market for medical tourism. McKinsey Quart 2008; May: 1-11

2. Youngman I. Medical tourism statistics: why McKinsey has got it wrong. Int Med Travel J 2009. [Accessed 31 August 2011]. Available at: http://www.imtjonline.com/articles/2009/mckinsey-wrong-medical-travel/

3. Cross-border Health Services in the EU. Analytical Report 2007. [Accessed 31 August 2011 ] Available at: http://ec.europa.eu/public_opinion/flash/fl_210_en.pdf

4. Office of National Statistics. International Passenger Survey 2005- 2009. [Accessed 31 August 2011]. Available at: http://www.statistics.gov.uk/statbase/Product.asp?vlnk=1391

5. Which? Getting treatment abroad 2007. [Accessed 31 August 2011]. Available at: http://www.which.co.uk/campaigns/food-and-health/getting-treatment-abroad/our-investigation/

6. Crooks VA, Kingsbury P, Snyder J et al. What is known about the patient’s experience of medical tourism? A scoping review. BMC Health Services Research 2010, 10:266. 1-12

7. Snyder J, Crooks VA, Adams K et al. The 'patient's physician one-step removed': the evolving roles of medical tourism facilitators. J Med Ethics. 2011, 37: 530-534.

8. Lunt N, Hardey M, Mannion R. Nip, tuck and click: medical tourism and the emergence of web-based health information. Open Med Inform J. 2010 Feb 12; 4: 1-11

9. Lunt N, Carr. Systematic review of web sites for prospective medical tourists. Tourism Review. 2011, Vol. 66 Iss:1/2, pp.57–67

10. NHS Choices. Planned Treatment abroad. [Accessed 31 August 2011]. Available at: http://www.nhs.uk/NHSEngland/Healthcareabroad/plannedtreat

ment/Pages/Entitlement.aspx

11. Birch J, Caulfield, R, Ramakrishnan, V. (2007). The complications of ‘cosmetic tourism’ – an avoidable burden on the NHS, Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 60,1075-7

12. British Dental Association Concern over high levels of dental tourism. Policy and Research Bulletin Summer 2008. [Accessed 31 August 2011]. Available at: http://www.bda.org/Images/policy_and_research_bulletin_01

_summer_2008.pdf

13. McKelvey A, David A, Shenfield F et al. The impact of cross-border reproductive care or ‘fertility tourism’ on NHS maternity services. BJOG 2009.  116 (11); 1520-1523.

14. Joint Commission International. [Accessed 31 August 2011]. Available at:  http://www.jointcommissioninternational.org/about-jci/.

15. Quality Healthcare advice Trent. [Accessed 31 August 2011]. Available at:  http://www.qha-international.co.uk/ .

16. Accreditation Canada, International. [Accessed 31 August 2011]. Available at: http://www.accreditation.ca/accreditation-programs/international/

17. Australian Council on Healthcare Standards International. [Accessed 31 August 2011]. Available at: http://www.achs.org.au/whoweare/

18. National Accreditation Board for Hospitals & Healthcare Providers. [Accessed 31 August 2011]. Available at: http://www.nabh.co/main/

19. British Association of aesthetic plastic surgeons BAAPS consumer safety guidelines [Accessed 31 August 2011]. Available at:http://www.baaps.org.uk/safety-in-surgery/consumer-safety-guidelines

20. International Society for Aesthetic Plastic Surgeons. Key guidelines for plastic surgery travellers. [Accessed 31 August 2011]. Available at: http://www.isaps.org/medical-travel-guide/

21. American Medical Association. Guidelines for patients travelling overseas for medical care. [Accessed 31 August 2011]. Available at: http://www.ama-assn.org/resources/doc/cms/a-08cms1.pdf

22. American College of Surgeons. Statement on medical and surgical tourism 2009. Bulletin of the American College of Surgeons. 94, (4). 26-27

23. American Dental Association Tourism (Dental Care Away from Home) [Accessed 31 August 2011]. Available at: http://www.ada.org/3029.aspx?currentTab=1

24. Steering Committee of the Istanbul Summit 2008. Organ Trafficking and Transplant Tourism and commercialism: the Declaration of Istanbul 2008. Lancet. Jul 5; 372(9632):5-6

25. World Health Organization: Guiding Principles on Human Cell, Tissue and Organ Transplantation. [Accessed 31 August 2011]. Available at: http://www.who.int/transplantation/en/

26. Human Fertilisation Embryology Authority. Considering fertility treatment abroad: issues and risks. [Accessed 31 August 2011]. Available at: http://www.hfea.gov.uk/fertility-clinics-treatment-abroad.html  

27. European Health Insurance Card. [Accessed 31 August 2011]. Available at: http://www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/

Pages/Introduction.aspx

28. Cha RH, Kim YC, Oh YJ et al. Long-term outcomes of kidney allografts obtained by transplant tourism: observations from a single center in Korea. Nephrology (Carlton). 2011 May 24. Accepted article doi: 10.1111/j.1440-1797.2011.01480.x

29. NaTHNaC Clinical Update 13 August 2010. Multidrug-resistant Enterobacteriacae (NDM1) in India, Pakistan and the United Kingdom. [Accessed 31 August 2011]. Available at: http://www.nathnac.org/pro/clinical_updates/ndm1_130810.htm

30. Chan HL, Poon LM, Chan SG et al. The perils of medical tourism: NDM-1-positive Escherichia coli causing febrile neutropenia in a medical tourist. Singapore Med J. 2011 Apr; 52(4):299-302.

31. Meng-Kun Tsai, Ching-Yao Yang, Chih-Yuan Lee et al. De novo malignancy is associated with renal transplant tourism. Kidney International (2011) 79, 908–913.

32. Newman MI,Camberos AE, Ascherman J.Mycobacteria abscessus Outbreak in US Patients Linked to Offshore Surgicenter. Ann Plast Surg 2005; 55: 107–110.

33. Furuya EY, Paez A, Srinivasan A et al. Outbreak of Mycobacterium abscessus wound infections among “liposuction tourists” from the United States who underwent abdominoplasty in the Dominican Republic. Clin Infect Dis. 2008; 46(8):1181-8

34. Harling R, Turbitt D, Ushiro-Lumb I et al. Passage from India: an outbreak of hepatitis B linked to a patient who acquired infection from health care overseas. Public Health. 2007; 121(10):734-41

35. World Health Organization. Global database on blood safety. [Accessed 31 August 2011]. Available at: http://www.who.int/worldblooddonorday/media/Keyfactfigures

2007BTSsurvey.pdf

36. Chandra D, Parisini E, Mozaffarian D. Meta- analysis: travel and risk for venous thromboembolism. Ann Int Med. 2009 Aug 4; 151(3):180-90.

Links

NHS Choices: Planned Treatment Abroad

NHS Choices: Questions to ask the doctor or dentist

European Health Insurance Card

Foreign and Common Wealth Office