HealthAbroad.net: Point of View

Even as medical tourism picks up, the American Society of Plastic Surgeons has come up with a set of guidelines for patients who are seeking cosmetic procedures abroad (and also to protect their livelihood!).

Read here

Keeping with Singapore being the numero uno in cutting edge medical treatment, the New York Times recently reported that a local business claimed to be the first company to produce human embryonic stem cell lines commercially in a way that made them suitable for clinical tests. Researchers can buy vials of stem cells online from ES Cell for $6,000 each.

The article points out that the Bush Administration’s institutionalized reluctance to promote stem cell research has meant that many top American scientists have left for Singapore, which is luring them with tax holidays and incentives.

In the 1980s and 90s, focussing on the electronics market Singapore pole vaulted into the bracket of high income countries. Now faced with declining returns from electronics, the city-state is hedging its bets on biotechnology and early signs indicate that the country is well on its way to becoming a hub of biotechnology.

Singapore has already managed to lure big drug companies. Factories pumping out pharmaceuticals for Merck, Pfizer and Schering-Plough now generate about 18 billion Singapore dollars, or $11.4 billion, in annual revenue, and account for 5 percent of the Singapore economy. But Singapore wants companies to do more than make drugs here. To persuade them to conduct basic drug research and development as well, Singapore offered to pay as much as 30 percent of their building costs. At least 30 companies have responded, including the Swiss company Novartis, which has opened an institute to develop drugs to fight tuberculosis and the tropical dengue virus.

Singapore officials say they have spent 1.5 billion dollars on biotechnology since 2000 and have budgeted an additional 1.44 billion dollars over the next five years to finance development of new therapies and drugs.

Two prominent Bangkok hospitals are now offering in-house visa extension services to “help those who have to overstay their visas while undergoing medical treatment.” Both Bumrungrad and Samitivej Hospital are bearing the costs of providing the space and having Immigration officials come in once a week to process the paperwork.

While many people come to Thailand under a 90-day “tourist visa” specifically for treatment, others are increasingly taking advantage of their presence in Thailand under a 15-day visa-on-arrival to get a check-up and any accompanying treatment, if necessary. Either way, many find that an extension of stay is required. Most Westerners avail of visa exemption upon entering Thailand, which permits them to stay in the country for not more than 30 days.

Extensions are now being granted for periods of one month to 90 days, depending on which type of visa the patient is holding. A doctor’s certificate is required (organised by the hospital) along with original passport, a photocopy of the passport and one photograph.

Here, you can read a personal experience blogpost written by Bill Grimson on surgery in the Phyathai Hospital Bangkok. Thanks Bill!!

Explaining Thailand’s reputation for being a top medical tourism destination, Bill says, “this has occurred due to the cost of treatment being relatively inexpensive, but still A1 professional compared to the “through the roof” cost of medical treatment in North America, Europe and Australasia.” People are clearly doing their research, crunching the numbers and figuring out that the deal for elective surgery+airfare+recuperation in a luxury hotel is  far better than what is on offer cost and quality wise at home.

Bill is also very impressed by the cleanliness and efficiency at the said hospital. An intrepid traveller who had previously availed of minor medical treatment in Thailand, Bill comes away suitably impressed with whats on offer at the hospital.

According to an article in The Korea Times, South Korea’s Presidential Commission on Healthcare Industry and Innovation has announced plans to increase the number of incoming foreign patients to 50,000 a year by 2008 and 400,000 by 2014.

As of 2006, less than 10,000 foreign patients came to South Korea to avail of medical services.

The article quotes an official representative of the agency as saying that cosmetic surgery and medical screening are the care seeking services most in demand with the foreign patients.

To increase the numbers, the Government is aiming to provide a one-stop all inclusive strategy (transit transport, medicare, hotels and tourism) to cater to medical tourists.

South Korean medical professionals have succeeded in establishing a niche for
themselves in East Asia in the field of cosmetic surgery. Although the domestic
demand has been substantial (for a variety of reasons!), the more enterprising doctors are now eyeing the big honey pot that is the Chinese market.

In acknowledging medical tourism to be the next big growth sector, India has launched a massive global campaign to promote India as a destination for medical tourism at competitive costs and high skill set.

According to an official press release used by Zee News, “The medical tourism market in the country, which stands around 300 million US dollars with an estimated 1.5 lakh foreign patients visiting the country every year is expected to grow into a two billion dollars business by 2012.”

According to Development Network Africa, a private economic and development consulting firm, South Africa is making moves to maximise the potential of its medical tourism industry. Much like a kid in a candy store- the country is reaching out to grab more with one hand while creating a defensive circle around its own possessions and assets- home-bred medical professionals in this case.

In the recent months, two developments have caught the attention of industry watchers. Firstly, two of SA’s largest health-care groups, Netcare and Mediclinic, concluded large accusations of hospitals in the UK and the Middle East. Secondly, the health minsiter of SA worried by the flight of home-bred medical professionals to foreign locations has announced plans to increase retention and crack down on the migration of foreign health professionals to SA to take over vacant spots.

As the article points out, “SA has a well-developed efficient and competitive health-care sector. It also has enviable climate, is in the same time zone as Europe, and presents an appealing and afforadable travel destination. This bodes well for health tourism, and the number of patients seking “surgical safaris” in SA has risen strongly over the last decade.”

However, survey data has shown that around 40% of the medical graduates leave the country once qualified. Even nurses are leaving in large numbers with the UK receiving 3000 applications for registration from South African nurses a year, second only to the Phillipines. This vaccum is filled by African doctors and nurses who lured by better incomes and a higher standard of living are flocking to SA.

To buck the trend, the government has adopted a two pronged approach. A cumpolsary community service programme, which requires all medical graduates to undertake a full year of service in public institutions, has been started and immigration and registration requirements for doctors from developed countries have been made extremely restrictive. Quite clearly, this is a regressive move as it stymies the growth of the private sector and constrains imports. More importanly, it does not address the underlying cause of the flow of doctors from the public sector to the private sector and from SA abroad.

To the international audience, Argentina has for long been well known for football, tango, high quality beef, beautiful women and relatively less known for cosmetic surgery. When I was in Peru in 2004, I found that some men would colloquially refer to urbane Argentine women as “Barbie Dolls” for their undeniably enchanting cocktail of European and South American features coupled with a terrific sense of style but somewhat disparagingly for their plastic-like (sometimes altered) facial and physical attributes.

In Argentina, there exists a massive domestic market for cosmetic surgery and going under the scalpel is quite accepted in society. So it came as no surprise to read an article in The Post and Courier, on the boom in nip-tuck tourism in Argentina, pegged to the visit of a 59 year old retired airplane employee to Buenos Aires for a hair replacement treatment.

The industry which till now primarily catered to domestic demand is now increasingly courting foreign patients, who are eager to take advantage of a devalued peso to get everything from tummy tucks to hair transplants to dental work and fertility treatment. According to the International Society of Aesthetic Plastic Surgery’s most recent figures used in the article, “Argentina ranks third in the world for cosmetic procedures, roughly 50,000 a year, trailing only Mexico and the US.” In additon, most North Americans find relative comfort in the cultural likeness of upscale Buenos Aires to their own environment back home. Medical visits are  also being made attractive by offers of private tango lessons, visits to Patagonia, Iguazu waterfalls and the wine country of Mendoza.

However, cost continues to be the major factor. Procedures in Argentina tend to be about a third to half the cost in the United States. According to figures provided by the American Society of Plastic Surgeons (ASPS), while the cost of liposuction in the US is $2,223, the same costs $1,200 in Argentina, hotel stay included. Breasts implants cost about $2100 in Argentina compared to $3,373 in the US.  

As is the case with the growth of medical tourism the world over, some doubts remain. Last month, a 27 year old American student died following complications from liposuction. Skeptics also point to the difficulty in follow-up care once the patient leaves the country. There have been numerous cases of plastic surgery having gone horribly wrong, sometimes with fatal consequences. Thus, it becomes very important to check qualifications and experience levels of the operating team or if need be, going through an established medical company as opposed to a fly-by-night operator offering runaway discounts.   

The Palo Alto, California based Institute for the Future (IFTF) has issued a timely warning about the dark side of medical tourism. It takes a lot of searching amongst the generally-glowing articles about the MHTI to find stories that highlight the dark underside of this high-growth industry that is attracting its share of racketeers.

IFTF has profiled an article from the UK’s Guardian newspaper, 20 April 2006: UK transplant patients go to China for organs from executed prisoners.

The relevant text of the article is published below:

The British Transplantation Society said that “an accumulating body of evidence suggests that the organs of executed prisoners are being removed for transplantation without the prior consent of either the prisoner or their family”.

Thousands of organs are thought to be involved in the lucrative trade, it said. Transplant centres, patients, and the Chinese authorities and judiciary could all be implicated in a breach of human rights….

[E]vidence from doctors who have left China suggests that many patients are travelling for kidney or liver transplants, perhaps in desperation because of the shortages of donor organs in their own country. Most patients came from Japan and Korea and there were quite a few reports of Chinese Americans returning to China for their operation, he said.

Websites of Chinese transplant centres openly tout in English for business from foreigners. Although they do not suggest the organs come from executed prisoners, they offer a fast supply - between a week and a maximum of a month for a kidney transplant. One website declares: “Viscera providers can be found immediately!”