HealthAbroad.net: Point of View

Michael Moore is at it again, for better or for worse. Sicko, his new flick on the state of the American healthcare system is creating quite a media buzz at Cannes. Knowing that he is a bit of a rabble rouser and enjoys getting under the skin of his detractors, this new production is surely going to start a fiery debate. So put on the warpaint and please don’t bring a knife to a gun fight!

Under its “Comment is Free” section, The Guardian carries an interesting piece on his film. The views expressed are solely of the writers and we do not subscribe to or reject them. This is only an FYI.

A few numbers from the article-

1. 50 million Americans have no healthcover
2. 250 million American who do have healthcover are denied treatment when they need it.

I personally can’t wait to see the film. Watch the official trailer here.

Basic but good background resource. Some good links down at the bottom. Check here.

Business 2.0 magazine says that third-party medical tourism facilitators are raking in the moolah helping Americans go abroad for high quality but cheaper medical treatment. After all, there is little that American consumers wont leave home for if the price is right.   

Americans spend more than $570 billion at US Hospitals annually. Faced with spiralling healthcare costs, individuals and businesses are looking overseas for medical treatment. This year alone, upwards of 500,000 Americans are expected to travel abroad to get their bodies fixed, at prices 30 to 80 percent less than at home. Closer to home, Costa Rica and the Dominican Republic have become top destinations. Further away, India, Philippines and Thailand are competing for a piece of the pie. According to David Hancock, author of The Complete Medical Tourist, Americans are expected to help turn global medical tourism into a $40 billion-a-year industry by 2010.

Those who also stand to gain from this phenomenon are not only the hospitals and the patients but also medical tourism agencies. These companies take on the burden of doing the research and finding suitable hospitals, scheduling surgeries, buying airline tickets, reserving hotel rooms and even planning sightseeing tours for the patients, all for a hefty fee. 

These days many top hospitals in tune with medical tourism have created in-house departments responsible for advertising, outreach and securing patients. However, the market being big and varied, many American entrepreneurs are beginning to fill the vaccum by establishing partnerships with foreign hospitals.

According to the article, the top places for surgery are-

Teeth in Hungary- Quality dental care and $35 one-way fares to Budapest have opened up this market to U.K. clients.

Heart in Malaysia- A hot spot for advanced heart care, its doctors open up clogged blood vessels and replace worn valves with robotic assistance.

Nose in Costa Rica- With its abundance of U.S.-trained plastic surgeons, Costa Rica is known as the Beverly Hills of Central America.

Body sculpting in Brazil- The country’s body-sculpting prowess at liposuction and excess skin removal spawned a national magazine on the subject, Plastic & Beauty.

Hips in India- Hospitals here have pioneered hip resurfacing, a less costly alternative to hip replacement.

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.

Fantastic article in The Guardian on the growth in nip and tuck tourism in South America and how Brazil is gaining ascendancy in the field. Considering how little is written about the medical tourism industry in South America, this is a much needed article. Having spent time in Peru, I can vouch for the fact that medical tourism is already massive and growing in South American countries particularly Argentina, Brazil and some Central American nations. Why they loose out in coverage is possibly due to the language barrier as a result of which the local media machinery does not feed into the mainstream English language media.

“For decades Brazil has been considered a thriving centre for cosmetic surgery, and it is now at the heart of a growing wave of surgery tourism, with foreigners jetting in for a few days on the cutting board and a week’s recuperation on the beach. After the United States, home to 5,000 registered cosmetic surgeons, Brazil comes in a close second, with around 4,000.”

The Brazilian culture of sun, sand and samba and a general acceptance of plastic surgery in society, means that there is a thriving domestic market for cosmetic surgery. According to the article, although figures are hard to come by the American Society for Aesthetic Plastic Surgery says that Brazil is not too far behind the $12.4 billion Americans spent on plastic surgery in 2005.

With the increasing popularity of cosmetic surgery in Brazil and aided by the advent of new techniques such as “minimal incision” and “less invasive” operations, “walk-in clinics are starting to democratise access to cosmetic surgery.”

Brazil has had a headstart on the US in terms of new techniques for cosmetic surgery. For example, silicone breat implants, outlawed in the US for 10 years, have been used in Brazil since 1993.

The article winds up with a list of the new procedures being practiced in Brazil.

Threadlift- The new walk-in answer to a facelift. Making a small incision around the temple with local anaesthetic, the surgeon implants a series of threads, tightening loose skin. The operation takes about an hour and is said to be like having a tiny “umbrella” opened under your skin.

Liposelection- Brother of liposuction, which uses ultrasound to reshape knees, buttocks, hips and “male breasts”. The unwanted fat is liquefied and removed causing, it is claimed, “minimal pain, swelling and bruising”.

Internal bras- Developed in Brazil since 1988, the internal bra is part of the new wave of “minimal scar” surgery. The surgeon implants a small piece of gauze under the skin, which lifts the breast as if the patient was permanently wearing a bra.

Jet peel skin rejuvenation- Skin rejuvenation promises to “pressure wash” your skin in a series of quick, “virtually painless” sessions. Regular “maintenance” sessions are required so as not to lose “skin clarity” its makers say.

Words of Prathap C. Reddy, founder of Apollo Hospitals, one of the biggest private health care providers in Asia in an article in The Washington Post in late 2004.

Bless Google Alerts for pulling up this piece by the brilliant John Lancaster. This is one of the first articles written by a western broadsheet on the growth and potential of MHTI in India. The corro bases his story around the case study of one Howard Staab who chose a $10,000 treatment for a life threatening heart condition over a $200,000 bill for the same treatment in the US. Smart guy.

Aside from the usual lyrical that we have come to associate with articles written on the Indian MHTI, Lancaster raises some important points which I paraphrase here.

• The growth in medical tourism is another example of how India is cashing in on the growing integration of world economies. MHTI is imitating the banking and insurance sectors. Good service at a third of the prices.
• Even as medical tourism grows, it is still early days for the industry as most of the foreigners treated in India come from developing countries in Asia, Africa or the Middle East. Travel from US and Europe involves considerable distance and time and thus is an impediment.
• In addition and rather importantly, India continues to suffer from the image of poverty and deprivation. So, the idea of getting a top notch medical aid in a country with creaking infrastructure and rampant poverty is hard to fathom for most Westerners.
• The Indian healthcare system is hardly a model, with only about 4 doctors per 10,000 people. The public health care system is derelict and inequitable at best.
• The land of byzantine complexity and contradictions that is India, the country also offers a growing number of “centers of excellence” which are armed to the teeth with cutting edge equipment and staffed with highly qualified medical staff trained in the West.

In the animal farm, India is perhaps a bumbling elephant. It coats itself with mud only to clean with water, to be followed by another coat of mud. The final word goes to Anupam Sibal, a British trained paediatrician and Apollo’s director of medical services- “”Nobody even questions the capability of an Indian doctor, because there isn’t a big hospital in the United States where there isn’t an Indian doctor working.”

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.

Medical tourism is a threat to American hospitals and medicare. This, according to a Fortune 500 report ”The Five Most Dangerous Trends Facing Hospitals.”

2. Cutthroat competition to our medical centers include medical tourism. Medicare and Medicaid recent reimbursement reductions have made it harder for medical centers to survive. Competition from diagnostic testing facilities, ambulatory surgery centers and specialty hospitals are growing at record rates. India has recently become an early threat with two hospitals that have been approved by the JHACO.  

Experts also predict an estimated shortage of 150,000 to 200,000 beds nationwide by 2012 because of profitability issues.

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The report lists the five most dangerous trends as:

1. Bottom line performance is not improving. Efficiency and cost-cutting policies are not working. While hospitals have been going out of business at a rate of one hospital every eight days for the last 30 years, the bankruptcy trend has started to accelerate in 2005.
2. Cutthroat competition to our medical centers include medical tourism. Medicare and Medicaid recent reimbursement reductions have made it harder for medical centers to survive. Competition from diagnostic testing facilities, ambulatory surgery centers and specialty hospitals are growing at record rates. India has recently become an early threat with two hospitals that have been approved by the JHACO.
3. Public is losing confidence in our hospitals. Thirty-five percent of patients indicate a likelihood of not returning to the same hospital. Forty-one percent wouldn’t recommend a hospital to their family.
4. Staff satisfaction is low. Nursing shortage of more than one million nurses, as well as significant shortages in pharmacists, lab technicians and other technical employees are expected by 2010. The hospital working environment is a key contributor to the 20 percent average burnout and staff turnover.
5. Lawsuits are on the rise. Medical malpractice has grown at an annual rate of 30 percent faster than all other U.S. tort cases. The average malpractice settlement more than tripled from $95,000 in 1986 to $320,000 in 2002.

The Hospital CEO Forum was created to improve on the education model that teaches hospital executives how to survive in a tough economy, improve patient outcomes, mitigate staff stress, reduce medical errors and improve bottom lines.

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!”