HealthAbroad.net: Point of View

Still on South Africa, we have some statistics. Albeit old, they’re still a useful indication of the size of the market. “Although South Africa has not yet commissioned an in-depth, formal, independent study on the local Medical Tourism industry and its potential earnings, available statistics show that the country attracted 8,000 patients, generating ZAR 120 million during 2003, evidently showing that there is a market out there.” That’s about USD 16.5 million at 2003 rates.

These are pretty small numbers but it would be interesting to track the growth in this market. South Africa has a highly-acclaimed medical sector but the long distance from North America, Europe and Middle East makes it a difficult place to travel to.

See the full article here.

The same article also quotes research saying that 10 percent of patients in EU countries seek treatment abroad, with an annual spending of Euro 12 Billion. 10,000 patients in the USA seek treatment abroad - an annual spending of USD 4 Billion. 

In a bid to harness its latent potential and intensify its competitive muscle on the world stage, the South African medical tourism industry has recently constituted the Medical Tourism Services Association (MTSA). The body will serve to regulate, promote and market the industry.

Medical tourism is a relatively new phenomenon in South Africa (SA) but the country finds favour with many medical tourists due to cutting edge technology, highly skilled medical professionals, competitive prices and also its cultural affinity to the Western world. Not without reason is SA keen to dip its fingers into the honey pot that is the global medical tourism market currently valued at $ 40 Billion. The move to structure the industry is also necessitated by the stiff competition from Thailand and India, who have been at it for longer.

SA has a long legacy of medical innovation and world-class healthcare in leading medical technologies, expertise and value-for-money attracting foreign clients for a myriad of cosmetic, corrective, dental and other procedures. The country has also been successful at creating a well developed public and private hospital system and South African medical colleges have produced professionals whose qualifications and expertise are well recognised worldwide, (so much so that, SA is now battling brain drain).

Clearly, the benefits that might accrue through medical tourism cannot be seen in isolation, as they will be accompanied by a myriad of spin-off benefits for the entire SA economy. A win-win proposition but how it actually pans out remains to be seen.

A Canton, Ohio, based company is signing a deal with a medical tourism company which would give its employees the option of going to India to receive care for company-insured medical procedures. Pretty amazing huh? This is definately pushing the envelope. So far, we’ve just heard of individuals travelling abroad for medical treatment but this move by this American company could be a harbinger of broad changes in the way companies abroad approach their employees’ medical insurance.
See the full story here

The Rhode Island News journal of May 19 carries a story that should be read by all of us connected to the medical tourism industry in any way. It’s a sobering story about an American individual who was advised to desist from a liposuction operation in her home country in her current condition but who nevertheless proceeded with the operation in India. Result: she died 2 days after the operation in India.

We’ll never know if her death was a freak accident or if Indian doctors at Wockhardt hospital in Mumbai (where her operation was carried out) decided to ignore the risk of the operation and proceed anyway.

Wockhardt Hospital is, incidently, JCI accreditated and is acknowledged to be one of the best healthcare service providers in India. It seems unbelievable that the patient’s doctors would have ignored medical advice in carrying out this operation, but the picture gets murkier who one considers that the deceased’s American doctor advised her to not have the operation until she brought her weight down to a manageable 140 lbs.

Here’s the full story:

Cosmetic surgery overseas ends in death for R.I. woman

Like a growing numer of Americans, Jude Jarvis was attracted by promises of expert care and costs much lower than in the United States.

01:00 AM EDT on Friday, May 19, 2006

BY TOM MOONEY
Journal Staff Writer

Before she flew off to India 13 days ago for cosmetic surgery, Jude Jarvis had consulted a local doctor who explained the realities she faced if she was to have the procedure done here.

Jarvis, 35, and a single mother of three, would have to get her weight below 140 pounds before the doctor would perform the breast reduction and tummy tuck. And there was the matter of cost: $20,000.

“She knew she would never get to 140 pounds and she didn’t have much money,” her sister, Elizabeth Wright, said yesterday. “That’s when I told her about the 60 Minutes show I had seen.” The TV segment highlighted the growing trend of Americans traveling to countries such as India and Thailand for good medical care at a fraction of the cost.

Jarvis, of Scituate, went online and within a few weeks’ time, Wright said, Wockhardt Hospital in Mumbia, as Bombay is now called, had arranged for her visa, to pick her up at the airport, perform the procedures and dote on her for 2 1/2 weeks of recovery — all for $4,000 (not including the $1,000 airfare).

Jarvis flew alone on May 6, her first overseas trip. She had the procedure on May 9. She died Saturday, four days later. Her memorial service is scheduled for today in Narragansett.

Doctors in Mumbai have told Wright in phone conversations that her sister died of a blood clot that traveled to her lungs.

It was unclear when the clot formed, Wright said, or whether it was related to her surgery. Jarvis told her family she had received excellent care before and after her operation, Wright said.

Still, said her sister, “I wish now I never told her about that 60 Minutes show.”

The medical tourism trend has received growing attention.

A Dallas Morning News story in November said the Confederation of Indian Industries estimates that 150,000 foreign patients traveled to India for treatment in 2004. According to one consulting firm, the outsourced medical care could bring India $2.2 billion by 2012.

Indian hospitals advertise for foreign patients on Web sites that champion the skills of their Western-educated doctors and publish testimonials from happy patients who saved thousands of dollars on their hip replacements and face-lifts. The Web sites direct viewers to links for five-star hotels and translator services.

Dr. Patrick Sullivan, a local plastic surgeon and Brown University professor, warns, however, that traveling medical consumers get what they pay for.

“They seem to think they can shop around for things like this like they are buying a car — go to whoever you get the best price from,” he said.

“We’re seeing the complications of people who go outside the country to places where the whole level of care is different — the Caribbean, Mexico, South America. They are having procedures done that have the same words,” said Sullivan, “but the technique used in the operating room might be very different, and the standard of care is very different.”

Once Jarvis contacted doctors in Mumbai, “there was no stopping her,” said her sister. And the hospital seemed to have everything covered.

Jarvis’ only worry, said her sister, was being able to communicate with the Indian driver who would pick her up at the airport. But the hospital eased her concern by giving her his cell phone number so she could contact him ahead of time.

Once at the hospital, Jarvis received a telephone and a computer so she could stay in touch with her family back in Rhode Island.

Wright, of South Kingstown, said her sister was “thrilled” with her Indian doctor and her care after surgery.

The day after the surgery, Jarvis wrote to her sister that nurses were getting her up to walk but the pain, which was expected, was horrible.

“They walked her around for two days and she e-mailed me all the time. Then Friday I was looking for the e-mail and it was not there.”

The hospital, 11 1/2 hours ahead, called Wright Friday night. “They said, ‘Your sister is in critical condition. You need to get the next of kin over here.’ I said, ‘It takes 20 hours to get there, I can’t come right now.’ They called back two hours later and said she didn’t make it.”

“It was a freak accident. I truly believe that,” said Wright. “They did not do a bad operation.”

Wright said her sister’s legacy “is that she was an awesome mother. If you ever met her kids, you would see it.”

The children, Kayla, 15, Nicole, 14, and Paul, 12, attended Scituate schools but are moving to Connecticut to live with their father, Wright said.

Jarvis, who had a previous back operation and was receiving Social Security disability and Medicare assistance, had no life insurance. The family has started a fund to help the children. Donations can be made to the Jude Jarvis Benefit Fund, c/o Webster Bank, 150 Main St., Bristol, CT 06010.

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.

A recent report by RNCOS- Research & Consultancy Outsourcing Services, has reiterated what is quickly becoming common knowledge- that India is becoming the hub for Western tourists seeking chronic or cosmetic surgery. According to the report, in 2005 alone, about 1,53,000 foreigners landed in India fleeing soaring costs and endless waiting lines at home and wanting to avail of comparitively low priced and efficient medical services in India.

The few reasons for the growth in medical tourism are:

1. The reputation earned by Indian medical professionals all over the world. Most Western hospitals are staffed by Indian doctors, nurses and paramedics, who also form the backbone of the Indian private healthcare system.
2. Medical procedures in India cost just a quarter as compared to the West and the quality of attention matches international standards.

As per experts at RNCOS, “The number of foreigners visiting India for medical treatment is growing at the rate of 17% per year and the foreign patients are likely to spend about $2.5 billion on medical treatment in India by the year 2012.” 

Goa, loved by foreigners and Indians for being an enclave of debauchery is also becoming a destination for medical tourists. The Yorkishire Post reports, that a new Bradford based company, Going to Goa, is now is offering its clients flights, luxury accomodation and surgery for a third of the cost of an operation in England.

Jan Bostock, the Company Director of Going to Goa, was inspired to start this venture as he was fed up with people being ripped off for surgical procedures. After doing a quality assessment of the hospitals in Goa, the company zeroed in on the Victor Apollo Hospital. Operations on offer include heart bypasses, knee surgery and dental teatment. A heart bypass costing British Pound 15,000 can be had for British Pound 5,000 at the Apollo.

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.

___

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.

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.   

Off late, a lot is being written about Hungary’s ascendancy as the top destination for dental work. Came across this article in the San Francisco Chronicle, which documents the visit of a Californian, Jim Paggi, to a hi-tech dental clinic in Gyor, Hungary.

The cost of 24 crowns, seven implants, two root canals and two bridges totalled to $15,900. Total cost, including airfare for him and his wife and hotel stay at $52/night would still be less than $20,000. For the same procedures, he would have paid upto $60,000 in the US. With a insurance cover that did not cover implants and even basic dental work, Paggi had a fairly easy call to make.

The article also points out that dental procedures are common choice, “as only 50 percent of Americans have insurance for such care. And those people who are insured often face stiff dental bills.” According to Jell Album, spokesman for Delta Dental of California, the state’s largest dental managed-care company, “Employers generally choose not to cover high-priced cosmetic services, instead offering routine dental coverage as part of the package of health benefits.”

To many, Hungary might seem like a strange choice for a place to get one’s teeth fixed- as the country still remains an unknown quantity, conjuring up images of crude Soviet style dentistry. However, the country’s top-notch dental universities are churning out well trained dentists and medical workers who by creating “islands of excellence” are enhancing the country’s reputation, thereby attracting inadequately insured individuals such as Jim Paggi.