From health checks in Thailand to hip replacements in Hungary, overseas treatment is more popular than ever. But is it always advisable? Jenny Southan reports.
In today’s globalised world, it makes sense to look overseas for cheap, immediate medical treatment, especially for those of us who live in countries where the cost of healthcare is painfully high, waiting lists are long and globe-trotting is part of our daily routine.
It’s imperative you do your research, though, because if things go wrong, you could be in a worse position than when you started. Get it right, on the other hand, and you could be on your way to vitality at a fraction of the cost.
The number of UK people travelling overseas for treatment is 70,000 a year, according to treatmentabroad.com – with cosmetic and obesity surgery, dentistry, and fertility treatment being the most popular procedures.
The financial advantages are impossible to ignore – the 2012 Treatment Abroad Medical Tourism Survey found that 71 per cent of 1,000 respondents saved more than £2,000 on medical expenses, while almost 13 per cent saved more than £10,000. The average trip was 16 days, with only three days in hospital, and the most popular countries were Belgium, Hungary, Poland, the Czech Republic and Turkey.
Keith Pollard, managing director of Intuition Communication, which publishes the International Medical Travel Journal (IMTJ) and treatmentabroad.com, says medical travel “has always existed, for the reasons of expertise” and will continue to do so.
“Look at premiership footballers – when they get injured, they don’t necessarily get treated in the UK,” he says. “If the best guy at fixing knees is in Sweden, the footballer gets on a plane. If the best hernia clinic in Europe is at Munich airport, they send them there.”
But he adds: “What’s happened in the past five years is that a lot of attention has been paid to low-cost medical travel – so people are jumping on planes, trains and boats for stuff that you can’t get on the NHS, or treatments you can get somewhere else cheaper.”
Executive health checks are also popular, as Josef Woodman, chief executive of medical guide-book publisher Patients Beyond Borders, points out. “You can get full-blown checks – dental, vision, hearing, even endoscopies and MRIs for your back and neck, as parts of packages that are 70 per cent lower than what you would pay in some of the more expensive healthcare countries. Korea, Malaysia, Turkey and some Latin American countries are really good for this.”
Nowhere is the high cost of healthcare more of an issue than in the US, especially for those whose insurance policies won’t cover the cost of treatment. There are more than 45 million US citizens without medical insurance and when you consider that, according to data provided by Patients Beyond Borders, a coronary artery bypass in the States would cost US$88,000, flying to India, where you could get it for US$9,500, may well be the only way to save your life.
Even though President Barack Obama’s new Affordable Healthcare Act will make treatment cheaper and more accessible when it comes into play in January, one has to wonder how it will affect waiting lists and whether it will really solve the problem. In all likelihood, going abroad will remain an attractive option. In 2007, 750,000 Americans sought help from foreign shores; last year, there were an estimated 1.6 million.
Woodman first got involved with the medical tourism industry when his father went to Mexico to get “a mouthful of new teeth” for US$17,000, against a US$31,000 quote in the US. “Dentistry was just the tip of the iceberg,” he says. “At that time [2000], India had just coined the term ‘medical tourism’ to try to define the phenomenon of a lot of patients coming in from the UK for orthopaedic and cardiology procedures. That’s when the NHS was such a big mess that there were all these waits – 18 to 24 months for speciality care, so they were heading to India where there was good healthcare emerging.”
He adds: “Much was also inbound to the US as it was considered number one in research and all other kinds of care. But a lot of it got knocked down after 9/11, when all the [security] profiling began. The big trend that opened up medical tourism was the rapid rise of quality healthcare in Asia. Alongside this, the internet gave consumers access to information about quality hospitals and places where they could go to gain affordable speciality care.”
Pollard explains that the countries most appropriate to your needs tend to be in your geographical vicinity. “It’s a very regional business. If you are in Australia or New Zealand, the destinations for you are Thailand, Malaysia and Singapore. If you are in the US, you go north or south, so destinations would be Costa Rica, Mexico or Brazil.” In Europe, emerging budget destinations include Latvia, Lithuania, the Czech Republic and Estonia.
So how do you know which clinics, hospitals and doctors are reputable? Jim Tate is president of the Medical Travel Commission (MTC), one of a number of bodies that certifies medical institutions in recognition of the high level of healthcare and support they give. “Just because a hospital may have a very nice website, that doesn’t mean anything,” he says. “You have to look for hospitals that have achieved some kind of international accreditation.”
The JCI (Joint Commission International) is the largest hospital accreditation agency in the world, and is a good place to start – the MTC won’t consider evaluating a facility without it having the JCI’s approval. Founded in 1994, the body now has a presence in over 90 countries with more than 500 approved hospitals, such as the renowned Bumrungrad in Bangkok.
However, even if you have done your homework, there is no guarantee that you won’t face problems, and having to deal with them may be all the more difficult in an unfamiliar country where regulations and the language are different. “If a hospital is serious about attracting international patients, they have to be serious about language and culture,” Tate says. “They have to be able to converse in the two primary languages of medical travellers and provide local newspapers, TV channels and internet access.”
James McDiarmid, consultant plastic surgeon and BAAPS (British Association of Aesthetic Plastic Surgeons) council member, has reservations about people going abroad for cosmetic surgery, explaining that accreditation is only a small part of it.
“There are some expert surgeons out there but it’s very difficult for the patient to find out who is good and who isn’t,” he says. “You can’t tell by looking at the hospital or by how nice the surgeon’s suit is or how much gravitas they appear to have. I had a lady that needed to change her breast implants and she had about the worst possible outcome at what you would have described as a five-star establishment. She saw this very senior guy and he did the kinds of things a first-year trainee in plastic surgery wouldn’t do. In this country, she would have been perfectly entitled to question the doctor’s registration as well as seek compensation.”
Pollard points out: “In the UK, you normally have an agreement that says the hospital will cover you if anything goes wrong or if there are complications that happen within 15, or in some cases 30, days of your surgery. The same will happen in the better clinics abroad. But as with the UK, if something goes wrong outside that time or there is clinical negligence, you are into court and suing people, and that is less straightforward when you are dealing with people in another country.”
Woodman says: “The good news is that I have still yet to encounter a law suit regarding a medical travel patient that experienced a poor outcome. Usually the hospitals make good on it – sometimes even paying for in-home care in the person’s home town, and also these hospitals will give you the royal treatment and make sure you return home safe and sound. Many of them insist that you stay at the hospital or in a recuperation facility or hotel after surgery for 20 days, and by that time you are usually out of the high-risk [zone].”
If you do decide to go for treatment overseas, what advice would the experts give? Woodman says: “Once you get access to a quality doctor and a good hospital, then the risks in medical travel involve complications you might experience on the return home. What we advise is that the patient informs their surgeon and their doctor before they leave, lets them know where they are going and takes all of their paperwork, blood tests, consultations, lab work and X-rays home, so that if there are complications then the doctor has an opportunity to address them.”
Pollard emphasises having an insurance policy that covers medical complications: “If you are going abroad for surgery on your normal annual travel insurance and you miss your flight, the insurance is quite within its rights to say you are not covered because there’s an exclusion – the prime reason for travel is medical.”
He adds that cover has to apply to the doctor, too, and prospective patients should always ask if they have professional liability insurance, which is not compulsory in many countries.
With regard to invasive surgery, McDiarmid says: “Think long and hard – what if it doesn’t work out? Will you pay again in the UK? I would say get your work done in the country you come from so that you can communicate more easily, have more family support and go back to the clinic easily, and then enjoy a nice holiday when everything has settled down.”
Woodman concludes: “A lot of the early publicity around medical travel grew up around tourism – go get a tummy tuck and then take a vacation. We don’t endorse that at all. We ask patients to look at medical travel like business travel, where you have got a job to do, you get into a country, you get your job done and you get out.
“What I wouldn’t want to see is a business trip combined with orthopedics, a hip replacement, or heart surgery – it is hard enough travelling with business objectives, so I think the business traveller should restrict themselves to laser surgery, in-and-out testing such as MRIs, and health screenings.”
READER EXPERIENCES
(from businesstraveller.com/discussion)
Julmops: “Last time I was in India, I needed a crown put on a broken front tooth so decided to give it a go as I was there for five weeks on business. I had four appointments and, at the end, paid 10 per cent of what I was quoted originally in the UK. And to my entire satisfaction.”
LHR_Fan: “My mum kept getting horrendous pains in her legs and knees but was turned away by her GP in the UK. We then went to India – luckily we have family there in the medical profession who had her checked out by an orthopedic surgeon, who advised immediate knee replacement surgery. It cost £9,000 at the time (2005) to get both knees done – the best money we have ever spent.”
Capetonianm: “I considered having a dental implant done in various countries – South Africa, Poland, Hungary, Colombia and Malaysia, having heard good first-hand reports of all. The problem was it was a three-step process spread over about five months, which meant committing to being in specific places at specific times and three return air fares. With an irregular travel schedule, often at short notice, this wasn’t practical. My other concern was that if anything went wrong, it could mean a long, expensive, possibly painful journey across the world to have it fixed. In the end I had it done in France as I was in their social security system and was spending most of my time in European countries. [The result was] excellent, and about 70 per cent of the not inconsiderable cost was refunded.”
IamSpartacus: “I have had dental work done in Mauritius and was thoroughly happy with the results. I can’t remember the exact costs but I certainly saved a lot on the comparable treatment in the UK and had three weeks in the sun to boot.”
FCTraveller: “I suffer from IT Band Syndrome, otherwise known as runner’s knee. I read about a sports clinic in Bordeaux and a surgeon there who was recognised as one of the leading practitioners in the world. I got an appointment fairly quickly. He sent me for an ultrasound immediately, and suggested an ultrasound-guided injection, which could only be done the next morning. Not being French, I had to pay and claim back on my own insurance but this was the cost breakdown – consultation e40, ultrasound examination e45, ultrasound guided injection e80. To have all that done on the NHS would have taken months as it was not a serious case. And having it done privately in the UK would have cost upwards of £1,000.”
petrocs: “Thailand has always treated me well. Bangkok is somewhat cheaper than the UK and much better. My wife and I go to Khon Kaen in the north-east for three to four months every year. I am uninsurable and have had a couple of ‘enforced’ hospital visits. After three visits and several tests, the NHS didn’t know what was wrong. I was already booked to go to Thailand and, after a couple of days, went to the main hospital in the city. Two hours, four tests and an ultrasound later, they diagnosed what was wrong and treated me. It cost me about £45. My other visit was also first class – the hospital was clean, the nurses were uniformed and spotless, and the doctors were excellent and spoke English well.”
CASE STUDY: Grand Resort Bad Ragaz, Switzerland
Just over an hour from Zurich, the sleepy town of Bad Ragaz (resortragaz.ch), in the foothills of the Swiss Alps, has been a medical tourism destination since the 13th century thanks to its proximity to healing thermal mineral springs in Tamina gorge. In the old days, Benedictine monks would lower sick people over the edge on ropes to allow them to bathe in the warm water below, naturally heated to 36.5ºC. Now, visitors can take a dip in more luxurious surroundings at the spa in Grand Resort Bad Ragaz, which pipes water in directly from the source.
The Grand Hotel Quellenhof, one of four hotels in the Grand Resort Bad Ragaz complex, opened in 1869. In 2008, the dedicated Medical Health Centre was expanded and renovated, establishing the resort as a leading medical travel destination. It now provides access to more than 30 doctors specialising in a wide range of areas, from ophthalmology, orthopedics, rheumatology and dermatology to plastic surgery, dentistry, fertility and complementary medicine. The following year, a new SFr 40 million (£27 million) tower was added with 56 cutting-edge Spa Suites and Lofts.
One of the most popular options is a two-day health check-up (SFr 2,450/£1,633), which includes a thorough medical examination, lifestyle assessment, hearing and eyesight tests, screening for skin changes, spinal column check, joint status, central nervous system function check, and cardiovascular, lung function and blood tests. Patients can then pay for additional treatments and diagnostics such as a coloscopy or an ultrasound.
If you have not considered having a health check-up before, you are probably an ideal candidate. Dr Clemens Sieber, resident cardiovascular and lung specialist, says: “The goal is not really to look at people with lung disease after smoking for 40 years – that’s too late. The health check is for people who are healthy or with small problems. The biggest health concerns for men aged 35-55 are hypertension, sleep problems, anxiety disorders, diabetes, weight, lower back pain, dyslipidemia [abnormal fat levels] and hypercholesterolemia [high cholesterol]. The burnout phenomenon is also getting more common – too much travelling, not enough sleep, too much pressure and no time for doctors visits.
“`If you tell people their fitness is only 70 per cent of what it should be, you can kick-start a better lifestyle. I think it makes a difference hearing it from a doctor – especially if you combine it with tests.”
I underwent a cardiovascular test, which involved me being wired up to an ECG machine that measured my blood pressure and heart rate while cycling progressively faster on an exercise bike for ten minutes. I also had a lung function test – breathing in and out of a tube, first normally, then holding my breath, then breathing in and out as deeply as possible – while a computer monitored the results.
The doctors and nurses I met were all very welcoming and professional, and the facilities immaculately clean and modern. I would certainly be interested in doing a more in-depth check-up in the future.
Jenny Southan
Top medical tourism destinations and their areas of expertise
- Antigua - Addiction and recovery
- Barbados - Fertility/IVF
- Brazil - Cosmetic surgery
- Costa Rica - Dentistry
- Hungary - Dentistry
- India - Orthopedics, cardiology
- Israel - Fertility/IVF
- Malaysia - Health screenings
- Mexico - Dentistry, bariatrics
- Singapore - Cancer
- South Africa - Cosmetic surgery, cardiology
- Thailand - Everything from health screenings to gender reassignment
