Do the Risks Outweigh the Benefits of Medical Tourism?

Ooh, this rains on my parade. I was about ready to head to the Philippines for some psychic surgery, and now I'm waffling.

I'm interested to know:

• How do you propose to set about limiting medical tourism?
• How do you propose to prove the origin of any particular bug?
• Your article doesn't carry any analysis of the risks, only suggests that there might be more risk, is it documented?
  

Very good questions. I will express my opinion on the matter.

How do you propose to set about limiting medical tourism?

Where there is a will, there is a way. I am not sure that there is an effective way of limiting medical tourism... How do you determine if someone is traveling for vacation versus surgery? In some cases, it may be easy to tell, but in others, it would be more difficult. I was focusing more on the should it be limited than proposition of how to limit it.

How do you propose to prove the origin of any particular bug?

There are some diseases that are much more prevalent in some countries than others. That being said, there is probably no clear cut way to determine 100% that a specific disease came from a place. Although, it would seem more than a coincidence if someone has a foreign disease and went out of country recently for surgery.

Your article doesn't carry any analysis of the risks, only suggests that there might be more risk, is it documented?

Correct. I didn't dissect the risks. I just wanted to present them and get them out there. I didn't look for documentation or frequency of these occurring risks, but I am sure the information is out there.

"'How do you propose to set about limiting medical tourism?'

"Where there is a will, there is a way. I am not sure that there is an effective way of limiting medical tourism..."

Who's will?

What organization or ruling body shall have the final say on where you receive treatment?

What organization or ruling body shall have the final say on what type of treatment you receive?

What organization or ruling body shall have the final say on who does and who does not get treatment? What must the criteria be?

I should have been more specific... People who really want to go to a different country for medical treatment will find a way to get there.

Why the talk about regulating it?

Why regulate it at all whether it is internal to the country or external?

Obviously, Visas apply just like any trip, but anyone that comes to this country for medical treatment (on their dime) just spends money into our economy.

Yes, there are risks, but any treatment has risks. The buyer needs to do their homework.

I like the free enterprise system. It gives consumers choices and choices make better competitors and better products and services.

Why the talk about regulating it?

The biggest concern I have is that people bring home diseases that spread rapidly due to lack of natural resistance. This burdens the home country, both in time and expense.

No doubt this is a perceived problem. However, the number of normal business and tourist class travelers present the same problem or possibly a bigger problem.

While those travelers may not visit hospitals where the contact risk is higher, the sheer magnitude of those travelers probably statistically makes up for or more likely exceeds the risk of medical tourists.

Just look at the H1N1 flu and how rapidly it spread world wide from just normal travelers.

So far we have seen a few examples cited of the problem, but no real data. We need statistically sound data to either make a case or determine the actual risk factor is not significant. Everything else is just conjecture.

The worry about pandemic disease is a real worry, but I believe that linking this to medical tourism is a misplaced worry. With patients, surgeons, nurses, medical salesmen, members of the World Health Organization and worried relatives of patients hopping to all parts of this globe in just a few hours. Pandemics will happen. New diseases will happen.

The only way to handle these outbreaks are by the due diligence of these very same people and recognizing when and how sterile protocols may have been compromised. By following these protocols it is possible that humanity limited the expansion of H1N1 (the swine flu) pandemic. But like all paths not taken, no one will ever be sure what might have happened if we had not sounded the pandemic alarm.

Please do not think that I am trivializing the death or suffering of anyone who came down with this or any other disease. Each and everyone of them was a tragedy that if I could have, I would have stopped. If I had a real magic wand...

Instead we have to face reality. As much as we try to prevent disease and pandemics, they will still happen. So we have to plan for them to happen and not blame the sick, their family or their caretakers for what happens.

Okay whether a person travels for business or pleasure they may need medical attention at sometime. So what do we do stop that also? So that none of these bugs make it out.

If we did that what about the doctors and scientist that life's work is to combat these types of problems. Tell them if they go they can't come back? And lose their knowledge and skills where the maybe needed next.

War, Disease or Famine sooner or later one of them going to get us. If you increase isolation from others then you increase the chance of it being war. Open the borders then it's disease. With out either happening we may over populate our world beyond is ability to produce food for us. That will lead to war. Catch 22

Personally I hope it's disease. The science of war just creates better killing machines. Medical science improves life.

"That which does not kill us makes us stronger."
Friedrich Nietzsche

This same issue caught media attention in Australia in the last week.

Two complete hospitals are "infected" with a superbug. This has been genetically traced back to a clinic in an overseas country where both were treated.

Now, Australia has to cary the burden of cleaning up those hospitals, treating the infected patients, finding others that are not aware they too were infected overseas and the increased risk to the whole population that has been created.

Australia does have medical agreements with other recognised institutions worldwide for care that is not available here, or where skills are more developed overseas. These patients then receive appropriate post operative care when they return.

Those that choose to go "outside the system" are almost like smugglers, bringing contraband across our borders and compromisingthe health of the whole community.

For me this is a serious concern that while it may not be able to be stopped should be regulated in some way so that the associated risks involved for the whole community can be managed.

Imagine if some of the haemoragic diseases from Africa were to make it into Australia or the USA. The population density and means of spread of those diseases would change the course of history.

hi Jaxy,

The statistical reasons for medical tourism in the survey you quoted do make it look like the majority of this tourism is to fill a genuine need.

Living in Canada, where just about everyone I know is throwing up their hands in despair of getting even the most basic and necessary diagnostic tests and treatments, there is a compelling reason to travel abroad for medical care (usually to the US), if you need it and can afford it.

There are resistant bacteria in hospitals everywhere - you risk that infection by undergoing any hospital procedure and increase your risk if you have to use antibiotic treatments in that environment. The latest gene for resistance may have started in India or Pakistan, but it will only be a few years for most 'superbugs' to find their way around the world. This doesn't depend entirely on hospital stays, either. MRSA for example has become as common in daycare centers as it is in hospitals. Antibiotic resistance genes can even be picked up from food, where the food animals have been chronically dosed with antibiotics and become hosts for resistant strains.

With so many routes for exposure, and as long as there is travel from country to country, there is no way to avoid the migration of antibiotic-resistant bacteria and all the rest. Patients have to be free make their own health decisions. The only business of government or other concerned agencies is to ensure that those decisions are as well-informed as possible.

Governments could be asked to take responsibility for regularly assessing the prevalence of drug-resistant infections in their hospitals, and for making that information public or requiring that a recent assessment is provided to all prospective patients so that they understand and are aware of the risks. The assessment would also be available to other hospitals, so that high risk patients admitted from other hospitals could be quarantined or subject to additional cautions to prevent spreading resistant pathogens.

Ultimately though, a completely different approach to treatment of infectious diseases is going to be required. Antibiotic resistance is inevitable under the present treatment model which acts as a breeding program for resistance. It would be foolish to believe that we can simply continue this without expecting the same result.

Hospitals, and daycares, are also places where the "99.9% effective" cleansers are used regularly and routinely for sanitation, making a strong selection force for the 0.1% not effectively killed. The sanitation products create an empty niche for the resistant strains by continually eliminating all their competitors. The same happens inside the patient's body when given antibiotic treatments that create an empty niche for the resistant strain. Resistant pathogens will continue to emerge and spread under this model, whether there is medical tourism or not.

Superbugs are more likely to develop in parts of the world where antibiotics are used extensively or incorrectly, either for human or animal treatment. Bacteria generally do not evolve protective mechanisms for things they are not normally exposed to. Ergo, one is more likely to encounter superbugs in the US than, say, in Canada.

Here in Panama, medical tourism is a major business. There is a dual medical delivery system, with socialized medicine for the less advantaged, and relatively expensive facilities for the more advantaged- i.e., the tourists who come for treatment. By far, the strongest case for someone to come to Panama for treatment is cost and availability. Even the most expensive procedures here in Panama are less than half what one would pay in the US- in some cases, only 10% of what one would pay in the US. A good deal of the savings comes from the fact that medical malpractice suits are uncommon here, which means doctors spend a whole lot less on their medical insurance than their counterparts in the US. An interesting aspect of medical providers here in Panama- a good number of doctors are educated in North America or Europe. Some of the more popular hospitals for medical tourists are actually extensions of US hospitals (i.e., Johns Hopkins).

While there are tropical diseases to which one could potentially be exposed during a visit to Panama (malaria, dengue fever, hantavirus), tourists are generally not exposed to the vectors in the facilities where they are most likely to be treated.

There is a much greater threat of a superbug migrating to Panama from the US than the other way around...

No need to regulate medical tourism - if someone is fool enough to do it then more power to them.

I have zero interest in 3rd world medical facilities. Spent too many years working in odd places to have any interest in going there for medical treatment.

The rules are not the same! The safety is not the same. The medical training is not the same.

So that means you never go on holidays, outside of your own country. So you'll never have to have travel insurance and you'll never be involved in an accident in a foreign country. So you'll never have to rely on the medical capabilities of that foreign country. But many of us do holiday in foreign countries and, love the experience of other countries, cultures and atmospheres. God forbid us being involved in an accident, we have to rely on whatever medical ability they can offer us.

Why hasn't somebody asked the question, why people do this and, why has it become so popular. It's because in the so called developed world, the medical (caring) profession has become a money making bandwagon. They have truely forgot the reason why the founding fathers of the medical profession, set out oaths. They've become more focused on the coin, rather than the well being of mankind. As they've become relied upon so much, so thay've made us pay. An the introduction of insurance companies, Oh what a wonderful world we live in.

I have traveled extensively all my life - in all parts of the world. There are good doctors many places - there are many more lousy doctors the same places in the developing world. Emergency medical treatment has nothing to do with medical tourism. For elective surgery - if you can't afford it at home, don't do it.

Many places in the 3rd world you don't really have to worry about super bugs - those are generally due to overuse of medicines and cleanliness - not something you typically find in medical tourist destinations. Many corners are cut - cleaning being one.

The medical profession in the 3rd world is hit and miss and often not regulated except by accident.

If you wish to go where you have no real idea of a doctors capabilities except by word of mouth or meaningless reference - go ahead. In most of those countries the doctor has no real responsibility except collecting the cash. Follow up care - how when you are back home?

The blurb above about the medical profession is pure BS for most doctors - except those pushing high volumes of clients or some immigrants from off shore medical schools.

Emergency medical treatment has nothing to do with medical tourism. Of course it does they're the same thing when we're discussing, bring diseases and bugs back from other countries, see OP. It's just that some people have sort medical treatment intentionally and others haven't.

The blurb above about the medical profession is pure BS for most doctors - except those pushing high volumes of clients or some immigrants from off shore medical schools. You must be one of those lucky people, who's in a very comfortable position and in a country where the medical system is good. You should take some time and watch the film 'SICKO' by Micheal Moore. And it's mainly about the so called greatest country in the world. Alot of people think he's a conspiracy theorist, but there must be alot of truth in what he portrays.

You seem to have a bit of a problem with definitions - If you are working or traveling and need emergency care you take it where you can get it. If you get on a plane and go for the express purpose of medical care there it is called medical tourism.

It will be a cold day in Hades before I watch anything produced by M Moore.

The guy is a complete wacko only wanting to kiss the backside of his heroes - Castro & Chavez. Why must there be 'a lot of truth' in what he portrays?

I have seen first class care around the world. In developing countries have seen a lot of doctors that I would not let treat my dog.

I have also seen my old boss jump on a plane and fly to London whenever he had a toothache. Being a billionaire he could have used any doctor he wanted to at home but did he - no way. Same with health care - his mother had cancer and off to Sloan Kettering.

If you are working or traveling and need emergency care you take it where you can get it. So introducing the possibility of returning home with some disease or superbug. It's irrelevant if you intentionally seek medical care abroad, your still exposing the population of your home country.

I have also seen my old boss jump on a plane and fly to London whenever he had a toothache. Being a billionaire he could have used any doctor he wanted to at home but did he - no way. Same with health care - his mother had cancer and off to Sloan Kettering.

This says it all and, that's why you'll never appreciate the point of veiw of anybody who's in a less fortunate position as you. The arrogance of it all, tut tut.

As far as the thread goes I know I need a good deal of dental work that I could get done maybe within my budget in Mexico. I am aware I may end up with a few more gold teeth than I might prefer. Funny how dental care, which is crucial to a long life, and known to be consistently required is rarely included in health plans. It is an elective, sort of, aye.

Is Michael Moore some sort of enemy of yours? Regardless of his views why not take them into account? Certainly at the very least he has some humor about these horrific situations and ways of thinking that go on in our world.

One of Castro's heros was Kennedy.

It's a complicated world and things are always changing.

The Vet that back dated my dog when I was in Canada and leaving with my dog was a friend to me.

Within the US you do have States, which within some the care is widely different. Not much different really than differences between some nations for some health issues.

Moore is not a conspiracy theorist. From his own words in an interview, he is an opportunist. He fully understand what the hot buttons are for the Left/Progressives and as he stated in the interview, he happily gets filthy rich from it.

Unfortunately, Moore has no noble motives for his works and no one has any reason to expect honesty in his assertions. In other words, he is not a credible source for anything.

The issues that were pointed out includes any tourism (not only medical).

The H1N1 exported by the advanced countries to the thirdworld is a case in picture.

Do you think medical tourism should be limited due to the spread of disease from country-to-country?

The obvious answer would be not only medical, but any type of tourism.

And as far as the superbugs are concerned, with due respect to Russ, their origination are as much in developed as in the third world.

for example US, another,

And as far as the aforesaid superbug is concerned, with due respect, the naming of the bug itself is clear about the intentions and also the two antibiotics that the superbug is not resistant to, any guess about the pharma companies who makes it?

and about cleanliness in hospitals

Using disinfectants could help superbug bacteria become resistant not only to the disinfectant itself but to antibiotics, even if they have not been exposed to them, according to a new study from Ireland

another

In a study published in the journal Applied and Environmental Microbiology, researchers at the University of Michigan, reported that they found antibiotic-resistant bacteria in drinking water at several sites in Michigan and Ohio — as well as in source water and water that had gone through treatment plants.

and

While MRSA outbreaks are fairly common in North America, some European countries - including the Netherlands, Finland and Sweden - have been very aggressive in dealing with the bacteria the list goes on. The whole hullabaloo is simply a gimmick to (a) denigrate and (b) to sell a specific range of medicines. After all the first world exported H1N1 have more deaths per day in developing countries than the total number of infections by the above suberbug. So let us not play politics as an engineering community. After all there are much more damaging non-superbugs in life (for example conficker)

If you read correctly I said that the 'super bugs' were of less a problem in the 3rd world.

H1N1 is from where? Check up on that point as you are wrong.

A big problem in parts of the developing world is the quality of drugs - some are equal to anywhere else and many are of between questionable and poor quality - some are even dangerous.

If, for example, the ground water in India or China in areas of drug production were to be tested it would be another scare story. I have seen and read of everything else being dumped and can not imagine the drug companies are any different.

I have come to realize recently that there seems to be an overwhelming human compulsion to regulate the actions of others.

I had a hard slap in the face when I entered my opinion on a friends argument with another friend. Here it goes: "If you had an interesting life, you would not find interest in mine". Man it hurt, it took years to get over it, but, there was more than a grain of truth there.

Are we really discussing another's want to receive medical care as they see fit. Down to its frame, I guess we should regulate the distance a person could travel from their home to receive treatment, I think 5 miles should do it. If what they need or want is not within that 5 miles, maybe we could regulate that it be there next.