Challenges to Medical Tourism

With all its promise, medical tourism faces significant challenges to its growth: legal discrepancies and recourse for malpractice, ethical issues, lack of standards, health dangers and complicated follow-up care are some if the main ones (Healism). In addition, inferior providers or outright fraud can result in disaster (Thailand Forum).

Legal issues are especially important for patients from the United States, which has the most litigious health care system in the world. Americans are accustomed to suing people and companies when they perceive that they have been wronged. However, if something goes wrong with a procedure abroad, most countries offer very little legal recourse. Each country has a very different legal system, so patients can seek legal recourse in the country in which they are treated, but this is much different from the American system. The timeliness of the court system is far slower in most cases and, even if a tourist were to win a trial (it can take ten years or more), the concept of awards of damages is vastly different. This is a major risk of medical tourism.

The protective laws in a patient’s home country are rarely enforceable in other nations, so in practice, patients who receive poor or damaging medical treatment usually have no legal recourse. Malpractice and negligence by either the individual doctor or the institution are very rarely covered under medical tourism contracts, leaving patients to fend for themselves. In connection to legal risks, health facilities treating medical tourists may lack an adequate complaint policy to deal appropriately and fairly with complaints made by dissatisfied patients.

Medical tourism may introduce ethical issues in provider countries. In India, some argue that a policy of “medical tourism for the classes and health missions for the masses” will lead to a deepening of the inequities already embedded in the health care system. In Thailand, it was stated that, “Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care.” Medical tourism that is focused on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. It is often difficult to differentiate between acceptable medical innovation and unacceptable patient exploitation, when pioneering advanced technologies or “unproven” therapies with patients outside of regular clinical trials. Medical tourism can also raise major ethical issues involving the illegal purchase of organs and tissues for transplantation, which has been alleged in India and China.

Choosing to have medical treatment abroad necessarily means having less information about the proposed provider, which increases the importance of accreditation, evidence-based medicine and quality assurance of the quality of the medical provider. However, it can be difficult to check the qualifications of the doctors, anesthesiologists and other specialized staff at medical facilities that are privately owned and operated.

Medical tourism also carries some health risks that locally provided medical care does not. Some countries, such as India, Malaysia, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery, paratyphoid) as well as mosquito-transmitted diseases, influenza, and tuberculosis. Local diseases could significantly weaken progress or introduce complications. In addition, travelers will be out of their element both during and after the procedure, potentially adding stress to the situation.

Depending on the extent of the surgery, traveling soon after an operation can increase the potential for complications. Long air flights increase the chance of swelling, blood clots and infection. Long flights and decreased mobility in a cramped airline cabin are a known risk factor for developing blood clots in the legs such as venous thrombosis or pulmonary embolus economy class syndrome.

Aftercare can be a significant risk to certain types of procedures from which patients require considerable time to recuperate, and it can be lengthened significantly in case of procedures gone wrong (AOL Health). Once the patient returns home, s/he is far from the provider of the treatment, and physicians in the home country may have a “hands off” attitude, especially when they fear malpractice. Medical accountability is confused in the case of medical tourism. To compound matters, many medical tourism packages provide very little, if any, follow-up care after treatment. The importance of aftercare varies significantly with the procedure. For example, recovery time is usually short for dental work, even when the procedure is relatively invasive. Outpatients can therefore travel, receive dental work and then spend the remainder of their time enjoying a vacation.

Lastly, as with all globalization, medical tourism depends on several industries and conditions, which may fail. The 2002 outbreak of SARS caused international business worldwide to shrink significantly because travel entailed significant risk (Wikipedia). The September 11, 2001 attack had a similar impact on international travel. Medical tourism also depends heavily on rapid, inexpensive air travel, which depends on reasonably priced fuel. Unlike other types of international business, medical tourism requires travel: a doctor cannot operate unless the patient is in the room.

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