Health tourism: don't forget your toothbrush…

by Alison Moore ,  Health Service Journal | 2009-01-12

What medical treatment have you had abroad? An emergency trip to hospital for a holiday illness? Or are you one of the rising number of Britons who have travelled overseas specifically to get treatment?

Medical tourism is a growing trend in the developed world. Some estimates put the number of Britons who will travel abroad for planned treatment this year as high as 150,000. Figures from the international passenger survey, which samples people leaving the UK, suggests 77,000 left for medical treatment in 2006.

These figures are dwarfed by the numbers of US citizens who go abroad for treatment, often to get it cheaper than they could at home - sometimes with the support of their health insurers. In 2007, 750,000 are believed to have sought treatment abroad, with some predicting this to rise to 10 million by 2012.

It is a trend that has been helped by the use of the internet to look for overseas care and the improving reputation of some hospitals outside the US and Europe. Increasingly, Asian hospitals are being recognised as centres of excellence and are receiving international accreditation. Bumrungrad International Hospital in Thailand, for example, now treats more than 400,000 overseas patients a year.

The biggest market for UK residents is thought to be in dental work, often in Eastern European countries. Cosmetic surgery, fertility treatment and elective procedures are also common, according to a survey for website Treatment Abroad.

At the moment much of this is funded by the patient, although health insurers do occasionally pay for treatment abroad, for example when a pioneering treatment is not available at home.

Cheaper treatment

A major reason for seeking treatments overseas is lower cost for those not provided or not fully funded by the NHS - such as cosmetic surgery, weight reduction surgery or dental work. Savings compared with paying for private work in the UK are often as much as 50 per cent, even allowing for travel and accommodation costs.

Other patients want to get treatment that is not available in the UK or that would be denied them because of their personal circumstances. Infertility treatment clinics abroad may be cheaper and offer easier access to private treatment than here, where availability of IVF and other fertility treatments is often dictated by where patients live.

"The reason they are being driven abroad is because they should be funded by the NHS [but aren't]," says Laurence Shaw, consultant at the Bridge Clinic in London and spokesman for the British Fertility Society.

Patients may seek fertility treatment which is not available to them in the UK, such as infertility treatment for women in their late fifties and sixties or selecting embryos for non-medical reasons - such as the desire to have a child of a certain sex - which is not permitted in the UK but can be done in some other countries.

Mr Shaw identifies the shortage of donor sperm and eggs as one factor driving patients abroad. This may be to get an ethnic match between patient and donor, or because the removal of anonymity for donors has affected their availability. Other patients may be trying to access new techniques or treatments that are only performed at a few centres or have yet to reach the UK, such as some stem cell treatments.

But a minority of patients will be travelling abroad to pay for elective treatment they could get on the NHS here.

"I really do think people have misconceptions that waiting times are long for everything in the UK, whereas we will be better than many countries in Europe for waiting times," says King's Fund fellow in health policy Tony Harrison.

"There are still people who are not prepared to wait and are happy to pay to go somewhere else," says Keith Pollard, managing director of the firm that runs Treatment Abroad.

And concerns about infection control in the UK can play a factor in patients' decisions to go abroad.

"We had a guy ring up the other day who only wanted to go to Scandinavia or Holland because of their low MRSA rates. A lot of it is Daily Mail driven perception of how bad the NHS is," says Mr Pollard.

But does this increased travel affect the NHS? One obvious impact is patients suffering side-effects or complications of treatment abroad once they return home. It is hard to be specific about how widespread this is (particularly given the difficulty in establishing how many people are receiving treatment abroad) and whether these complications are more common or severe than would be expected from any cohort of patients having these treatments.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons has called for clearer guidance to the NHS on when to treat patients who have problems such as infections and wound breakdowns following cosmetic surgery overseas. It says in 2007 more than 200 patients were seen in NHS hospitals after surgery overseas, of whom three quarters had complications and, of those, 26 per cent needed emergency surgery and a third needed further elective surgery to rectify the problem.

British Association of Aesthetic Plastic Surgery spokesman Patrick Mallucci points to some of the difficulties patients travelling abroad can face, such as finding out about the people who will treat them, language barriers and issues about continuity of care. As some patients are travelling abroad for surgery that will need regular follow-up care, an added complication can be how much information is available about what treatment they have received.

And British Obesity and Metabolic Surgery Society president John Baxter says that although surgery for weight loss is often very good, patients are reluctant to travel again for the aftercare, leading them to turn to the NHS.

Another potential impact on the NHS is from fertility treatment abroad. Women undergoing embryo implantation in the UK are increasingly implanted with just one or two embryos, to avoid multiple births. But some overseas clinics are more willing to transplant up to four, potentially leaving the NHS to cope with the consequences of multiple births, which include greater use of special care baby units and put babies at greater risk of long term health problems.

"Triplet, quadruplet and higher order multiple pregnancies are very challenging high risk pregnancies. National regulatory bodies can be sidestepped by couples desperate for a baby and the myriad of tempting offers of fertility treatments can lead them to serious adverse consequences



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