Medicine Sans Frontiers

The booming business of health tourism, by Mariel Chow.

Dr. Somasundaram Sathappan - March 14, 12:00 AM

As healthcare costs in first world nations continue to rise, citizens are searching for destinations outside homelands to receive quality healthcare at much lower rates, says the Malaysian Healthcare Tourism Council (MHTC). In 2016, over 11 million travellers left the United States, crossing the globe seeking affordable procedures from fertility treatments, cosmetic operations and dentistry, to orthopaedic and cardiac surgery. As specified by the MHTC website, recent reports by Visa and Oxford Economics state that numbers of medical travellers will continually increase by 25 percent every year for the next decade as competition between countries for health tourists become fiercer. 
South East Asian nations like Malaysia, Thailand and Singapore remain the top ten medical tourism destinations worldwide. It’s not hard to see why. Malaysia, for instance, is globally recognised for its world-class healthcare facilities. Besides being well governed by strict healthcare regulations, stringent standards are likewise set by its Ministry of Health, ensuring consistent quality of care. Furthermore, Malaysia’s specialists are expertly trained by reputable institutions in the United Kingdom, United States and Australia. Notwithstanding honed skills, Malaysian consultants speak multiple languages, allowing better doctor-patient communication. In this article, we dive into the world of international medical travel by speaking to industry experts. In addition to revealing the booming industry’s many driving factors, our experts also provide tips and tricks on choosing the right doctor/travel destination so that one receives and undergoes the best quality healthcare at the most competitive price. 
Malaysian flag
What is Medical Tourism?
Benjamin Philip George (Benjamin), Chief Operating Officer of the medical travel facilitation agency, George Medical Getaway, explains that medical tourism is by and large quite specific. He outlines, “Medical tourism is when patients decide to travel to other countries for healthcare or wellness reasons.” Medical tourism can also be divided into international medical tourism – country-to-country – or domestic travel – within states. While common consensus labels this trend as ‘medical tourism’, reasons for travel aren’t always medical-related (treatment and surgery) as patients also travel for wellness. “This is why we use the term ‘health travel’,” Benjamin says. He continues, “In fact and according to market numbers, data reveals that wellness numbers far exceed medical procedures.” Nonetheless, both medical sects are intertwined as wellness is considered everything outside treatment, but necessary before and after patients under go any procedure. Therefore wellness treatment may include diagnostics, follow-up care, adjunct therapies before and after surgery, and so forth. 
The other reason ‘tourism’ has converted to ‘travel’ is because tourism is commonly related to holidays or vacations. When patients travel, they undergo surgery and experience downtime which often disallows vigorous activity. Consultant Plastic and Reconstructive Surgeon and Chief Executive Officer of George Medical Getaway, Dr. Benjamin George Jr (Dr. George) opines that medical travel extends to patients’ family as well. He explains, “If medical travellers’ family members chose to undergo unplanned, less invasive, ad-hoc treatments while they’re here, then this group can be considered medical tourists, as they don’t experience downtime and are hence able to enjoy holiday activities.” 
Consultant Plastic and Reconstructive Surgeon, Dr Somasundaram Sathappan

A Booming Industry
Before developing nations offered high-quality healthcare, patients from poorer countries flew to first world nations for better care and a wider range of treatments. Now, we are seeing patients from the UK, US and Australia voyaging to Malaysia, India, Thailand, Mexico and Costa Rica for elective and required surgery. The question is, why is this phenomenon taking place, and is it only the result of cheaper prices? Consultant Plastic and Reconstructive Surgeon, Dr. Somasundaram Sathappan (Dr. Soma) explains, “The entire industry stems from the awareness of overseas plastic surgery availability– at a fraction of the cost.” He adds, “While travellers are now globetrotting for all forms of medical treatment, cosmetic surgery was the industry’s initial driver.” In short, once patients realised excellent care could be had in inexpensive regions, individuals seized opportunities of undergoing procedures in Malaysia (for example) as treatments weren’t simply cheaper but outstanding too. 
Besides competitive rates, Benjamin expounds there are different elements that drive medical travel. The reasons are as follows:
1. Accessibility and availability: Patients may choose medical travel as specific procedures aren’t locally permissible. For example, although Malaysia offers exceptional plastic surgery, transgenders may not choose Malaysia as their destination of choice, as sex reassignment surgery isn’t practiced. On the other hand, there are patients who travel to certain nations at higher costs as depth of field differ. Because procedures vary in seriousness and difficulty, there are chances that only a handful of countries offer exclusive treatment types, surgeries or technologies.
2. Quality:Patients may opt for medical travel as quality care in home countries don’t meet world standards. For instance, Malaysia was awarded ‘Health and Medical Tourism Destination of the Year’ in 2015, 2016 and 2017. We’re also accredited by the Joint Commission International, Australian Council on Healthcare Standards, and Malaysian Society for Quality in Health. This is precisely why we’re seeing increasing numbers of Pakistani, Bangladeshi and African patients who desire excellent treatment but have limited access to quality medicine. 
3. Fraction of the Cost:World-class medical management in Malaysia is cheaper than the US by 65 to 80 percent. In fact, American employers are reinsuring themselves, providing employee healthcare benefits which not only cover procedural costs, but business-class flights, five-star accommodation and a holiday to boot. While total costs may seem exorbitant, such added perks are still cheaper than having employees undergo treatment in local hospitals.
4. Advisability: Indonesians (for example) travel to Malaysia because our doctors comprehensively explain procedures. Due to the limited number of surgeons per capita, Indonesian doctors may not have time to painstakingly explain procedures. Therefore many Indonesians are flying to Malaysia for treatment as Malaysian specialists are known for thoroughly explaining procedures’ inner workings, including their pros and cons. This not only emboldens patients, but reinforces peace of mind as well. 

Quality Care, Quality Physicians
The difficulty with medical travel is ensuring quality of care. How can we confirm excellent standards if we aren’t physically there? Dr. George recommends, “Before selecting destinations, research the country’s regulatory boards. Ask yourself what the country’s Ministry of Health is doing in terms of policing healthcare benchmarks.” He adds, “Question a doctor’s experience and qualifications and look into a hospital’s accreditation and nursing standards. While a doctor may be experienced and qualified, good treatment won’t be achieved if hospitals are in poor condition or aren’t accredited.” 
When choosing a doctor, physician or surgeon, research is key, Dr. Soma shares. “All overseas patients must visit a doctor’s website, certifying it is a professional practice,” Dr. Soma recommends. He further advises, “For instance, if patients desire cosmetic surgery in Malaysia, they can investigate a surgeon’s credentials by visiting the Malaysian Medical Council and Malaysian Association of Plastic, Aesthetic and Craniomaxillofacial Surgeons websites.” Once doctors’ qualifications and credentials are confirmed and backed by governmental or non-governmental organisations, patients can further contact physicians through websites, emails or direct phone numbers. For more information, explore the doctor’s educational history, qualifications and success rates. You may even request to speak to a physician’s ex-patients for elevated peace of mind. 
Medical Travel Pitfalls
Like any industry, medical travel is not without its hazards. The problems, according to Dr. Soma, are as follows:
1. Misinformation: Misinformation between international patients and receiving doctors can happen – especially when dealing with complex procedures. If patients’ home country doctors don’t communicate with doctors in receiving countries, mishaps may occur. To avoid problems, guarantee that receiving surgeons have all the information they need, particularly data concerning present diseases, allergies, previous medical procedures and psychiatric history. Current patient photos are likewise needed for assessments of suitability. While images play significant evaluation roles, doctors can only gauge patients’ expectations through face-to-face consultations. Patients must also understand that surgeons may not operate on individuals they’re uncomfortable with – even if travellers have already made the trip.
2. Language barriers:This is a serious issue, says Dr. George and Dr. Soma. The former has even experienced a patient who jumped off the surgical table just before the surgery because all the conversations around him, including instructions by Dr. George to the nurses were in Malay! The disadvantage of language barriers is common among travellers from China, Japan and the Middle East, laments Dr. Soma. When patients don’t understand languages receiving doctors speak, they have difficulties grasping the pros and cons of proposed treatments. If interpreters aren’t provided by hospitals or readily available, misinformation including confusion over consent forms are definite risks. 
3. Consent form misinterpretation: Before signing away, patients must recognise what they’re consenting to. Malaysian consent forms are a mere two-pages long compared to American consent forms, which run over 16 pages. Dr. Soma opines, “Patients vary, people vary, so ensure you fully comprehend procedures before signing on the dotted line.”
4. Necessary follow-up care:Surgeries differ and therefore have varying healing rates, follow-up care and complications. Although patients are only discharged after they’re well enough, some may require supplementary care in homelands. This is precisely why communication between doctors must be constant and consistent.
5. Long-term complications: If complications occur while patients are in receiving countries, they aren’t permitted to depart until problems are resolved. Should complications happen after patients leave, they’ll have to seek emergency medical treatment in home countries and return to receiving countries for corrective surgery. In the event travellers don’t return and opt for local corrective surgery instead, patients need to understand that prices will be accordant to local rates. 
6. International medical litigation: International medical malpractice suits are exceptionally convoluted and difficult. While patients can always sue doctors for malpractice, they’ll have to engage with a lawyer from the receiving country. Secondly, and in Malaysia, international patients are required to pay heavy deposits to the high court before cases are even heard. While these points act as a deterrent against medical litigation, laws differ between countries, so speak to a lawyer before moving forward with international malpractice suits. 
Averting Problems
So that one may avoid aforementioned problems, both Dr. George and Benjamin share one tip: research, research, research. If patients are tech savvy, they’re probably smart enough to Google and filter things down. If patients aren’t technologically-abled with added hindrances of being unable to understand confusing medical jargon, they may find researching treatments, procedures and hospitals problematic. This is precisely why Benjamin and Dr. George advocate medical travel facilitators (MTFs). With facilitators, patients can connect with experts on the ground who can recommend doctors and decipher confusing medical jargon. Though employing facilitators isn’t necessary, it certainly makes pre and post-treatment processes much simpler. As a matter of fact, many medical travel pitfalls can be bypassed should individuals choose good MTFs who have patients’ best interests at heart. Here’s why:
1. The best doctors: Scouring the Internet for doctors is a chore, so why not let someone else do the work? With MTFs, patients are recommended a list of specialists which suit their needs. Besides having established relationships with various health and non-medical service providers, MTFs are able to offer multiple quotations of comprehensive packages at the most competitive price.
2. Better access: Some of the most exasperating aspects of international medical treatment is waiting time and language barriers. You wait for hospital check-ins, you wait for consultations, and in the end, don’t understand a word. With MTFs, facilitators are able to provide better hospital access, good interpreters and expedited consultations or check-ins.
3. Local navigation: Aside from connecting patients with doctors, facilitators can plan supplementary but necessary travel prerequisites. These may include transport, accommodation and even vacation recommendations for friends and family. 
4. Knowing your doctor: Another tricky issue with medical travel is not knowing who your doctor is. Of course, they can claim this, that and the other, but how sure are you of their skills? With MTFs, agents not only share doctors’ qualifications, specialities and success rates, but also directly connect patients and their doctors from home countries with international surgeons of choice.
5. Continuity of care: Continuity of care begins before patients even leave homelands. When doctors from receiving and home countries consistently communicate, success rates increase while complication rates reduce. In instances where patients don’t have personal physicians in home countries, MTFs can connect them with one. Once individuals consult with homeland consultants, physicians in receiving nations will have access to all pre-needed data. After patients are discharged, medical histories will be forwarded back to doctors in home countries for better managements of post-operative care, side effects and possible long-term complications. 
6. Peace of mind: All medical procedures have risks. Because complications are possible – albeit rare, hiring an MTF enhances peace of mind. Besides checking-in on patients to ensure ongoing safety and comfortability, MTFs may also recommend complication insurance (at an added cost). In the odd event travellers experience severe complications before flying home, MTFs may activate the insurance, allowing patients to stay in the country for emergency treatment at no extra cost. 
If complications occur while patients are in receiving countries, they aren't permitted to depart until problems are resolved. Should complications happen after patients leave, they'll have to seek emergency medical treatment in home countries and return to receiving countries for corrective surgery.
How to connect with MTFs
Connecting with MTFs depends on whether patients are searching for specialists in home countries or foreign lands, Benjamin says. “If American patients are undergoing required surgery (cardiac or orthopaedic), they’re linked with MTFs through local brokers, insurance agencies and employers.” This option is regrettably unavailable to those travelling for elective treatments including cosmetic surgery, dentistry or fertility treatments. If patients are self-paying customers, Benjamin recommends connecting with local brokers who can link patients with MTFs in receiving countries. Otherwise, try Googling the International Medical Travel Journal, MHTC and Medical Tourism Association which share lists of credible medical travel facilitators. If more research is needed, try Googling ‘Medical Travel Facilitation’ or ‘Medical Travel Concierge’ for direct links to medical travel facilitation agencies. 

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