Medical tourism: implications for general practice

Transcription

1 Medical tourism: implications for general practice Assoc. Prof. Brent Lovelock Department of Tourism Dr Kirsten Lovelock Department of Public Health, Wgtn

2 Definition Medical tourism is the practice whereby individuals travel across national borders with the intention of receiving medical care

3 Scope Cosmetic surgery (breast, face, liposuction) Dentistry (cosmetic and reconstruction) Cardiology/cardiac surgery (by-pass, valve replacement) Orthopaedic surgery (hip replacement, resurfacing, knee replacement, joint surgery) Bariatric surgery (gastric by-pass, gastric banding) Fertility/reproductive system (IVF, gender reassignment) Organ, cell and tissue transplantation (organ transplantation; stem cell) Eye surgery Diagnostics and check-ups.

4 Destinations

5 Costs USA India Thailand Singapore Heart bypass 113,000 10,000 13,000 20,000 Hip replacement 47,000 9,000 12,000 11,000 Spinal fusion 43,000 5,500 7,000 9,000 Gastric bypass 35,000 11,000 15,000 20,000 Rhinoplasty 4,500 2,000 2,500 4,375 Breast implants 6,000 2,200 2,600 8,000 US dollars; Lunt et al 2011

6 Scale Somewhere between 60,000 and 50 million medical tourists! US$60B industry (Deloitte 2007)

7 Demand side drivers Changes to domestic health systems Familiarity Availability Cost Quality Bioethical legislation (Glinos et al 2006) Privacy Tourism

8 Why people do medical tourism Most advanced technology Better quality care Quicker access Lower cost 32 McKinsey 2008

9 Decision making Internet Media Networks- professional, friends and family We need to know more about how individuals access, process and judge medical tourist information they retrieve given such information may be confusing, overwhelming, and even contradictory (Lunt et al 2011)

10 Quality of information Direct-to-Consumer sales model A study using the search term breast augmentation located 130 sites and concluded that 34% of these sites contained information that was either false or misleading (Jejurikar et al., 2002).

11 Quality of care, clinical outcomes lack of comparative quality and safety data lack of information on infection rates for overseas institutions lack of reporting of adverse events evidence of clinical outcomes is limited Travel component poses additional risk

12 Continuity of care patient follow-up by providers is rare

13 Liability and redress Differences in standards and regulations Difference in legal liability Lack of knowledge of how to pursue a complaint Jurisdiction legal disclaimers

14 Implications for health systems at home Costs of emergency or remedial treatment Infection outbreaks E.g. Superbug NDM-1 [New Delhi metallo-betalactamase] Impact on private health sector exacerbating two-tier system? (Lunt et al 2011) Savings for public health systems- from outsourcing? (Smith et al 2011) Potentially drive down costs in domestic health systems? (Herrick 2007)

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16 Ethical issues Some procedures illegal in home country Or experimental E.g. rewarded kidney donation

17 Cases from our study Qualitative study of New Zealanders who had travelled abroad for medical treatment.

18 Rob : 40 yrs, Auckland Procedure: Ear pinning Destination: Thailand Chris was travelling to Thailand with his wife, who was undergoing a breast augmentation, so decided to get his ears done too. Cost: $5500 for both airfares, accommodation and holiday expenses, plus his surgery ($2000) NZ quote $6500. I d definitely go overseas because you get a holiday out of it, and you still get a cheap operation Didn t talk to his GP

19 Jane : 42yrs, Auckland Procedure: PET scans for family member who had a malignant neuroendocrine tumour Destination: Australia Family member Individual had surgery in NZ. Yearly PET scans recommended Travel necessary as radio-nucleotide has a very short half life, and cant be used in NZ Travel and scans covered through health insurance

20 Suzanne : 61 yrs, Auckland Procedure: Full face lift Destination: Malaysia Chose Malaysia because had never been to Kuala Lumpur Booked procedure through Beautiful You Holidays Cost was $7000 c.f. $30,000 in Australia. Could have recovery time while away and not have to go through the why I ve been away questions Chose provider on basis that they had worked on the Malaysian Royal Family Didn t tell GP

21 Alan 28yrs Auckland Procedure: Blepharoplasty Destination: Thailand Alan walked in off the street to a clinic in Phuket Has had three rounds of revision surgery/treatment in Australia (all failed) Currently having more corrective work done in NZ Complete disaster... Cost thousands, and not covered by ACC Lost all confidence, emotionally devastating,..

22 Bob 75yrs, Central NI Procedures: Cardiac ablation Destination: France Searched internet, leading expert in France Procedure (at the time) was not available in NZ Specialist (Auckland) said there is no procedure, you ve got it for life, fella Specialist: Why do you want to have a froggy poking around in your heart for? GP pushed the idea and acted as liaison with France

23 Paul, 59yrs, Auckland Procedure: cardiac ablation Destinations: Italy, France At the time there was only one person in NZ, who was just starting to do the procedure Paul wanted the best, and undertook an internet, finding a provider in Milan. But the procedure didn t work, and his condition returned on arrival back in NZ Claimed a success rate of 80% but that turned out to be only 12%... Xxxxx was a charlatan No evidence that he had actually done anything

24 Karmel 44 yrs, Wellington Procedure: IVF Destination: India Grew up in India. Married again at 40yrs, premature menopause Did not meet criteria for public funded IVF in NZ Couldn t afford private $12,000 per treatment In India- cost $7000 incl airfares, travel around India, treatment and medication Needed a donor egg- availability and strict criteria NZ GP didn t want to know anything about it

25 Vijay 48yrs, Auckland Procedure: Polycystic kidney treatment Destination: Thailand, India Very negative experience with NZ public health system Travelled to Thailand where a friend worked and recommended some doctors But not happy with culture and language there So flew on to India (where grew up) and had operation successfully there GP was supportive of travel for treatment

26 Jack 58 yrs Dunedin Procedure: mitral valve replacement Destination: India Prognosis 2 yrs to live, could get public funded surgery in NZ, but internet search revealed that in Dunedin they cut you open c.f. overseas you can have microsurgery Internet search: US $100,000; Singapore $40,000; India $10,000 (final cost was $12,000) Google: 5 hospitals in Delhi; 4 in Chennai; 3 in Mumbai. Infection in wound- 3 days in hospital in NZ

27 Implications for GPs 1. Inadequate regulation within the industry 2. Lack of systematic reporting of clinical outcomes. 3. Replacement of clinical decisions with financial ones 4. Exposure to new health and safety risks 5. Threats to informational continuity of care 6. Provision of follow-up care and monitoring happens at home 7. Procedures might be illegal or untested (Crooks and Snyder 2011)

28 Critical questions for GPs Should I support my patient s medical tourism? How much should I be involved? Will my involvement implicate me if anything goes wrong? Shouldn t the specialist play a role rather than me? If something goes wrong, how can I best support my patient?

29 Where do GPs fit?

30 GPs potential roles decision-making stage strategies for minimizing health risks medical records follow-up care