who have proceeded to this point indeed may wonder why anyone would
their home and the medical care system that they were used to and seek help
someplace else, often thousands of miles away. Readers also know the answer in
that to a greater of lesser extent, the medical care systems that are presently
in place all over the world do not always work the way they are supposed to.
They may be inadequately funded (as is often claimed in the UK) or they may not
cover all the citizens that they should (as is definitely the case in the USA).
These deficiencies often result in waiting list (UK) or high co-payments (USA)
or the patient having to pay completely (as is the case of many cosmetic
procedures in the USA). Believe it or not, but the World Tourism Organization
in 2005 estimated at about 100 million patients crossed national borders to
receive medical care and spent 60 billion dollars to get it. Amazing, literally
these staggering figures, it is important to differentiate that part of the
Travel that is
obligatory and that part that is elective. As Dr. Jones and I noted in our
paper, travel that deals with reproduction is often elective (although some say
that it will soon be obligatory). In all probability, it began in the early 70s
when laws regulating the termination of pregnancy forced unknown thousands of
women who desired pregnancy termination to travel to countries where this
operation was legal. This circumstance was certainly well known in the United
States before the Row-Wade decision of the early 1970s that made abortion legal
throughout the country.
women had been traveling from the US to other countries for in-vitro
fertilization and other assisted reproductive therapies because the cost of
such treatments is so high (approximately $10,000 per cycle, on average) and
some insurance plans do not cover it.
examples of elective tourism include those patients who want cosmetic plastic
surgery or knee replacements but either have no insurance or cannot afford the
high co-payments. What would you do if you were offered the same operation at a
greatly reduced price in Thailand or India that included your airfare and hotel
accommodations through the early recuperation and allowed you to take a
companion as well. You probably would think long and hard for reasons why not
to take this offer, if you could be persuaded that the quality of care was
comparable to what you would get at home. Well, the quality of care in many of
the centers that accept foreign patients and indeed seek them out is quite
similar to that of this country because the doctors were trained here in the US
or the UK and because many of the large University Hospitals are sponsoring the
clinics outside the US and lending a hand at supervision.
is the involvement of the large US institutions that is the forerunner for the
obligatory outsourcing. Consider if you were a large US insurance company that
paid for 10,000 knee replacements annually at a great cost. Would you not
consider outsourcing to a clinic supervised by a US institution of quality
where the entire procedure, including airfare for two and hotel accommodations
would cost 60% of the US cost, or even 70-80%? As they say in business, a
savings is a savings is a savings.
case any reader is stimulated to read further, there are many sources that one
can turn to using PUB MED on the computer and typing in the key words “medical
outsourcing”. It is important to remember, however, that this is an area of
medicine that, at present, is totally unregulated. Anyone considering doing
this must check out the success rates of the institution that is being considered
as well as their complication rates and, in the case of serious operations,
their mortality rate from this operation.
Jones, C. and Keith, LG. Medical Tourism and Reproductive Outsourcing:
Dawning of a New Age. Int. J. Fert and Women’s Med. Vol. 53 (Jan/Feb 2007).