Medical Tourism Companies Luring Americans Abroad with Surgery-Vacation Trips

Newspaper article

By: Maria M. Parotin

Date: September 3, 2004

Source: Fort Worth Star—Telegram

About the Author: This article was written by a contributor to the Fort Worth Star—Telegram, a daily newspaper based in Fort Worth, Texas.

INTRODUCTION

Medical tourism is travel to other countries for surgical, dental, or medical treatment, often in combination with a vacation. The phenomenon has been fueled by the growth of cheap international travel, the Internet, and better standards of medical technology and care in many countries. In addition, common medical procedures are sometimes much less costly and more readily available than they are at home.

The vast majority of medical tourists come from the United States, Canada, Great Britain, Western Europe, Australia, or the Middle East—all countries where vacationing is common and there is a high demand for plastic and elective surgery. The most frequent destinations are India, South America, Greece, Turkey, and Eastern Europe. Sometimes the flow of traffic is reversed, and medical tourists visit Great Britain to take advantage of the United Kingdom's free or low-cost National Health Service. With the expansion of the European Union and unrestricted travel between countries, this trend is likely to intensify.

Some countries are both a source of medical tourists and a destination for them; in Germany, for instance, robot-assisted minimally invasive surgery is offered at one center; dental services and plastic surgery are offered at Munich Airport as part of a "fly in, fly out" package.

The article below describes the experience of two fairly typical medical tourists—women who visited Mexico for plastic surgery. They welcomed the chance to recover from their face-lifts in private and pleasant surroundings, a factor that drives many to seek rhinoplasty (nose remodeling), liposuction, breast reduction, and dental procedures abroad.

PRIMARY SOURCE

MEDICAL TOURISM COMPANIES LURING AMERICANS ABROAD WITH SURGERY-VACATION TRIPS

Byline: Maria M. Perotin Fort Worth, Texas— Carolynne Bond Kent and her cousin Patsy embarked on a vacation getaway to the mountains of central Mexico three years ago.

There, the women strolled along cobblestone streets, sampled restaurant dishes, and relaxed in a quaint hacienda.

They also recuperated from the face-lifts that were the real purpose of their trip. Both 69 at the time, the pair traveled to Mexico to have plastic surgery—joining the ranks of "medical tourists" who are venturing outside the United States for cosmetic surgery and other procedures.

The women found a surgeon online at www.faceliftmexico.com, which promotes a 10-day vacation—surgery package in historic San Miguel de Allende, Mexico. And they paid a fraction of the price that doctors would have charged at home.

"I've done a lot of traveling in my life. I wasn't nervous at all," said Patsy, a Texas resident who asked that her last name be withheld. (She wouldn't want people to know she's had a face-lift, after all.)

Although statistics are not available, businesses that market medical trips are turning up all over the globe. Many tout the low price of treatments, boast luxurious accommodations, and advertise attention-grabbing packages—such as "surgeon and safari" expeditions in South Africa or "breast implants and tango" trips to Argentina.

That concerns some U.S. doctors, who worry about the credentials of the foreign surgeons, the sanitary conditions of their operating rooms, and patients' access to follow-up care.

The risks can be significant.

In June, the national Centers for Disease Control and Prevention warned that 12 women had bacterial infections after traveling to the Dominican Republic for "tummy tucks," liposuction, and breast surgeries.

The women—from New York, Massachusetts, North Carolina, Rhode Island, and Puerto Rico—had been treated at various surgery centers in that country's capital city over 10 months. Nine of them became so badly infected that they were later hospitalized.

"People want to go for the deal. They want to go abroad because, quote unquote, 'They can get the same surgery for a reduced price.' Therein is the fallacy," said Rod Rohrich, president of the American Society of Plastic Surgeons. "America has the best health care system in the world."

Kent, of Birmingham, Ala., counters that many countries have well-trained doctors and clean facilities. And she preferred her stint in a Mexican hospital to an outpatient procedure in the United States, she said.

"This was a three-day hospital stay, where you are monitored and all of that constantly," Kent said. "I thought that just sounded a whole lot better."…

For Kent, the trip to Mexico had one notable advantage beyond the low price—discretion.

Kent was able to recover far from home and curious acquaintances when her discolored post-surgery face looked its worst. By the time she returned to Alabama, she was able to hide the remaining bruises with makeup, she said.

"When I finally went out, nobody even noticed," Kent said. "And I didn't tell anybody."

That's a prevalent selling point for many medical tourism packages, which highlight the ease with which patients can disguise their surgeries.

"Why should anyone else have to know or need to know?" asks one travel company that offers cosmetic surgery in Malaysia. "With Beautiful Holidays … you just go away on holiday and return having never looked better before."

Rohrich said some patients return from surgery vacations only to face severe medical complications, including infections from unsterilized surgical equipment, slipped breast implants and loss of skin.

Rohrich receives about a dozen calls each year from victims of botched foreign cosmetic surgeries or from hospital emergency rooms where patients have sought help, he said.

Those patients sometimes must spend more money to undo the damage of the previous procedures, he said. And they often have to persuade U.S. doctors to tackle the complications of another physician's surgery.

"You're putting yourself and your body and your life at incredible risk. Is it worth saving $500 on your face-lift if it could kill you?" Rohrich said. "There are excellent surgeons in Mexico and all these countries. But I can tell you most of them don't have these fly-in, fly-out deals."

Luiz Toledo, a surgeon in Brazil who is active in the International Society of Aesthetic Plastic Surgery, said patients generally look outside their own countries for better-quality services, cheaper prices, or a combination of the two. But he warned against seeking treatment from "cowboys."—untrained doctors with different specialties who perform cosmetic procedures for quick profits.

"A patient may travel to Brazil, Mexico, South Africa, or Costa Rica and have top-quality surgery with a cheaper price, due to the exchange rate or to economic differences between countries," Toledo said in an e-mail. "It is wrong, however, and it should not be encouraged, to travel for surgery only because it is cheap."

Medical tourism companies provide varying amounts of information about their doctors for clients who want to check out the qualifications of their surgeons. Some offer resumes and references from previous clients, while others provide little more than a doctor's name.

While most of the vacation-surgery packages emphasize cosmetic procedures, sponsors of medical tourism promote other services too—including fertility treatments in Barbados, LASIK eye surgery in Malaysia, and heart bypass surgery in Costa Rica.

Plenitas, a 1-year-old company in Argentina, offers more than 20 medical specialties, including cardiology, ophthalmology, dentistry and plastic surgery.

Chief Executive Officer Roberto Gawianski said the company has targeted U.S. clients most aggressively but also draws patients from Canada, Great Britain, Spain and other countries.

So far, Plenitas serves about 10 to 12 patients monthly and has plans to expand further, Gawianski said.

While low-cost plastic surgery—as cheap as $1,000 for liposuction—is most in demand, dental care and gastric banding services are big sellers too, Gawianski said. The company's most popular package: a seven-day "breast implants and tango" trip that includes private Spanish and dance lessons for patients.

One Plenitas client from Los Angeles, who asked to be identified only as Nancy, said she spent the days before her surgery last month skiing, then went sightseeing in Buenos Aires and at Iguazu Falls near the Argentina-Brazil border.

"I was looking to combine the procedure with travel," she said. "I only get so many days off in a year, and I didn't want to spend them laid up in a hotel room."

The 37-year-old executive secretary—who had liposuction of the inner thighs, arms, abdomen and waist—traveled to Thailand for a nose job last year.

This time, she said, she considered returning there or having surgery in Japan or Tijuana, Mexico. But she opted for Plenitas' package because the $2,400 fee was far cheaper than elsewhere.

She didn't contemplate any California surgeons at all.

"Given my income, it would've been prohibitively expensive to do it here in Los Angeles," she said. "So I took to the Internet, like a lot of people do."

Nancy tried to conduct research about her surgeon and the operating facilities before the procedure, but admits she learned little more than his name.

"It was a leap of faith, because I must tell you there wasn't a whole lot of information available on the doctor," she said.

Nonetheless, she said she's satisfied with the results of her surgery—especially because colleagues haven't guessed the true reason for her visit to Argentina this summer.

"Nobody at my office knows. They haven't noticed. They just think I lost a few pounds," she said. "I've got so many pictures taken at Iguazu Falls and taken in front of the presidential palace. People don't suspect that I had time to go into a hospital."…

SIGNIFICANCE

Plastic surgery is still the most common reason people travel abroad for medical treatment. But as the industry expands so, too, do the indications: LASIK surgery (which uses laser treatment to correct vision), infertility treatment, and dental work have become popular choices for medical tourists. Some also travel for more urgent treatments such as joint replacements and heart bypass surgery, often because of long waiting lists for these procedures in the home country. British patients have even been encouraged by their doctors to have joint replacements in France where there is spare capacity. This may save months, if not years, of pain and disability; for many, this makes it worth the cost.

Medical tourism is now a global industry, but its long history began with the pilgrimages made by the ancient Greeks to the famous temple of Asklepios (Asclepius) the healing god, in Epidaurus. Roman Britons traveled to the spa at Bath, and wealthy Europeans have been drawn to spas in Germany, Hungary, and Slovenia since the nineteenth century. Indeed, the spa holiday, a close cousin to medical tourism, is becoming increasingly popular, with far-flung destinations in Sri Lanka and Thailand.

Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia, and Thailand. Others, such as Belgium, Poland, and Singapore have begun to develop their own destinations. Some countries offer specialized packages that reflect their culture and heritage: South Africa, for example, promotes "medical safaris": plastic surgery and a chance to see wildlife. Israel offers infertility treatment along with a tour of religious sites.

India is, however, the leading destination for medical tourism. Under its national health policy, medical treatment for foreign patients is considered an export and eligible for all financial incentives extended to export earnings. The country has also moved into a related area, medical outsourcing, in which subcontractors provide medical services for overstretched systems in other countries. Research suggests that medical tourism could earn India one to two billion U.S. dollars by 2012. The industry is boosted by a large supply of well qualified medical staff and continuing advances in medical technology. One of India's largest centers treated around 60,000 medical tourists between 2001 and 2004.

Naturally, medical tourism has minuses as well as pluses. Tourists may find, for example, that their medical insurance does not cover their treatment, which forces them to pay out of pocket. Many choose to do this for elective or plastic surgery, particularly if the trip costs no more than a regular vacation and insurance would not cover the procedure even if it were performed at home. When serious medical conditions are involved, the investment may be worthwhile in terms of improved health even without help from insurance. This must be weighed, however, against the possible lack of aftercare in some foreign centers, particularly since health systems in foreign countries may not treat complications that arise. In addition, the return trip could pose the danger of deep vein thrombosis (blood clots) if lengthy air travel is attempted too soon after surgery. Many medical tourist destinations also have weaker malpractice systems than the United States and so redress, if things go wrong, is far less likely.

Medical tourism and medical outsourcing sometimes draw resources from the destination country, and may even restrict treatments to the local population. Some medical tourism centers counter this by offering free or low-cost services to locals alongside those for foreigners. As with other Internet-driven international ventures, medical tourism is difficult to regulate. As the industry expands, some countries have set guidelines and regulations for both patients and medical practitioners, while others allow the industry to operate with little oversight.

FURTHER RESOURCES

Periodicals

Bhattacharjee, S. "Noor Fatima, and Medical Tourism." Journal of the Indian Medical Association. (August 2003): 101(8) 497.

Web sites

CBC News Indepth. "Medical Tourism: Need Surgery, Will Travel." 〈http://www.cbc.ca/news/background/healthcare/medicaltourism.html〉 (acccessed November 19, 2005).

Medical Tourism. "Destinations." 〈http://www.medicaltourism.com/destinations.aspx〉 (accessed November 19, 2005).