The tragedy involving four Americans who were recently kidnapped – and two of them murdered – while seeking plastic surgery in Mexico has renewed the discussion of “medical tourism”, a term that, in my view, implies that the trip was recreational and fun. I prefer the term “foreign medical travel” and would say that these Americans’ travel abroad should remind us how inaccessible health care is here and the lengths people will go to get the care they want or need.
I prefer the term “foreign medical travel” and argue that traveling abroad should remind us how inaccessible health care is here.
It’s not just about plastic surgery: Americans look abroad for a wide range of treatments, from dental care and hip replacements to fertility treatments, organ transplants and cardiovascular care. For the 30 million Americans without health insurance, such procedures may be out of your price range here in the United States.
And even those who have insurance may find that they can get the care they seek cheaper or more quickly in another country.
A root canal in Hungary or Vietnam, for example, can cost a quarter of what the procedure costs in the United States. The same goes for an angioplasty in Malaysia.
My cousin, Jessica Koller Gorham, a bariatric surgeon at Ochsner Health in New Orleans, told me that Louisiana’s state plan only covers bariatric surgery for 300 state-insured employees per year statewide. The waiting list for weight reduction surgery, which has lasted three years, is growing. “It’s crazy,” she said. “So what do some of these people do? Mexico is not far away. Traveling for medical care is often a desperate measure for anyone who has tried the normal path and encountered only barriers.
However, outside medical travel can come with numerous risks. Quality and safety standards, licensing, accreditation, and clinical criteria for receiving procedures are not consistent across countries and hospitals. If surgeries are performed under substandard conditions, for example, the risk of poor results or complications is greater. Some people may leave the US in search of treatments that have not been approved in the US because they are considered experimental and risky.
But these risks don’t begin or end with the surgery itself. A patient’s medical records will not necessarily be accessible to a surgeon abroad, and doctors here who treat those who have had surgery abroad will not always have a complete understanding of what a patient has had abroad and whether there were any known complications. People who perform procedures close to home usually have a follow-up appointment with the surgeon or clinic that performed the procedure. Postoperative consultations are not always possible for those who have traveled abroad.
Americans may feel they have little legal recourse if a medical team abroad makes a mistake during surgery.
Americans may feel they have little legal recourse if a medical team abroad makes a mistake during surgery. Surgery can put the patient at risk for blood clots, as can sitting still for hours in, say, a car or plane. Traveling abroad for surgery, then, increases the risk of such a complication.
In other words, traveling for medical care has far more implications than lower costs and more inconvenience. It means taking a range of risks, and the costs of those risks have an impact on individuals seeking care, their families and our health care system.
Even before the recent kidnappings and murders in Mexico, healthcare communities in the United States were already talking a lot about establishing guidelines on medical tourism to improve standards and patient safety. The Centers for Disease Control and Prevention already has several guidelines for people considering outside medical travel. These include researching the health facility’s reputation and quality, discussing planned care with health providers here, traveling with a complete set of medical records, purchasing travel insurance that includes emergency evacuation to the US if necessary, obtain medical records from the treatment facility prior to returning to the US and arrange follow-up care at home prior to the procedure.
During post-procedure travel, it is important to prevent blood clots by keeping moving, for example doing arm or leg exercises or taking walks down the hall. And, as the tragedy that befell Americans seeking care in Mexico reminds us, it is also important to consult the safety advisories for travel to the region where care is sought.
Offsite medical travel is already a global industry valued at hundreds of billions of dollars and is set to grow dramatically over the next five years, particularly for cardiovascular and bariatric procedures. Obviously, most of those who go abroad will not become victims of crime, but we must still find it tragic that the inaccessibility and high cost of health care at home continues to drive so many Americans to take such extraordinary steps in seeking care.