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Medical tourism – coming to a place near you?


Sometimes I smugly think that I know a reasonable amount about health care in Canada and elsewhere. Well, it is always good to have one’s smug illusions shattered every once in a while.

When in Europe recently, I was at a presentation by the Turkish government about their focus on “medical tourism” – attracting residents from other countries to Turkey to have their medical needs and wants met.

They are convinced that this business will be an important cog in Turkey’s economy, while at the same time providing a valuable service to foreigners. They say they will be successful because of Turkey’s location (at the crossroads of Europe and Asia, with hundreds of millions of people living less than 3 hours flight away), the long wait times for services in some European countries, the quality and relatively low price of Turkey’s medical services (many of their hospitals are accredited by international organizations) and its natural and historical beauty (why not have a holiday with your family after you have your cataract surgery?).

These folks are serious.

The Turkish Medical Tourism Association (yes, there is such a group!) has produced a comprehensive “Turkey Health Care Guide” which lists the large number of hospitals, clinics and spas eager to welcome foreigners. Although a big part of their market is cosmetic services and spa treatments, they also offer medically necessary treatments such as a heart valve replacement (at a price of $16,950), knee joint replacement ($11,200), cataract surgery ($1,000-2,000), and spinal fusion ($7,125).  You can also have any variety of MRI scans, CT scans and other diagnostic tests.

I must admit I had a variety of strong and somewhat conflicting reactions to their presentation; some rational and some emotional.

First, I was amazed by their seriousness and the resources they plan to commit to this. They showed pictures of health care centres in advanced stages of planning that looked liked vacation theme parks – modern medical facilities located beside a sandy beach surrounded by nice hotels, restaurants and amusement parks for the enjoyment of patients and their families. Turkey seems to be taking the thought that health care can be a driver of the economy very seriously.

Second, I wondered about the practicalities of this if I was a patient. The most obvious concern is quality, but my gut tells me that the hospitals involved are of an international standard. And, I would only go there for discrete procedures – I wouldn’t go to have my chronic disease managed. What about the risks and hassle of travel? If I really need a heart valve replacement, I don’t think I would want the stress of even a 2 hour flight. On the other hand, if there was a 6 month waiting list for a hip replacement or cataract surgery in my region and I could afford the cost of the surgery, why not? It sounds a lot cheaper and nicer than Florida. My main concern would be what would happen if I got a complication while there – who would pay for the management of my blood clot after the surgery? I don’t know the answer to that.

Third, why shouldn’t the Ontario Ministry of Health pay for my cataract surgery elsewhere if I pay for my airfare, the facility is accredited, and the cost is cheaper than in Ontario? This may not be as far fetched as it sounds. Narayana Hrudayalaya, which owns and runs hospitals in India known for their high quality and low cost, has announced a plan to build a large hospital in the Cayman Islands, in partnership with Ascension Health Alliance, the largest Catholic healthcare organization in the United States.

One of the groups they are targeting as clients is Americans on the east coast. Why not Ontarians? If Narayana Hrudayalaya can do procedures that are of similar quality to Ontario at a much lower cost, why not take advantage of that? After all, the Ontario government used to pay for Ontarians to have bariatric surgery in the United States, and paid a higher cost than they would have paid in Ontario.

I don't think having surgery in the Cayman Islands is the same as jumping the queue at home. By going abroad for surgery, I would not be delaying access for anyone else in Ontario nor would I be drawing Ontario physicians out of the limited pool in the public system, as would happen if I had my surgery in a private system in Ontario. One could argue that I would be opening up a slot for other Ontarians and saving the government money at the same time.

However, it's not entirely clear to me what the effects of medical tourism will be for hosting countries like the Cayman Islands.  To better understand these effects, healthydebate.ca has invited researchers from Simon Fraser University's Medical Tourism Research Group to share their insites in a blog later this week.  I look forward to hearing their perspective.

I suspect medical tourism will increase in popularity and become more a part of our lives in the future.  It will be interesting to see if competition from off-shore hospitals changes the way we provide care in Ontario.

Andreas Laupacis is a general internist at St. Michael's Hospital and the editor-in-chief of healthydebate.ca.

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6 comments

  1. Anna Delorme

    Dr. Laupacis,
    you chose an interesting title to your article. It already has! I hadn’t even heard the term medical tourism until CCSVI hit the airwaves and everything else in its way. Your third point states, “Third, why shouldn’t the Ontario Ministry of Health pay for my cataract surgery elsewhere if I pay for my airfare . . . ” I agree. Why shouldn’t OHIP pay for something if it’s actually going to save money? Now, just to stir the pot a bit, why won’t they pay for our treatment for CCSVI? Having blood refluxing back into your brain and spinal cord is not a healthy thing. So until Canada figures out the who, what’s, where’s, why’s and how’s it should be covered by OHIP. It’s a procedure not available in Canada and those of us who want treatment have to leave the country. Now, imagine if it were done in Canada! Now, imagine the cost-saving pleasantries that come with that! In a perfect world, medical tourism wouldn’t exist but in the meantime, I think the province still has some ownership to life saving or treatment-based procedures that cannot be performed in their own back yard. I for one, am not letting my passport expire.

    • Andreas Laupacis

      Hi Anna. I believe that the Ontario Ministry of Health and Long-Term Care (ie taxpayers) should only pay for out of country treatments that have clearly been shown to do more good than harm. You and I differ about venoplasty treatment for CCSVI, where I don’t think that bar has been met.

  2. Suz

    Cross-border health care including medical tourism has gained quite a bit of significance in Europe over the past years. With travelling times being relatively short and wait times varying significantly by country, cross-border health care has grown steadily. And it will probably continue to grow as the new EU directive on patient’s rights in cross-border health care will enter into force in October 2013: http://ec.europa.eu/health/cross_border_care/legislative_framework/index_en.htm This directive attempts to regulate some of the issues raised in your article, such as who pays for the treatment, who is responsible for the quality of care, what happens if something goes wrong during treatment etc.

  3. Michelle Walsh

    They are doing a study at Simon Fraser University about this topic right now. I honestly never even thought of going abroad for a medical procedure until I was put in a situation where I had to and had no other choice because MS patients who have vascular issues have had no other choice Dr. Laucapis. I did not just want to go anywhere. I researched where I wanted to go first because there are alot of places doing these medical procedures who are not up to the North American standards.

  4. Anna Delorme

    Hi Dr. Laupacis,
    I guess we respectfully agree to disagree.
    1. There are many studies out there that have proven it’s safety.
    2. We’re still waiting for our CCSVI trial’s protocol – and it’s starting very soon but no protocol to be found.
    3. I’d like to see the efficacy and safety studies that were thrust upon angioplasty.
    4. Autoimmune has not been proven either yet an entire industry has been built around this. Not sure how deaths from drugs prove that they are safer than venous angioplasty.
    I digress on medical tourism but thought some points were important to be made.

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