Medical tourism warts-and-all

Medical tourism warts-and-all

By Libby Peacock


Article from: The Australian


LINDA Beier, an expatriate living in Hong Kong, was unhappy with the appearance of her teeth, so when she had the chance to join a friend for a 10-day break in Thailand she included a visit to a well-known Bangkok dental practice, where the problem was fixed for a fraction of the cost in her adopted home.
Beier's dental procedure was just a tiny cog in the global medical tourism wheel which, according to some estimates, is a $50 billion global industry.

Several hospitals in Asia have carved out such outstanding reputations that medical tourism has become a big money-spinner; the typical combined hospital and doctors' charges are 60 per cent to 85 per cent lower than those in, say, US hospitals.

In Singapore and Thailand, government agencies have been set up to help market their expertise globally. Medical travel agencies have sprung up and top Asian hospitals routinely have international desks and services to assist overseas patients with everything from doctors' appointments to accommodation.

Thailand
Bangkok's Bumrungrad International Hospital has won international acclaim and is Thailand's best-known facility for health tourism. It was the first hospital in Asia, and the only one in Thailand, to be accredited by the US-based Joint Commission International, an organisation aiming to elevate healthcare delivery standards through an evaluation and accreditation process.

Last year, 435,000 international patients from more than 150 countries were treated at Bumrungrad, with surgeries ranging from comprehensive check-ups and cardiac surgery to cancer treatment and plastic surgery. An elective coronary artery bypass operation that would typically cost $70,000 is about one-quarter of that fee at Bumrungrad.

The hospital's group marketing director Ruben Toral says: "We deliver a Mercedes product at a Toyota price." He's referring to the three things Bumrungrad prides itself on: high-quality, international-standard medical services, immediate access to those services and specialists, and affordable prices.

Mr Toral says the hospital is a one-stop medical centre with more than 900 internationally trained medical specialists under one roof. Patients arriving for treatment might well be guests checking in at a five-star hotel; there are concierge-style services and an electronic medical-records system that eliminates paper and waiting.

Like other top Asian hospitals, Bumrungrad works with the travel industry to promote medical tourism and the hospital has a partnership with Diethelm Travel, Thailand's largest inbound tour operator, which has an office in the hospital; the hospital also has a new kiosk at Bangkok's international airport.

All Bumrungrad's doctors are Thai, but more than half have international training or overseas board certification.

Another Thai institution providing international services is the Bangkok International Hospital, which boasts a considerable portion of foreign patients. Its International Medical Centre features a team of multilingual interpreters.

Also in Bangkok, the BNH Hospital offers a range of medical services, from orthopedic surgery and ophthalmology to pediatrics. Various check-up programs are on offer for set package prices (a general heart check-up including a chest X-ray, electrocardiogram, a blood test and tests for blood pressure and diabetes costs the promotional fee of $165 until June 30). The hospital's International Travel Medicine Clinic provides full medical services and immunisations and the "first comprehensive spine centre in Thailand".

Southern Thailand's Phuket may be famous for its beaches and warm seas, but to some tourists it has another attraction: sex-change surgery. (This is one of the top 10 procedures attracting foreign patients to Thailand.) The Bangkok Phuket Hospital is part of the Bangkok Hospital Group, a network of 15 private hospitals. The hospital offers sexual reassignment surgery, as well as extensive health-check facilities (it has the equipment to perform full-body CT scans and 4D ultrasounds). Years ago the hospital set up a subsidiary travel agency, Phuket Health and Travel, offering packages for procedures such as plastic surgery, dialysis, hip or knee replacements and annual check-ups.

Singapore
Singapore is another player in the Asian medical tourism market, which is unsurprising given the super-efficient city-state's reputation for sophisticated facilities and advanced technology. Critics say costs are 30 per cent to 50 per cent higher than those in Thailand but, even so, they remain appreciably lower than in the US and Australia.

In 2003, Singapore created Singapore Medicine, a government-industry partnership to develop Singapore as an international hub for medical travellers, research, conventions and education.

According to Singapore Medicine director Jason Yap, Singapore received 374,000 healthcare visitors in 2005 and services ranged from transplants and hip replacements to fringe procedures.

The eMenders group consists of more than 50 specialists based at the Mount Elizabeth Medical Centre in Singapore, covering more than 25 specialty areas. All the doctors have internationally recognised qualifications and have received their specialty training, or additional training, at leading institutions in those countries.

Medical tourism vs medical travel
According to eMenders chief executive Moonlake Lee, it is important to differentiate between the terms medical tourism and medical travel. Most eMenders patients fall into the category of medical travel (they go to Singapore primarily because of medical reasons). For other patients, medical services may be incidental to their trip; those in this category mainly have elective, cosmetic or minimally invasive procedures, such as dermatology, dental, general health screening and aesthetic procedures. Many patients also come to seek second opinions on treatments or on diagnoses made by their doctors back home.

The Mount Elizabeth Hospital is owned by the Parkway Group, which also owns the East Shore and Gleneagles hospitals in Singapore and a network of hospitals in Asia. Parkway's International Patient Assistance Centre helps patients to access the right channel of expertise and assists with travel and other necessary arrangements.

Dentistry also draws international patients to Singapore. Doctor Ansgar Cheng of Henry Lee Dental Surgery says dental services have been provided at the Mount Elizabeth Medical Centre for more than 27 years and overseas patients come from throughout Asia, Australia and New Zealand.

The practice also has a growing number of clients from Russia, Canada, Britain and the US, says Dr Cheng, who has fellowships in Singapore, Canada and Australia. Typically, international patients seek procedures such as dental implants, crowns, veneers and dentures.

Another Singapore hospital with an international patients' centre is Raffles Hospital, which offers fixed-price packages, from screening for osteoporosis for about $S100 ($80) to total knee replacements. The package price for a coronary artery bypass graft runs at $14,000 for up to an eight-night stay with two nights in the intensive care unit.

India
Think of India and images of ancient temples, tigers, call centres and the information technology boom may jump to mind. These days, health care is also on the list. India has some excellent medical care providers; in 2004, Indian facilities treated an estimated 150,000 medical tourists.

Cardiac care is one specialty drawing overseas patients to India. The Escorts Heart Institute and Research Centre in Delhi is a state-of-the-art institute where more than 35,000 open-heart operations have been performed.

At Escorts, open-heart surgery costs about 200,000 rupees ($6000). Like most international hospitals in Asia, the centre helps foreign patients with visa arrangements, airport pick-ups and accommodation.

The Apollo Hospitals Group runs hospitals across India, including in Delhi, Hyderabad, Chennai, Bangalore and Kolkata. Some patients are also drawn to India's holistic approach to healing, where disciplines such as yoga and meditation may be used alongside the latest medical techniques. Various city hospitals across India have ayurveda natural healing centres.

The Wockhardt Hospitals Group has a chain of super-specialty hospitals, such as the Wockhardt Eye Hospital, Wockhardt Bone and Joint Hospital and Wockhardt Heart Hospital in Mumbai, and others in Bangalore, Hyderabad, Kolkata and Nagpur. The group has an association with Harvard Medical International, an arm of the Harvard Medical School.

Other Indian hospitals treating increasing numbers of foreign patients include Global Hospitals, a dedicated centre in Mumbai for multi-organ transplants also focusing on cardiology, liver diseases, oncology and haematology. There is also the well-regarded L. V.

Prasad Eye Institute in Hyderabad. The Ruby Hospital in Kolkata even has an exclusive lifestyle floor, The Enclave, housing private apartments.

Malaysia
At the forefront of medical tourism in Malaysia is the state of Penang, where the Government is actively promoting its private facilities for cosmetic surgery. Hospitals drawing international patients include the Gleneagles Medical Centre with its own foreign patients' service and a range of services and packages (a standard executive health screening test including examination, electrocardiogram, chest X-ray and blood and other tests runs at about 455 ringgit or $160).

The 258-bed Penang Adventist Hospital is a private hospital that is part of an international network of more than 500 facilities and claims to be the first private hospital in northern Malaysia to have performed procedures such as coronary bypass and laser heart surgery.

Another Penang hospital that has established an international reputation in Southeast Asia is the modern Island Hospital which, apart from the usual facilities, also has a heart centre, urology centre, fertility centre and laser vision-correction centre. A standard executive screening program here costs $100.

Philippines
The Philippines is also starting to cash in, with an official Philippines medical tourism program running in co-operation with its Department of Tourism. The first Philippines Medical Tourism Congress was held in Manila late last year and it's hoped patients from the US and Australia will be attracted in the future. Several healthcare facilities are participating in the program, but so far St Lukes Medical Centre in Quezon City is the Government's only full medical tourism partner.

Pre-travel warning
A word of warning: do your homework before you fly. Asia is home to many international-standard hospitals, but if you don't choose well your medical holiday could end in disaster.

Related story Botched: Warning on cheap 'holiday surgery' fixes »

In the southern Chinese city of Shenzhen, for example, there are thousands of unlicensed centres offering all sorts of plastic surgery. But don't fall for it. Elective treatments at overseas hospitals or clinics are not claimable from Australian health funds and, if post-operative problems or negligence issues arise, suing a foreign doctor is likely to be a labyrinthine process. That bargain procedure may just be the final cut.