The dark side of medical tourism: How quick and cheap treatment abroad can prove costly to health, and our health-care system

When Mike Watson chose to go under the knife on the other side of the world, he made the decision “out of necessity.”

 

After doctors in B.C. told the Okanagan father-of-three that, for medical reasons, he would have to wait six months to have a liver transplant done here, Watson looked elsewhere for options.

Doctors in Hong Kong told him his odds of survival would be better if he had the operation done immediately.  Watson, 39, travelled across the Pacific with his wife, Lisa, last month so that surgeons at Hong Kong’s Queen Mary Hospital could perform the surgery, with Lisa donating two-thirds of her liver to her high-school sweetheart.

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“The medical care received was world class,” Watson said last week from Hong Kong, where he’s receiving followup care and monitoring.

“After being through the process I have absolutely no regrets,” he said. “I received a second chance at life through their system.”

However, other Canadians have deeply regretted their decision to go abroad for medical care.

Among them is Emily Reed, 46, who travelled to Tijuana, Mexico, for weight-loss surgery last year. Reed, who lives in Hythe, Alta., near the B.C. border, said she has lost more than half her body weight in the last 14 months and now fears for her health as her weight continues to decline. She blames the botched surgery for her health issues.

“I’m just devastated,” Reed, who now weighs 124 pounds, said last week. “I’m just about out of my mind … I don’t have a lot of strength.”

She wants to share her story to warn other Canadians about the complications that can arise from a botched surgery abroad, she said.

“I want to tell people: ‘Please be very careful when you’re doing this. You don’t want to end up like me.’”

Medical tourism growing

“I often say medical tourism is really good for some people and, unfortunately, really bad for others,” said Valorie Crooks, a Vancouver-based expert on the growing trend of international travel for medical care. “And there’s often no way to predict from the outset if someone’s going to have a wholly positive or wholly negative experience.”

More than 50,000 Canadian medical tourists make such trips every year, according to a report last year from the Fraser Institute. The same report suggested British Columbians are more likely than anyone else in the country to be medical tourists. Common reasons for going outside Canada for medical treatment include long waiting lists at home and high costs for treatments not covered by MSP.

It’s big business, too. Market analysts have estimated the value of the global medical tourism industry will grow to more than $32 billion a year by 2019, and the Conference Board of Canada reported last year that Canadians spent more than $440 million in 2013 travelling abroad for medical treatment.

Medical tourism entrepreneurs say Canada, despite its socialized health care system, is a market that’s ripe for major growth.

 

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When Crooks, an associate professor in SFU’s department of geography, and her colleague Jeremy Snyder, an associate professor in SFU’s faculty of health sciences, co-founded the Medical Tourism Research Group in 2009, it was the first group of its kind in Canada. Since then, the amount of research on the topic has grown significantly, said Snyder.

But despite increased awareness, experts say there’s still a lack of data.

“If you think about the last time you went through customs, you’re not asked, ‘Did you access surgery?’” said Crooks.

“So what that tells us is that there’s actually no reliable way to know how many Canadians are engaging in this practice. (But) there are some clues we can look to.”

Those clues include hospital admissions for patients returning from abroad with complications, and surveys of Canadian doctors and dentists.

A study published last month in the Canadian Journal of Surgery examined costs borne by the public health care system of Alberta because of patients returning with complications after having bariatric surgery outside of Canada. The report concluded that “the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources.”

The study said the estimated extra cost of $560,000 a year to the Alberta health system was an “extremely conservative estimate,” and doesn’t account for long-term care or hospital stays.

“If some of these anecdotes actually are indicative of a wider pattern, it could be incredibly expensive,” said Snyder. “But we can’t act on that without having better data.

“The argument goes, if you have somebody who is getting some kind of surgery abroad and they’re paying out of pocket, then that’s actually saving the Canadian system money.

“But on the other hand, it’s well documented that when things go bad, they can go bad pretty catastrophically and be incredibly expensive — millions of dollars in some cases. I can’t say with confidence what side of the balance that lands on … but it’s certainly something worth knowing.

“There’s the potential there for something that’s actually draining a lot of money out of the medical system.”

Patients return home with complications

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When Crooks and Snyder started the Medical Tourism Research Group in 2009, the top international destinations Canadians reported visiting for treatment included India, Thailand and China.

Crooks calls those the “Medical Tourism 1.0” destinations: Asian countries with large hospitals and investments in medical infrastructure looking for ways to use excess capacity while generating revenue.

In the last five or six years, Crooks said, more Canadian medical tourists have reported trips to “Medical Tourism 2.0” destinations, which are often in the Caribbean or Central America, with smaller, purpose-built medical facilities tailored to foreign clientele.

“In that ’Medical Tourism 2.0’ sector, there’s a lot more of a view that this is a tourism diversification project, often being led by Ministries of Tourism or Trade, and not by the health sector, which creates a lot of challenges,” she said.

B.C.’s Ministry of Health advises against travelling out of Canada for medical treatment.

“We recommend patients have surgeries locally so they can benefit from the support provided by our health care system before and after the procedure,” ministry spokeswoman Kristy Anderson said in an email.

“All surgeries come with some risk, and people who go abroad could have potentially life-threatening complications, particularly in countries that may not have the regulations or standards that we have in B.C.”

Some physicians say that while they discourage out-of-country surgery, they understand what drives patients to make that choice.

Dr. Ali Zentner, a specialist in internal medicine and obesity, always advises her patients against leaving Canada for bariatric surgery. But when Canadians such as Emily Reed decide to travel abroad to have bariatric surgery, Zentner understands the “need and the desperation.”

“With the scarcity of bariatric options available to British Columbians and to Canadians as a whole, it’s no surprise that these patients are going elsewhere for care,” said Zentner, director of the Vancouver Island Bariatric Program.

“Patients are forced to perhaps put themselves at risk of substandard care. You can get a botched surgery, absolutely, let’s be frank, because who knows what the standard of care is?

“We’re seeing a lot of patients who went elsewhere and had complications, and now we’re definitely faced with the added burden, the added concern associated with that.”

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Dr. Ali Zentner says more Canadians are returning from foreign treatment with complications, which burdens local health care.

It’s a symptom of the Canadian health system’s inadequate treatment of obesity, said Zentner.

In Canada — where one in four adults is clinically obese — providing better care is not only “good medicine, it’s also good finances,” said Zentner.

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