Professional Documents
Culture Documents
Medical Tourism: Cross Border Health Care
Medical Tourism: Cross Border Health Care
• Money!
• Boost tourism revenues
• Generate foreign exchange
• Increase gross domestic product
• Improve medical services
• Upgrade services / resources available to citizens
• Stem ‘brain drain’ to other countries
Why do patients want medical tourism?
• Lower cost
• Timely alleviation of pain and disability
• Access to innovative procedures
• Exotic locations and travel ‘mystique’
• Privacy – particularly for some cosmetic
procedures
Issues
• Clinical / Medical
• Financial
• Ethical
• Legal
Clinical Decision Making in Medical
Tourism
• How does the ‘commoditization of care’ affect clinical
decision making?
• Potential predisposition to recommend surgical / more complex
procedures over conservative Rx
• Potential risk of minimizing risks to avoid “losing a client”
• Potential risk of focus on visible signs of quality / luxury over
medical quality assurance
• Either is possible…..
Bumrumgrad Hospital - Bangkok
• Morad et al 2000
• 515 Malaysian patients transplanted in China or
India
• >90% graft and patient survival
• Sever et al 1997
• 540 Saudi patients transplanted in India
• 96% graft survival
• 89% patient survival
• Similar results to those transplanted in Saudi Arabia
Renal Transplant - Inferior Outcomes
• Kennedy et al 2005
• 16 Australian patients
• 66% graft survival
• 85% patient survival
• Sever et al 2001
• Turkish patients
• 84% graft survival
• patient survival similar to locally transplanted
patients
Canadian experience
• Canadian data - 1998-2005
• 20 transplanted abroad - unrelated donors
• 22 transplants
• South Asia (12), East Asia (5), Middle East (4), SE Asia (1)
……..compared to……
• 175 living biologically related donors transplanted in
Canada
• 75 living emotionally related donors transplanted in
Canada
Canadian experience - 2
• 33% - no records, 77% - incomplete records
• 1/3 hospitalized on return, primarily for sepsis
• Hospital stays of 4-113 days (mean 19 +/- 36)
• Complications:
• 27% systemic sepsis
• 52% opportunistic infections
• 23% CMV
• 9% fungal infections
• 14% tuberculosis
• 5% cerebral and spinal abscesses
• 25% wound infections
• 38% pyelonephritis (incl. MDR E coli)
• 10% each: allograph nephrectomy, wound dehiscence, lymphocele
• 5% each: obstructive hydronephrosis, urine leak, metastatic cancer
Compared to Canadian Transplants….