Medical Tourism: Risks, Benefits and Legal Issues

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Introduction

Medical tourism is increasingly becoming a favored concept among people in developed nations resulting from the perceived nature of medical experience that they receive from other nations relative to their own (Cohen, 2010; Turner, 2007). A person may travel to other countries to seek medical care for a condition that they have and seek treatment methods that may not necessarily be available in their own countries. The nature of these medical interventions may not necessarily be similar to those of conventional medicine. They may not even be approved for medical use but may offer an alternative solution to the ailments that patients may have.

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Some of the services that patients may seek from other nations include complex medical procedures like critical surgeries involving the hip or knee joints, the heart and lungs. Others include surgeries that are considered to be of a cosmetic nature like face and breast lift surgeries (Cohen, 2010; Milstein & Smith, 2007). In some countries, these surgeries are considered nonessential and are thus not offered at all or offered at a high cost in other countries. Dental surgeries are also sought after under the concept of medical tourism as a result of a few experts in dental surgery that are present all over the world (Henrick, 2007). In addition, depending on the type of surgical expert that the patient seeks, medical tourism would allow such a patient to access foreign doctors.

Medical tourism differs from the traditional concept that defined international medical travel by deviating from the usual travel of patients from underdeveloped countries to developed ones in search of improved medical services (Marcelo, 2003; Perez, 2001). Similarly, both types of medical travels are prompted by individuals who seek treatment for conditions that are better understood by medical practitioners in those countries. Most countries have accepted this type of service as a major contributor to national income and are embracing the concept more and more (Schoen, Doty, Collins, & Holmgren, 2005). It, however, faces significant challenges in the measures of accreditation that are used to determine the safety and nature of such kind of tourism. It has been widely investigated and realized that some of the tourism activities may not only be hazardous but may also be detrimental to the health of medical tourists. Other forms of danger may be encountered, like theft of valuables, which may significantly affect the medical activities of the tourist.

The practice of medical tourism takes many forms and has been practiced for a long period. People all over the world have been known to visit spa towns, sanitariums and hot water springs as a result of beliefs that the mineral waters could give health and life to people and provide relief to various diseases including gout and liver disorders. People with such diseases were thus known to travel to such places, a concept that can now be considered medical tourism. This stems from the fact that various aspects of medical tourism result from the fact that some facilities that are required for alternative medicine are not available in some countries and are thus sourced by visiting other countries (Anderson, Reinhardt, Hussey, & Petrosyan, 2003). Alternative medicine is constantly becoming a popular concept that fuels medical tourism after most conventional medical practices have failed in the host country. Although the exact working of alternative medicine is not clear, many people continue to embrace the healing properties of nature.

In addition, medical tourism popular has grown in popularity owing to the increased cost of medical care in developed countries. Services that are offered in both countries would, however, be cheaper in the developing countries because of the reduced income levels of people in that country. As a result, the ease in affordability of travel arrangements and the reduction in travel procedures and requirements have made medical tourism even more accessible (Einhorn, 2008).

Waiting times are also higher in the developed countries owing to the huge number of patients who are served and require access to health care systems as compared to the developing countries. As a result, those patients who may not have the patience to wait or do not simply have the time to wait and may require the services in a more speedy manner, may resort to seeking services from other countries. These developed countries may operate a public system of health care that would place more emphasis on the essential medical care such that those patients who seek nonessential medical care may have to wait for a while. Patients requiring services considered as nonessential medical procedures like hip replacements may have to wait for several weeks before they get the service. This they prefer to handle by scheduling the procedure in other countries that may provide the services as they seek them.

In addition, some of the services sought after by patients include knee and hip replacements. As such, they are offered at much higher costs, a factor that ends up discouraging the patients thus making them resort to other countries that can provide the service at a much lower cost and without limitations.

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This migration to other countries is, however, perceived to have several consequences on the economy of the country. Various studies have depicted the fact that the health care providers in developed countries could lose significant levels of revenue from the increasing number of patients taking their money to other hospitals in other countries to seek medical care (Terry, 2007). The public health care delivery system, which relies on this revenue, maybe one of the sectors that may be significantly affected by this move and whose effects may spiral down to those who rely on this service. Other countries may also quote prices that are not inclusive of everything and may only cover the medical expenses. Other associated charges such as accommodation and hospital stay over expenses may be omitted from the overall charges that are given to the patients, a situation that may lead to unexpected expenses being incurred by the patient in seeking these services.

Medical tourism has increasingly received mention in the media with several countries actually advertising their “medical safaris” to other countries. The costs to be incurred and the nature of the technology used is detailed in the information provided (Cutler, Huckman, & Landrum, 2004). Of particular interest is the reproductive tourism that allows couples to travel to other countries to receive in-vitro fertilization, and surrogate pregnancy among other assisted reproductive technologies that enables them to have babies. These practices are just some of the factors that make various people consider the concept of medical tourism as a risky venture that should not be entered into lightly.

Agencies and Process

The field has advanced to such an extent that various agencies have come up that function as intermediaries and seek to connect medical tourists all over the world with various medical institutions and doctors in their various countries and even possibly from other countries. These agencies may perform this role at a cost that enables the patients to understand all the factors that may be involved in accessing the health care services in those countries, detailing any other hidden costs that may be incurred by the patient. There are also various agents that are assigned to each medical tourist to enable them access customer care service at any hour and assist them with the pre and post-travel medical issues that they may have to face (Cohen, 2010).

In order to access medical services from other countries, the patient makes the initial step by contacting agencies that are often referred to as the medical tourism providers with a detailed medical report that contains the nature of the ailment, the local doctor’s opinion, the medical history and diagnosis among others. These agencies then post the case to potential health care providers who provide their medical opinions and how they seek to go about the case with a detailed choice of hospitals. The costs, destinations and duration of stay are then relayed to the potential patient who then makes the choice and prepares their medical visa and other financial arrangements. The patient then travels to the destination country to meet the caseworker who has been assigned to their case to enable the treatment. Once treatment has been accomplished, the patient may remain in the country for some time while recuperating or may choose to return home immediately.

Risks

There are various risks associated with medical tourism even when compared to the locally provided medical care in the host country (Cortez, 2010). Different countries have got different infectious diseases as compared to others. There are some diseases that are endemic in some areas that are not present in other countries. As such exposure to those diseases may be a potential hazard to people who are foreign to the nature of such diseases and especially if those people already have a weakened immune system. Some of these diseases may significantly affect the outcome of the disease process as a result of their nature to affect the immunity of the individual. Some of these tropical diseases include influenza, tuberculosis and mosquito-transmitted diseases like malaria which are otherwise considered nonexistent in the western countries. This thought process makes the doctors in the west overlook the symptoms of diseases that may be associated with tropical diseases, a concept that would otherwise be considered by doctors in tropical areas. There have been isolated cases of such diseases being misdiagnosed in developed countries as a result of their presence only being associated with developing or tropical countries.

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The quality of post-operative care also varies dramatically as a result of the nature of protocol that the hospital follows. Some of these hospitals may only allow a doctor to perform a surgery in the hospital, but the resulting post-operative care is left in the hands of the hospital. Neglect and inadequate care may often result in patients developing complications when the operative wounds become septic. In addition, the patient may seek to travel back to their home country before the wounds are healed as a result of the nature of medical care that may be available post-operative. There is the possibility that some of the wounds may become septic. These factors may significantly affect the patient’s health outcome and impair the healing process, making the operation more detrimental than beneficial for the patient.

The host hospital may also have a policy that does not include medical tourists and thus does not insure them against any damages or risks that they may come into as a result of their medical operation and stay while they are recovering. Neglect, harassment and poor hygiene are some of the issues upon which a patient may wish to make complaints. A patient who is dissatisfied may also not get a fair and appropriate channel to voice their complaints in the event that the host hospital does not have a policy that covers this aspect.

As a result of the significant differences in the culture and nature of services that various hospitals in the world offer, there may be problems in handling complaints once the medical tourist has returned to their country. The healing process may take some time, even months after the patient has left the country in which they went to have their operation done. Should complications arise once they are back home, there may not be an efficient system to trace the doctor who performed the surgery in order to correct the mistakes? The particular doctor may also not be available for consultation by other doctors from the patient’s home country to facilitate a consultation so that the exact nature of the surgery may be understood. Even in cases where the doctor is traced and is available for corrective surgery, the patient will again have to spend money in traveling back to the original doctor so that these complaints can be handled.

The obvious risk of crime is one that has slowly encroached into the aspect of medical tourism and marked it for definition as a trade that, while seeking to preserve life in one, denies life in its fullness for another. Global crime has realized the exploitation of innocent victims of their organs, which are harvested illegally and sold to leading agencies that offer them to medical tourists at a price. Medical research on human transplants is possibly one of the greatest vices ever undertaken by man owing to the nature of criminals who have made a living from robbing people of their organs to necessitate these procedures. The organ market has over the years been depleted to the extent that criminals have resorted to harvesting organs for the desperately ill patients across the globe in order to make profits while violating a wide array of human rights (Panjabi, 2010).

There are risks that countries receiving medical tourists may flood their health care system with foreigners at the expense of locals. Because of the fact that medical tourists pay a slightly higher amount of money for medical care as compared to the local citizens, doctors are increasingly seeking medical tourists to cater for so that they can receive higher revenue. The local population, which may pay less because of their reduced earning power, may end up being ignored by these doctors and even hospitals may not have any beds left to admit the local population when the beds have been occupied by medical tourists. The hospitals may alternatively have enough bed capacity to cater to the population. However, doctors may be busy taking care of the medical tourists who can pay more compared to the local population. The result is a compromised health care system within a country that is well staffed but unable to offer health care services to its people.

The new technologies that are sought after through medical tourism may also be the subject of a lot of controversies owing to the potential danger that they pose to the patients should the procedures fail. Patient safety is often compromised as some of the interventions are based on trials that have not been properly documented. Some therapies are offered to patients outside the approved clinical trials without the obvious loss of ethics, allowing for patient exploitation in the name of acceptable medical innovation (Hall, Bobiski, & Orentlicher, 2007). Hence patients may be advised that such a procedure is available and legal in one country, yet it has not completed its expected clinical trials. Medical care offered to such a patient may be on the basis of a clinical trial that enables the medical institution to learn while providing therapy to the patient (Arlen, 2010).

Legal Issues

There are various legal issues bound to arise as a result of the use and management of medical tourism in the country. Some employers are perceived to be trying to abuse the concept of medical tourism by seeking travel programs for their employees so as to cut the health care costs that are incurred by the company in meeting the health costs of the employees. This has significant implications both to the employee and the employer as a result of the various risks that are encountered in the implementation of medical tourism. It may result in death of patients in foreign countries. This will in turn result in lawsuits that may be detrimental to the reputation of the company (Sunstein & Thaler, 2003).

Various employees may also be forced to obtain their own funding for some of the medical procedures that they would wish to have in the event that they are not comfortable with traveling to other countries to receive medical care. This would mean more costly health care and an insurance scheme that does not take the needs of the employee into consideration leading to poorly motivated employees. The health care industry within the country would also face significant losses as a result of the outsourcing of health care services for various employees in the country. Corporate medical schemes are some of the tools that the government utilizes to manage its health care system and enable the provision of health care services to disadvantaged members of its population. If these corporate schemes outsource their services, government stands to lose revenue.

Despite this, companies are still offering incentives for employees to seek medical care outside the country with some employers offering to pay entire medical bills for their employees should they accept to seek medical care in foreign countries. This has, however, exposed these employees to a variety of medical issues arising from the differences that are encountered in the litigation systems of countries all over the world. Medical malpractice is one of the main challenges that medical tourism faces as a result of the varying definitions that the concept has achieved in the countries (Danzon, 2000). Different countries have got different ways of defining malpractice, detailing the various aspects that can be considered as a medical malpractice and what may not be included (Zeiler, 2007). As such, a medical malpractice in the United States may not be considered so in Mexico.

If a patient has got a complaint against a medical institution or a medical practitioner in a foreign country, they may have to be content with receiving no justice for their complaint as a result of the medical laws in the foreign country. They may be unable to seek compensation from the foreign medical institution as a result of inadequate medical insurance of the medical institution of the doctor. This further sheds light on the financial capacities of the medical institutions offering medical tourism to be able to finance their medical activities. Compromised medical care often results from such conditions, which further exposes the patient to danger (Cohen, 2010).

The health laws in the United States normally cover patients who undertake medical tourism by traveling to other countries for medical care and those traveling simply to other states within the United States for treatment. Every state has got different laws that govern its health care systems. As a result, a law considered commonplace in one state may not be applicable in another. In light of the above legal issues, the American Medical Association (AMA) developed regulations that have been integrated into law to ensure that medical tourism is regulated effectively (Roosevelt, 1999).

In a case where a patient chooses to seek medical care outside the country, the patient should feel free to do so without coercion. In addition, financial incentives that are given to patients to enable them to go outside the state for medical care should not be done in a manner that limits the diagnostic and therapeutic alternatives that the patient is entitled to. It should also not restrict treatment or referral options that the patient may require in the event that they opt out of medical tourism.

Hospitals outside the country that wish to offer medical services are required to register for accreditation to ensure that their facilities are inspected by medical professionals and accreditation bodies. This will ensure that they are able to offer services that are up to the standards that patients are used to in the United States. This list is then provided to companies and medical institutions such that if financial incentives are offered then they should only be used for care at institutions that have been accredited by international accrediting bodies (Martinez, 2003). It has, however, been realized that some countries that offer medical tourism do not even have a single facility that has received accreditation to operate but still receives a large number of patients from the United States seeking various forms of surgery.

Local follow-up care should also be coordinated, and financing arranged to ensure continuity of care for the patient before they even start on a trip to the hospital. This will ensure that the patient is able to receive care after their surgery wherever they would be sick without the possibility of deterioration of health as a result of lack of post-surgical follow-ups. Patients should also be informed of their rights and legal recourse before traveling outside the country for medical care. This will ensure that they understand that the laws that govern the medical system in various countries are different. In case of a medical malpractice, then some laws may not apply in the manner that they would wish.

In addition, patients have a right to know about their physicians’ background and licensing information. This will ensure that patients are able to make an informed decision on the type of doctor that they would wish to operate on them with confidence. Facility accreditation information and outcomes data should also be available to the patients to allow them to understand the nature of service that they will receive from the institutions so that they can choose one that can fully cater to their needs. Patients should also understand that they have a right to privacy and according to the American Medical Association, patient records should be treated in the most discrete manner.

There are potential risks associated with combining medical procedures with long flights and vacation activities involving the risk of contracting other diseases that may be detrimental to the patient’s health outcomes (Madison, 2000). The patients thus have a right to be informed of such risks that may occur and the possible diseases that the patient may be exposed to when traveling to such destinations. In addition, any vaccines that the patient should take before traveling to such countries should be indicated to the patients to ensure that they are medically able to deal with the various infections that they may be exposed to in the foreign countries.

Cases Supporting the Legal Issues

Medical malpractice

It may not be realistic to prevent individuals from seeking medical treatment from other countries as a result of fears of medical malpractice and the possibility of not receiving any compensation in the event of such an occurrence. Similarly, the institutions themselves are not allowed to make a patient sign a form that enables the hospital to waive all medical malpractice liability or alter the hospital’s state of medical liability. This is seen in the case of Tunkl v. Regents of the University of California, where a patient who was admitted to the university’s medical center signed a contract releasing the hospital from all liability in the event of wrongful and negligent act or omissions of its employees (Cohen, 2010). After the death of the patient during surgery at the hospital, his estate brought suit to the hospital, and the California Supreme Court rejected the hospital’s waiver claim defining that the contract itself was in contravention of public policy. Consequently, medical malpractice is handled strictly to protect the public. This may, however, not be the case in other countries making it imperative that patients carefully understand the consent forms that they are signing. In Florida, the medical malpractice statute of limitations stipulates that a person has two years with an outside limit of four years from the time of occurrence of the medical malpractice, to report the event in court.

Personal jurisdiction

When a patient seeks to initiate a legal process against a doctor for medical malpractice that was committed outside the patient’s country, the process may be ridden with several challenges. There may be a lack of systematic and continuous contact with the patient’s home state, a process that is required to establish general jurisdiction. These patients will thus have difficulty establishing specific personal jurisdiction against foreign doctors because they do not normally avail themselves of court proceedings. A court within the United States must have personal jurisdiction over the foreign hospital for the patient to maintain the suit. If these foreign doctors do not come into the country for accreditation, then it may be difficult to find them. This is depicted in Burger King Corp v. Rudzewicz (1985), which suggested that even if a foreign doctor enters the state even briefly then the Supreme Court suggested that the serving process on the doctor at that time would suffice to establish personal jurisdiction.

Intermediaries

These are business agents that seek to attract potential patients to their countries in order to make some money from performing surgeries among other medical interventions. These intermediaries may also be sued for medical malpractice cases in the event that they fail to provide adequate information to the patient at the initial time of contact. Negligence on the part of intermediaries to fail to review their list of doctors may lead to incompetent doctors performing medical malpractice on patients. This is seen in McClellan v. Health Maintenance Organization of Pennsylvania in 1992, whereby the intermediary is liable to pay the patient for damages because the patient subscribed to the services of the intermediary and not the doctor directly; it was the role of the intermediary to ascertain the competence of the doctor before referring the patient.

Comparison with foreign laws

In the United Kingdom, the medical malpractice statute of limitations stipulates that a person has three years, as opposed to two years in Florida, from the time of occurrence of the medical malpractice, to report the event in court. Personal jurisdiction is not necessary for the UK and a person can sue a hospital or medical practitioner in the United Kingdom. This means that if a patient receives cosmetic surgery in another country like Belgium and is not satisfied with its results, he has the right to sue the Belgian doctors in the United Kingdom.

Recent News

Patients can now seek medical alternatives outside their state and even country with much ease following the recent developments in the insurance companies are now offering “Patient Medical Malpractice Insurance”. At least one company, AOS, now offers this kind of insurance to pay out economic damages that the patient may incur as a result of medical tourism. It, however, offers this insurance based on a variety of factors that are placed into consideration before they can initiate a case against any medical practitioner or hospital in a foreign country. This includes a predetermined list of physicians abroad from whom the patient is allowed to seek medical attention (Cohen, 2010).

These insurance schemes are available to patients all over the country and are offered at a rate that is agreeable to the patient. The patient may choose a policy cover that they can efficiently afford in relation to the type of surgery that they would wish to have. In addition, these schemes are also offered to even those patients who do not have medical cover from any institution in the country; they protect for some time for even those members of the public who would otherwise have no medical insurance scheme.

A favorable approach to the concept of medical tourism is an insurer prompted medical tourism scenario, whereby the process is prompted and paid for by health insurers. As a result of the rising cost of medical insurance, most employers would be interested in a medical scheme that offers medical insurance to its employees with the option of medical tourism to pay low premiums. This approach ensures that the employees are able to access a wide array of medical treatment options in their cover while the employers get to pay reduced premiums, thus reducing operating costs. This concept will differ slightly from the concept of insurance from the nature of the party that will be initiating the contract. In the insurance-prompted scenario, the patient will not need to have medical insurance to access medical services abroad. Furthermore, it will be upon the patient to get insured before seeking medical services abroad. However, in the insurer prompted scenario, the patient will need to have medical insurance from their employer within which the provisions for medical insurance will be stipulated.

Management Suggestions

As a manager, it is vital to evaluate the possible benefits and threats that medical tourism could pose to the employee, company and the economy in general before making decisions about whether to support the concept or not. Incentives that are offered to employees are meant to boost their work performance by making them realize that the employer has their best interests at heart. Medical insurance is one of those incentives and the way that the employer implements this scheme is also a vital determinant of job performance. Incentives to enable employees to seek medical services in foreign countries may be acceptable to some employees, especially when they are able to access certain facilities like dental care that may otherwise be uncovered in their medical scheme. On the other hand, not all employees will be comfortable with the concept, creating an atmosphere of possible inequality.

There are significant savings that can be made by the employer if some or even all the employees operate under medical tourism. This may create a scenario whereby the original medical covers are not given as much attention as they should, thus forcing the employees to resort to this even if they do not find it favorable. Managers have to define the crucial concept of medical tourism to their employees should they choose to incorporate it into their management system. It should be done in such a way that the basic rights and freedoms of the employees are not violated.

The economic implications of medical tourism on the economy are slowly being realized. The number of patients embracing the concept is steadily rising. An increasing number of US citizens are opting to seek medical attention in foreign countries for various conditions. These conditions are either not insured in the country, or are charged highly relative to other countries. Millions in revenue are lost as a result of people seeking medical treatment outside the country, a situation that could significantly affect the public health care system that depends on this revenue. Hence as a manager, it is vital that the revenue factor is considered in a manner that will ensure the continuity of the public health care system in the country. This can be done in a balanced manner that ensures that some of the services are offered to the public health care system while options are availed that allow employees to seek medical care outside the country. It is only in this manner that the revenue can be divided against the two sectors in a manner that allows the employer to receive some relief in the expenses that are incurred in the daily management of the company while also fueling the public health care system. It is estimated that if the trend continues for ten years, the public health care system in the country will be compromised. Medical insurance and medical tourism are policy issues that can only be manipulated by top-level managers within the company. As such, the issue of medical tourism should be handled in a manner that does not curtail the basic rights of employees.

Conclusion

This paper has looked at the possible definition, mechanisms, risks, and benefits of medical tourism. It has handled current issues and guidelines that govern medical tourism. Medical tourism is on the increase as a result of the high cost of medical care in the United States compared to other countries. It has been realized that health care is expensive in the United States due to the high expenditure incurred in the payment of staff and procurement of medical facilities and equipment. It is argued that medical care is much cheaper in these other countries owing to the reduced amount of money that is spent on paying medical personnel allowing the hospitals to earn more revenue and thus be able to offer their services at a much lower cost.

Various other reasons for the preference of medical tourism have also been explored in the paper detailing the short waiting time and the fewer regulations that are imposed on various procedures like surrogate pregnancies, as opposed to their home country. In some countries, it is even much easier to receive organ transplants as a result of the illegal organization of organ theft in those countries. These countries have got existing cartels that harvest illegal organs making it much faster to receive an organ.

The paper has shown that there are also significant risks associated with medical tourism, including the aspect of medical malpractice. Patients may not have a proper legal channel to use in the event that they are provided with services in a manner that is not pleasant to them. There are cases whereby the patient receives surgery in a manner that they do not expect. However, because of the different laws that govern each country, it may be difficult to seek compensation. The paper also discussed other risks including exposure to tropical diseases and the presence of hidden costs among others.

The paper has also handled the various challenges that are associated with the legal issues that may arise as a result of medical malpractice. Different laws are stipulated by each country when dealing with medical malpractice. As a result, it would be impossible for patients to seek compensation for actions that are not considered illegal in the country in which the surgery was done. Most insurance companies are slowly embracing the concept of medical tourism in a bid to lower their operating costs. As a result, incentives are being offered to employees who agree to have their surgical procedures done in other countries or states. However, this is a concept that is probably being pursued at the expense of other employees who may not embrace medical tourism. Medical tourism should be implemented carefully with the possible effects that it may have on the economy and public health care system evaluated critically before it is allowed to grow.

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