July, 2008

By 2015 the health of the Baby Boomer generation will begin to deteriorate. This leaves more than 220 million people in Canada and the US, Europe, Australia and New Zealand seeking medical care in what is an already crowded and expensive health care market.

Although medical tourism seems to be more popular of late, it's certainly not a new concept. Thousands of years ago a small territory in the Saronic Gulf called Epidauria was famous for medical tourism. Greek pilgrims travelled from all over the Mediterranean to the sanctuary of the healing God, Asklenios. Spa towns and sanitariums may be considered an early form of medical tourism as well. In eighteenth century England, medtrotters visited spas for the benefits found in their mineral waters, which were said to have strong healing properties and treated ailments including liver disorders and bronchitis.

Since that time people from all over the world have been seeking medical care that is timely and affordable. An estimated 43 million people in the US are without health insurance and 120 million without dental coverage. Patients in Britain and Canada are facing a waiting period of more than a year for hip replacement surgery, when, if they could come to Bangkok or Bangalore they would be in the operating room the day after getting off the plane. Countries such as Thailand, India, Costa Rica, Cuba, Hungary, Israel and others are actively promoting medical tourism and are offering packages that include a recovery vacation. South Africa specialises in medical safaris combining procedures such as a nose job with the chance to see lions and elephants.

Safaris and beach getaways aside, the real attraction for most medical tourists is the price. The cost of surgery in Thailand, India or South Africa can be one tenth of what it is in the US or Europe, sometimes less, even after factoring in the cost of flights and lodgings. A heart-valve replacement operation that costs $200,000 in the US goes for $10,000 in India, including air fare and a vacation package; a metal-free dental bridge worth $5,500 in the US costs about $500 in Thailand; a full facelift in the US costing upwards of $20,000 can be obtained in South Africa for about $1,250. Sexual reassignment (sex change) surgery is in the top ten procedures people come to Thailand for and costs less than $6,000 whereas in the US it runs upwards of $15,000.

The Thai medical profession is being accredited as having one of the most advanced systems in the region. Huge investments have been made in equipment standards so that they achieve ISO 9001 accreditation. The Kasikorn Research Centre reported that 1.3 million foreigners received care at Thai hospitals in 2005 which generated about 33 billion baht. By 2006 this rose to 36.4 billion. This figure does not include the total amount of revenue generated by tourism while the patient is in the country.

Although it is thought by many that medical tourism is mainly popular in Thailand in areas of cosmetic surgery and dental work, adult stem cell replacement therapy is becoming quite popular with last year's government approval for TheraVitae, an Israeli-Thai research company, to expand their services. They are currently working on a facility in Bangkok that, when complete, will produce 1,000 batches of adult stem cells a month. Up to now only 200 no-option heart patients have been treated. Adult stem cell therapy for heart disease creates new blood vessels that improve blood flow as well as generate new tissue in the heart itself. Although there has been considerable controversy around stem cell therapy, this company is producing the stem cells from the patients' own blood as opposed to embryonic tissue. It makes the procedure very safe, as the body will not reject its own stem cells. Patients who have exhausted other treatment options such as bypass and balloon angioplasties are candidates. It also relieves angina (chest pain), lack of energy, shortness of breath and those who are dependant on nitro tablets. Last year TheraVitae received the World Economic Forum 'Pioneer Award' for their groundbreaking technology. China is becoming quite popular for westerners who want to take part in experimental stem cell treatments for conditions such as paralysis.

Thailand's Bumrungrad Hospital is also home to the innovative 64-slice scanner device. This machine delivers 64 views of body tissues and organs and provides detailed 3-D pictures in a matter of seconds. This new technology allows doctors to detect a wide range of life threatening illnesses at early stages and can diagnose early stages of cancer, neurological disorders, strokes, bone fractures and more.

Some insurance companies are now covering overseas treatments and surgeries. Read the fine print here though, as many of these companies will not cover any follow up treatments required. You also have very little legal recourse if something happens to go wrong.

The downsides to this growing trend of medical tourism is the lack of proper follow-up care, risks associated with travelling to a foreign country with fragile immune systems that are more susceptible to various infectious diseases after surgery, weak malpractice laws and lack of sufficient medical care for the local population.

A Medical Hub Project was introduced in 2003 to promote foreign medical care. Since then, foreign patients to Thailand have increased more than 50%. Thailand's public hospitals and medical schools have been suffering as well, as scores of doctors, nurses, specialists and field experts are moving to privatehospitals. The Thailand Centre of Excellence for Life Sciences (TCELS) is currently looking at ways to promote the medical hub project without damaging the country's health care system. Finding a solution to create this balance isn't going to be easy. Low paid medical staff working at public hospitals are also faced with increased work loads since the introduction of the 30 baht health care system. Good luck to TCELS in trying to persuade people out of taking a job with a higher salary and a lighter workload.

Ethical issues are being raised as people believe that it is creating more inequities between classes. Should the rich be able to attain better health care than the poor? Ethically, perhaps not, but in our world where the rich get richer and healthier and the poor stay poor and get sick, it doesn't seem that strange does it?