Dr Neil Lunt, Senior Lecturer in Public Policy in Management at the University of York gave an academic perspective on medical tourism to Caroline Ratner of IMTJ about medical tourism at the recent medical tourism workshop at the Infection 2009 conference in Birmingham.
How did you become interested in medical tourism?
I have always worked in the area of health and social services. I was living in New Zealand for a while and when I returned to the UK in 2007 I realised that the country had become more European in outlook which was a very interesting change and because of my work I began looking into the growth of patient mobility.
Why do you think there has been a steady increase in medical tourism in Europe?
I think the increase is due to the availability of low costs flights within Europe which has led to increased mobility and the notion of the possibility of increased patient flow throughout Europe has led more people to travel for surgery. The idea that NHS patients and self paying patients in the UK can travel is increasing and one of the reasons is that it is getting harder for some patients to access certain parts of the NHS, i.e. it may be their age or their location that makes access difficult to certain services.
What other social/economic factors are contributing to the growth of medical tourism
There is an increased willingness of people to travel for surgery and a large part of this is the growth and acceptability of cosmetic surgery in our culture. In the last ten years cosmetic surgery has gone from being the preserve of the rich and famous to becoming acceptable and accessible to a much wider range of people from all types of socio-economic groups. Cheap flights, the growth of celebrity culture and body obsession and the easy access to information about how to access treatment abroad has contributed enormously to these changes. As a result having cosmetic surgery, both here in the UK and overseas is now available and acceptable to large numbers of people from different demographics who previously would never have considered it.
What do you see as the downside of the growth of medical tourism?
One of the major downsides is the as yet lack of formal research; a lot of current research is anecdotal and piecemeal. There is no proper research into botched surgeries, we only hear about surgeries that have gone wrong in the press, there is no impartial research funded by trusts, the industry or other medical organisations into the actual numbers that are travelling, how many surgeries are going wrong, how people are making their choices about procedures and where to go. While there is a growing amount of information available overall, the general public are not that well informed.
What kind of research into the medical tourism market is needed?
I would be very interested in talking to people who have had a range of treatments about what motivated them to have surgery and their decision making process. I’d also like to know how they judged their experience, the quality of the surgery and treatment, the clinical outcomes, whether they needed post-operative treatment for infections etc., or whether they needed medical care on their return to their home country.
What’s interesting is to me at the moment is how people make their choices; do they book directly or do they go through a facilitator? How do they conceptualise the risks of what they are doing, how do they make their choices? What’s more important to patients? Price or quality and reputation? If they are using the internet for research what tools are they using to ascertain whether the information they are using to make a decision is credible? These are all important questions for the industry to consider.
What about other issues in medical tourism such as ethics and safety records?
Ethical issues are another area that needs examining. Questions need to be raised when you merge medical procedures that could be considered controversial with commercial considerations. When you get the two things together you could get certain treatments offered by commercial operators that could raise ethical questions. i.e. what is the age ceiling for IVF treatment? Likewise, some controversial treatments available abroad might not be countenanced by doctors or sanctioned here and patients need to be aware of the potential implications of having these kinds of treatments.
Safety is another area that needs to be looked into as standards vary widely throughout the world. The NHS is very upfront about its safety record and there is transparency of information. NHS patients have access to a lot of information which can’t be said about some European and other destinations and the information that is available does not always bear up to public scrutiny.
In fact, worse than no safety records, or evidence, is misleading evidence. Stories have emerged from a major hospital in Thailand about statistics about the number of foreign patients that make no sense; the numbers just don’t stack up. Obviously the hospital is trying to give a good impression but the information is not verifiable and this is the problem. Hospitals should be giving prospective patients information that is independently scrutinised and monitored and medical tourists need to be aware of this.
Another grey area is accreditation, what do kite marks, and accreditation show patients? What does it all mean? There needs to be industry wide clarification so that patients can confidently make choices based on unbiased information.
What responsibility do you think brokers and facilitators have towards their customers?
Questions need to be asked about what brokers/facilitators do and what are their boundaries and responsibilities and how their role is defined. Integrity is of high importance here when brokers are advising medical tourists on where to go. How are brokers providing information? On what basis are they basing their recommendations? Are they being based on solid, impartial information or otherwise. I think it is important that the industry sets standards in this area and that those facilitators remain unaffiliated to clinics and hospitals.
Many hospitals and clinics, especially in poorer countries and the developing world claim that treating foreign patients helps the local economy and thus contributes to higher standards of care for local patients. Do you agree?
Many countries like India, Thailand and Eastern European countries claim that the influx of medical tourists helps the local community but in countries like India, which has high levels of poverty there are ethical issues that need to be considered when foreign patients are treated in local hospitals. Of course foreign patients will improve the local economy but do they medically help the locals who might need different types of treatments to the ones being sold to the medical tourists. It could be that a hospital provides very high tech treatment for foreign patients while squeezing out necessary low-tech services that locals need.
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