How the EU directive may stimulate an increase in child care


I am a pediatric surgeon by training, so it was only a matter of time before I would turn my attention to the issue of “treatment abroad for children”.

As a young Pediatric Surgeon at the Great Ormond Street Hospital for Children in London, I was constantly involved in the treatment of children from across the world, including my home country, Greece.

Great Ormond Street” was then and continues to be an international center of excellence. It has a thriving international and private patient service based in the Harris International Patient Centre. The hospital generates over £25 million from its private and international patient income

Treating these children from abroad was medical tourism, but we did not regard or refer to it as such.

Why did these “medical tourists” come to Great Ormond Street?

It certainly was not because treatment was cheaper than “back home”. In fact, when all expenses were factored in, it turned out to be quite a bit more expensive (although in quite a few instances, the government or health fund “back home” picked up the bill, as payer or cost-bearer.

They came:

  •     To get the best treatment
  •     To get treatment that was not available at home
  •     To get treatment that was not provided “just as well” at home

Internal medical tourism for children

Recently we started hearing (again) about “internal” or “domestic” medical tourism (see Medical Tourism and the West's Revenge).

Well, there was and still is domestic medical tourism for children. For example, Great Ormond Street is a referral hospital receiving young patients from all over the UK.

Children’s hospitals and services

…for small adults?

Children are not small (i.e., scaled down) adults (although, we surgeons – when in a humorous mood, would say that pediatricians are).

Diseases and surgical conditions in children have considerable and fundamental peculiarities whose management requires specific knowledge and training which “adult doctors” do not have. This is the reason that Pediatrics and Pediatric Surgery (and now its several sub-specialties) came into being.

The appropriate management of children’s diseases requires age-specific knowledge and experience. And acquiring knowledge and experience requires “large number of cases” and dealing with many “same case cases”.

Practically every country has children’s hospitals and services. But, not all countries have children’s hospitals with the required expertise and resources to offer services at the “best practices” and “excellence” levels.

This may be due to budgetary constraints or a small population (which precludes the accumulation of experience and expertise). In such cases, children with complex or rare conditions (rare and orphan diseases) are best treated at Reference Centers and Centers of Excellence, which may be abroad.

The rational distribution of Centers of Excellence for Children

…and European Crossborder Healthcare

One of the arguments for the existence of the European Healthcare Cross-border Scheme, which makes perfect sense, is the rationalization and distribution of Centers of Excellence for the management of rare and complex diseases.

This will ensure that rare and complex cases can be treated by expert teams who see and handle many “same case cases”. Many of these conditions manifest themselves at an early age.   

Children going abroad for what?

What do (and will) children go abroad for?

This (as an indicative listing) includes such complex or rare conditions as:

  •     Malignancies (e.g., nephroblastoma and adrenal gland neuroblastoma, lymphomas and leukemias, requiring bone marrow transplant)
  •     Separation of conjoined twins
  •     Rare and orphan diseases such as muscular dystrophy
  •     Congenital heart disease
  •     Other complex congenital abnormalities requiring surgery (e.g., esophageal atresia, anorectal agenesis, Hirschsprung’s Disease, intersex – ambiguous genitalia)
  •     Congenital ophthalmic conditions (as strabismus)
  •     Neurosurgical conditions related to spinal fusion abnormalities

It must be pointed out that some congenital conditions require urgent and immediate management, which precludes “treatment abroad”.

But even these can become candidates for “specialist treatment abroad” once they have been “stabilized”, or when the urgent “first stage management” is provided locally.

Where can they go?

Without endorsing any destination or facility, the following are some destinations which come to mind:Israel (Pediatric malignant diseases)

  • Turkey - Istanbul (for bone marrow transplant)
  • The United Kingdom - London (for practically all complex and rare diseases in children)
  • USA - Boston (for malignancies in children)
  • South Africa - Cape Town (for pediatric cardiac surgery, expertise developed many years ago by the “Barnard” brothers of heart transplant fame - Chris and Marius)

healthCare cybernetics has created a non-commercial site devoted to the subject of Health Tourism for Children. The site may currently be password-protected whilst it is being developed.


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