Regulation and legislation in medical tourism

Medical tourism has often been berated for being unregulated, uncontrolled and dangerous. Any treatment has an element of risk. A rush of stories on the dangers of cosmetic surgery, the need to regulate medical spas, proposals for controlling ayurvedic hospitals, are all concerned with domestic treatment, not medical tourism.

Medical tourism has often been berated for being unregulated, uncontrolled and dangerous. Any treatment has an element of risk. A rush of stories on the dangers of cosmetic surgery, the need to regulate medical spas, proposals for controlling ayurvedic hospitals, are all concerned with domestic treatment, not medical tourism. Any media scares or discussion of regulation also effects medical tourism, as does a new app for the Iphone that scarily turns cosmetic surgery into a game, and American proposals to tax all cosmetic surgery.

Some problems on alleged risk can arise from differences in interpretation in differing countries, and problems in translation – particularly when Asian and South American clinics and agencies refer to plastic surgery that in Europe and elsewhere would be called cosmetic surgery. In the US, some surgeons make the distinction; others refer to everything as plastic surgery. Cosmetic surgery, sometimes called aesthetic surgery is purely elective, a lifestyle choice undertaken to enhance physical appearance, improve self-esteem and boost confidence. It is a treatment for want rather than for need. Cosmetic surgery differs from plastic surgery, which is generally surgery to repair or reconstruct tissue or skin damaged by congenital (inherited) disease, injuries or burns. The primary role of plastic surgery is to restore function, and aesthetic improvement is secondary.

Governments are rarely enthusiastic about any legislation on cosmetic surgery, unless they see income. $5.8 billion over ten years is what a new tax that has suddenly appeared within US healthcare reform proposals, expects to generate. The White House-backed plan would impose a five-percent tax on all elective cosmetic surgery in the US. The measure exempts plastic surgery done to remedy a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.

Individuals who seek purely elective procedures, typically paid for directly out of patients’ pockets, would have to pay the new tax from January 2010. Recession has not dented US demand for cosmetic surgery procedures, up three percent in 2008 to 12.1 million procedures, according to the American Society of Plastic Surgeons. But breast augmentations were down 12 percent from 2007, to 307,230, while botox injections were up eight percent to just over five million procedures.

The tax would be paid by the patient receiving the cosmetic procedure and collected by the doctor. If the patient fails to pay the tax, the medical professional who performed the procedure would be liable. The tax would apply to all, including medical tourists to the US.

Alternative health is rarely regulated, but in India, the Department of Ayush is preparing a voluntary scheme in collaboration with the Quality Council of India (QCI) on accreditation of AYUSH hospitals similar to the highly successful hospital accreditation programme under its National Accreditation Board for Hospitals and Health Care Providers (NABH).

Medical tourism agencies need to keep up with new and proposed legislation in countries where they send patients. Although hospitals and larger clinics may have national and international accreditations, many smaller clinics, and much of the health and wellness industry remains unregulated with no real international benchmark to judge by.