The hidden costs of medical tourism revealed
By Dr Brighton Chireka
We all like to travel and spend sometime on holiday. It is good for our health as we cannot work all the time without a break. While on holiday we can combine that trip with our medical treatment. Some just go to overseas countries for medical treatment only. There is now an industry that is catering for people who want to combine their treatment and luxury. Medical Tourism (MT) is that industry.
Medical tourism is sometimes described as the best way to enjoy luxury while getting excellent medical treatment. It is mainly for people who do not have health facilities in their own country that can perform certain procedures. Some people prefer medical tourism if the cost is cheaper than their country of origin or if they do not trust or have confidence in their own health system. Some use medical tourism as a status symbol and would seek overseas treatment for services that are locally available.
We see a lot of people in Zimbabweans shunning their local facilities in preference to those in countries like India , Malaysia, Singapore and South Africa. We are all guilty of this and sadly we are seeing even the heads of states, government officials , business people , medical doctors etc seeking medical treatment outside Zimbabwe. Some of the treatments that we are seeking from overseas health institutions are locally available.
The financially less advantaged people are also fundraising in order to get funds to go overseas for treatment. With all this rush to seek treatment outside Zimbabwe , no attention is being given to the impact of this “medical tourism rush” to our country. I will try to look at the impact of this rush and also discuss some solutions which hopefully will make you change your mind about our health system in Zimbabwe.
Majority of people use medical tourism as they perceive it to be “cheaper”. I have been involved in medical tourism for several years now and would like to share with you my experiences. As already stated above, I hope after reading this article you will be wiser in making a decision about medical tourism.
Cost of healthcare in Zimbabwe
The cost of healthcare in Zimbabwe is relatively high and majority of the people cannot afford it. Zimbabweans have been looking outside their borders for medical treatment and countries such as India are preferred as there are perceived to be cheaper. I welcome some reductions in the cost of medical services that are already taking place. May I say thank you to those health practitioners that have reduced the cost of consultation fees and also to those that have reduced the cost of operations. This is a step in the right direction and it will go further if the whole country does the same as these health professionals cannot go further down if the cost of living remains high.
Surely should we celebrate sending people to India ?
I have heard of success stories and even our media recently published an article about 7 patients that returned from India after open heart surgery. What did not come out clear in that article is that all those patients could have been operated at Parirenyatwa. We now have basic equipment at Parirenyatwa to carry out open heart surgery although more funding is needed to be able to carry out other procedures such as Coronary Artery Bypass Grafting (CABG) . We need Cath lab for that and the resources we are using to send people to India can be channelled into buying equipment for the lab.
A catheterization laboratory or cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found. This will help our country to be able to treat heart attacks quickly and effectively.
A paper presented last week at just ended ZIMA congress by one of the “heart surgeons” in Zimbabwe clearly highlighted the impact of Medical tourism on their operations. The local surgeon highlighted the lack of resources and equipment but what touched me was the lack of patients. How can we have lack of patients when we are sending several of them to overseas countries ? This means that our local surgeons will lose their skills as they are not having enough people to operate. Some of these surgeons may end up leaving the country and our health system will remain in ruins.
The quality of some of our local health facilities is not too bad and with support as well as good committed leadership, will be able to compete at the international level. The support has to start from the highest level in Zimbabwe and the rest will follow suit in using our local facilities. Some of our local facilities have a long way to go to meet the international standards and it is our duty to make sure that they improve and are properly funded, run and led.
Benefitting overseas countries
Countries like India are now known for Medical Tourism and this gives the country a good image and many people would want to visit it. This will result in huge foreign currency earnings for the country . Jobs will be created and hotels as well as airlines will see a lot of business coming their way.
Some problems in overseas countries
Medical tourism in these countries is run by private companies and specialists leave government hospitals to go and work in the private sector. This means that the public sector in countries like India may end up losing as most of the specialists will be in the private sector. The local population will suffer as they cannot afford the cost of health care in the private sector.
Solutions that may help governments promoting Medical Tourism
A committed leadership is needed and laws needed that medical tourism benefits everyone such as requiring private hospitals to treat the local population at a low fee. We know Medical tourism promotes ” internal brain drain” . Experienced health professionals are drawn to large urban centres and into large corporate run health institutions. Laws must be put in place that will require the specialists in the private to offer certain hours in the public sector.
Taking a closer look at the cost of some of the procedures.
Medical tourism may appear cheaper but my experiences tells me otherwise. I will share with you a true scenario to illustrate my point. I would like to discuss with you about a procedure called Total Hip Replacement . In short this is a surgical procedure that replaces a damaged hip with a new ” prosthetic hip” . This procedure aims to relieve pain and improve mobility.
Total Hip Replacement currently cost 11 000 USDollars in Zimbabwe whilst in India it cost 7 500 USDollars . At first look it appears that one is likely to save 3500 USDollars. Please wait a minute as I explain to you the whole process. The patient will need to go with someone to India so 2 return tickets to India will cost approximately 3000 . When in India the accommodation of the patient is included but not for the accompanying person. The accompanying person will need food and accommodation and for 2 weeks the cost is approximately 700 USDollars. This already gives us a total bill of 11 200 USDollars which is now more expensive than the local cost.
Things can get worse and they do in reality. One hopes for the operation to go well and the patient comes back in 2 weeks having used about 12 000 including other minor expenses. In some cases the patient may develop infection which may prolong the stay in hospital at an extra cost and also patient may be slow to be fit to walk and may need more time. Any delay in getting better will mean more expenses for the patient and the accompanying person. The original cost does not include this extra stay or any complications.
In some rare but not uncommon circumstances things can get worse and the patient dies away from home. If that happens in India then one is looking at 2500 USDollars to repatriate the body back to Zimbabwe. This cost is not covered in the initial cost and it will have to be met by the family of the deceased. If the trip was funded by donations then another embarrassing call will be made asking for more donations to get the deceased back to Zimbabwe.
I do not want to scare you but I am addressing reality so that you are wiser in your planning and decision making about seeking treatment outside Zimbabwe. In most cases the operation is successful but a problem comes in following up. If one needs a review or develops complications having left India then they have to fly back. This is another cost that is never mentioned when one is told about how good medical tourism is. Also the regular doctor of the patient in Zimbabwe may not be aware of what treatment was done in the overseas health institutions. There are no arrangements made between the doctors in the overseas health institutions and the doctors in Zimbabwe.
Bringing the undesirables back to Zimbabwe
As we go to these overseas health institutions it means that we will be exposed to hospital acquired infections(HAI). Some of these HAI are new to Zimbabwe and treatment is not easily available . This means that we are now bringing severe infections into our country when our health system is struggling to cope with what it has already. Lots of lives will be lost just because one person decided to seek medical treatment overseas. The sad thing is that the treatment that was sought overseas is available and is of high quality in Zimbabwe.
Message to those that might be thinking of or are using medical tourism
Medical tourism is justified as a temporary measure if the expertise and health facilities are not available in the country of origin. If both the expertise and facilities are there then it is advisable to use local facilities. Make sure you are referred by your local doctor and you both agreed that it is the best option for you. When choosing the country to seek the treatment , make sure that you get more information about the overseas health institutions and their doctors. You would want to make sure that the health institution is properly registered and it offers high quality medical services. Make sure that the doctors are properly registered and have good reputation .
You must ask for a Patient Advice and Liaison Services (PALS). Excellent international hospitals will have some form of PALS. PALS offer confidential advice, support and information on health-related matters to patients, their families and their carers.
Make sure that you have taken an insurance to cover your death if things do not workout well or have resources put aside for this.
Ask for follow up arrangements and make sure that these will be agreed and communicated to your regular doctor in Zimbabwe.
Make sure that medical tourism is carefully governed and watched by the government you intend to visit so that your rights as a patient or tourist are safeguarded.
Message to my colleagues in the medical profession
At times we do not address the issue of death properly. It is high time that we start these discussions early when a patient is faced with a terminal illness. Failure to address this issue will give patients false hopes and the inappropriate use of the meagre resources that they may have. Desperate patients and relatives will end up going to overseas country for no reason trying to find a cure for a terminal illness. It is better to be open with your patients and then give them the option to seek a second opinion if they so wish. Many patients will take your advice and prepare for their death rather than traumatising themselves with unfruitful trips to overseas medical institutions.
If you decide to refer your patients to overseas institutions , you should ask to be kept informed on the treatment and progress of your patient and discharging of the patient must be discussed with you. You should have directed contact with the health professionals who will be treating your patients.
A challenge to the local health professionals is that why can we not join in this medical tourism industry and make Zimbabwe a place to visit for luxury and affordable quality medical treatment?
Let me conclude by saying that It is my hope that one day I will open the newspaper and read the following advert:
“Visit the Victoria Falls in Zimbabwe, one of the Seven Natural Wonders of the World, for a safari , with a stopover for plastic surgery , a nose job and a chance to see lions and elephants”
This hope of our healthcare system rests with the radicals, the heretics and mavericks in our midst; the people who are willing to stand up, think outside the box, challenge the status quo and make change happen because they can see that there is a better way.
This article was compiled by Dr Brighton Chireka , who is a GP and a blogger based in Kent in the United Kingdom. Feel free to contact him at firstname.lastname@example.org and you can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professionals for a diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.