As medical tourism, in which a person travels to another country for medical care, becomes more popular, it’s important to understand the pros and cons.
According to the Centers for Disease Control and Prevention, each year millions of U.S. residents engage in medical tourism, traveling to Mexico and Canada, as well as Central America, South America, the Caribbean and the far East.
Medical tourism is widespread within the United States. People may travel from city to city, or state to state to find the right physician and facility that meets their medical needs. This kind of medical tourism can be very safe and achieve positive results.
But medical tourism outside of the United States is different. Some patients travel because of cultural preferences, seeking to be treated in their country of origin. Others may need a procedure or medication unavailable or not approved in the United States. The primary motivation, though, is cost. Many procedures, including those in my field of plastic surgery, may be cheaper in other countries. But anyone considering this option must understand the potential risk.
In the United States a plastic surgeon needs to follow the highest clinical standards. These standards do increase the cost of health care, but they also increase safety. When you see lower costs, you must ask yourself what elements of safety and recovery are not included.
Recently I took over the care of a woman from Pennsylvania who looked abroad for plastic surgery options. She found a physician in Mexico to perform her “tummy-tuck.” The woman underwent surgery the day after her arrival without any pre-operative protocols.
The attending physician and staff did not have full access to the patient’s history, which included susceptibility to resistant infections. So she received insufficient pre-operative antibiotics, and as a result suffered a severe infection that was not caught promptly. When it was diagnosed, the woman could not be treated at the facility that performed the operation. Instead, she was sent back to San Diego for emergency care.
After two weeks at the hospital, she returned to Pennsylvania for continued management of infection and wound care. She survived her complications but was left with permanent deformities of her body.
When complications do occur, the money saved quickly evaporates. A patient’s medical insurance rarely covers incidental expenses incurred in a country outside the United States. Medical tourism physicians may be reluctant to order expensive antibiotics and other medications, and the facility may not have access to a qualified recovery unit or hospital. Often, no family is present when severe complications occur.
Negative outcomes do not always happen with medical tourism, but they are avoidable in the first place. The missing component in medical tourism is standard of care.
In the United States we have the gold standard in terms of safety and regulations. When followed correctly, each patient is scheduled for a first visit so that they meet their doctor. Their discussion assures full understanding of the surgery, outlines what preparations the patient will need to take in advance, and addresses any concerns the patient may have.
The meeting is a precursor to obtaining a complete history of the patient. A full physical is performed, labs ordered, and health status determined. This is followed by a workup plan and assurances that all issues are addressed. Surgery takes place in a fully accredited facility with a board-certified anesthesiologist and board-certified plastic surgeons. Post-surgical recovery should include the attending surgeon’s participation to assure continuity of care.
Not all countries follow these standards. Many sacrifice health standards and safety to save money. When traveling to other countries time is limited. The CDC notes that complications depend on the destination, the facility where the procedure is being performed, and whether the patient is in good physical and psychological condition for the procedure.
Other issues that can increase the risk of complications include infectious disease. All medical procedures have some risk of complications, but those associated with procedures done in other countries can include wound, bloodstream and donor-derived infections, as well as diseases such as hepatitis B, hepatitis C, and HIV.
Antibiotic resistance is a real concern and a global problem. However, you are more likely to get an antibiotic-resistant infection outside the United States and not have access to the appropriate medications.
Quality of care differs significantly in some countries where requirements for maintaining licensure, credentialing, and accreditation may also be less than what would be required here. In some countries, counterfeit medicines and lower quality medical devices may be used.
Communicating with staff at the destination and healthcare facility may be challenging. Receiving care at a facility where you do not speak the language fluently could lead to misunderstandings about your treatment and care.
For people considering medical tourism, I recognize that excellent surgeons exist all over the globe. In the United States, though, we have the most advanced and regulated training for surgeons in the world.
For example, plastic surgeons in the United States are required to have six to nine years of training after they receive their medical degree. We are observed over years by a committee of peers before and after obtaining board certification. This is followed by acceptance into the American Society of Plastic Surgeons and American Society for Aesthetic Plastic Surgery for continued training and education.
The bottom line is if you are considering medical tourism as a cost-effective option for plastic surgery, consider a board-certified doctor in the United States first. Talk to your plastic surgeon, ask as many questions as you like and investigate his or her credentials as well as the accreditation of the surgical center where you will be operated. Then, you can compare all this information. Cost savings are never worth your health and well-being — or even your life.
Dr. Hector Salazar-Reyes is a board-certified plastic surgeon with the La Jolla Cosmetic practice.