Medical Tourism Q & A: Are Cost Savings Worth the Risks?

Dr. Michael McGuire, president of the American Society of Plastic Surgeons, shares his views on medical tourism, the potential risks involved in seeking surgery abroad, and the ethical obligations of physicians once patients return for care in this country.

Question: Why does medical tourism seem to be so popular right now?

Dr. McGuire: I think probably the most recent impetus has been the recession and the layoffs that have resulted in a loss of health care coverage. Obviously, if you need to have surgery and you don’t have insurance, it can be extremely expensive to pay for it on your own. But patients also need to understand that the cheapest surgery is not going to be the best surgery. If they were to seek the top surgeons around the world, they wouldn’t save much money. The savings comes in going to lesser trained surgeons, often in lesser qualified hospitals.

Question: What are the risks involved in getting surgery abroad?

Dr. McGuire: I divide the risks into three components: the preoperative phase, the interoperative phase, and the postoperative phase, each of which presents significant logistical and safety issues for patients. The major challenge in the preoperative phase is how to find a qualified surgeon. But even if you find the right surgeon, that still doesn’t mean that the rest of the surgical team will be up to the same standard. For example, in many less developed countries, nursing training is little more than a high school–level course, and the nurse may not speak English.

During the interoperative phase, patients are faced with making a long trip, which raises the risk of blood clots and pulmonary embolism. Adding to that risk, patients preparing for surgery can’t be on anticoagulants.

Then there’s the postoperative phase. The medical tourism industry often paints a picture of a patient recovering from surgery on an exotic beach. Unfortunately, that’s not the reality. Patients recovering from hip replacement, coronary bypass surgery, or cosmetic surgery have a lot of healing to do and should not be exposing themselves to possible infections and other contamination problems they could face while traveling. Perhaps even more important, once they get home, patients must face the issue of who will take care of them if they experience a complication from surgery.

Question: If a patient does return with a complication from surgery, what’s the ethical responsibility of the U.S. surgeon?

Dr. McGuire: It is a real challenge. I think if it’s a true emergency, you must take care of the patient without question. But if it’s something more elective, you have to be very cautious. I think it has to be done on a case-by-case basis, evaluating the patient and trying to minimize your exposure to liability.

There are obviously agreements that you can make, such as developing a “hold harmless” contract so that the patient understands that you cannot assume liability for all that’s happened before. That can minimize the exposure risk. But again, it depends on whether this is a patient whom you know and one who will have realistic expectations. In that case, I think it’s certainly possible to work something out, but you have to be careful.

Question: What about insurance? Is that becoming a driver at all? Are insurers creating packages where people can go abroad for surgery?

Dr. McGuire: Insurance companies were beginning to get involved in medical tourism, but that has really declined recently. In speaking to some insurers, I have pointed out that once they encourage or incentivize people to have surgery abroad, they are no longer functioning as an insurance company. And as a result, they assume liability if the patient does not have a good outcome. Needless to say, the malpractice attorneys are very anxious to have a deep pocket like an insurance company that they can sue. So that has put a significant damper on the insurance industry’s enthusiasm for promoting this.

Question: Do you think medical tourism will continue to grow?

Dr. McGuire: In terms of aesthetic surgery, I see it as plateauing. I don’t see it as dramatically increasing, because the real costs involved are so significant that it’s not going to be enough of a savings for most people. And most people who are interested in aesthetic surgery are not looking for bargains.

In terms of insurance-covered procedures, I think it depends entirely on how much health care reform minimizes the number of people without insurance. As the economy improves and more people gain insurance, I think that’s going to be the major driver in terms of the growth of insurance-covered medical tourism. Right now, I think we’re seeing a bit of a spike simply because there are more and more people without insurance. Once that trend changes, I think the number of people going abroad will significantly decline. Virtually nobody is going abroad if they have insurance coverage.

Dr. Michael McGuire, president of the American Society of Plastic Surgeons, shares his views on medical tourism, the potential risks involved in seeking surgery abroad, and the ethical obligations of physicians once patients return for care in this country.

Question: Why does medical tourism seem to be so popular right now?

Dr. McGuire: I think probably the most recent impetus has been the recession and the layoffs that have resulted in a loss of health care coverage. Obviously, if you need to have surgery and you don’t have insurance, it can be extremely expensive to pay for it on your own. But patients also need to understand that the cheapest surgery is not going to be the best surgery. If they were to seek the top surgeons around the world, they wouldn’t save much money. The savings comes in going to lesser trained surgeons, often in lesser qualified hospitals.

Question: What are the risks involved in getting surgery abroad?

Dr. McGuire: I divide the risks into three components: the preoperative phase, the interoperative phase, and the postoperative phase, each of which presents significant logistical and safety issues for patients. The major challenge in the preoperative phase is how to find a qualified surgeon. But even if you find the right surgeon, that still doesn’t mean that the rest of the surgical team will be up to the same standard. For example, in many less developed countries, nursing training is little more than a high school–level course, and the nurse may not speak English.

During the interoperative phase, patients are faced with making a long trip, which raises the risk of blood clots and pulmonary embolism. Adding to that risk, patients preparing for surgery can’t be on anticoagulants.

Then there’s the postoperative phase. The medical tourism industry often paints a picture of a patient recovering from surgery on an exotic beach. Unfortunately, that’s not the reality. Patients recovering from hip replacement, coronary bypass surgery, or cosmetic surgery have a lot of healing to do and should not be exposing themselves to possible infections and other contamination problems they could face while traveling. Perhaps even more important, once they get home, patients must face the issue of who will take care of them if they experience a complication from surgery.

Question: If a patient does return with a complication from surgery, what’s the ethical responsibility of the U.S. surgeon?

Dr. McGuire: It is a real challenge. I think if it’s a true emergency, you must take care of the patient without question. But if it’s something more elective, you have to be very cautious. I think it has to be done on a case-by-case basis, evaluating the patient and trying to minimize your exposure to liability.

There are obviously agreements that you can make, such as developing a “hold harmless” contract so that the patient understands that you cannot assume liability for all that’s happened before. That can minimize the exposure risk. But again, it depends on whether this is a patient whom you know and one who will have realistic expectations. In that case, I think it’s certainly possible to work something out, but you have to be careful.

Question: What about insurance? Is that becoming a driver at all? Are insurers creating packages where people can go abroad for surgery?

Dr. McGuire: Insurance companies were beginning to get involved in medical tourism, but that has really declined recently. In speaking to some insurers, I have pointed out that once they encourage or incentivize people to have surgery abroad, they are no longer functioning as an insurance company. And as a result, they assume liability if the patient does not have a good outcome. Needless to say, the malpractice attorneys are very anxious to have a deep pocket like an insurance company that they can sue. So that has put a significant damper on the insurance industry’s enthusiasm for promoting this.

Question: Do you think medical tourism will continue to grow?

Dr. McGuire: In terms of aesthetic surgery, I see it as plateauing. I don’t see it as dramatically increasing, because the real costs involved are so significant that it’s not going to be enough of a savings for most people. And most people who are interested in aesthetic surgery are not looking for bargains.

In terms of insurance-covered procedures, I think it depends entirely on how much health care reform minimizes the number of people without insurance. As the economy improves and more people gain insurance, I think that’s going to be the major driver in terms of the growth of insurance-covered medical tourism. Right now, I think we’re seeing a bit of a spike simply because there are more and more people without insurance. Once that trend changes, I think the number of people going abroad will significantly decline. Virtually nobody is going abroad if they have insurance coverage.

Dr. Michael McGuire, president of the American Society of Plastic Surgeons, shares his views on medical tourism, the potential risks involved in seeking surgery abroad, and the ethical obligations of physicians once patients return for care in this country.

Question: Why does medical tourism seem to be so popular right now?

Dr. McGuire: I think probably the most recent impetus has been the recession and the layoffs that have resulted in a loss of health care coverage. Obviously, if you need to have surgery and you don’t have insurance, it can be extremely expensive to pay for it on your own. But patients also need to understand that the cheapest surgery is not going to be the best surgery. If they were to seek the top surgeons around the world, they wouldn’t save much money. The savings comes in going to lesser trained surgeons, often in lesser qualified hospitals.

Question: What are the risks involved in getting surgery abroad?

Dr. McGuire: I divide the risks into three components: the preoperative phase, the interoperative phase, and the postoperative phase, each of which presents significant logistical and safety issues for patients. The major challenge in the preoperative phase is how to find a qualified surgeon. But even if you find the right surgeon, that still doesn’t mean that the rest of the surgical team will be up to the same standard. For example, in many less developed countries, nursing training is little more than a high school–level course, and the nurse may not speak English.

During the interoperative phase, patients are faced with making a long trip, which raises the risk of blood clots and pulmonary embolism. Adding to that risk, patients preparing for surgery can’t be on anticoagulants.

Then there’s the postoperative phase. The medical tourism industry often paints a picture of a patient recovering from surgery on an exotic beach. Unfortunately, that’s not the reality. Patients recovering from hip replacement, coronary bypass surgery, or cosmetic surgery have a lot of healing to do and should not be exposing themselves to possible infections and other contamination problems they could face while traveling. Perhaps even more important, once they get home, patients must face the issue of who will take care of them if they experience a complication from surgery.

Question: If a patient does return with a complication from surgery, what’s the ethical responsibility of the U.S. surgeon?

Dr. McGuire: It is a real challenge. I think if it’s a true emergency, you must take care of the patient without question. But if it’s something more elective, you have to be very cautious. I think it has to be done on a case-by-case basis, evaluating the patient and trying to minimize your exposure to liability.

There are obviously agreements that you can make, such as developing a “hold harmless” contract so that the patient understands that you cannot assume liability for all that’s happened before. That can minimize the exposure risk. But again, it depends on whether this is a patient whom you know and one who will have realistic expectations. In that case, I think it’s certainly possible to work something out, but you have to be careful.

Question: What about insurance? Is that becoming a driver at all? Are insurers creating packages where people can go abroad for surgery?

Dr. McGuire: Insurance companies were beginning to get involved in medical tourism, but that has really declined recently. In speaking to some insurers, I have pointed out that once they encourage or incentivize people to have surgery abroad, they are no longer functioning as an insurance company. And as a result, they assume liability if the patient does not have a good outcome. Needless to say, the malpractice attorneys are very anxious to have a deep pocket like an insurance company that they can sue. So that has put a significant damper on the insurance industry’s enthusiasm for promoting this.

Question: Do you think medical tourism will continue to grow?

Dr. McGuire: In terms of aesthetic surgery, I see it as plateauing. I don’t see it as dramatically increasing, because the real costs involved are so significant that it’s not going to be enough of a savings for most people. And most people who are interested in aesthetic surgery are not looking for bargains.

In terms of insurance-covered procedures, I think it depends entirely on how much health care reform minimizes the number of people without insurance. As the economy improves and more people gain insurance, I think that’s going to be the major driver in terms of the growth of insurance-covered medical tourism. Right now, I think we’re seeing a bit of a spike simply because there are more and more people without insurance. Once that trend changes, I think the number of people going abroad will significantly decline. Virtually nobody is going abroad if they have insurance coverage.