Warning – health tourism may result in loss of health

By Mike Head

According to Wikipedia, health tourism (also known by a few other terms such as medical tourism or global healthcare) describes the rapidly-growing practice of travelling across international borders to obtain health care. Reasons for doing so are varied, and do include – quicker delivery of healthcare; cheaper medical care for the ‘tourist’; the surgery or intervention is not available in the individual’s own country; you get to go to an interesting country and get a fab holiday out of it at the same time (although one would hope fewer people respond with this reason than some of the other explanations).

But health tourism is not without risk. As well as there being various legal and ethical issues on offer (such as the illegal practices of organ trading, for examples see here and here), there are further health implications to consider.

A hepatitis B paper by Zuckerman and Hoet records some habits of the health tourist travelling from various high-income European countries. Amongst their cohort, there were 100 people who went abroad to areas deemed moderate to high risk of hepatitis B infection for the purposes of medical treatment. Of these, only 19 said they had been vaccinated against hepatitis B, 16 were unsure and 65 said no. The following is a paragraph from the paper –

Health tourists were more likely to be high income earners, immigrants, sexually uninhibited and moderately frequent travellers. Brazil, Romania, Russia and China were the most frequent  destinations for health tourists. Health tourists underwent dental work overseas (75%), eye surgery (21%), cosmetic surgery (19%), hip replacement (3%) and other procedures (15%). Individuals travelled for financial reasons (80%), because they believed that better, newer or more modern methods were available in other countries (36%), because of long waiting lists in their home country (35%), or for other reasons (12%). Fifty-four percent of health tourists consulted a healthcare professional prior to travelling but 58% of those did not recall receiving hepatitis B vaccination.
So what we have here is a group of people who are in the habit of having a fair bit of money to burn, like a lot of risky sex, have medical procedures that would pose a reasonable risk of infection wherever they were in the world, and half of whom do not check with a doctor beforehand about their vaccination status and any other health concerns.

Lovely.

And the risks are not without substantiation. Harling et al document in 2007 how a health tourist returned from India and promptly spread hepatitis B around a UK hospital. Kennedy et al report from Australia in 2005 that, of sixteen patients who had a kidney transplant abroad, five subsequently died. The authors conclude –

Patients who received commercial transplants were more likely to develop infections such as HIV, hepatitis B virus, cytomegalovirus and fungal infections. Previous reports have found that patient and graft survival were comparable to local results, whereas we found that patient and graft survival were worse than transplantation within Australia. Patients considering the option of overseas commercial donation should be advised that heightened risks to life and graft survival exist.

Meanwhile, back in the UK, Miyagi and colleagues reported earlier in 2012 on an observational study involving nineteen health tourists who went to Europe and Asia for cosmetic procedures (mostly breast enhancements). Eleven patients required NHS treatment when they arrived home at a total cost of £120,841, with the main complication being wound infection, and they describe the costs of managing complications of cosmetic health tourism as ‘substantial’.

I’ve searched the medical literature, and couldn’t find any comprehensive review on the likelihood of adverse outcomes in having surgery abroad as opposed to in the UK (or other comparable westernised country). If such data do exists, would be keen to see it. A 2010 review entitled ‘Medical tourism: Assessing the evidence on treatment abroad’ included some interesting comparisons of the cost of treatments in the UK compared with other countries (hip replacement in Lithuania for £3252, at a saving of 59% anyone?). But they highlight many gaps in the evidence – for example, the section of clinical outcomes (2.3) has several references about the scarcity of evidence and how little is known about relative clinical outcomes for particular treatments, institutions, clinicians and localities.

So, if you are keen to take a trip to the doctor and require a passport to do so – be careful. Bad boob jobs, or poorly-applied dental fillings, could combine with a particularly interesting invasive fungal infection or a positive HIV test to make it a Health Tourist Holiday from Hell (a programme which the author wearily acknowledges has probably already been made somewhere).

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