Sun, sea, sand ... and surgery

We travel for business. We travel for pleasure. And now, increasingly, we travel for our health as well. The health tourism industry is still in its infancy and hard figures are difficult to come by, but last year an estimated 50,000 "medi-tourists" are thought to have travelled overseas from the UK for an extraordinary range of check-ups, treatments and operations, to countries as far afield as Thailand, South Africa, India and Cuba.

"Word is getting around," says Leslie Smith, a medical insurance broker who runs Treatment Choices, a net-based business matching UK patients with hospitals and surgeons abroad. "The idea is out there and people are investigating. This month I had four times as many internet hits on keywords like 'surgery abroad' as I had the month before."

Paul Smith, who runs Medplex - a similar business helping to organise surgery in, among other places, Thailand, Singapore and Istanbul - agrees. "Virtually every country is thinking it can offer this kind of service," he says. "Tourist boards are putting out literature saying, 'Come here for a safari, or a spell at the beach, or an operation.' If you're going to feel rotten you might as well feel rotten somewhere sunny, so you can at least enjoy nice weather as you recuperate."

The main reason cited for looking abroad is NHS waiting lists. "In this country we are used to a high level of free healthcare, but the fact is there are long waiting lists for some very nasty conditions - hip replacements, for example. What you find is that people are in a lot of pain and they have expectations of efficiency in the health service. They are appalled when they are told how long they're going to have to endure their suffering before they can be fixed.

"They're often older people, so they have a reasonable disposable income. They've got children who have backpacked round the world and who have maybe seen at first hand the medical facilities in places such as Asia and South Africa and can testify to how good they are."

The real crunch comes when they decide to dip into their savings and go private, and start phoning around UK private health providers to see how much a new hip or knee is going to set them back. "They're horrified at the prices," says Leslie Smith.

"Then someone tells them about a company like ours, or they talk to someone else who knows someone who has had surgery abroad, and they realise that prices abroad are cheaper, even taking into account travel and accommodation for a partner or friend. On average, I'd say most people are able to save around a third by going abroad."

For most patients, initial fears about language difficulties and the logistics of travelling overseas are allayed by linking up with a company experienced in putting health trips together. Some, such as Surgical Attractions in South Africa, even offer add-on "recuperation holidays". "A lot of our clients come here for cosmetic surgery," says Ingrid Lomas, who runs the company. "They have liposuction or breast augmentation and combine coming to Cape Town or Johannesburg for the surgery with the chance to take a holiday. Typically, they would fly over, have the procedure, rest for a few days in one of our hotels or guest lodges, and then have a wineland tour or go on safari.

"As it's cosmetic surgery, the incognito factor is huge. But the big draw has to be the exchange rate, which makes it very good value indeed." Some of her clients, says Lomas, are able to have their surgery and a holiday for less than the cost of the surgery alone in the UK. "It's a growing phenomenon - I'm getting more and more calls," she says. "At the moment we've got around 10 people a month travelling here from the UK - I'd say around four men to every six women."

At the Hinduja hospital in India, Anupam Verma says patients from the UK are travelling out for operations such as cataract removal, heart surgery, knee and hip replacements and cosmetic surgery. "An operation that would cost $10,000 in the US would be about $4,000 in India," he says. "Perceptions are changing - people from the UK have experience of Indian doctors in the NHS and they appreciate their expertise. Confidence levels are increasing - and satisfied customers returning home put the word out that travelling overseas can be a positive experience and encourage others to do the same."

Indeed, according to Leslie Smith, patient satisfaction is about more than just the low prices. "In Europe there's a whole different attitude among doctors towards their patients. I've seen doctors hugging patients - can you imagine that happening with a consultant here? The hospitals are far more patient-centred."

The majority of patients going overseas for surgery at the moment are self-financing. Those who have private medical insurance are usually only able to use their payout at approved hospitals which, at the moment anyway, are mostly within the UK. For NHS patients, the opportunities are limited - but they do exist, in some areas at least. For the last nine months Dominic Conlin has been project manager of London Patient Choice, a pilot scheme offering certain patients awaiting orthopaedic surgery the chance to have treatment in Belgium. The project works in four hospitals with long waiting lists, and offers pa tients who would otherwise be facing a long wait the chance to have the surgery much more quickly if they don't mind travelling to Brussels for it - all free of charge.

"The Belgian team come over, usually once a month, and they see all the patients who have agreed to be put forward for the programme," says Conlin. "If accepted for surgery they're given a date that's between one and five weeks away. They attend a pre-admission clinic at their local hospital, and they meet at the hospital on the day of travel. They are picked up, transferred to the Eurostar train, escorted on the journey and taken from the station in Brussels to hospital.

"We have helpers we call e-pals who sort out any communication difficulties. Usually they have their operation the next day and will stay in the Brussels hospital for between eight and 12 days - it's a little longer than usual because we have to make sure they're fit for the journey home.

"We've sent 320 patients from the London area to Brussels over the last nine months for orthopaedic procedures and the feedback has been universally positive."

From a cost point of view, sending a patient to Belgium for a hip replacement costs around £8,400 compared to £5,900 for the same procedure in London, although the Belgian figure includes some of the aftercare, while the London figure is for surgery only. It is not, says Conlin, seen as a long-term answer to NHS waiting lists, but it is certainly an expanding solution: from this month, the project is looking to extend to other areas of the UK.

But it is in the private sector that the effects of health tourism are likely to be most deeply felt. Leslie Smith says he has already had UK surgeons contacting him who are prepared to undercut European colleagues to attract business to their clinics. The insurance companies too, he says, are watching developments keenly, and the overall effect of cheaper prices on the continent could well push bills for private medicine down here in the medium term.

Meanwhile, says Paul Smith, going abroad is likely to become more and more acceptable. And it won't just be for operations, he says. People will increasingly think of combining an MOT-type general health check with a beach holiday, and companies looking after overstressed execs are already thinking in terms of combining a health check with a spa or seaside hotel overseas.

medplex.co.uk
medicaltourism.co.uk
treatmentchoices.co.uk
surgicalattractions.com
euro-meds.com
kreativdent.ie

Thanks to guardian.co.uk who have provided this article. View the original here.