August 26, 2017    7 minute read

The Complexities of Medical Tourism

Health Risks    August 26, 2017    7 minute read

The Complexities of Medical Tourism

Medical tourism is a big business. The Medical Tourism Association estimates it’s already worth $439bn worldwide (though the International Medical Travel Journal considers that figure grossly inflated). According to one report, from 2006-2007, more than $3bn was spent by $2m medical tourists in three nations alone: Singapore, Malaysia and Thailand. That trinity is often placed among the top 10 destinations for medical tourism, but they’re not the only ones.

For Britons and other Europeans, Spain, Turkey and Germany are among the most popular medical tourism destinations. Other desirable locations in Europe and Asia include Romania, South Korea and India. In the Western Hemisphere, Mexico is the most popular destination for Canadian and US citizens looking beyond their borders.

Advantages of Medical Tourism

Europeans and Canadians have universal health coverage at home, and the US itself is a popular medical tourism stop, so why is medical tourism from the West becoming increasingly popular? Among the reasons are:

  • Cost. In the US, universal health coverage is still a goal, not a reality, and health costs are among the highest in the world. For those without health insurance, lower prices – as much 80% less in some countries – can be a dominant concern.
  • The excellence of care. Malaysia, Costa Rica and Mexico also have some of the best health care in the world – often in the top five – based not only on affordability but also the excellence of staff and facilities. Looking to Asia, a 2000 report by the World Health Organization rated Singapore the 6th highest in the world.
  • Shorter waiting times. They may be able to obtain treatment sooner in another country.
  • Privacy. Those who do not wish to disclose a serious illness to acquaintances (heart surgery or cancer treatment) for fear that it would affect their job prospects or cosmetic surgery for fear of embarrassment may find that a trip to Latin America, Europe or Asia can make a good cover.
  • Travel. It’s not insignificant that these medical tourism destinations often have beautiful scenery and amenities, too. An exotic environment may help with recuperation.

Disadvantages of Medical Tourism

But there are risks as well. The US Centers for Disease Control and Prevention (CDC) warns:

  • The language barrier could be a problem which hampers clear communication.
  • Other countries may not test and regulate medications for quality and counterfeits as rigorously as one’s native country.
  • Antibiotic resistance is rising around the world, but not at the same rate everywhere. It may be higher in a chosen destination.
  • After some surgeries, flying poses a greater risk for blood clots.
  • Financial. Although costs are less, insurance probably doesn’t cover medical tourism. Even for Europeans travelling to other EU countries, the European Health Insurance Card doesn’t cover scheduled treatment, only urgent medical treatment that cannot be postponed until a return to the home country.

Why Addiction Treatment is Less Popular

Another type of health problem that has become big business is addiction or substance abuse treatment (SAT). By one reckoning, in the US alone it’s become a $3bn market. But the twain of addiction treatment and medical tourism rarely meet. Crossroads Centre Antigua, a 12 step-based rehab started by musician Eric Clapton, seems a rare exception.

According to a November 2015 report by CBI (the Centre for the Promotion of Imports from developing countries, based in the Netherlands), only 3% of “light medical tourism” from Europe is for addiction treatment, less than for dental (18%), cosmetic surgery (16%) or oncology (4%). US medical tourism for SAT also appears negligible.

In addition to the usual reasons medical tourism can be undesirable:

  • Redundant. SAT often begins by leaving one’s normal environs, filled with people and situations that trigger addictive behaviour. Particularly in the US, there’s no need to travel out of the country.
  • Irrelevant. Although many rehabs have beautiful natural surroundings, treatment is treatment first, whether at a 12 step or non 12 step rehab: detox, cognitive behavioural therapy. Amenities don’t matter much.
  • Aftercare. One of the most important parts of rehab is what happens after the initial rehab. Addictions aren’t cured, only managed. Follow-ups may be important with cosmetic surgery (see Botched on E!), but they are vital for addiction.
  • Law. Many medical tourism destinations have harsher drug laws than the US or Europe. Addiction is considered a legal matter only, with dealers facing a death sentence and addicts mandatory imprisonment and treatment (often of the cold-turkey and hard labour variety).

Treatments Not Available At Home

There’s one more reason to travel abroad for health care, and it can apply to substance abuse treatment, too: medical services that are not available in one’s home country. Some travellers from the Middle East come to the US or Europe for drugs or treatments they can’t get at home because they haven’t been approved yet.

There’s at least one area of substance abuse treatment that isn’t legally at least available in the US or Europe, but is in other nations, or at least falls into a grey area: psychedelic drugs.

It’s been thought, though not widely known, that psychedelic, psychoactive or hallucinogenic drugs such as ibogaine, ayahuasca and psilocybin might be able to treat – perhaps even cure – addiction.

Ibogaine

For instance, in 1962 young heroin addict Howard Lotsof took ibogaine – a white powder derived from the root bark of a West African shrub – simply because he was looking for a new high. He had an intense “trip” that lasted a day-and-a-half or so, and when it wore off, he said he was “cured” of his heroin addiction. That is, he had no withdrawal pains nor any desire to take heroin or ibogaine again. Several friends had the same experience when he gave it to them.

Lotsof became a crusader for the drug. He tried but never succeeded in getting it made legal in the US. It remains on Schedule I of the Controlled Substances Act, along with heroin and cannabis as an irredeemable drug.

Many experts say that ibogaine is dangerous (there have been deaths, usually among people with pre-existing health conditions), or that it only “resets” the brain to a pre-addictive state and still requires conventional treatment and aftercare. Still, the clinics attract medical tourist addicts from around the world, including Scott Disick of Keeping Up with the Kardashians infamy. A non-hallucinogenic version of the drug, 18-MC or 18-methoxycoronaridine, is under development.

In the meantime, Lotsof convinced enough people of his cure that ibogaine clinics have spring up around the world – some popular medical tourism nations – including the Netherlands, Mexico, Costa Rica and New Zealand. Other psychedelics – including ayahuasca, psilocybin and LSD – have their advocates and their clinics.

Safety Of Medical Tourism

With alternative substance abuse treatment, it’s not always possible to do research, avoid the charlatans, and be reasonably assured of safety. It usually is with basic medical tourism: cosmetic surgery, hip and joint replacement, cardiovascular. Look for destinations with:

  • Political transparency and stability. Avoid areas that are war-torn or warlord-dominated.
  • State-of-the-art medical technology and best practices.
  • Internationally trained staff (maybe even the US or UK).
  • Internationally accredited, with government and private investment.

Conclusion

As demand for containing health care costs increases, more insurance companies may determine (as some employers already have) that it’s in their interest to encourage medical tourism. It seems that the industry will continue to grow. It must be ensured that this occurs – safely and healthily.

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