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Contemplating Medical Tourism? Weigh your options wisely

Travelling abroad to receive faster, cheaper treatment seems to be a growing trend in Canada. Approximately 20 medical tourism companies are operating across the country, most providing options for elective surgeries such as knee or hip replacements, cardiac surgery, cosmetic surgery, or transplants. But what makes people consider getting care abroad? It may be to alleviate frustration due to long wait times, to save money for elective surgeries that would not be covered by provincial health care, or even to access new treatments that are not yet offered in Canada. Whatever the reason, or no matter how great the benefits, Canadians must understand the importance of doing their research and making an informed decision before considering health care abroad!

Who would be providing your care?
What type of health care facility should you expect?
Who will arrange your care abroad?
Who will follow up on your care?
What’s the bottom line?

Who would be providing your care?

Canadian health providers are very aware of the consequences they face in the event of the following: if they harm a patient, if they practice beyond the scope of their knowledge, or if they are negligent. Not only are they accountable to both their College of Physicians and Surgeons and their hospital board, but possibly even the courts. This means that Canadian doctors are strongly motivated to practice sound, evidenced-based medicine, and that patients can be compensated for any type of malpractice-related injuries.

Doctors, medical staff, and hospitals in other countries are certainly subject to regulations and legal accountability; however navigating a foreign health care or legal system can be difficult and costly for non-citizens. Without an intimate knowledge of the culture, it is difficult to know just how effectively another country’s regulatory system polices the behaviour of its health professionals. In Canada, the medical profession is highly supervised and medical professionals undergo peer review; Canadians can file a complaint and seek recourse if they’ve received inadequate medical care. However, in another country, this process may be non-existent, poorly organized, or hard to access as a tourist. Also, in the event that you need to take legal action, it will likely be necessary that you travel back and forth to appear in court. Keep in mind, court rewards for medical malpractice in a foreign country may be a small fraction of what you would expect to receive in Canada.

What type of health care facility should you expect?

Although hospital standards will vary greatly from one country to the next, it is important to note that your experience may be very different from what you are used to here in Canada.

Provincial legislation and various non-governmental associations hold Canadian hospitals to high standards of organization, cleanliness, infection control, and safety. And while they are certainly not perfect, hospitals in Canada enjoy a strong reputation for quality around the world. Canadian hospitals are also required to accurately and regularly report on the health outcomes they achieve.

In certain countries, care facilities may not be accountable for their health outcomes. Or, in some cases, reporting practices for these outcomes may not be readily accessible, or may not be available at all. The Joint Commission is an American accreditation agency that has partnered with the World Health Organization (WHO) to establish standards of patient safety in hospitals internationally. It is critical that you check any overseas hospital for accreditation by The Joint Commission if you are considering health care abroad.

Who will arrange your care abroad?

Patients who travel for treatment often do not enlist the help and support of their family doctor for several reasons. They may be concerned about what their doctor might think, or they might assume that Canadian doctors are not well versed in foreign treatment practices. As a result, medical tourism brokers or facilitators often arrange for overseas treatment. Keep in mind that these individuals may not be medical professionals, and have a financial interest in your decision to go forward with the treatment. For this reason, it may be very difficult to obtain impartial information on the specific facility where your procedure is to take place. Additionally, it is unlikely that they will have any detailed knowledge when it comes to your current health concern or your health history; this can significantly impact both your choice of treatment and your road to recovery.

If you receive care in another country, remember that you may not be speaking in your native language. Not being able to communicate with a caregiver could be scary or frustrating at best or life threatening at worst. Most medical tourism companies offer translation services, but you will want to feel confident that you can access them anytime you need them—day or night.

Who will follow up on your care?

If you have surgery in Canada, your surgeon will normally see you for at least one follow-up visit to ensure you are recovering as expected. Support staff (e.g., nurses) will also be present to assess your recovery, risk of infection, and general well-being immediately after your surgery, as well as over the days and weeks that follow. Depending on your medical concern, there may be an entire host of tests, therapies, and follow-up visits that you should participate in. If you suffer complications from your surgery, your surgeon will once again involve himself in your treatment, especially if further surgery is needed.

If you choose to have surgery overseas, there may be little or no further contact with the surgeon who initially performed your procedure. In addition, you will be relying on the foreign medical staff, or the medical tourism company, to provide your Canadian doctor with the medical records from your overseas treatment as well as any recommendations for post-operative care. Your doctor at home may come across translation issues or missing information that you will need to retrieve in order to ensure the follow-up care you receive is appropriate. Also, if you do require further care from a domestic surgeon, there is an increased possibility that medical data and/or health recommendations could be missed because you have not received continuous care throughout the course of your treatment. If your doctor is unfamiliar with the treatment you received or does not obtain any follow-up documentation, it can affect his ability to properly monitor your recovery in Canada, which, in turn, can have an impact on your future health.

Also, in the event that something goes wrong during your surgery abroad and you require emergency medical treatment back home, getting to Canada could prove both costly and complicated. Not only can air evacuation services cost anywhere from $15,000 to $150,000 (or more), the hospital in Canada could deny you admission depending on the availability of beds.

With all of these unknowns, you may wonder why anyone would opt for surgery abroad. However, for some people, the benefits outweigh the risks.

What’s the bottom line?

If you are considering medical tourism, make sure to do your research to find out as much as you can about your options. Just as importantly:

Talk to your Canadian doctor first: Consult your physician to discuss your options and get his opinion. Does your doctor think you are well enough to travel? Is your condition serious? Can you wait for treatment in Canada without your health being negatively affected? How are you managing your health while you wait? Have you visited another health professional for a second opinion? Perhaps, in your case, surgery is not the best option. Another doctor may know of alternative treatments that he could recommend to you.

Very often, you will need your doctor to provide your medical file to the physicians abroad. If you decide to undergo treatment overseas, your current medical specialist and/or family physician should speak one-on-one with the overseas provider. Be cautious of foreign doctors who will not comply.

Consider the costs: In rare cases, you may be able to get partial reimbursement for your treatment if it is a medically necessary service unavailable in your province or elsewhere in Canada. Note your provincial ministry of health will need to agree to cover the treatment beforehand. If this is the case, you will likely have to pay up front, and then seek repayment after your treatment. You should work with provincial authorities (you can likely do so through your specialist) at home prior to leaving the country to determine if your situation qualifies and how much will be reimbursed. Each medical concern is evaluated on a case-by-case basis, so contact your ministry or department of health to learn more (see Ontario’s Out of Country Services or Manitoba’s Out-of-Province Medical Referrals for examples).

Some overseas medical programs offer financing programs. Read all contracts carefully before signing, and, if in doubt, consult a lawyer to review the terms of the contract.

Research, research, and research some more! Not sure where to start? Find the answer to the following questions before you make a final decision:

• Who will be providing treatment? What are their credentials? Find out as much as you can about the doctor who will be performing the surgery.
• How is the medical procedure performed? Have your doctor review the details too.
• What is the facility itself like? Consider facilities that frequently perform this procedure, and strongly consider only those with official, documented clinical effectiveness, such as published materials that your Canadian physician can review. It may be helpful to look for credible foreign facilities with existing international patient programs.
• How will your care be documented? Find out what information will be included, and if it will be sent to your Canadian physician securely and in a timely manner.
• What type of facility will you be staying at for your follow-up care?
• What is the risk of complication? How they will complications be handled, and by whom?
• What are the timeframes for treatment and follow-up care? Find out when it is safe for travel (flying is not advised after certain treatments).
• What is the country itself like? Is it safe? What will you need before travelling? Are there any medical reasons why you should not travel? Will you need a medical visa, vaccinations, etc?

The more you know, the better you can assess whether medical tourism is the right option for you. Enlist the help of your care team; your Canadian health care providers can be your allies throughout the process. Above all, make sure that your decision to undergo surgery abroad is an informed one—and the right one for you.

Key Websites:

• Canadian Family Physician: Medical tourism – What Canadian family physicians need to know (requires Adobe Reader)
• Simon Fraser University Medical Tourism Research Group

Related Articles:

• Effective Complaining: Knowing how and when to voice your concerns
• Hospitals: Understanding your access to quality care
• How Can Your Provincial College of Physicians and Surgeons Help You?
• Medical Emergencies: What to do if you are ill or injured while travelling abroad
• Travel Immunization
• Travelling Within Canada: Your out-of-province health coverage
• Travel Smart: Plan ahead for your health
• Where Medicare Ends: Requesting coverage for a non-covered service

References