The Growing Trend of Medical Tourism What Nurses Need to Know About the Risks and Benefits for Patients

AJN REPORTS

The Growing Trend of Medical Tourism What nurses need to know about the risks and benefits for patients.

osmetic procedures like liposuction and ab- FAAN, president and chief executive officer of CGFNS dominoplasty, which typically aren’t covered International (also known as the Commission on Cby health insurance, can be pricey. In 2014, Graduates of Foreign Nursing Schools) in Philadel- 28-year-old Beverly Brignoni of New York City phia. “Affordability is most likely the largest deter- sought a cheaper way to have those procedures minant of medical tourism, particularly regarding done—and decided to travel to the Dominican Re- patients traveling from developed to developing coun- public to a clinic recommended by friends. But while tries.” Cost savings can be substantial depending on undergoing surgery there, Brignoni died of a pulmo- the country in which treatment is delivered. For ex- nary embolism. An inspection of the clinic shortly ample, using U.S. costs as a benchmark, patients can after her death revealed the presence of bacteria and expect to see a “discount” of 20% to 30% in Brazil, violations of biosanitary regulations, and the operat- 45% to 65% in Costa Rica, and 65% to 90% in In- ing room was ordered temporarily closed. dia, according to Patients Beyond Borders. Around the same time as Brignoni’s death, the Cen- “Another benefit [of medical tourism] could be ters for Disease Control and Prevention traced a multi- obtaining medical treatment that is not available in state outbreak of mycobacterial infections, including [a patient’s] home country,” says Shaffer. “Patients some that are antibiotic resistant, to 21 women who may find better technology, specialists, or services had undergone cosmetic surgery at clinics in the Do- abroad. Often, health care providers who focus on minican Republic. These and other serious adverse medical tourism offer more personalized care.” events prompted the U.S. State Department to issue a Conversely, patients may face serious risks when warning to travelers considering undergoing cosmetic receiving medical care abroad. These include infec- procedures in that country. tious disease, complications with pre- and postsurgi- Cosmetic surgery is one of many types of services cal care, and low quality of care. “Often, medical sought via “medical tourism”—the practice of travel- tourism health systems do not have standardized ing to another country for medical care. According to credentials evaluation in place,” says Shaffer. Patients Beyond Borders, a provider of medical travel Legal risks are another caveat. “Typically, when information, about 1,400,000 Americans are esti- dealing with medical tourism, there is no government mated to have traveled overseas for medical reasons— or legal watchdog, which can lead to jurisdiction is- including cancer care, dentistry, and cardiovascular sues or cross-border disputes,” Shaffer adds. care—in 2016. And Americans aren’t the only ones Katrina Bramstedt, PhD, a clinical ethicist at crossing borders to find affordable health care. Pa- the Bond University School of Medicine in Robina, tients Beyond Borders estimates that the worldwide Queensland, Australia, points out some of the ethical medical tourism market is growing at a rate of 15% concerns that surround medical tourism. Regarding to 25% per year, with the highest numbers of patients informed consent, for example, patients in unrelenting heading to Mexico and Southeast and South Asia. pain or with chronic, debilitating, or life-threatening Not all medical tourism stories become caution- illnesses are vulnerable to exploitation. “If patients are ary tales: given the rising medical costs and inade- also financially troubled, they become an even larger quate health insurance that drive patients to seek target for victimization,” she says. “The combination care elsewhere, many end up pleased with the ser- of their illness burden, its quality of life impact, and a vices they obtain and the lower prices they find. But lack of finances can result in circumstances that impair the potential pitfalls of receiving medical care in a objectivity during medical decision making.” foreign country underscore the need for caution. Language barriers can create an additional prob- lem when patients have difficulty understanding the RISKS VS. BENEFITS medical information that is presented to them. And, “Medical tourism poses many risks as well as bene- Bramstedt says, “If the hospital or [medical] tour- fits,” says Franklin Shaffer, EdD, RN, FFNMRCSI, ism broker is unscrupulous, there may be a lack of

18 AJN ▼ July 2017 ▼ Vol. 117, No. 7 ajnonline.com The 10 most popular worldwide destinations for medical tourism are (from left to right) India, Malaysia, Thailand, Turkey, Costa Rica, Mexico, Taiwan, South Korea, Singapore, and Brazil. The percentage ranges above each bar indicate the average cost savings of receiving medical treatment in each country compared with the cost in the United States. Image courtesy of IgeaHub.com.

transparency about important matters such as hos- ACA, medical tourism poses an additional opportu- pital or facility accreditation, outcomes, safety pro- nity for insurers to expand into an emerging market files, physician training and certification, follow-up space.” care, and recourse in situations of medical error.” Patients seeking organ transplants abroad are par- NURSES’ ROLE ticularly at risk, Bramstedt adds. They may unknow- Nurses can play an important role in educating pa- ingly receive organs bought on the black market, tients on the risks and benefits of traveling abroad for infected with disease, or both. And any complica- medical care. Shaffer points out that nurses should tions from a transplant performed outside a patient’s also understand the importance of their role when home country will not be covered by insurance. these patients return. “One aspect of the care contin- uum that is often missing in medical tourism is post- POLITICAL INFLUENCES treatment and follow-up care,” he says, noting that The current political climate in the United States may nurses can help promote a continuous care process affect medical tourism for both incoming and outgo- and ensure that care gaps are closed. When working ing patients. Stricter U.S. entry and immigration poli- with medical tourists, cultural competence and an cies could make it more difficult for overseas medical understanding of the barriers that often exist between tourists to enter the country. And possible changes in patients and providers is also critical. U.S. health care policy could drive more Americans “First and foremost, we need to understand the to seek care elsewhere. Should the Affordable Care dynamics of medical tourism, and to ensure that it is Act (ACA) be repealed, for example, “it is expected being performed for the right reasons, with a compe- that many Americans will lose health coverage, po- tent staff, and with knowledgeable patient[s],” says tentially resulting in increased cases of U.S. patients Shaffer. “More nurses need to be involved in this in- traveling abroad for medical tourism,” Shaffer says. dustry to ensure that patients are safeguarded across “Further, as health insurers have withdrawn from the the care spectrum.”—Roxanne Nelson ▼ [email protected] AJN ▼ July 2017 ▼ Vol. 117, No. 7 19