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Medical Tourism and the Air Ambulance

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Are “medical tourists” poised to overtake traditional air medical patients as the leading users of international air ambulance services? It could happen — one day.

Yesterday, in fact, a UC lecturer expressed his concerns on the growth of international medical tourism, noting that its current booming status is the result of the failure of some governments to respond to increasing demands for public health services.

Earlier this month, the air ambulance service FDN (Flying Doctors Nigeria) went on the record in Nigeria’s The Nation to state that its purpose is “not” to promote foreign medical tourism.

Earlier this year, Iranian President Ahmadinejad boasted of advances in medical science and technology, purporting that Iran is now welcoming about 30,000 international medical tourists into its healthcare facilities each year.

Meanwhile, they say that a rising number of wealthy Chinese citizens are turning to so-called medical tourism for better care. Venturing abroad to hospitals countries such as Singapore, Japan, Switzerland, Germany, and the United States, Chinese medical tourists are becoming an increasingly common sight in international hospitals.

At the same time, the Wall Street Journal has reported that India’s flourishing medical tourism industry is set to double by 2015, with tourism growing at a rate of 40% every year.

Truly, medical tourism is a global phenomenon.

No Signs of Stopping

People from all over the world with the desire for better healthcare — and the means to obtain it — are turning to hospitals in countries other than their own to cure their deepest ailments, treat their most sensitive conditions, and even improve their personal appearance (at least, they think so).

Those hospitals are a lot further away than, say, the healthcare clinic or cosmetic surgeon around the block– in most cases, incredibly so — but the distance isn’t an issue for medical tourists. And healthcare providers in destination countries aren’t complaining.

Japan, for example, has been utilizing its reputation for being on the cutting edge of technology to tap into the “market” of medical tourism. Pamphlets and online advertisements are being used to promote the Japanese health system’s expertise in a variety of advanced medical services, such as regenerative medicine and heavy particle radiotherapy.

Meanwhile, the Japanese government has been taking specific action to promote the country’s medical tourism industry: starting up a program to issue special six-month visas for international travelers visiting the country to receive medical treatment. Japan’s health ministry is also reportedly working on an accreditation system for medical facilities specifically to help out foreigners seeking medical care.

The medical tourism movement could be largely fueled by an aging global population with an increased level of disposable income. However, it’s a two-sided coin.

Medical tourists seek out healthcare services in other countries for manifold reasons. For countries with a reputation for excellence in certain areas of medicine that are able to provide it to patients at a lower cost, medical tourism can provide a true source of economic relief. In countries that send off more tourists than they welcome in, huge financial losses for healthcare providers are at stake.

But one industry that is clearly profiting financially from the global rise in medical tourism is the air ambulance industry.

Particularly among patients seeking treatment internationally for serious illnesses and critical injuries, air ambulance is arguably the most logical way to get from point A to point B. While medical choppers may not be able to quickly shuttle people between all countries, helicopter air ambulances are certainly an option for patients looking to travel from, say, countries in Central America to Costa Rica or Panama, two of the most popular worldwide destinations for medical tourists.

Of course, for “tourists” needing to traverse oceans or otherwise vast distances for medical care, such as traveling to or from the US, the UK, Switzerland, China, Germany, Singapore, Japan, and so on, arranging a fixed-wing air ambulance flight is a logical choice. Thus, many hospitals and care providers in countries with a large medical tourism industry have dedicated resources specifically to arranging air medical transportation for patients who require or desire it.

The costs of transportation on an air ambulance or even on a commercial airline are not always cheap. However, for some, the costs of travelling round-trip internationally can be significantly outweighed by the lower costs of obtaining healthcare services in another country.

Despite the huge number of people who come to the United States for high-quality healthcare and advanced medical treatments, U.S. citizens themselves are some of the most avid medical tourists. While a report found that a total of approximately 60,000 – 80,000 “tourists” came to the United States for in-patient medical care in 2008, the same study estimated that 750,000 (roughly 10 times as many) American medical tourists traveled from the U.S. to other countries for medical treatment in 2007.

Some companies in the U.S. even offer “medical travel” packages to cut down on the costs of providing health care for their employees.

This phenomena isn’t brand new, either. For example, take a look at a February 2008 article in the Wall Street Journal titled “Health Matters: The next wave of medical tourists might include you.” Earlier that year, a large supermarket chain began footing the bill for employees to travel to Singapore for hip and knee replacement procedures, including travel for the patient and companion. The cost-benefit analysis of sending employees on the 9,000 mile trip to Singapore was apparently preferable compared to sending them to a facility closer to say, Maine, where the chain is based.

The Other Side of the Coin

But are there downsides to medical tourism?

Well, yes. Skyrocketing growth in medical tourism over the coming years could potentially cost healthcare providers in the U.S. billions of dollars in lost revenue. But there are problems besides those of the financial variety.

According to parties in some popular “tourist destinations,” the phenomenon is harmful to existing national shortages of physicians — particularly in rural areas. Some groups in Southeast Asia have been particularly vocal about this potential problem. In both Thailand and Japan, some have cast medical tourism in a negative light; arguing that doctors will be preoccupied helping an influx of wealthy foreign patients rather than attending to a large number of their homeland’s less affluent citizens who are already experiencing a care shortage. (Ironically, it’s the same issue that is driving medical tourism in some other countries — as average lifespans continue to increase in countries around the globe, aging populations are resulting in an increased demand for medical services.)

In addition, patients who choose to receive medical care in other countries and do not educate themselves sufficiently beforehand may run into unfamiliar legal systems. Patients, particularly from areas such as the United States, may not be used to the more limited litigation available in other nations. A patient who seeks legal recourse for a negative experience with a foreign healthcare provider may find the avenues available to them to be more limited than he or she expects. What if a physician or hospital is uninsured or otherwise unable to cover the costs of paying financial damages to the patient? These are important things to consider for a medical tourist before hopping an air ambulance to a healthcare facility in an unfamiliar country.

There are potential ethical issues a medical tourist may run into when turning to healthcare in other countries as well. These issues are obviously highly variable depending on the destination, and some of the more severe problems should not be seen as an argument to not seek treatment internationally. Nevertheless, potential ethical hazards medical tourists may encounter include: illegal “black market” organ transplantation (so-called “transplant tourism” as labeled by the Declaration of Istanbul), lack of accreditation, clinically unproven medical therapies, and differing safety standards from the patient’s home country.

Of course, in some (hopefully few) cases, this is exactly what travelers are looking for. Alternative medicine and therapies that have been banned in a person’s homeland are readily available in some countries. This is a major reason that traveling to other countries for procedures is not always perceived positively in first world nations.

Nevertheless, a whole infrastructure is developing to support the demands of health tourism in North America and Europe. Intermediaries are uniting potential medical tourists with provider hospitals and healthcare organizations in other countries. Meanwhile, businesses looking to lower costs are seeking out the most cost-effective options for providing healthcare to their employees.

Many major medical centers and hospitals in the United States are home to international patient centers catering to patients from other countries who have come to the U.S. seeking medical treatment. Many of these healthcare facilities also offer assistance coordinating arrangements for medical care, medical transportation, accommodations, and finances. Naturally, an important part of these arrangements revolves around the coordination of international air ambulance services.

Beyond the obvious — increased utilization of international air ambulance services by so-called “medical tourists” — how else is this growing phenomenon affecting the air ambulance industry? What about the healthcare industry? Is medical tourism something to be promoted, or discouraged?

Air Medical Net would like to know your thoughts on this issue. Please leave your comments in the area below by signing in with Facebook, Twitter, or your Air Medical Net account.

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Discussion
  1. pdickey2010

    9 / 24 / 2012 8:16 pm

    Very interesting read. I think it’s rubbish if air ambulance companies are to cater more to those with money to burn on plastic surgery operations and unethical organ transplants rather than to help patients who are more in need of emergency medical services. I can only hope that the number of these cases are not too high in the overall picture. At the least, if any ambulance is to cater more to these type of clientelle then i guess they’ve made a choice against helping those who are truly in need of care.

    Reply

  2. Alpo

    10 / 9 / 2012 2:04 pm

    If I was treated overseas, I would also be worried about the use of drugs and treatment regimes that are not available or approved here. If something happened after I returned, and I needed to seek emergency care stateside, that seems problematic. The doctors here might be at loss on how to treat me. Fantastic and thought-provoking article. Keep up the great work!

    Reply

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