The "Thailand Tuck"

Sand, surf – and surgery. The ads have been around for years, offering nurses and other healthcare professionals the chance to work in a recreational paradise, where moonlit beaches or died-and-gone-to-heaven backcountry skiing are right outside your door.

But now, these ads aren't geared towards prospective employees, they're geared to prospective patients.

But Why?

The main reason for someone becoming a medical tourist will never be the features of the tour or the picturesqueness of the view. In the case of Americans, medical tourism is usually prompted by the desire – or need – to have procedures done on the cheap. Statistics show that 43.3 million Americans lack health insurance. Obviously, having a hip replaced in India for $3,000 is much more affordable than having one replaced in the US for $39,000. And having a heart valve replaced in India for $10,000 (including airfare) makes the $200,000 it could amount to at home seem like extortion or robbery.

In the case of Canadian and British citizens, the main reason is to cut wait times. In Canada, the conservative think tank The Fraser Institute states in their October 2004 publication about waiting times in Canadian healthcare: "Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties … rose from 17.7 weeks in 2003 to 17.9 weeks in 2004." And according to UK numbers, "Waiting times rang(e) from one to two years or more for non-emergency operations in NHS hospitals …."

And as for the countries themselves – medical tourism is big business. While Japan became an economic colossus by exporting automobiles and television sets, other nations now hope to maintain a favorable balance of trade by importing clogged arteries, fat butts, and droopy breasts.

The Wheres & the Whats

Europe has a long tradition of medical tourism, going back to the water cures of the spas, where the healing mineral waters offered miracle cures for all known diseases. Private Swiss clinics, looking to lure the new capitalists of Eastern Europe, have placed ads in Swissair's in-flight magazine with the slogan "Get well in Switzerland." In 1997, medical tourism brought Switzerland over 25,000 patients and US$340 million, and through expanded publicity campaigns, the Swiss clinics are trying to expand this already lucrative market.

German physicians, relying on their nation's reputation for quality and efficiency, and using the slogan "Healthcare made in Germany," are looking for wealthy patients from Eastern Europe and the Middle East. To make it easier, travel agents offer package deals, arranging for visas, transportation, and translators. The agencies will even make appointments with physicians, and help with the check-in procedures at hospitals.

In Eastern Europe, Lithuania is also offering medical services. International Medical Services, with offices in Santa Ana, California, advertises: "Consider this: a world-class hospital, an experienced professional doctor, complete privacy and an IMS representative by your side whenever requested; plus full body Liposuction and a Face Lift – this whole package for only $8000!"

Meanwhile, Cape Doctor, in Cape Town, South Africa, lists on its website the wide-ranging procedures it offers: "cosmetic & reconstructive surgery; maxillo facial & oral surgery; urology surgery; renal disease & kidney dialysis; dialysis (regular and holiday services); kidney transplants (family); orthopaedic surgery; general & vascular surgery; gynaecology surgery, gynae oncology and paediatric gynaecology; ear, nose & throat surgery including cosmetic rhinoplasty & botox therapy; fertility surgery; ophthalmic and cataract surgery."

Closer to home, Costa Rican surgeons offer a variety of cosmetic procedures, including tummy tucks and full dental restorations, all at bargain prices, and Barbados offers infertility treatments. In the Far East, meanwhile, Malaysia promotes Lasik eye surgery.

Some nations, particularly India, focus on the problem of treatment delays to lure business from fellow Commonwealth nations of the United Kingdom and Canada. Prathap Reddy, a cardiologist and founder of Apollo Hospitals, a chain of Indian proprietary hospitals, has been quoted as saying, "if you wait six months for a heart bypass you may not need it anymore." India attracted about 150,000 medical tourists in 2003, and is aiming for as much as US$2.2 billion in trade by 2012. Indian hospitals offer joint replacements, heart bypasses, cataract operations, and gallstone removal. While there is some resistance to flying to a third world nation for medical care, India can offer some of the lowest prices in the world.

By any standards, the country with the lead in medical tourism has been Thailand. In 1997, Thailand's currency collapsed. Local hospitals began looking for a way to increase income, so they started luring Westerners with a combination of modern facilities, low prices, and beautiful beaches. Since then, they have perfected a formula of luxury accommodations, quality care with Western-trained doctors, and procedures that are not normally covered by insurance. While Thai hospitals offer most modern medical services, they offer particular bargains in aesthetic surgery, including sex changes. Hospital staff are expected to be not simply efficient, but friendly, while the hospitals themselves may be located in resort areas or on park-like grounds. And in place of the hospital cafeteria, Thai centers offer fine dining, while the gift shops offer luxury merchandise at bargain prices. And after your liposuction, you can buy your new wardrobe in the bargain bazaars of Bangkok.

The tour package is great, but what about the risks?

Those nations – such as Switzerland and Germany – that can offer the best quality care, do. Other countries, such as Thailand, compete chiefly on more questionable bases of price, luxurious amenities, or background scenery.

Thus the downside of medical tourism starts to show itself. Dr. Mukesh Haikerwal, vice president of the Australian Medical Association, says undergoing foreign operations is at your own risk. While many hospitals indicate that their doctors were trained in Western nations, there's less assurance that the nursing and other staff are equally qualified. Even if the care is excellent, are all the procedures medically necessary?

Further, in some other countries, standards are well below those in more developed nations. For example, an Associated Press article from February 6, 2005, reported that some Mexican plastic surgeons (who draw on trade from Texas) operate in an unregulated manner, with neither licensing standards nor adequate facilities. The article described mishaps, such as disfigurement and even fatal infections, often linked to unaccredited hospitals and unlicensed surgeons.

One California surgeon said, "We're seeing many more cases in emergency rooms of people returning from overseas with botched procedures that were done on the quick and by insufficiently trained surgeons." The New England paper, The Eagle-Tribune, described Dominican surgeons coming to the United States where they organized parties to extol their low-cost cosmetic surgery. Tragically, many of these procedures led to serious complications. And Asian Week, a magazine for Asian Pacific Americans, reported, "Canadian police have issued a warning about a bizarre world of secret underground cosmetic surgery clinics that target Asian Canadian women – They say the cut-rate procedures, often performed by untrained people posing as doctors, can kill."

Increasing Volume

In spite of disturbing stories like these, medical tourism seems sure to increase. The nature of global markets has led to the flight of manufacturing jobs from developed nations to underdeveloped nations. This was followed by the export of service sector jobs, such as shifting customer service telephone lines to India and Pakistan. While jobs in the healthcare sector have been relatively secure, they too may be sent to nations where basic costs are lower. If cosmetic surgery was the first step, then all elective surgery may be close behind. After all, insurers may be more willing to pay airfare to Asia than costs for recovery in a Western hospital.

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