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One of the ugly things that has emerged from the medical tourism trade is the gross exploitation of desperate people. These desperate people are both the buyers and sellers of organs for transplant. There’s a new article on Bloomberg discussing this problem.  This is not a new phenomenon, reports have emerged from Asia and China with growing frequency.  Particularly disturbing are reports that incarcerated Chinese individuals have been made to forcibly donate their organs to feed a increasingly lucrative business.  The linked articles talk about executed prisoners, but there is evidence that this is happening to other prisoners as well.

This isn’t confined to China, in one article I read several years ago (still looking for it) it was estimated that as many as 15% of all Phillipino males had sold a kidney.

Organ Trafficking (2008) article from the Journal of Transplantation

France 24 report on Chinese transplant business

From 2006: UK Independent

Organ transplant in the European community

This along with the growing surrogacy market in India is consumerism and capitalism at its worst. As a healthcare provider dedicated to the safety and well-fare of my patients (and all patients) I do not interview, endorse or support providers, companies or consumers engaging in this sort of conduct. The surgeons that I have met, and spoken with in Colombia do not engage in these practices.  All patients from outside Colombia are required to bring their living-donor-related (brother, sister, mother) with them to Colombia.  While I am certain that underground markets exist, I will in no way participate or assist these people in this endeavor.

While my heart goes out to people needing organ transplantation – the results do not justify the means.

Mother Jones – an excellent article about surrogacy in India

A new article (November 2011) claims Colombia is one of the top countries for black market transplantation – unfortunately even though the article makes it sounds like ‘hordes’ of Americans in organ failure are hightailing it to Colombia and latin America – there is very little hard or even anecdotal evidence to accompany the story.  I wouldn’t be terribly surprised if there was a large secret market in Colombia, Argentina, Brazil just because all of these countries have a high degree of medical sophistication (without the American price tag).  It makes sense that countries that are ideal locales for other types of medical tourism would be good for this illicit trade too..  So even if the idea is abhorrent to me, I certainly can’t deny that it exists.  I will continue to actively abstain from interviewing or becoming involved with any surgeons suspected of this practice.

 

 

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A round up of our recent discussions on Medical Tourism

In several previous posts, we talked about various Medical Tourism topics:
– including medical tourism in India due to recent publicity; including Superbug (New Delhi – 1 ) contamination of water sources in India, and
President Obama’s adoption of India’s medical tourism industry (and the medical tourism industry in general) as a target for his derision, rather than more justly, as a symbol of America’s failing health system.

I’ve also talked about why I see Colombia, as an ideal medical tourism destination, for several reasons; many of which I outlined in an article published on Colombia Reports.com**  and a new article on Yahoo! Associated content.

We’ve even discussed the Colombian government’s role and support of medical tourism, and medical tourists.

We’ve talked about the global effects of medical tourism, and the ethics of medical tourism

** Astute readers may notice that I have referenced Colombia Reports.com several times (links). Colombia Reports.com is the largest, in country English language newssource, and is widely relied upon by English speakers, like myself, living in Colombia.
Colombia Reports.com has published my work in the past – as part of their series of articles (by various writers) on medical tourism in Colombia so back in April, I traveled in April to interview Adriaan Alsema, the editor -in -chief.

Hope you enjoyed this retrospective review of Cartagena Surgery, and medical tourism in Colombia.

UK doctors say medical tourism to India spreading superbug

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As predicted, the medical tourism section in India has responded strongly to remarks and plans by President Obama to attempt to restrict/ prevent Americans from traveling to India for medical tourism procedures. In this article, Dr. Javali, a cardiovascular surgeon in the large Fortis network replies. More interesting than Dr. Javali’s somewhat predictable comments are the medical tourism estimates quoted in this article – which differ by more than a factor of ten from what I’ve read elsewhere.  So where do they get these numbers?  How accurate are they?  Well – that’s certainly up to considerable debate..

Estimations about the number of medical tourists/ medical tourism procedures performed yearly vary widely and are notoriously unreliable and subject to much debate – however, previous polls and studies suggest that medical tourism to India alone is much more prevalant that the 150,000 suggested in this article. India is one of the most popular destinations, if not the most popular destination for Europeans. Several years ago a large British poll shows that 1:10 patients used medical tourism to travel outside the UK. That potentially accounts for 150,000 right there..

More interesting to Americans however, is the latest article from a Physician Assistant writing for Business Insider – which gives American medical tourism statistics, which estimate annual outbound tourism at greater than 1 million people per year (using Deloitte center statistics – they are the most widely quoted and accepted figures, and even these are debatable). Otherwise, many of the statistics are recycled and amplified which makes real discussions on the topic quite difficult. Furthermore, few if any reported data separates medical tourism into destination countries, though several articles list Thailand as the number one destination for North Americans (again, not a logical choice in my opinion).

One of the points Mr. Halasey makes in the above mentioned article is one of the topics we’ve covered here several times – the growth of health insurance sponsored medical travel. We talked about it in our first book, and now again in the Bogota project – since many people don’t even realize – that not only does your insurance pay for medical care to places like Colombia – many times they offer strong incentives to do so. Some companies offer to pay for elective cosmetic procedures (that would otherwise be outside of coverage), other companies such as Anthem have large divisions to assist patients with arranging for medical tourism..

I think if Obama wants to take on medical tourism – the first thing he will have  to do to is get out of the back pocket of the very insurance companies that are sending patients outside the USA.  Then he will need to provide reasonable domestic alternatives and strong disincentives to outbound tourism.  All of that requires a strategic, methodical, well laid out plan, which are not Obama (or his cabinet’s) strong points..

So, I think patients will remain safe to explore their medical options globally, for the foreseeable future.

Next time – we’ll talk about something in the statistics that I found much more interesting.. the reasons for medical tourism (only 9% reported cost as the primary factor!)

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President Obama and Medical Tourism have been making the headlines lately. It’s also been a hot topic in the operating rooms during my visits.

What do I think?
– I think Medical tourism will certainly continue – despite President Obama’s position – because of all the reasons medical tourism has become popular in the first place (which we talked about in previous posts). All the presidential comments in the world won’t change the impending surgeon shortages – only a real concerted effort at increasing funding to surgical residency programs (and several articles don’t think that even this would be sufficient).

– Also, while I am not always his biggest fan (I think his ‘plans’ are generally big, vague, unrealistic outlines) – I agree with his sentiments. “I’d like you to be able to get it [affordable medical care] right here in the United States of America that’s high quality.”
I would like my American patients to get great care at home, too.. (and I like to think I provide that care too..)  But for many people, that care is completely out-of-reach.  If the alterative is medical tourism, or going without  – I’ll drive you to the airport myself.

Besides, what position is our president supposed to take? The ‘go ahead and outsource our largest industry’ position?
But the difference between Obama and I is – about a factor of five. He makes big, vague pronouncements : “Yes, We Can” with little or no specific follow through – and I provide very specific, very detailed, methodically researched information.. This is not a criticism of Obama, per se – it’s how politics works in general. Even when former President Clinton’s speechwriters started the trend of identifying one blue class worker in each crowd (i.e. the “Joe the plumber” tie-in) we are still talking about a politician making pronouncements that are supposed to be generic enough to satisfy 300 million people.

Why is he picking on India? He’s chosen India merely because of their high-profile, which is unfair but that’s what happens in politics.  As you can see from some of my links below – he’s set off a firestorm of commentary over recent comments calling medical tourism “cheap Indian doctors’.  (I would normally say he needs a new speechwriter in my opinion, to give him some class/ polish, but I think he enjoys creating controversy).

As my readers know, I advocate against travel to India and Thailand, but this is due to the travel distance involved, which I think is a clear health risk to medical tourists travelling from North America.

Now Medical Tourism, in general, and it appears India, specifically have become Obama’s personal target, or symbol in his push to further his own ObamaCare agenda. But until we get a real, workable healthcare plan – people will have little choice but to explore their off-shore medical tourism options.

Obama says – Americans stay home.
Obama and Medical Tourism in India

Obamacare to exclude Medical Tourism

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Is it ethical to visit India, a country of more than 1.1 billion people, with some of the greatest discrepancies between wealth and poverty on the face of the earth for medical tourism?  Is it fair to divert the resources of that nation for American/ outside use (medical tourism)?  Especially since the revenues from that medical tourism are not going to support facilities and services that benefit the native population.  That’s the question the Indian government and the World Health Organization are asking regarding the medical tourism industry..

While Colombia certainly has its share of poverty and hardship – (with over three million displaced people) the sheer size of India’s millions of disenfranchised makes the problem much more acute. Rural populations are suffering the most from the medical tourism phenomenon.

Also, President Santos (and his predecessor, Uribe) have approached medical tourism in a more thought-out way – to try to maximize the benefit to their nation, not just individuals and private hospitals with a multi-part plan addressing medical tourism and it’s role in the economic growth and health of the country.

In comparison to India, (and to a similar extent, Thailand), medical tourists traveling to Colombia are not being diverted to exclusive single purpose facilities that were built for that purpose. They are going to the same hospitals are many other Colombian residents – meaning when American patients go to Cardioinfantil, Santa Fe de Bogotá or any of the other myriad of facilities here – the money generated from medical tourism is going to hospitals that treat Colombians, and support public health programs for Colombians..

In Thailand, medical tourism has hurt the country by luring away medical professionals (doctors and nurses) from community hospitals to lush, private facilities catering only to foreigners. Again, given the way that medical facilities and services are supplied here in Bogotá – that is less likely to happen.

We’ll continue this discussion later – right now I have another interview..

Update: 28 April 2011 Medical Tourism in Thailand is Bad for Thailand

New article published in the Guardian by Andrew Chambers about Thailand and Medical Tourism reiterating all the claims we presented here, such as the idea that medical tourism to Thailand adversely affects poorer Thai residents, and that Medical Tourism in Thailand may actually force Thailand to import doctors to treat their own populace.

Issues regarding the use of private [expensive] clinics catering to foreigners is also mentioned in the article:
“There are also concerns over the growing divergence between state and private health provision. Some of the big private hospitals now resemble five-star hotels. Doormen will guide you to a gleaming marble foyer before elevator attendants take you to your waiting room. These “hotel-spitals”, designed specifically for the needs of foreign patients, mean that the Thai middle classes are increasingly unable to afford private healthcare provision at these centres.”

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