Medical Tourism

1

The Outsourcing of Surgical Procedures to

Asia:

Economic, Social, Surgical, Moral and Quality of Care

Issues

Claire Langham, Ph.D.Dennis M. Richmond, M.D.,

F.A.C.SMichele A. Rubin, Ph.D.,

MHMS

2

Sociological Aspects of Medical Outsourcing

ECONOMIC

Country Sending Patients

Country Receiving Patients

Lower Costs Additional income revenue

Savings passed on to other needs

Monetary benefit to nation

3

Sociological Aspects of Medical Outsourcing

SOCIAL

Country Sending Patients Country Receiving

Patients

Appreciation given host nation

Opportunity to encounter others

Greater respect to host nationals

Increased cultural exchanges

Opportunity for family to visit abroad

More tourism promotion in effect

4

Sociological Aspects of Medical Outsourcing

LEGAL

Country Sending Patients Country Receiving

Patients

Promote development of agreements

Greater international legal ties

Potential for redefining of malpractice suits

Internationalization of practices

5

Sociological Aspects of Medical Outsourcing

MEDICAL

Country Sending Patients Country Receiving

Patients

Increased contacts in exchange of people and information

Increased prestige in medicine for host nation

Less control of medical practices

Raise issues of international medical ethics

Questions of safety in follow up Reputation importance

Concerns for medical standards Inspections by international medical regulatory boards

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The Outsourcing of Surgical Procedures to

Asia:Cardiac:

Procedures&

Services USA India Thailand Singapore

Coronary Angioplasty

$35,000 –$83,000

$4,000-$11,000 $13,000 $13,000

Coronary Artery Bypass

$100,000 –$123,000

$4,000-$10,000 $12,000 $20,000

Heart Valve (single)

$160,000 –$281,000

$9,000-$10,000

$10,000-$11,000 $13,000

Note: Angioplasty in Malaysia averages $4,000 - $6,000

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The Outsourcing of Surgical Procedures to

Asia:Gastrointestinal and General Surgical:

Procedures

& ServicesUSA India Thailand Singapore

Gall Bladder Removal

$20,000-25,000

$8,000-$10,000 $10,000 $11,000

Hernia Repair $5,000 $250-$300 $350 $390,000

Gastric Bypass

$48,000-$70,000

$11,000-$17,000 $15,000 $15,000

Hysterectomy

$20,000-$30,000 $3,000

$4,000-$5,000 $5,000

Mastectomy$23,000-$35,000

$7,000-$8,000

$9,000 $12,000

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The Outsourcing of Surgical Procedures to

Asia:

Procedures & Services USA India Thailand Singapore

Radiology Reading

$1,000-$3,000 $200 - $300

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The Outsourcing of Surgical Procedures to

Asia:Orthopedics:

Procedures & Services USA India Thailand Singapore

Hip Replacement

$44,000-$64,000 $9,000 $12,000 $12,000

Knee Replacement

$40,000-$61,000

$8,000-$9,000 $10,000 $13,000

Rotator Cuff$40,000-%60,000

$4,000-$7,000 $8,000 $8,000

Knee (ACL) Repair

$17,000-$20,000

$4,000-$6,000

$7,000-$8,000 $8,000

Spinal Fusion$63,000-$91,000

$5,000-$6,000 $7,000 $9,000

Spinal Disc $90,000 $10,000

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The Outsourcing of Surgical Procedures to

Asia:

Cosmetic:

Procedures & Services USA India Thailand Singapore

Face Lift$10,000-$20,000

$2,000-$3,000

$3,000-$5,000

$3,000-$5,000

Breast Augmentation

$6,000-$12,000

$2,000-$3,000

$3,000-$5,000

$3,000-$5,000

Breast Reduction

$6,000-$12,000

$2,000-$3,000

$3,000-$5,000

$3,000-$5,000

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The Outsourcing of Surgical Procedures to

Asia:

Cosmetic (continued):

Procedures & Services USA India Thailand Singapore

Liposuction$7,000-$12,000

$1,000-$2,000

$2,000-$3,000 $3,000

Nose Surgery

$7,000-$12,000

$2,000-$3,000 $3,000 $3,000

Tummy Tuck

$7,000-$12,000

$2,000-$3,000 $3,000 $3,000

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The Outsourcing of Surgical Procedures to

Asia:

Costs (Dollars)

Transplant Procedures USA India PRC

KidneyUp to

$500,000*$10,000-$15,000

$15,000-$20,000

LiverUp to

$500,000*$10,000-$18,000

$21,000-$28,000

*Cost of Dialysis can exceed $1,000,000

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The Outsourcing of Surgical Procedures to

Asia:

Altruistic Donation

Transplant Procedures USA India PRC

Kidney Yes No Yes/No

Liver Yes No Yes/No

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The Outsourcing of Surgical Procedures to

Asia:

Waiting Time

Transplant Procedures USA India PRC

KidneyMonths to

Years Weeks (3) Weeks (3-5)

Liver Months Weeks (3) Weeks (3-5)

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The Outsourcing of Surgical Procedures to

AsiaA. Are the surgeons skilled?

YesB. Are the results satisfactory?

Yes = Western ResultsC. Ethical Considerations:

1. Is XS waiting time unethical?Yes

2. Is “XS” cost unethical?Yes

3. Indications for Transplant Surgery: Age and Diagnosis4. Altruistic vs. Non-Altruistic Organ Donation “Eye of the

Beholder”

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Quality of Care Issues

More than 500,000 U.S. residents in 2005 traveled abroad for medical and dental treatment.

Source: National Coalition on Health Care

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Quality of Care Issues

Health care errors seriously harm 1 in every 10 patients around the world.

Source: World Health Organization (WHO)

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Quality of Care Issues

Goals:• Reduction in high numbers of serious

medical injuries.

• Strengthen and improve patient safety and quality of healthcare worldwide.

• Spread and reinforce proven best practices.

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Quality of Care Issues – International Patient Safety

Goals

Goal 1 – Identify Patients Correctly

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Quality of Care Issues – International Patient Safety

Goals

Goal 2 – Improve Effective Communication

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Quality of Care Issues – International Patient Safety

Goals

Goal 3 – Improve the Safety of High-Alert Medications

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Quality of Care Issues – International Patient Safety

Goals

Goal 4 – Eliminate Wrong-Site, Wrong-Patient, Wrong-Procedure Surgery

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Quality of Care Issues – International Patient Safety

Goals

Goal 5 – Reduce the risk of health care-acquired infections.

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Quality of Care Issues – International Patient Safety

Goals

Goal 6 – Reduce the risk of patient harm resulting from falls.

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Quality of Care Issues“The belief that one day it may be possible for

the clinical error suffered by a patient in one part of the world to be a source of transmitted learning that benefits future patients in many countries is a powerful force…”

Sir Liam Donaldson, MD, Chair of World Alliance for Patient Safety

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