When Mike Watson chose to go under the knife on
the other side of the world, he made the decision “out of necessity.”
After
doctors in B.C. told the Okanagan father-of-three that, for medical reasons, he
would have to wait six months to have a liver transplant done here, Watson
looked elsewhere for options.
Doctors
in Hong Kong told him his odds of survival would be better if he had the
operation done immediately. Watson, 39,
travelled across the Pacific with his wife, Lisa, last month so that surgeons
at Hong Kong’s Queen Mary Hospital could perform the surgery, with Lisa
donating two-thirds of her liver to her high-school sweetheart.
“The
medical care received was world class,” Watson said last week from Hong Kong,
where he’s receiving followup care and monitoring.
“After
being through the process I have absolutely no regrets,” he said. “I received a
second chance at life through their system.”
After facing a six-month wait for a liver transplant in B.C., Mike Watson has ‘absolutely no regrets’ about going to Hong Kong for the operation, in which his wife Lisa donated two-thirds of her liver. The Watsons are pictured In Hong Kong three weeks after the operation.
However,
other Canadians have deeply regretted their decision to go abroad for medical
care.
Among
them is Emily Reed, 46, who travelled to Tijuana, Mexico, for weight-loss
surgery last year. Reed, who lives in Hythe, Alta., near the B.C. border, said
she has lost more than half her body weight in the last 14 months and now fears
for her health as her weight continues to decline. She blames the botched
surgery for her health issues.
“I’m just
devastated,” Reed, who now weighs 124 pounds, said last week. “I’m just about
out of my mind ... I don’t have a lot of strength.”
She wants
to share her story to warn other Canadians about the complications that can
arise from a botched surgery abroad, she said.
“I want
to tell people: ‘Please be very careful when you’re doing this. You don’t want
to end up like me.’”
Medical tourism growing
“I often
say medical tourism is really good for some people and, unfortunately, really
bad for others,” said Valorie Crooks, a Vancouver-based expert on the growing
trend of international travel for medical care. “And there’s often no way to
predict from the outset if someone’s going to have a wholly positive or wholly
negative experience.”
More than
50,000 Canadian medical tourists make such trips every year, according to a
report last year from the Fraser Institute. The same report suggested British
Columbians are more likely than anyone else in the country to be medical
tourists. Common reasons for going outside Canada for medical treatment include
long waiting lists at home and high costs for treatments not covered by MSP.
It’s big
business, too. Market analysts have estimated the value of the global medical
tourism industry will grow to more than $32 billion a year by 2019, and the
Conference Board of Canada reported last year that Canadians spent more than
$440 million in 2013 travelling abroad for medical treatment.
Medical
tourism entrepreneurs say Canada, despite its socialized health care system, is
a market that’s ripe for major growth.
Valorie Crooks is an
associate professor in SFU’s geography department who studies the effects of
medical tourism. She says a growing number of people travelling abroad for
procedures are heading for the Caribbean and Central America.
When
Crooks, an associate professor in SFU’s department of geography, and her
colleague Jeremy Snyder, an associate professor in SFU’s faculty of health
sciences, co-founded the Medical Tourism Research Group in 2009, it was the
first group of its kind in Canada. Since then, the amount of research on the
topic has grown significantly, said Snyder.
But
despite increased awareness, experts say there’s still a lack of data.
“If you
think about the last time you went through customs, you’re not asked, ‘Did you
access surgery?’” said Crooks.
“So what
that tells us is that there’s actually no reliable way to know how many
Canadians are engaging in this practice. (But) there are some clues we can look
to.”
Those
clues include hospital admissions for patients returning from abroad with
complications, and surveys of Canadian doctors and dentists.
A study
published last month in the Canadian Journal of Surgery examined costs borne by
the public health care system of Alberta because of patients returning with
complications after having bariatric surgery outside of Canada. The report
concluded that “the financial cost of treating complications related to medical
tourism in Alberta is substantial and impacts existing limited resources.”
The study
said the estimated extra cost of $560,000 a year to the Alberta health system
was an “extremely conservative estimate,” and doesn’t account for long-term
care or hospital stays.
“If some
of these anecdotes actually are indicative of a wider pattern, it could be
incredibly expensive,” said Snyder. “But we can’t act on that without having
better data.
“The
argument goes, if you have somebody who is getting some kind of surgery abroad
and they’re paying out of pocket, then that’s actually saving the Canadian
system money.
“But on
the other hand, it’s well documented that when things go bad, they can go bad
pretty catastrophically and be incredibly expensive — millions of dollars in
some cases. I can’t say with confidence what side of the balance that lands on
... but it’s certainly something worth knowing.
“There’s
the potential there for something that’s actually draining a lot of money out
of the medical system.”
Patients return home with complications
Source: Glenn Cohen, a
Harvard Law School professor and a leading expert on medical ethics and the
law. Cohen says Canadian medical tourists often travel to the country of their
birth or ethnic origin. In other cases, says Cohen, certain countries have
become known for specific kinds of medical tourism.
When
Crooks and Snyder started the Medical Tourism Research Group in 2009, the top
international destinations Canadians reported visiting for treatment included
India, Thailand and China.
Crooks
calls those the “Medical Tourism 1.0” destinations: Asian countries with large
hospitals and investments in medical infrastructure looking for ways to use
excess capacity while generating revenue.
In the
last five or six years, Crooks said, more Canadian medical tourists have
reported trips to “Medical Tourism 2.0” destinations, which are often in the
Caribbean or Central America, with smaller, purpose-built medical facilities
tailored to foreign clientele.
“In that
’Medical Tourism 2.0’ sector, there’s a lot more of a view that this is a
tourism diversification project, often being led by Ministries of Tourism or
Trade, and not by the health sector, which creates a lot of challenges,” she
said.
B.C.’s
Ministry of Health advises against travelling out of Canada for medical
treatment.
“We
recommend patients have surgeries locally so they can benefit from the support
provided by our health care system before and after the procedure,” ministry
spokeswoman Kristy Anderson said in an email.
“All
surgeries come with some risk, and people who go abroad could have potentially
life-threatening complications, particularly in countries that may not have the
regulations or standards that we have in B.C.”
Some
physicians say that while they discourage out-of-country surgery, they
understand what drives patients to make that choice.
Dr. Ali
Zentner, a specialist in internal medicine and obesity, always advises her
patients against leaving Canada for bariatric surgery. But when Canadians such
as Emily Reed decide to travel abroad to have bariatric surgery, Zentner
understands the “need and the desperation.”
“With the
scarcity of bariatric options available to British Columbians and to Canadians
as a whole, it’s no surprise that these patients are going elsewhere for care,”
said Zentner, director of the Vancouver Island Bariatric Program.
“Patients
are forced to perhaps put themselves at risk of substandard care. You can get a
botched surgery, absolutely, let’s be frank, because who knows what the
standard of care is?
“We’re
seeing a lot of patients who went elsewhere and had complications, and now
we’re definitely faced with the added burden, the added concern associated with
that.”
Dr. Ali Zentner says
more Canadians are returning from foreign treatment with complications, which
burdens local health care.
It’s a
symptom of the Canadian health system’s inadequate treatment of obesity, said
Zentner.
In Canada
— where one in four adults is clinically obese — providing better care is not
only “good medicine, it’s also good finances,” said Zentner.
More
Canadians seem to be returning from overseas procedures with complications —
and not only in her field, said Zentner.
“More and
more, we’re seeing it for hip replacements and knee replacements,” she said.
“Medical tourism is happening. It’s a definite reality, especially when a need
is greater than a supply.”
Many
'transplant tourists' have complications
Dr.
Jagbir Gill, a transplant nephrologist at St. Paul’s Hospital, said stories
like that of Mike Watson — a Canadian who travelled abroad with a live donor to
get an organ transplant — are fairly rare.
More
common, Gill said, is a practice called “transplant tourism,” where patients
travel overseas to pay for an organ on the black market. This practice is
illegal, unethical and dangerous, said Gill.
“Buying
and selling of organs is illegal in Canada and in the vast majority of
countries,” he said.
Those
countries include the most common destinations for Canadian transplant
tourists: China, Pakistan and India.
“The
hospitals and doctors that facilitate the purchase of organs are breaking the
law in their country, so we can’t realistically expect that they will ensure
the safety and standards required to safely deliver transplantation,” said
Gill.
A “large
percentage” of transplant tourists experience complications, including severe
infections and higher rates of rejection, Gill said. And the risks are not
limited to those patients.
“What’s
most worrisome is that the types of infections we are seeing in patients who
return after obtaining a transplant abroad are often more severe and may not be
the typical infections we see after transplantation here.
“For
example, we have certainly seen more multi-drug-resistant infections in these
patients and this, in my opinion, is a major problem from a public health point
of view. It’s a serious concern for all Canadians when we are importing complex
infections through illicit organ transplantation.
“In my
view, we need to seriously consider the implications of this on the public
health of all Canadians and what measures we can put in place to prevent this.”
Gill’s
team at St. Paul’s still sees three to five cases a year of returning
transplant tourists, he said.
“If we
have a patient to whom we have expressly advised against this option, it is
disconcerting when they still go this route. There’s no question that this
tarnishes the relationship between the doctor and the patient,” Gill said.
“We may
feel that it is best to transfer the chronic care of this patient to a
different transplant program within the city. This is not meant to punish
patients who have purchased a kidney, but is to provide the most objective care
possible for all patients.”
Canadian companies coordinating treatment
abroad
A growing
number of Canadian companies are entering the multi-billion-dollar medical
tourism industry.
Last
year, the inaugural edition of Canada’s medical tourism trade show attracted
participants from 20 countries to Montreal.
This
year, Destination Health is expected to draw thousands of attendees to Ottawa
in September, said founder Pablo Castillo. He’s considering holding the 2017
event in B.C.
The show,
Castillo said, “is about empowering people so they can easily find reliable
health care services in other countries.”
Medical
tourism “is still a taboo in Canada” but “without a doubt a rapidly growing
sector,” he added.
Guillaume
Debaene, general manager of West Vancouver-based MediTravel International, said
medical travel “is becoming more and more popular for Canadians.”
“However,
millions of them still don’t know what it is exactly and that it is available
as a possible solution for them.”
Meanwhile,
in Armenia, Raffi Elliott has founded a company that he is aiming to turn into
the “expedia.com of health or medical tourism.”
The
Canadian is based in the Caucasus republic’s capital, Yerevan, which he
described as “the Silicon Valley of the (former) Soviet Union,” and a perfect
place for a “marriage of tech and health.”
His
company, gettreated.ca, targets Canadians seeking medical care abroad, helping
them access dental work and plastic surgery in Armenia. His Canadian customers
have been happy so far, Elliott said, even though some of them may have never
heard of Armenia before.
Gettreated.ca
will soon increase the range of medical services it offers, Elliott said. “It
could be anything from open-heart surgery to invitro fertilization.”
Along
with a wider range of services, Elliott said he plans to expand from Armenia to
serve Canadian medical tourists in Israel, Ukraine, the United Arab Emirates
and Poland.
The goal
is to serve 35 to 50 clients a month through gettreated.ca by the end of this
year, Elliott said. They are targeting 100 patients a month next year.
“Public
health care in Canada is seen as a bit of a religion. It’s something you can’t
really criticize or discuss openly,” Elliott said. “But it has its shortfalls
and a lot people end up falling through the cracks.
“I think
a lot of Canadians would actually be surprised by the number of Canadians who,
despite public health care, actually go to the United States and pay tens of
thousands of dollars to get something done,” he said.
Plan to make B.C. a health-care destination
fell flat
When
Kevin Falcon raised the idea of promoting B.C. as a destination for medical
tourism, it did not meet a healthy reception.
Then
B.C.’s health minister, Falcon told the legislature in May 2010 that he had been
in touch with a number of B.C. surgeons and “the message that I’ve received is
that government should not just look at health care as a cost, that there is a
potential for revenue to be generated in the health care system.”
With
hundreds of thousands of Americans flying out of the U.S. every year for
medical care, Falcon said, “You could charge these individuals enough that you
could not only cover the costs of the operation or whatever the elective
surgical procedure may be, but you could also have enough ... to plow back into
the system to provide quicker and better access for British Columbians that may
be on elective waiting lists.”
Earlier
that year, Falcon had asked: “Why can’t British Columbia be the Mayo Clinic of
the North?”
Several
voices piped up in opposition.
The idea
Falcon floated was described as “a non-starter for health care” in an op-ed
from Alice Edge, co-chair of the B.C. Health Coalition.
“We need
to build on the proven public innovations that make this system stronger, and
not be distracted by marketing schemes dressed up as public policy,” Edge
wrote.
In a 2012
article in the academic journal Healthcare Policy, Leigh Turner, an associate
professor from the University of Minnesota’s Center for Bioethics & School
of Public Health, concluded: “Canadians should tell their elected
representatives to ‘Hold the Mayo’ and not waste public resources on efforts to
attract international patients to provincial health care systems that already
face many challenges in providing Canadians with timely access to medically
necessary care.”
The idea
seems to have died on the table.
Last
week, a Ministry of Health spokeswoman said: “At this time the ministry is not
considering a plan to market health care services to individuals outside our
province. Our priority at this time is to improve access to care for British
Columbians and to ensure that British Columbians are able access the care they
need as close as possible to home.”
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