More New
Zealanders travelling to countries for cheap healthcare is further widening a
two-tier system, both here and abroad, says Otago University researcher Kirsten
Lovelock.
A senior
research fellow at Wellington School of Medicine's Department of Public Health,
Dr Lovelock has conducted several research projects on the growing popularity
of medical tourism.
The most
common procedures people travel for are dentistry, heart surgery, and hip and
knee replacements, with cosmetic surgery also popular.
The
research team has held in-depth interviews with New Zealanders who have
returned home with new hips or knees, or having had other surgical and dental
procedures at overseas clinics that provide services for medical tourists.
Patients
were quizzed on how they researched and prepared for the procedure, how it
went, how they were cared for, and how much it cost.
Web sites
for international healthcare had become increasingly popular, following reports
of cheaper medical treatment in some Asian countries - even when airfares are
included - and with the bonus of a holiday thrown in.
It's not
a new phenomenon - Dr Lovelock said people had travelled for healthcare for
centuries - but the demographic was changing as public health waiting lists
lengthened - not just in New Zealand but in the UK, Canada and the United
States.
"Increasingly
it is not just elites that are travelling for care, but it is middle-income
earners in countries like New Zealand," she said.
She said
the change was hugely driven by the internet.
"You
have people basically working out what their treatment options should be, and
it may not necessarily be the case."
Dr
Lovelock said the tourism part of medical tourism was a "bit of a
ruse", except perhaps for dentistry.
"The
reality is that's quite serious surgery and it's highly unlikely you'll be
shopping in the local bazaar."
She said
surgeons in New Zealand worried about the lack of professional care given to
patient travellers before, and especially after, surgery.
"The
question for New Zealanders travelling abroad is ... are they really giving
informed consent when they have these quite serious procedures done
overseas?"
For
example, an orthopaedic surgeon colleague told Dr Lovelock he would not allow
his patients to travel overseas for three months after surgery because of the
risk of embolism.
Health inequality pushed up in poorer countries
Dr
Lovelock said a wider issue was how medical tourism contributed to the two-tier
system, both at home and in countries like India, Malaysia and Thailand.
"They
have state-of-the-art hospitals and they certainly have technical competency,
and they are catering for their own elite as well as the elite from
abroad."
But while
New Zealanders may be getting a cut-price operation, many local people were not
getting even the most basic health care.
"In
India there are huge disparities between the wealthy and the poor, where only
the elite can afford to pay for decent healthcare.
"So
while we might go getting a cheap hip job while we're over there, there are
people who don't have clean water or adequate sanitation - let alone access to
appropriate healthcare."
She said
there were only 10 doctors per 10,000 people in India, and in other Asian
countries medical tourists were also encouraging the movement of doctors from
rural to urban centres where the pay is better.
And when
procedures do not go well, patients may need remedial work and become a burden
on the public health system back home, as has been found in Britain's National
Health Service.
Commodification
There can
be other unintended consequences of medical tourists becoming global consumers,
Dr Lovelock said.
"For
example the NDM1 drug-resitant enzyme was thought to have spread to Canada, the
United States and the UK from medical tourists who had been having treatment in
India."
Dr
Lovelock said New Zealanders may be unaware they were at risk.
"We
have met people who have had things go wrong with heart surgery and have had to
fly to another country for an urgent remedy."
People
had also had negative experiences of cosmetic surgery.
"People
having to have up to eight or nine remedial efforts for cosmetic outcomes that
were less than satisfactory ... so the cheap facelift turns into an expensive
nightmare."
Dr
Lovelock said among those who travelled for surgery, many said the public
health system here did not care about them.
"But
the way they express care that they've experienced abroad actually mirrors all
sorts of inequalities that are part of our colonial heritage.
"So
you have 'lovely Indian people' being so kind and so polite and marbled walls
etc, and when you're at home the hospitals are run down, the staff are
stressed."
Dr
Lovelock said there has been a very significant cultural shift in the notion of
care, who was going to provide that care and who could afford to pay for it.
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