MEDICAL TOURISM OMAN
RESEARCHED AND MODIFIED BY VASU RANA.
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Medical tourism refers to a foreign excursion made for the purpose of medical treatment. In early times, it used to be referred to the foreign trips made by ill people from the under-developed countries to well-developed countries for the advanced level health treatments. But now, people from well-developed countries also travel to developing countries for cheaper treatment options. Surgeries are most common medical treatments taken by patients in Medical Tourism. Other two most common treatments are Dental treatment and Fertility Treatment. People with rare conditions may travel to countries where the treatment is better understood. Medical tourism is also useful for infrequent medical conditions whose treatment is not available at home. In other words, medical tourism is the healthcare treatment taken by patient in abroad.
Factors that make medical tourism popular include high healthcare costs, long waiting times for certain procedures, the ease and affordability of international travel, and improvements in technology and standards of care in many countries. Avoiding waiting is a major driver of medical tourism in the United Kingdom, whereas in the United States the main driver is lower prices abroad. In addition, mortality varies greatly between industrialized countries. H. Great Britain versus seven other leading countries including the United States.
Many of the surgical procedures in medical tourism destinations cost a fraction of the costs they incur in other countries. For example, in the US, a liver transplant, which costs $ 300,000, usually costs about $ 91,000 in Taiwan. Convenience and speed are the main draws of medical tourism. Countries using public health systems often have long waiting times for certain operations. For example, approximately 782,936 Canadian patients spent an average of 9.4 weeks on medical waiting lists in 2005. Canada has also set a standard waiting time for non-patients. Emergency medical procedures, including a waiting period of 26 weeks for hip replacement and a waiting period of 16 weeks for cataract surgery.
In First World countries such as the United States, medical tourism has great growth prospects and has the potential to have a destabilizing effect. Estimates published in August 2008 by Deloitte Consulting estimated that US-based medical tourism could increase by ten factors over the next ten years. About 750,000 Americans went abroad for health care in 2007, and according to the report, 1.5 million will receive health care outside the United States in 2008. Growth in medical tourism could cost US healthcare providers billions of dollars in lost revenue.
A Harvard Business School body says that "medical tourism is being promoted more in the UK than in the United States".
In addition, some patients in some First World countries find that insurance does not cover orthopedic surgery (such as knee or hip replacements) or limits the choice of device, surgeon, or prosthesis to use.
Popular destinations for medical tourism around the world are: Oman, UAE, Canada, Cuba, Costa Rica, Ecuador, India, Israel, Jordan, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, USA.
Popular cosmetic surgery destinations are: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Turkey, Thailand and Ukraine. According to the Sociedad Boliviana de Cirugía Plástica y Reconstructiva, more than 70% of middle and upper class women have had plastic surgery. Other destinations are Belgium, Poland, Slovakia and South Africa.
Some people travel for assisted pregnancies such as in vitro fertilization or surrogacy or to freeze embryos for reverse production.
However, the perception of medical tourism is not always positive. In countries such as the United States, where quality standards are high, medical tourism is seen as a risk. In some parts of the world, broader policy issues may affect where medical tourists choose to receive medical care.
Medical tourism providers have emerged as intermediaries bringing potential medical tourists along with surgeons, hospitals and other organizations. In some cases, US surgeons have teamed up with medical tourism providers to travel to Mexico to treat American patients. It is hoped that hiring an American surgeon can allay fears of overseas travel and convince independent American employers to offer their workers this low-cost option to save money while ensuring quality care. Companies that focus on worthwhile medical tourism usually offer nurse managers to help patients with medical problems before and after the trip. They can also help provide resources for follow-up care after a patient returns.
The surrounding tourism also expands the health tourism area. Medical tourism is travel for the purpose of access to medical services that are legal in the destination country but illegal in the country of origin. This may include trips to view unapproved fertility treatments in your home country, abortion and doctor-assisted suicide. Abortion tourism is most widespread in Europe, where traveling between countries is relatively easy. Ireland and Poland, two European countries with very strict abortion laws, have the highest avoidance rates in tourism. In Poland in particular, an estimated 7,000 women travel to the UK each year, where abortion is free through the National Health Service. Independent organizations and doctors such as Women on the Wave are also working to help women circumvent the law to gain access to medical services. With Women on the Wave, the organization uses mobile clinics on board to perform medical abortions in international waters where flag state laws apply.
Dental tourism is a trip to cheaper dentistry or oral surgery. The same porcelain veneer made in a laboratory in Sweden can cost A $ 2500 in Australia but only A $ 1200 in India. The difference in price cannot be explained by material costs.
Types of Medical Tourism
There are several categories of medical tourism:
1) A majority are temporary medical tourists, who travel for either check-up or treatment for a brief time
2) A very few are Long-term residents like people who move to a better location for their health care (Few Americans moving to Florida or the Caribbean)
3) Medical tourist from two neighbouring countries who share common borders and have agreed upon to share health care system
4) Outsourced patients are patients who are sent abroad by their respective government, as the essential required management and care is not available locally. This category matches many of the Omani patients.
Issues arising from Medical Tourism
Issues arising from growing medical tourism Medical tourism carry many risks (health related, quality related, destination related), some perceived by traveller as well. These are security, safety, quality of services, risks to patients’ health, risks of travel, pre- and post-operative risks, and compensation in case of complications. Undergoing a procedure that is illegal in the home country can also expose to unknown risks. Patients can develop psychological and emotional distress being away from home. There are several problems with medical tourism as discussed by several authors these include poor or no follow-up of care. After being in hospital for a short period, the patient comes home often with complications of surgery or toxic side effects of the drugs. As a principle every surgeon must look after his own complications and obviously that does not apply for most patients who have been treated abroad. Many destined countries have very weak malpractice legislations and patients have restricted capacity to complain about any poor medical care. Medical tourism also influences host countries with the setback of internal brain drain; whereby all high-quality doctors abandon serving the public sector to go into the lucrative private health care centres serving the medical tourists. Thailand’s Bumrungrad Hospital, which treats about more than half a million international patients a year, is a major source of internal brain drain leading to a political discussion within Thailand and shortage of Thai doctors in Bangkok because of the higher pay offered by Bumrungrad. Globalisation thus impacts world health care, both in the host and the donor countries. There are other risks which medical tourism poses to patients. For example, patients may not tolerate travel very well, or may not have inherent resistance to some of the diseases in the host countries. The article in this issue of this journal reported a 15% complication rate. A survey by the British Association of Plastic, Reconstructive and Aesthetic Surgery showed 37% complication rate arising from overseas cosmetic surgery, much higher than NHS locally. In another survey in the UK, 60% of complications were of emergency nature requiring inpatient admission Many medical tourists are often satisfied with their endeavour. Satisfaction, however, does not always corresponds with quality of care, standard of care or desired outcome. Often satisfaction can merely be a result of courteous service . An institution has to be accredited for good medical care with a quality assurance programme rather than just good service. Now more and more of the provider institutions try for accreditation by either the Joint Commission International (JCI) or for Canadian accreditation ACI. Patients going abroad should get good prior advice. According to the World Tourism Organization’s Global Code of Ethics for Tourism, tourists even medical should have the same rights as citizens of destination countries . Unfortunately, this is not always true and that is another potential source of problems like in areas of confidentiality and an informed consent. An additional probable substantial snag with medical tourism is that often it impacts the source country’s health care system. A source country may befall complacent by sending its citizens abroad and thus fail to improve its health care services appropriately. The late acquisition of positron emission tomography (PET) in Oman is an example. Sending patients abroad is expensive, and dilutes the political will and commitment to develop several essential national services. This situation creates a two-tier system in the destination country where the local population receives second-class treatment while medical tourist gets much better treatment in the more sophisticated, well-equipped, state-of-the-art hospitals. Another disadvantage of medical tourism is related to health insurance companies, who refuse to provide cover for a patient going abroad for legitimate reasons, or conversely may actually encourage patients to go abroad if the treatment is cheaper, but then not cover the travel and logistic expenses. If the insurance companies are asked to cover the cost of overseas treatment this may imply rising premiums, another undesirable effect on medical tourism for some patients. Medical tourism commonly raises the expense of health care in the host country, by declining services and internal brain drain of hospital administrators and of doctors as described previously. A foremost concern associated with medical tourism is the ethical aspects of treatment . It should be examined and the risks discussed with the patient. On the other hand, patients must have their own autonomy in decision making. Beneficence and non-maleficence are the basis of medical ethics and it is our obligation to promote patients’ well-being, treat them with justice and improve their health while avoiding harm to them. These ethical principles are not easily upheld in the delicate balance of commercial interests versus medical ethics. Another attribute of medical ethics is the ownership of responsibility for treating the complications of the treatment given abroad. Each country may have a distinct standard and code of medical ethics. For example, an experimental therapy in one country like stem cell transplant is routinely used in the private institutions providing care for medical tourists in other countries. Similarly, the medical ethics related to organ transplant vary from country to country. Most countries do not allow the involvement of money in organ donation, yet it is a common practice in some countries and donors can be a living non-relative. The Declaration of Istanbul on Organ Trafficking and Transplantation Tourism, 2008, has condemned organ transplant tourism  and it is the responsibility of medical profession to stop the trend of treating medicine and health care like goods, trade, or business [40,41]. Medical tourist from Oman showed a 95% satisfaction rate with lowest from India as 83.3%. Nearly 55% patient came back from abroad with improved clinical condition, and a reported complication rate was 15-33% . Burney has pointed out in SQUMJ that medical tourism may receive "uncalled for treatment" . The quality assurance trend in health care has introduced the term “consumer” to describe patients in an effort to improve the quality of care in hospitals. Unfortunately, the term “health consumer” is now misused in the business of delivery of health care. The quality and safety of medical treatment abroad has to be studied and questioned and it should be under the scrutiny of the medical profession and the Ministry of Health in Oman. Unless we have good grip on the quality of the care that our patients are receiving abroad, their safety may be at risk. We need more statistics, better studies and better reporting systems. The question of who will look after these patients when they return, has not been answered, but must be tackled. Thus, there is a major lack of systematic data about health services provided abroad, not only for Omanis, but, also for citizens of many other countries. More organised studies are needed and specifically outcome studies. Research into the delivery of health care has not yet adequately evaluated medical tourism. The issue of lack of data must be taken very seriously. Medical tourism has some benefits, but there are more problems with it and, as physicians, we have to keep in mind our basic principles of beneficence and non-maleficence.
Discussion and conclusions
A very small report published from Oman of 45 patients in 2011 disclosed that Orthopaedic ailments were the most frequent settings leading Omani patients to pursue treatment abroad. Thailand was the most preferred destination (50%) followed by India (30%). Approximately 85% of patients went abroad for only treatment purpose, 10% for treatment plus tourism; while 2.5% were healthy and went overseas for a routine health check-up. Intriguingly, 15% of the subjects went abroad without first seeking any medical care in Oman. From those who were initially evaluated and managed in Oman 38.2% had no precise diagnosis locally, and over 1/3 obtained treatment locally which was ineffective. About ¾ acquired information on management abroad from a friend, whereas Internet and medical tourism offices were the least used sources. More than 15% of the patients suffered from complications after their treatment abroad . Oman has a national committee for making decision and advice on treatment abroad and decides on the eligibility of candidate patients. The number of people it sent for treatment abroad was only 20 per 100,000 of the population in 2010 (nearly 610 patients), declined from about 59 per 100,000 in 1977. There is further decline in this government outsourced number recently with the availability of PET scan in Oman. The number of patients going privately on their own expenses still remains high. The total expenditure on treatment abroad by the Ministry of Health (MOH) in Oman in 2003 was US$ 2.6 million [3,42]. It is a common observation in Oncology practice that at least 60-70% patients of cancer in Oman travel at least once during their management timeline. Over 85% patient come back to continue the treatment in Oman. The major reasons of travel are failure of early and prompt diagnosis, time delays in investigations and diagnosis, some investigations are not available, bottle necks and waiting lists in hospital, inability of primary and secondary care to envision and narrow down diagnosis, inability to refer timely to appropriate speciality, mistrust in the system and health care professionals, family pressures, social pressures, a symbol of affection to patients, a symbol of affluence and status, etc. Another perplexing issue is that a good number of patients Mehdi I (2020) Medical tourism in Oman Cancer Rep Rev, 2020 doi: 10.15761/CRR.1000212 Volume 4: 4-5 and their family are not informed about their diagnosis of malignancy. When they are not cured it obviously makes the patient to loose trust on treating physicians. Multiple different factors clearly have an important influence on remedial tourism. Different motivations of medical tourists lead them to travel, whereas existing various risks also associated with it influence medical tourists to avoid destinations or avoid the travel. Travel constraints hindering the initiation of travel may also influence the decision making of medical tourists in terms of their visit intentions. The motivations of medical tourists differ and may also vary based on individual needs and based on these perceived risks of medical tourists. Form of travel constraints can also be changed according to their regions of residence, health conditions, and medical needs. We therefore need to have better scientific studies on the impact of medical tourism on the health care services of the source and destination countries as well as on the patients themselves. We need more statistics on the rate of complications. Americans and Europeans now realise that they need to analyse the impact of medical tourism— beneficent or maleficent—on the patients and the country’s health care system. Many of the patients do not get standard of care abroad, as the practices and management of foreign patients is not absolutely controlled and regulated. This is due to short stay and lack of knowledge on part of patients and their families. The outsourced patients, sent by government, are better off in this respect as the destination can be selected and de-selected periodically as per evaluation. Many patients coming back from abroad after consulting private physicians, brings with them fancy prescriptions which are standard of care not approved by regulatory bodies, nor recommended by international guidelines, after phase III randomized controlled trials. There are obviously issues of regulating practice at host destinations. The patients after being back insist on these, out of nowhere, treatment plans. In oncology it is a catch 22 situation, as an advanced cancer will progress after an interval. If you do not follow and change these out of bound prescription, on progression of disease you gets the blame. It puts clinical practice on defensive. On one hand you have to balance advice from abroad, while on other you have to satisfy those who are your practice regulators locally. Due to low medical care costs India and Thailand were the most popular destinations for treatment abroad in Oman. Saudi patients travelled more to Pakistan, Philippines, Egypt and the United States. About 10% Omani travelled for tourism as well. A study on reproductive health tourism in the United Arab Emirates (UAE) observed that yet another reason for travel is privacy; an apprehension in a society where both infertility and in vivo fertilisation are yet stigmatised. It is interesting thing that a good number of the patients travel abroad directly without any local consultation or management. The reason for such trend is not clear, though dissatisfaction with local treatment may well be a reason. People still use traditional methods (word of mouth) as their source of information. One may think that medical care abroad is cheaper, overall costs are still turn out to be high. The complication rate is quite high and late complications may ensue at a later date like graft rejection, CMV and hepatitis B and C. More studies in the GCC region is needed to obtain a clearer picture of the treatment abroad trend. It is often difficult to obtain information on patients who travel abroad for treatment. There is a need to establish national registries and databases. Facts, figures, costs, implications, issues, and rights regarding medical tourism should be made clear to the community and must be safeguarded by appropriate regulatory and advisory agency. There must be a system to Accredit medical tourism companies and the institutes they represent and then regularly review their accreditation. These promotor companies must be obliged to contribute to funds to protect clients from financial losses and to compensations. The people should be mandated to report to their primary health care institution on their return for recording and follow-up. Patients planning on medical tourism should know that they need to consult their local doctors first, for advice and help even for 2nd opinion abroad. If the trend of increasing medical tourism continues at an enhancing pace, it will have major global implications for public health systems, profession, practitioners and patients. A growing number of countries are now competing for patients by offering a wide diversity of medical and surgical services. There are growing medical tourism promotor companies with commercial interests which catch patients from hospitals and clinicians, facilitate appointments, and make travel arrangements and book hospital admissions. There is a business sort of situation, with commercial incentives for everyone at every level.
1. Debata BR, Patnaik B, Mahapatra S, Sreekumar S (2013) Efficiency measurement amongst medical tourism service providers in India. Int J Respon Tourism 1: 24-31 2. Hopkins L, Labonté R, Runnels V, Packer C (2010) Medical tourism today: What is the state of existing knowledge & quest. J Public Health Policy 31: 185-198. [Crossref] 3. Saleh S. Al-Hinai, Ahmed S. Al-Busaidi, Ibrahim H. Al-Busaidi (2011) Medical tourism abroad - A new challenge to Oman’s health system - Al Dakhilya region experience. SQU Med J 11: 477-484 4. Connell J (2016) Reducing the scale? From global images to border crossings in medical tourism. Glob Net. 5. Wongkit M, McKercher B (2016) Desired attributes of medical treatment and medical service providers: A case study of medical tourism in Thailand. J Travel Tour Mark 33: 14-27 6. Deloitte L (2008) Medical tourism: Consumers in search of value. 7. Crush J, Chikanda A (2015) South-South medical tourism and the quest for health in Southern Africa. Soc Sci Med 124: 313-320. 8. Guiry M, Scott JJ, Vequist IV DG (2013) Experienced and potential medical tourists' service quality expectations. Int J Health Care Qual Assur 26: 433-446. 9. Schiffman LG, Kanuk LL (2004) Consumer behaviour 8th Ed. New Jersey: Pearson Prentice Hall. 10. Johnston R, Crooks VA, Snyder J (2012) I didn’t even know what I was looking for”: a qualitative study of the decision-making processes of Canadian medical tourists. Glob Health 8: 23. 11. Medical Tourism. From: http://en.wikipedia.org/wiki/Medical_tourism. Accessed: Oct 2011. 12. Horowitz MD, Jones CA (2007) Medical Tourism: Globalization of the healthcare marketplace. Med Gen Med 9: 33. 13. Musa G, Thirumoorthi T, Doshi D (2012) Travel behaviour among inbound medical tourists in Kuala Lumpur. Curr Iss Tourism 15: 525-543. 14. Mwijuke G (2015) Rising medical bills sending East African patients abroad. Retrieved on 09062015. 15. Penney K, Snyder J, Crooks VA, Johnston R (2011) Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites. BMC Med Ethics 12: 17. 16. Gupta AS (2008) Medical tourism in India: winners and losers. Indian J Med Ethics 5: 4-5. 17. Cheung IK, Wilson A (2007) Arthroplasty tourism. Med J Aust 187: 666-667. Mehdi I (2020) Medical tourism in Oman Cancer Rep Rev, 2020 doi: 10.15761/CRR.1000212 Volume 4: 5-5 Copyright: ©2020 Mehdi I. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 18. Lautier M (2008) Export of health services from developing countries: The case of Tunisia. Soc Sci Med 67: 101-110. 19. Turner LG (2010) Quality in health care and globalization of health services: accreditation and regulatory oversight of medical tourism companies. Int J Qual Health 78. 20. Ramirez DAAB (2007) Patients without borders: the emergence of medical tourism. Int J Health Serv 37: 193-198. 21. Rerkrujipimol J, Assenov I (2011) Marketing strategies for promoting medical tourism in Thailand. J Tourism Hosp Cul 3: 95-105. 22. Khan MJ, Chelliah S, Haron MS (2016) Medical tourism destination image formation process: A conceptual model. Int J Healthc Manag 16. 23. Veerasoontorn R, Beise-Zee R, Sivayathorn A (2011) Service quality as a key driver of medical tourism: the case of Bumrungrad International Hospital in Thailand. Int J Leisu Tourism Mark 2: 140-158. 24. Kangas B (2007) Hope from abroad in the international medical travel of Yemeni patients. Anthropol Med 14: 293-305. 25. Khan MJ, Chelliah S, Haron MS (2016) International Patients’ Travel Decision Making Process-A Conceptual Framework. Iran J Public Health 45: 134-145. 26. Rokni L, Pourahmad A, Langroudi MHM, Mahmoudi MR, Heidarzadeh N (2013) Appraisal the potential of central Iran, in the context of health tourism. Iran J Public Health 42: 272. 27. Chinai R, Goswami R (2007) Medical visas mark growth of Indian medical tourism. Bull World Health 85: 164-165. 28. Ajzen I (1991) The theory of planned behaviour. Organizational behaviour and human decision Processes 50: 179-211. 29. Lam T, Hsu CH (2006) Predicting behavioural intention of choosing a travel destination. Tourism Manage 27: 589-599. 30. Wu K, Raab C, Chang W, Krishen A (2016) Understanding Chinese tourists' food consumption in the United States. J Bus Res 69: 4706-4713. 31. Floyd MF, Gibson H, Pennington-Gray L, Thapa B (2001) The effect of risk perceptions on intentions to travel in the aftermath of September. J Travel Tour Market 15: 19-38. 32. Gray HH, Poland SC (2008) Medical tourism crossing borders to access health care. Kennedy Inst Ethics J 18: 193-201. 33. Herrick DM (2007) Medical Tourism: Global competition in health care. National centre for policy analysis. 34. Madden CL (2008) Medical Tourism Causes Complications. Asia Times 7. 35. International Trade in Health Sciences. OECD - Directorate of Employment, Labour and Social Affairs. 36. Al-Hinai SS, Al-Busaidi AS, Al-Busaidi IH (2011) Medical tourism abroad: A new challenge to Oman’s health system - the Al Dakhilya region experience. Sultan Qaboos University Med J 11: 477-486. 37. Lunt N, Smith R, Exworthy M, Green ST, Horsfal D (2011) Medical Tourism: Treatments, markets and health system implications: A scoping review. OECD, Directorate for Employment, Labour and Social Affairs 11: 444-447. 38. World Tourism Organization’s Global Code of Ethics for Tourism. 39. Declaration of Istanbul on Organ Trafficking and Transplantation Tourism. 40. Top 5 Medical Tourism Destinations. Medical tourism can mean attractive opportunities for foreign patients and investors. 41. Tutton M. Medical tourism: Have illness, will travel. CNN Health. 42. Burney I (2009) The trend to seek a second opinion abroad amongst cancer patients in Oman. Sultan Qaboos University Med J 9: 260-3.