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McCarron MO, Black N, McCarron P, McWilliams D, Cartmill J, Marzouk AM, Miras AD, Loftus AM. Bariatric surgery tourism in the COVID-19 era. THE ULSTER MEDICAL JOURNAL 2024; 93:6-11. [PMID: 38707972 PMCID: PMC11067310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Background Since the start of the Covid-19 pandemic primary and secondary health care services in Northern Ireland have observed an increase in the number of patients who have had bariatric surgery outside of the UK. This study sought to estimate the frequency of bariatric surgery tourism and to audit indications, blood monitoring and medical complications. Methods All primary care centres within the Western Health Social Care Trust (WHSCT) were invited to document the number of patients undergoing bariatric surgery between January 1, 2017 and December 31, 2022. For one primary care centre, patients who underwent bariatric surgery were assessed against the National Institute of Health and Clinical Excellence (NICE) guideline indications for bariatric surgery. In addition, the blood monitoring of these patients was audited against the British Obesity and Metabolic Surgery Society (BOMSS) guidelines for up to two years following surgery. Medical contacts for surgical complications of bariatric surgery were recorded. Results Thirty-five of 47 (74.5%) GP surgeries replied to the survey, representing 239,961 patients among 325,126 registrations (73.8%). In the six year study period 463 patients had reported having bariatric surgery to their GP. Women were more likely to have had bariatric surgery than men (85.1% versus 14.9%). There was a marked increase in the number of patients undergoing bariatric surgery with each year of the study (p<0.0001 chi square for trend). Twenty-one of 47 patients (44.7%) evaluated in one primary care centre fulfilled NICE criteria for bariatric surgery. The level of three-month monitoring ranged from 23% (for vitamin D) to 89% (electrolytes), but decreased at two years to 9% (vitamin D) and 64% (electrolytes and liver function tests). Surgical complication prevalence from wound infections was 19% (9 of 44). Antidepressant medications were prescribed for 23 of 47 patients (48.9%). Conclusions The WHSCT has experienced a growing population of patients availing of bariatric surgery outside of the National Health Service. In view of this and the projected increase in obesity prevalence, a specialist obesity management service is urgently required in Northern Ireland.
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Affiliation(s)
| | - Neil Black
- Endocrinology & Diabetes, Magee Campus, Londonderry BT48 7JL
| | - Peter McCarron
- Altnagelvin Hospital, Londonderry, BT47 6SB, Northern Ireland, The National Drug Treatment Centre
| | | | | | - Ahmed M Marzouk
- Obstetrics and Gynaecology, and Surgery, Magee Campus, Londonderry BT48 7JL
| | - Alexander D Miras
- 120 Strand Road, Londonderry, BT48 7NY and Ulster University School of Medicine
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Heinz T, Eidmann A, Jakuscheit A, Laux T, Rudert M, Stratos I. Demographics and Trends for Inbound Medical Tourism in Germany for Orthopedic Patients before and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1209. [PMID: 36673964 PMCID: PMC9859416 DOI: 10.3390/ijerph20021209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Medical tourism is a rapidly growing sector of economic growth and diversification. However, data on the demographics and characteristics of the traveling patients are sparse. In this study, we analyzed the common demographic properties and characteristics of the inbound medical tourists seeking orthopedic medical care in Germany for the years 2010 to 2019 compared to a domestic group. At the same time, we examined how the COVID-19 pandemic outbreak of 2020 changed the field of medical tourism in Germany. Calculations were performed using administrative hospital data provided by the Federal Statistical Department of Germany. Data were analyzed from the years 2010 to 2020. A total of six elective orthopedic surgery codes (bone biopsy, knee arthroplasty, foot surgery, osteotomy, hardware removal, and arthrodesis) were identified as key service indicators for medical tourism and further analyzed. Factors including residence, sex, year, and type of elective surgery were modeled using linear regression analysis. Age and sex distributions were compared between patients living inside Germany (DE) or outside Germany (non-DE). Between 2010 and 2020, 6,261,801 orthopedic procedures were coded for the DE group and 27,420 key procedures were identified for the non-DE group. Medical tourists were predominantly male and significantly younger than the domestic population. The linear regression analysis of the OPS codes over the past years showed a significantly different slope between the DE and non-DE groups only for the OPS code "hardware removal". With the COVID-19 pandemic, an overall decline in performed orthopedic procedures was observed for the non-DE and the DE group. A significant reduction below the 95% prediction bands for the year 2020 could be shown for hardware removal and foot surgery (for DE), and for hardware removal, knee arthroplasty, foot surgery, and osteotomy (for non-DE). This study is the first to quantify inbound medical tourism in elective orthopedic surgery in Germany. The COVID-19 pandemic negatively affected many-but not all-areas of orthopedic surgery. It has to be seen how this negative trend will develop in the future.
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Affiliation(s)
- Tizian Heinz
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Annette Eidmann
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Tino Laux
- Distance and Independent Studies Center, Technical University Kaiserslautern, Erwin-Schroedinger-Straße 57, 67663 Kaiserslautern, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
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Felkai PP, Nakdimon I, Felkai T, Levin L, Zadik Y. Dental tourism and the risk of barotrauma and barodontalgia. Br Dent J 2023; 234:115-117. [PMID: 36707585 PMCID: PMC9880927 DOI: 10.1038/s41415-023-5449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/10/2022] [Indexed: 01/28/2023]
Abstract
Background and aim Dental tourism, which reflects the provision of health care services abroad, also includes a travelling component. Air travel after dental intervention may cause barotrauma and barodontalgia. This paper aimed to provide guiding principles regarding the minimal time interval between dental procedures and air travel to prevent these adverse effects.Methods A literature search was performed to reveal information with regards to complications related to flights following dental treatments. There is little research in this area and most of it has been conducted on the military aircrew population, which has different characteristics of flight and personnel than civilian commercial flights.Results The recommended time of flying is one week after most dental intervention and six weeks after a sinus lift procedure. The minimal time required between a procedure and flight is 24 hours after restorative treatment, 24-48 hours after simple extraction, 72 hours after nonsurgical endodontic procedure, surgical extraction, and implant placement, and at least two weeks after sinus lift procedure.Conclusions The provided guidelines may serve as a starting point for the clinician's decision-making. The tailoring of an individual treatment plan to the patient should take into consideration the patient's condition, dental procedure, complications and flight characteristics. Further research based on commercial flights is needed to formulate more accurate guidelines for the civilian population.
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Affiliation(s)
- Peter P Felkai
- Associate Professor, Internal Chair, Department of Travel Medicine, School of Medicine, Debrecen University, Debrecen, Hungary.
| | - Idan Nakdimon
- Head, Department of Aviation Physiology, Aero-Medical Centre, Israeli Air Force, Tel Hashomer, Israel
| | - Thomas Felkai
- Senior Lecturer, Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Liran Levin
- Faculty of Medicine and Dentistry, The University of Alberta, Canada
| | - Yehuda Zadik
- Professor and Chair, Department of Military Medicine and ´Tzameret´, Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Oral Medicine, Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
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Tonga F, Çaĝlar YŞ, Aktan ES. Possible Early Examples of Medical Tourism. Am J Med Sci 2021; 362:227-232. [PMID: 34081900 DOI: 10.1016/j.amjms.2021.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 01/31/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
Health tourism has hundreds of years of history, most notably in visitors traveling to thermal baths. Medical tourism, a type of health tourism, has rapidly expanded in the last quarter century by patients travelling abroad to health centers for medical treatment. Because of lack of records in ancient times, the history of tourism for actual medical treatment is unknown. In Ottoman archives, medical treatment consent forms of patients were officially documented. We analyzed these existing records to identify foreign citizens who came to the Ottoman Empire for medical treatment. In our screening of Konya Şer'iye registration records, we found medical consent forms for three non-Ottoman foreign citizens. All three patients had the same medical illness and came to Konya for medical treatment. Therefore we emphasized that those patients searched for the name of doctor who was an authority on that illness. This study indicates that medical tourism may have occurred well before the 20th century.
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Affiliation(s)
- Faruk Tonga
- Neurosurgery Department, Amasya University Faculty of Medicine, Amasya Merkez/Amasya, Turkey.
| | - Yusuf Şükrü Çaĝlar
- Neurosurgery Department, Ankara University Faculty of Medicine, Ibn-i Sina Hospital, Altindag/Ankara, Turkey
| | - Eray Serhat Aktan
- Neurosurgery Department, Ankara University Faculty of Medicine, Ibn-i Sina Hospital, Altindag/Ankara, Turkey
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Parmar CD, McCluney SJ, Rodriguez N, Behrens E, Lakdawala M, Kow L, Shikora S, Ramos A. A Global Survey by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) on Perceptions of Bariatric Medical Tourism (BMT) by Health Professionals: Guidelines from IFSO for BMT. Obes Surg 2021; 31:1401-1410. [PMID: 33387264 DOI: 10.1007/s11695-020-05185-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bariatric medical tourism (BMT) is a rapidly expanding industry, with over 650 million people with obesity worldwide and total number rising by over 300% between 2003 and 2014. The overall health tourism industry is worth over $400 billion/year. METHODS International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) conducted a global survey to analyze the details of BMT and the perceptions of bariatric health care professionals (HCP) regarding BMT. RESULTS A total of 383 bariatric HCP's with experience of 272,548 procedures responded from 65 countries. Seventy-three percent of respondents had managed BMT patients, whilst low cost of surgery was felt to be the driving factor in 77% of cases. The USA contributed the most patients travelling for BMT with 11.6%. Twenty-four percent of respondents stated that they had no access to adequate notes regarding the patient's operation, whilst 12% felt BMT is associated with a higher mortality. Only 49% of respondents felt that IFSO guidelines were followed by the operating surgeon. Sleeve gastrectomy was the commonly offered surgery and an overall mean operation cost was $8716. Nearly 64% of respondents felt BMT needed better coordination between practitioners, whilst almost 85% of respondents supported the idea of a forum to facilitate safe BMT worldwide. CONCLUSION This IFSO survey has outlined the current BMT trends worldwide and highlighted areas of concern in the care of such patients. It has expanded our knowledge and should be used as a starting point to establish international forums to aid collaboration.
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Affiliation(s)
- Chetan D Parmar
- Whittington Hospital, London, N19 5NF, UK.
- University College London Medical School, London, UK.
| | | | | | | | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders Private Hospital, Bedford Park, Adelaide, South Australia, Australia
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Almino Ramos
- Gastro-Obeso-Center Institute of Metabolic Optimization, São Paulo, Brazil
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Medical Tourism Markets: Models of Sustainability. The Case of Spain and The Costa del Sol (Malaga). SUSTAINABILITY 2020. [DOI: 10.3390/su12218818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The interest and relevance of medical tourism has increased significantly over the last few decades, and it has become a very lucrative source of income and profit for many firms. This paper analyses the sustainability of the medical tourism model in Spain in general, and in The Costa del Sol (Spain) in particular, in order to investigate the potential challenges that the domestic industry will face in the future. For this purpose, we first analysed the process of the globalization of health services and the main characteristics of the Spanish medical tourism industry (in terms of tourism and health services). Second, we examined the data availability on medical tourism for the cases of Spain, Andalusia and The Costa del Sol, and identified who travels, why, and for what reasons. The results show that Spain and The Costa del Sol offer high-quality medical and tourism facilities and services with very competitive prices, and with the high commitment and support of public local authorities, tourism and health providers, and universities. However, the lack of a real leadership, well-defined strategy, financial support, and specific training programs are considered to be crucial challenges for the near future. In addition to this, the novel coronavirus, the economic crisis, Brexit and the situation of British expats living in Spain and The Costa del sol are also discussed.
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Ayuningtyas D, Ariwibowo DA. The strategic role of information communication technology in succeeding medical tourism. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hunter BM. Going for brokerage: strategies and strains in commercial healthcare facilitation. Global Health 2020; 16:49. [PMID: 32471459 PMCID: PMC7260813 DOI: 10.1186/s12992-020-00578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The formation of domestic and global marketplaces during the past 50 years has opened up new commercial opportunities for third-party activity in healthcare systems. Commercial mediation of access to healthcare is one recent area of activity that sees companies and individuals offering to organise healthcare and travel in return for payment. With varying degrees of control over the location, type, cost and experiences of healthcare provisioning, these intermediaries occupy potentially influential positions in healthcare systems and yet much of their work is poorly understood. METHODS Drawing on social science theories of brokerage, this article presents a novel analysis of commercial healthcare facilitation. It focuses on facilitation companies and their workers as central, intermediating actors for people to access healthcare in markets characterised by complexity. Semi-structured interviews were conducted with people working in domestic and international healthcare facilitation in London and Delhi, and data were analysed using a framework approach that emphasises the structural features and personal agencies for this area of work. RESULTS Findings point to an institutional environment for commercial healthcare facilitation marked by competition and the threat of obsolescence. The activities of rivals, and the risk that users and providers will bypass intermediaries, compels facilitation companies to respond strategically and to continuously pursue new populations and activities to mediate - to go for broke. These pressures percolate into the lives of people who perform facilitation work and who describe a physical and mental burden of labour incurred by onerous processes for generating and completing facilitation work. The need for language interpretation services introduces an additional set of relations and has created further points of tension. It is an environment that engenders mistrust and anxiety, and which incentivises exploitation and a commodification of users whose associated commissions are highly prized. CONCLUSION Brokerage analysis provides valuable insights into the strategies and strains for commercial mediation of access to healthcare, and the findings indicate opportunities for further research on the contributions of interpreters, diplomatic and business networks, and new technologies, and on the growth of new forms of mediation in domestic and overseas settings.
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Affiliation(s)
- Benjamin M Hunter
- Department of International Development, King's College London, London, UK.
- Department of International Development, University of Sussex, Brighton, UK.
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Virani A, Wellstead AM, Howlett M. The north-south policy divide in transnational healthcare: a comparative review of policy research on medical tourism in source and destination countries. Global Health 2020; 16:37. [PMID: 32321561 PMCID: PMC7178960 DOI: 10.1186/s12992-020-00566-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/09/2020] [Indexed: 11/20/2022] Open
Abstract
Medical tourism occupies different spaces within national policy frameworks depending on which side of the transnational paradigm countries belong to, and how they seek to leverage it towards their developmental goals. This article draws attention to this policy divide in transnational healthcare through a comparative bibliometric review of policy research on medical tourism in select source (Canada, United States and United Kingdom) and destination countries (Mexico, India, Thailand, Malaysia and Singapore), using a systematic search of the Web of Science (WoS) database and review of grey literature. We assess cross-national differences in policy and policy research on medical tourism against contextual policy landscapes and challenges, and examine the convergence between research and policy. Our findings indicate major disparities in development agendas and national policy concerns, both between and among source and destination countries. Further, we find that research on medical tourism does not always address prevailing policy challenges, just as the policy discourse oftentimes neglects relevant policy research on the subject. Based on our review, we highlight the limited application of theoretical policy paradigms in current medical tourism research and make the case for a comparative policy research agenda for the field.
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Affiliation(s)
- Altaf Virani
- Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore, 259772, Singapore.
| | - Adam M Wellstead
- Department of Social Sciences, Michigan Technological University, Houghton, USA
| | - Michael Howlett
- Department of Political Science, Simon Fraser University, Burnaby, British Columbia, Canada
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Mathijsen A, Mathijsen FP. Diasporic medical tourism: a scoping review of quantitative and qualitative evidence. Global Health 2020; 16:27. [PMID: 32228641 PMCID: PMC7106793 DOI: 10.1186/s12992-020-00550-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is a growing recognition of the significance of the diasporic dimension of medical travel. Explanations of medical tourism are increasingly presented in a wider context of transnationalism, diaspora and migration. Yet diaspora and cross-border travellers rarely get through the broader narrative of medical travel. Objective Our aim in this scoping review was to extend the current knowledge on the emerging subject of diasporic travels for medical purposes. Specifically, we reviewed the existing literature on what is known about the determinants and motivational factors of diasporic medical tourism; its geographic scope and its quantitative estimation. Methods Using a scoping review methodology, we conducted the search in seven electronic databases. It resulted in 210 records retrieved. Ultimately, 28 research papers and 6 non-research papers (published between 2002 and 2019) met the following criteria: 1) focus on healthcare and health-related practices, 2) transnational perspective, 3) healthcare consumption in the country of origin (homeland) while being a resident of another country, 4) published in English. Results The findings from our review highlighted the importance of diasporic medical patients who had been researched and analysed on four continents. Even though quantitative evidence has been scarce, the data analysed in the scoping review pointed to the existence of non-negligible level of diasporic medical tourism in Northern America, and in Europe. Various motivational factors were enumerated with their frequency of occurrence: medical culture (12), time availability (“by the way of being home”) (9), communication (6), dissatisfaction with the current system (6), healthcare insurance status (5), quality of healthcare (5), second opinion (3), and value for money (3). Conclusion Diasporic medical tourists constitute an attractive segment of consumers that is still not well understood and targeted. They are part of transnational communities that cultivate the links between the two nations. They simultaneously participate in bi-lateral healthcare systems via return visits which impact the health systems of sending and receiving countries in a substantial way. In the current globalised, connected and migratory context, transnationalism seems to represent an answer to many local healthcare-related barriers. Sending and receiving countries have put in place an array of programmes and policies addressed to the diasporic medical travellers.
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Affiliation(s)
- Aneta Mathijsen
- SGH Warsaw School of Economics, Collegium of the World Economy, Aleja Niepodległości 162, 02-554, Warsaw, Poland.
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Sule S, da Lilly-Tariah O. Universal healthcare coverage and medical tourism: Challenges and best practice options to access quality healthcare and reduce outward medical tourism in Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_67_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Purpose
The purpose of this study is to investigate the inbound and outbound medical tourism in the UK to determine if the UK can be considered as a net exporter of health services as well as the impact of the 2007 global economic crisis, diaspora populations and the number of UK expats on medical tourism figures.
Design/methodology/approach
Using microdata drawn from the International Passenger Survey (2000-2016), the authors estimate the flows, number of nights and expenditure of tourists looking for medical treatment who complete international visits of less than 12 months’ duration to and from the UK. The authors also analyse the main destinations of UK residents, the country of origin of overseas residents and the particular case of British expats.
Findings
The results show the upward trend of inbound and outbound patients, the strong seasonality in outbound patients, and the significant increase in the levels of expenditure of overseas residents since 2005. Poland, France, Hungary and India are the chosen countries by UK residents to be treated, whereas Irish Republic, Spain, France, Gibraltar and the United Arab Emirates are the main countries providing inbound health patients. However, the processes of migration explain full or partly the inbound and outbound flows found for some countries.
Originality/value
This study offers a critical insight into inbound and outbound medical flows, demonstrating both the scope for and limitations to market development in this area.
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Qureshi AA, Gould DJ, Stevens WG, Fernau J. Report on Current Experience of ASAPS Membership and Management of Cosmetic Tourism Complications. Aesthet Surg J Open Forum 2019; 1:ojz009. [PMID: 33791605 PMCID: PMC7671244 DOI: 10.1093/asjof/ojz009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Cosmetic tourism is an expanding industry with increasing scrutiny in the public domain of complications and patient safety issues. The health and financial implications for patients are large and deserve further investigation. Objectives The aim of this study was to understand the experience of the American Society for Aesthetic Plastic Surgery (ASAPS) members treating medical tourism patients with complications who returned to the United States for secondary management. Methods A 20-question survey was administered electronically in August 2018 to ASAPS members with voluntary participation. Questions about surgeon experience, the nature of complications, type of initial surgery, and subsequent management were asked. Responses were tabulated and percentages of response choices were calculated and reported. Results Ninety-three responses were received from the 1611 physician ASAPS members (5.8% response rate). More than half of respondents had seen 2 to 5 patients in the last 12 months with a complication from cosmetic tourism. The most common procedure that patients had done abroad was abdominoplasty. The most common complication was infection caused by Gram-positive organisms, managed on an outpatient basis without surgical intervention. Involvement of an ASAPS member led to successful resolution of complications in the vast majority of patients. Estimated costs out of pocket for management of complications were most commonly between $1001 and 5000. Conclusions While the experience of ASAPS members is as varied as the complications faced by cosmetic tourism patients, the vast majority of complications is infectious and can be managed on an outpatient basis successfully with the involvement of an ASAPS member. Further collaborative efforts both domestically and internationally can help improve patient safety for cosmetic tourism patients.
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Affiliation(s)
- Ali A Qureshi
- private plastic surgical practice in Marina del Rey, CA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
| | - W Grant Stevens
- Surgery and Director of the Aesthetic Surgery Fellowship, University of Southern California School of Medicine, Division of Plastic Surgery, Los Angeles, CA
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Government roles in regulating medical tourism: evidence from Guatemala. Int J Equity Health 2018; 17:150. [PMID: 30236120 PMCID: PMC6148768 DOI: 10.1186/s12939-018-0866-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022] Open
Abstract
Background Regulation of the medical tourism and public health sectors overlap in many instances, raising questions of how patient safety, economic growth, and health equity can be protected. The case of Guatemala is used to explore how the regulatory challenges posed by medical tourism should be dealt with in countries seeking to grow this sector. Methods We conducted a qualitative case study of the medical tourism sector in Guatemala, through reviews and analyses of policy documents and media reports, key informant interviews (n = 50), and facility site-visits. Results Key informants were critical of the absence of effective public regulation of the emerging medical tourism sector, noting several regulatory gaps and the importance of filling them. These informants specifically expressed that: 1) The government should regulate medical tourism in Guatemala, thought there was disagreement as to which government sector should do so and how; 2) The government has not at this time regulated the medical tourism sector nor shown great interest in doing so; and 3) International accreditation could be used to augment domestic regulation. Conclusions The intersection of domestic and international regulation of medical tourism has been largely unexplored. This case study advances new research in this area. It highlights the need for and dearth of regulatory protections in Guatemala and lessons for other, similarly situated countries. National regulatory models from Israel and Barbados could be adapted to the Guatemalan context. Global governance could help to protect national governments from any competitive disadvantages created by regulation. Underlying the concerns over growth in medical tourism, however, is how it contributes to the ongoing privatization of health care facilities worldwide. This trend risks undermining efforts to reach targets for Universal Health Coverage and exacerbating existing inequities in the global distribution of health and wealth.
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An update on bariatric tourism: time for a national registry? Surg Obes Relat Dis 2018; 14:528-532. [PMID: 29426706 DOI: 10.1016/j.soard.2017.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/28/2017] [Accepted: 12/15/2017] [Indexed: 12/31/2022]
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Maguire Á, Bussmann S, Meier zu Köcker C, Verra SE, Giurgi LA, Ruggeri K. Raising concern about the information provided on medical travel agency websites: A place for policy. HEALTH POLICY AND TECHNOLOGY 2016. [DOI: 10.1016/j.hlpt.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Medical tourism: A snapshot of evidence on treatment abroad. Maturitas 2016; 88:37-44. [DOI: 10.1016/j.maturitas.2016.03.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
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McGlone ER, Roman A, Kayal A, Reddy M, Khan O. Experience of a specialist emergency bariatric surgical service. Surg Obes Relat Dis 2016; 12:1032-1036. [PMID: 27220824 DOI: 10.1016/j.soard.2016.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bariatric surgery is associated with late and procedure-specific acute surgical complications. There is very little evidence available regarding the volume, nature, and outcomes of acute surgical admissions directly stemming from bariatric surgery. Centralization of bariatric elective services in the United Kingdom may have an adverse impact on the ability of local services to manage such unpredictable complications. To address this potential problem, we set up a comprehensive and specialist emergency bariatric service. OBJECTIVES The aim of this study was to quantify and characterize the workload of a specialist emergency surgical bariatric service. SETTING University National Health Service hospital. METHODS Over 2 years, we prospectively collected data on demographic characteristics, management, and outcomes of all acute surgical admissions related directly to previous bariatric surgery. RESULTS Between December 2011 and November 2013, 69 patients had 71 emergency admissions due to a surgical emergency directly related to previous bariatric surgery. Thirty-seven (54%) had undergone primary bariatric surgery at our institution, 13 (19%) at a different National Health Service hospital, 16 (23%) at private U.K. hospitals, and 3 (4%) at private overseas hospitals. Forty-four endoscopic or surgical interventions were required, of which 17 (39%) were performed on nights or weekends and within 12 hours of admission. Of 27 operations, 25 (93%) were completed laparoscopically. Median length of stay was 2 days, there were no mortalities, and there was 1 readmission within 30 days. CONCLUSIONS There is a significant volume of late bariatric surgical emergencies, many requiring urgent intervention. These may be effectively managed by a specialist bariatric service.
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Affiliation(s)
| | | | - Ajit Kayal
- St. George's University Hospitals NHS Trust, London, United Kingdom
| | - Marcus Reddy
- St. George's University Hospitals NHS Trust, London, United Kingdom
| | - Omar Khan
- St. George's University Hospitals NHS Trust, London, United Kingdom.
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Hudson N, Culley L, Blyth E, Norton W, Pacey A, Rapport F. Cross-border-assisted reproduction: a qualitative account of UK travellers' experiences. HUM FERTIL 2016; 19:102-10. [PMID: 27144511 DOI: 10.3109/14647273.2016.1168530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surveys on patients' experiences of cross-border fertility treatment have reported a range of positive and challenging features. However, the number of such studies is limited, and there is no detailed qualitative account of the experiences of UK patients who travel overseas for fertility treatment. The present study used a cross-sectional, qualitative design and in-depth interviews. Fifty-one participants (41 women and 10 men, representing 41 treatment 'cases') participated in semi-structured interviews. The experiences reported were broadly positive with a large proportion of participants (39 cases, 95%) citing a favourable overall experience with only two cases (5%) reporting a more negative experience. Thematic analysis revealed 6 major categories and 20 sub-categories, which described the positive and challenging aspects of cross-border fertility travel. The positive aspects were represented by the categories: 'access', 'control' and 'care and respect'. The more challenging aspects were categorized as 'logistics and coordination of care', 'uncertainty' and 'cultural dissonance'. The study confirms findings from others that despite some challenges, there is a relatively high level of patient satisfaction with cross-border treatment with participants able to extend the boundaries of their fertility-seeking trajectories and in some cases, regain a sense of control over their treatment.
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Affiliation(s)
- Nicky Hudson
- a Applied Social Sciences , De Montfort University , Leicester , UK
| | - Lorraine Culley
- a Applied Social Sciences , De Montfort University , Leicester , UK
| | - Eric Blyth
- b School of Human and Health Sciences, University of Huddersfield , Huddersfield , UK
| | - Wendy Norton
- c School of Nursing & Midwifery, De Montfort University , Leicester , UK
| | - Allan Pacey
- d Reproductive & Developmental Medicine , University of Sheffield , Sheffield , UK
| | - Frances Rapport
- e Centre for Healthcare Resilience and Implementation Science (CHRIS) , Australian Institute of Healthcare Innovation, Macquarie University , Sydney , NSW , Australia
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Verra SE, Kroeze R, Ruggeri K. Facilitating safe and successful cross-border healthcare in the European Union. Health Policy 2016; 120:718-27. [PMID: 27142178 DOI: 10.1016/j.healthpol.2016.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Even though medical travel is expanding, limited research has identified pitfalls along the full process of medical travel. This study explores the experiences of medical travellers, with a focus on potential issues that may threaten safe and effective medical travel. METHODS The experiences of medical travellers were assessed using a cross-sectional questionnaire in the Netherlands in 2014. The questionnaire (n=101) contained 52 items measuring the transfer of records, quality of care abroad, follow-up care, and reimbursement. Additionally, experts provided feedback on the pitfalls identified. RESULTS 63.1% of medical records were not transferred in advance to the clinic abroad, and for 10.7% of cases these remained unknown during treatment. Although quality of care abroad was rated higher than in the home country, follow-up care was initially refused to 22.2% of patients. Additionally, patients reported problems related to reimbursement. CONCLUSION More effort is needed to facilitate safe medical travel. Medical professionals should be informed on procedures for medical travellers, especially concerning follow-up care and record transfers. Yet, medical travellers themselves are ultimately responsible for this transfer. Clear information on the necessity of this personal transfer, and clarification on reimbursement options and the authorisation procedure, should be provided by national contact points and third-party payers. Additionally, payment structures to care providers may need adjustments to cover costs of follow-up care.
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Affiliation(s)
- Sanne Elise Verra
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands.
| | - Renske Kroeze
- Department of Psychology, University of Amsterdam, Weesperplein 4, 1018 XA Amsterdam, The Netherlands.
| | - Kai Ruggeri
- Engineering Design Centre, Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK; Policy Research Group, Department of Psychology, University of Cambridge, Downing Site, Cambridge, CB2 3EB, UK.
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Ruggeri K, Záliš L, Meurice CR, Hilton I, Ly TL, Zupan Z, Hinrichs S. Evidence on global medical travel. Bull World Health Organ 2015; 93:785-9. [PMID: 26549906 PMCID: PMC4622152 DOI: 10.2471/blt.14.146027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 05/21/2015] [Accepted: 08/05/2015] [Indexed: 11/27/2022] Open
Abstract
The potential benefits of travelling across national borders to obtain medical treatment include improved care, decreased costs and reduced waiting times. However, medical travel involves additional risks, compared to obtaining treatment domestically. We review the publicly-available evidence on medical travel. We suggest that medical travel needs to be understood in terms of its potential risks and benefits so that it can be evaluated against alternatives by patients who are seeking care. We propose three domains –quality standards, informed decision-making, economic and legal protection – in which better evidence could support the development of medical travel policies.
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Affiliation(s)
- Kai Ruggeri
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, England
| | - Ladislav Záliš
- Department of Psychology, Masaryk University, Brno, Czech Republic
| | - Christopher R Meurice
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, England
| | - Ian Hilton
- North Central College, Naperville, Illinois, United States of America
| | | | - Zorana Zupan
- Department of Psychology, University of Warwick, Coventry, England
| | - Saba Hinrichs
- The Policy Institute, King's College London, London, England
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Stem cell tourism--a web-based analysis of clinical services available to international travellers. Travel Med Infect Dis 2015; 12:695-701. [PMID: 25449045 DOI: 10.1016/j.tmaid.2014.09.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Stem cell therapies are advertised through online resources which describe a range of treatments with diverse clinical indications. Stem cell tourists may not be aware of the information they should seek when consulting these clinics, or of the potential risks involved. The aim of this study was to characterise the therapies offered by online stem cell clinics. METHODS A web based search utilising five search terms was employed. The first twenty pages of each search result were screened against 340 variables. RESULTS 224 out of 1091 websites advertised stem cell clinics. 68 eligible sites covering 21 countries were evaluated. The top five clinical indications for stem cell therapy were multiple sclerosis, anti-ageing, Parkinson's disease, stroke and spinal cord injury. Adult, autologous stem cells were the most commonly utilised stem cell, and these were frequently sourced from bone marrow and adipose tissue and administered intravenously. Thirty-four per cent of sites mentioned the number of patients treated while one quarter of clinics provided outcome data. Twenty-nine per cent of clinics had an internationally recognised accreditation. Fifteen per cent of clinics stated that their therapies posed no risk. Eighty-eight per cent of clinics claimed treatment effectiveness, with 16% describing their curative potential. Over 40% of sites did not specify the number or duration of treatments. Fifty-three per cent of clinics requested access to patients' medical records, and 12% recommended patients discuss the proposed therapy with their doctor. No clinic recommended that travellers consult a travel medicine specialist or receive vaccinations prior to their intended travel. One quarter of sites discussed contraindications to treatment, with 41% of sites detailing follow up patient care. CONCLUSIONS There is potential for stem cell tourists to receive misleading or deficient information from online stem cell clinics. Both the stem cell tourist and travel medicine practitioner should be educated on the potential risks associated with stem cell clinical services advertised online.
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Panteli D, Augustin U, Röttger J, Struckmann V, Verheyen F, Wagner C, Busse R. Informed consumer or unlucky visitor? A profile of German patients who received dental services abroad. Community Dent Oral Epidemiol 2015; 43:415-23. [DOI: 10.1111/cdoe.12164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 03/19/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Dimitra Panteli
- Department of Health Care Management; Berlin University of Technology; Berlin Germany
| | - Uta Augustin
- Department of Health Care Management; Berlin University of Technology; Berlin Germany
| | - Julia Röttger
- Department of Health Care Management; Berlin University of Technology; Berlin Germany
| | - Verena Struckmann
- Department of Health Care Management; Berlin University of Technology; Berlin Germany
| | - Frank Verheyen
- Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG); Hamburg Germany
| | - Caroline Wagner
- Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG); Hamburg Germany
| | - Reinhard Busse
- Department of Health Care Management; Berlin University of Technology; Berlin Germany
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Omer S, Priebe S, Giacco D. Continuity across inpatient and outpatient mental health care or specialisation of teams? A systematic review. Eur Psychiatry 2014; 30:258-70. [PMID: 25278422 DOI: 10.1016/j.eurpsy.2014.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/08/2014] [Accepted: 08/09/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A central question for the organisation of mental health care is whether the same clinicians should be responsible for a patient's care across inpatient and outpatient settings (continuity of care) or if there should be separate teams (specialisation). Current reforms in Europe are inconsistent on which to favour, and are based on little research evidence. This review is the first systematic appraisal of the existing evidence comparing continuity of care and specialisation across inpatient and outpatient mental health care. METHOD A systematic search for studies of any design comparing mental health care systems based on continuity or specialisation of care was performed. Differences in clinical, social and cost-effective outcomes, and the views and experiences of patients and staff were assessed using narrative synthesis. RESULTS Seventeen studies met the inclusion criteria. All studies had methodological shortcomings, but findings point towards reduced length and number of hospitalisations, and faster or more flexible transitions between services in continuity systems. Survey and qualitative findings suggest advantages of both systems, whilst patients and staff appear to prefer a continuity system. CONCLUSION The evidence base suggests better outcomes and stakeholder preferences for continuity of care systems, but the quality of existing studies is insufficient to draw definitive conclusions. Higher quality comparative studies across various settings and population groups are urgently needed.
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Affiliation(s)
- S Omer
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - S Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - D Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom.
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