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Lower Costs of Care

Decreased overall treatment cost, including hospital, physician, and orthopaedic implant charges, are a major advantage to medical-related travel. Patients considering orthopaedic surgery may be motivated to travel for their procedure by high out-of-pocket costs (including deductibles and services that are not reimbursable) and lack of transparency for the average patient dealing with the U.S. healthcare system.

Travel and Treatment Bundles

There are a variety of companies that offer travel and treatment bundles, giving patients the opportunity to receive their medical care in a desired vacation destination. Having an experienced company help with the arrangements means the patient can spend less time worrying about logistics and more time focusing on their care.

Access to Care and Amenities

• Patients can receive care from a culturally similar physician or provider.
• Patients are able to undergo procedures or have access to state-of-the-art technology that is not available in the area where they live. Sometimes, even if a procedure or technology is available, surgeons in that area do not have a lot of experience using it; patients may want to travel to receive care from a surgeon with more experience. In addition, international medical tourism can offer access to devices and procedures not currently available in the U.S. due to Federal Drug Association (FDA) regulations and other restrictions.
• There can be less pressure for early discharge from the care facility.

Quality and Safety

The overall quality and safety of surgical care provided abroad can be highly variable.

While advertising may suggest state-of-the-art facilities and physicians, regulation and quality control of these facilities may be minimal, unlike hospitals in the U.S., which are strictly regulated. This is because there is no requirement for public reporting of surgical complications at many international health care facilities. Patients may therefore be vulnerable to misleading or incomplete information and not be aware of the true risks when consenting to surgery.

In addition, medical tourism is a business; therefore, international centers may prioritize volume of care (i.e. number of surgeries) over medical necessity, which may lead to surgeries being performed when they are not necessarily indicated (recommended in a specific case).

Communication

There may be a language barrier associated with receiving care at an international facility, even if the lead surgeon speaks English. 

Post-Operative Care

Continuity of surgical care after return home and management of complications remain challenges that could increase costs and care burden in the U.S. healthcare system.

• Many U.S. hospitals and physicians will be reluctant to provide care for procedures performed elsewhere, especially if medical records are not available or are in another language.
• Even if the surgery is effective, incomplete knowledge of the procedure by the U.S. surgeon who continues to follow the patient after surgery could lead to unsafe or overly conservative post-operative protocols, compromising the overall recovery.
• The cost of managing any complications that occur may not be covered by the patients’ insurance. Infection is of special concern, as medical tourists may develop infections due to unusual bacteria, posing risks to themselves and their local communities.
• Furthermore, travel itself can be risky. Risks may include blood clots occurring in patients returning home on long airplane flights; at least one study documents multiple deaths due to blood clots following medical tourism.

Liability

International centers are unlikely to accept responsibility for malpractice actions for medical errors or omissions. Cases where patients have had complications and were refused discharge by the facility until all bills were paid in advance have been reported. These issues can leave the patient with complications feeling stranded when issues arise during their travels or upon their return home.

Risks of Stem Cell and Other Experimental Therapies

Apart from surgical care, orthopaedic patients may travel abroad to receive stem cell treatments and other experimental therapies. Advertisements for these types of treatments often overestimate the benefits and underestimate the inherent risks or potential lack of effectiveness. Despite ongoing research related to the use of stem cells, receiving unproven treatment can be a waste of time and money, can lead to a delay in more appropriate care, and very rarely may cause serious complications such as significant infections or treatment-related tumors.

Because of the potential issues associated with medical tourism, the U.S. Center for Disease Control and Prevention (CDC) has made a list of preferred practices for medical tourism. The To Do list includes:

• Research the clinician and facility who will be doing the procedures. There are accrediting groups, such as Joint Commission International, DNV GL International Accreditation for Hospitals, and the International Society for Quality in Healthcare, that are responsible for accrediting overseas facilities .
• If you do not speak the native language, determine in advance how you will communicate with your care team. Even if your physician speaks English, other patient care providers may not.
• Schedule a pre-travel consultation with the physician you anticipate will perform your post-operative care. Discuss the specific risks you may face because of your health status, the procedure, and travel before or after the procedure.
• Obtain international travel health insurance that covers medical evacuation back to the U.S. Supplemental travel insurance may also help cover follow-up or emergency care from procedures performed abroad or out-of-plan.
• Bring copies of your medical records and imaging studies with you to inform providers at your destination of your medical condition.
• Pack a travel health kit with all your medications, preferably in unopened containers that are clearly labelled. Include several extra doses of each medication in case there are delays in your return home.
• Before returning home, get a copy of all your medical records from the medical facility where you had the procedure or treatment. These records may need to be translated to English.
• Arrange for follow-up care before your medical travel.
  
  • Identify where you will be staying after the procedure at your destination and once you return home.
  • Travelers considering medical tourism procedures should consider that follow-up care for medical complications can be expensive and not be covered by your health insurance.
  • Travelers considering procedures outside the U.S., especially, should understand the potential financial costs associated with follow-up care or emergency care in the event of complications, review their health insurance policies to determine what, if anything, is covered, and plan for the possibility of paying out-of-pocket for additional care.

Another way to ensure quality care is to look for surgeons who are fellows of the American Academy of Orthopaedic Surgeons (AAOS) or other specialty societies. Orthopaedic professional societies have members worldwide. If a doctor uses the "FAAOS" designation, it means that a doctor:

• Has successfully met rigorous professional and ethical standards, including certification by the American Board of Surgery (ABOS), American Osteopathic Board of Orthopaedic Surgery (AOBOS), or Royal College of Physicians and Surgeons of Canada (RCPSC)
• Has an advanced level of skill, training, experience, and professionalism
• Is committed to quality and ongoing learning beyond that of other healthcare professionals

Learn more about FAAOS designation.

Safe and reasonable medical tourism requires significant up-front planning and is not without risk. Discussing this in advance with your primary care doctor or local orthopaedic surgeon to carefully weigh the risks and benefits can help make this planning successful.