Taking healthcare abroad

As the costs of hospital and healthcare treatment in many countries have risen, more and more people are travelling abroad for treatment. Other factors that have led to the recent increase in popularity of medical travel include long wait times for procedures in industrialised countries, the ease and affordability of international travel, and improvements in technology and standards of care in many countries of the world.
   
A large draw to medical travel is convenience and speed. Countries that operate public healthcare systems are often so highly taxed that it can take considerable time to get non-urgent medical care. The time spent waiting for a procedure such as a hip replacement can be a year in the UK, however, in Singapore, Hong Kong, Thailand or India, a patient could feasibly have an operation the day after their arrival.
   
Medical tourists may seek essential health care services such as cancer treatment and transplant surgery as well as complementary or ‘elective’ services such as aesthetic treatments.

RISKS AND REWARDS
Medical tourism carries some risks that local medical procedures do not. Should complications arise, patients might not be covered by insurance or able to seek compensation via malpractice lawsuits. However, new insurance policies are available that do protect the patient should a medical malpractice occur overseas.
   
Some countries currently sought after as medical tourism destinations provide some form of legal remedies for medical malpractice. However, this legal avenue is unappealing to the patient. Advocates of medical tourism advise prospective patients to evaluate the unlikely legal challenges against the benefits of such a trip before undergoing any surgery abroad. Patients should also be aware that the quality of post-operative care also could vary depending on the hospital and country.
   
Also, travel soon after surgery can increase the risk of complications, as can vacation activities. For example, scars will be darker and more noticeable if they sunburn while healing, and long flights can be bad for those with heart or breathing-related problems.

TREATMENT ABROAD
www.treatmentabroad.net is the UK’s leading website for medical tourism, with over 50,000 visits every month. The treatment Abroad Medical Tourism Survey 2007 was the first study of its kind to be conducted on medical tourism in the UK. The aim was to collect quantitative data on the numbers of patients travelling from the UK to other countries for elective and cosmetic surgery, and dental and infertility treatment.
   
The survey was carried out by European Research Specialists ltd and compiled data from 132 clinics, hospitals and healthcare providers in 30 countries that promote their services to the UK market.
   
The survey showed that over 50,000 persons travelled abroad for treatment last year, and spent £161 million on medical tourism. The number of medical tourists increased by 25 per cent over the 12 months and the survey predicts that the number will continue to grow over the next 6-12 months.
   
The Medical Tourism Survey 2007 revealed that India, Hungary and Turkey are among the most popular medical tourism destinations for UK patients.
   
Dentistry is the most popular service with dental treatment such as crowns, dental implants, bridges and veneers leading the way. Over 20,000 Brits travelled abroad for their teeth last year, spending around £2,500 each, with an estimated market value of over £50 million per year.
   
Cosmetic surgery is a close second with around 14,500 patients travelling outside the UK. Breast augmentation, tummy tuck, liposuction and facelift are popular choices, with patients spending around £3,500 each, creating an estimated market size of £50 million.
   
The most common types of elective surgery for patients travelling abroad are hip replacement, knee replacement, laser eye surgery and cataract removal, with some 10,000 patients spending £37 million last year.

FORTHCOMING EU DIRECTIVE
The European Commission has delayed proposals for a Directive on cross-border health care, which was due to be published in December last year. The Directive has been produced in response to the need for clarification of European law in relation to patients who choose to go abroad for treatment, and has three parts outlining:

• Common principles under which healthcare should be delivered in member states
• A specific framework for the rights of patients to healthcare in another member state
• A framework for European co-operation on health services. Patients can already go abroad for treatment (and be reimbursed) under specific conditions, as stated by the European Court of Justice on several occasions. However, the European Commission has felt it necessary to codify these European Court of Justice decisions in a legislative framework, which clarifies the rights of patients, and thus facilitates their freedom of movement to receive healthcare in another member state.

The Directive states that patients have the right to access healthcare in another EU country (if the type of care is available at home) and to have this care reimbursed by their home funding body up to the amount that would have been paid at home. Prior authorisation for the receipt of non-hospital care abroad would not be required. However, the Directive does allow for member states to maintain a system of prior authorisation to be required in the case of hospital care.
   
Keith Pollard of Treatment Abroad says: “This directive could revolutionise the way we experience healthcare in this country and throughout Europe as it will take the concept of patient choice to a new level.
   
“Competition from European hospitals could prompt much needed changes within the NHS. Successive governments have made token gestures to introduce market forces within the NHS; ranked 17th out of 29 European countries in the recent Euro Health Consumer Index, the NHS now faces real competition in the marketplace.”
   
The Directive will provide a framework for cross boarder healthcare and will deal with issues such as quality of care, patient safety, method of funding and transfer of patient information. There are also plans to introduce “European reference networks” which would bring together medical expertise across Europe and encourage greater collaboration between centres of excellences.

Proposals of potential concern

• Member states will be obliged to abide by nine principles for healthcare systems. They concern patient information, quality and safety, complaints procedures, rights to privacy, and professional liability insurance. Failure to abide by these principles could expose NHS organisations to future challenges through the European Court of Justice.
• EU countries would only be able to justify prior authorisation for hospital care on the basis that, without it, the financial sustainability of their healthcare system would be undermined. Where prior authorisation is not a requirement to receive hospital or non-hospital care abroad, PCTs face uncertainty in financial planning, when they end up with bills for treatment of which they had no prior knowledge.
• There is a risk of exacerbating inequalities in access to care when patients who can afford to pay travel costs and advance treatment costs may receive care more quickly in another member state than those  without such funds.
• The draft proposal states that EU nationals should enjoy 'equal treatment' to residents of the country where treatment takes place. The right of a member state to prioritise its own residents is therefore called  into question and would need clarification. This provision could also pose significant difficulties for the NHS in terms of capacity planning.

Potential administrative impact

• The requirement to determine the specific cost of health treatments provided by the NHS in order to define the level of patient's reimbursement for care received abroad
• The provision of information to patients about the option to receive healthcare in another member state and the terms and conditions that would apply
• The setting up of national contact points responsible for disseminating information to patients on their rights related to cross border care
• The provision of information to patients from abroad seeking healthcare in the UK on procedures to follow in case of harm as a result of treatment in the UK
• The collection of statistical data on cross-border healthcare and healthcare delivery in the UK
• The provision of access to medical records of patients seeking treatment abroad, while respecting rights to privacy
• The setting up of mechanisms to verify the authenticity of prescriptions issued abroad and who issued it, and to ensure the patient understands all information concerning the product they are prescribed.

Planned action by the NHS
The NHS European Office will gather views on the potential impact of the proposals from representatives of NHS organisations to form the basis of an NHS position paper and lobbying campaign. It will also hold discussions with stakeholder organisations in view of developing alliances.
   
Once released by the European Commission, the draft Directive will go through the co-decision procedure, whereby members of the European Parliament and representatives of EU member state national governments in the Council of Ministers will propose amendments to reach a common position. The NHS European Office will be seeking to introduce changes before the legislation is finally agreed. There is, however, no publication date of the Directive foreseen.