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Global remedy to a local affliction

Date

More Australians are travelling overseas to countries such as India and Thailand for surgery as globalisation makes private medical care more affordable and waiting times lengthen back home, writes Jim O'Rourke.

Thousands of Australians who are frustrated at waiting up to 14 months for elective surgery, or cannot afford a private hospital, are travelling to developing countries for much cheaper operations as part of a booming $60 billion international ''medical tourism'' industry.

Medical tourism ''facilitators'' based in Australia say they can arrange procedures for major surgery - joint, spine, brain and heart - in specially designed ''medi-cities'' for international patients who pay a fraction of what they would spend at home, even after airfares.

Australians are travelling to India, Thailand, Singapore, South Korea, Turkey and the Middle East for treatment to avoid public hospital surgery queues, which are as long as 420 days for non-urgent elective operations in NSW.

Medical tourist ... Yasin Odeh is one of the many Australians travelling abroad each year in pursuit of cheaper medical services.

Medical tourist ... Yasin Odeh is one of the many Australians travelling abroad each year in pursuit of cheaper medical services. Photo: Graham Crouch

While Australian doctors warn that such patients are taking a risk with their health, the globalisation of medicine is making the journeys too tempting for many patients. A total hip replacement that can require a wait of up to 12 months in a NSW public hospital, or cost about $25,000 at a private hospital, can be booked and completed within a couple of weeks for $9000 in India - a price which includes airfares and accommodation in a guesthouse during recuperation.

With the strong Australian dollar, patients can save as much as 70 per cent on some procedures, but medical facilitators also offer extended payment plans for patients.

There are no official figures collected on the number of Australians who travel overseas for surgery, but one local company, Global Health Travel, says it makes arrangements for more than 800 patients a year to travel to a choice of eight countries. Its founder, Cassandra Italia, said her company could have a patient on an operating theatre table in a modern Indian or Thai hospital for a full hip replacement within a week of making a booking.

Medi Makeovers, which specialises in cosmetic procedures and dental work, arranges for about 400 Australians to visit Thailand each year to take advantage of cut-price medical care. Another operator, Hemani Thukral, who runs MyMedicalChoices, sends her clients to surgeons in India, many of whom have been trained in Britain and the US, she said.

Dr Thukral, who has a medical degree from India, has business relationships with some of her home country's biggest private hospitals and clinics in Delhi, Mumbai, Bangalore and Chennai.

''One of the surgeons I deal with has done 13,000 knee replacements,'' she said. ''Australians can be assured that the treatment and facilities are on par or better than they get here.''

Dr Thukral said the hospitals she dealt with were certified with international healthcare accreditation bodies. The hospitals are based in medi-cities - large medical campuses housing a variety of specialty clinics - built to attract international patients and offering special services including visa assistance, express check-in through dedicated international patient's lounges, concierges and language interpreters.

''This is offering Australians a fresh hope, rather than living with the pain and inconvenience, especially for orthopedics problems,'' Dr Thukral said.

''For all non-life threatening surgeries, overseas medical treatment is a viable option. People come to me who have had chronic pain for years, their lifestyles are debilitated and they can't do the things they enjoy. We give them options. We help them get from door to door, from the airport, to the hospital, to their guesthouse to recover.''

The Deloitte Centre for Health Solutions, an arm of the multinational Deloitte accountancy firm, said medical tourism has become a $60 billion worldwide business and is growing at more than 20 per cent a year. India alone attracts more than 700,000 medical tourists annually. Thailand attracts close to a million, Singapore 500,000, Malaysia 400,000 and the Middle East, including Israel and Dubai, 265,000.

The health travel consumer organisation Patients Beyond Borders said about 5 million patients a year become medical tourists, spending an average $US3000 per surgery and thousands more on airfares and accommodation.

While increasing numbers of people are paying for medical and accommodation packages for surgical procedures, the market is still dominated by travellers seeking cheaper dental treatment or cosmetic surgery.

Dr Thukral said dental, eye, and cosmetic surgeries in Australia cost three to four times as much as in India. A major operation, she said, such as robotic heart surgery in India, could be arranged for about $13,500, compared with $60,000 in Australia. The costs were lower in India because the capital and labour costs were well below those in the developed world, she said. ''And the medical devices, implants and medications are cheaper than in Australia.''

But Australian doctors remain concerned about poor surgical results and inadequate medical care after a procedure.

The Australian Medical Association's NSW president, eye surgeon Michael Steiner, said most specialists had seen patients who had travelled overseas for treatment. ''And we've all seen, from time to time, very significant problems as a result,'' he said. ''They think surgery here is more expensive, but we have extremely high standards and very highly qualified people.'' He said continuity of care was also important.

Latest official NSW government figures show that some patients were forced to wait up to 420 days to be admitted to a public hospital for non-urgent elective operations such as hip replacements. The median waiting time for non-urgent surgery across more than 80 NSW public hospitals and clinics was 212 days.

The chairman of the Royal Australasian College of Surgeons' professional standards committee,

Graeme Campbell, said he had heard anecdotally there had been an increase in the number of Australians having surgery overseas. ''If people are going abroad for mainstream surgery that is provided in the public hospital system, then that's a concern,'' Dr Campbell said.

He said there was ''no doubt'' that patients in Australia faced ''significant waits'' to see a surgeon: ''The fact that people are seeking an overseas alternative does reflect deficiencies in the public hospital system.''

He advised those who were contemplating surgery overseas to find out about the backgrounds of their surgeon and anaesthetist, and the reputation of the hospital or clinic.

''Many of those countries welcoming medical tourists have parts of their health systems that are of the highest quality. The best of their surgeons are at least as good as the best of our surgeons, but there is a greater variability [in service],'' Dr Campbell said.

''Ultimately you've got to work out, is it worth the risk?''

The Sun-Herald asked the Health Minister, Jillian Skinner, why NSW residents were opting for surgery overseas and why elective surgery waiting lists were so long.

A ministry spokesman said seeking treatment as a private patient, either within Australia or overseas, was a matter of individual choice.

Ms Italia said she saw a gap in the market for patients waiting for elective surgery.

''People tell me they are on an 18-month waiting list, they can't work, they can't take care of their children, they are at their wits' end,'' she said.

''We can get them onto the operating table within a week, as long as their medical records are up to date, and we can book them a flight. There are no waiting times, really.''

Global Health Travel also offered clients medical travel insurance which covered complications for up to six months after the treatment. ''The biggest risk is not infections or complications, it's getting a DVT [deep vein thrombosis] on the plane on the way home,'' Ms Italia said.

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