Biomed Imaging Interv J 2006; 2(3):e29
© 2006 Biomedical Imaging and
The sky is falling
MBBS, FRCR, KH Ng,
PhD, MIPEM, DABMP
Department of Biomedical Imaging, Faculty of Medicine, University
of Malaya, Kuala Lumpur, Malaysia
Medical tourism involves travelling to other countries to
avail medical, dental, or surgical care. A combination of various factors, such
as exorbitant costs of healthcare in industrialised nations, the increased ease
and affordability of international travel, favourable currency exchange rates
in the global economy, rapidly improving medical technology and standards of
care in many countries as well as the ubiquitous Internet, have led to the
recent increase in its popularity. The medical tourism market is estimated to
grow by USD 2.2 billion with a corresponding increase of USD 60 billion
in the healthcare market . Western Europeans and Canadians bypass the long
wait periods that are part of their national health plans by getting medical
care abroad. Ten per cent of EU patients seek treatment outside their own
country and spend an estimated 12 billion Euro . Medical tourism
is a rapidly growing industry even in the so-called developing countries, with
countries like Mexico, Brazil, Costa Rica, Dominican Republic, Hungary, India, Israel,
Jordan, Lithuania, Malaysia, South Africa, Thailand and the Philippines
actively promoting it .
According to a UN study, the cost differentials for medical
services for a variety of procedures may be:
- A heart-valve replacement that would cost USD 200,000 in the
US is available for USD 10,000 in India inclusive of the round trip
airfare and a vacation package.
- A joint replacement in Thailand with eight days of physical
therapy at a luxury resort costs less than USD 9,000.
- Cosmetic-surgery savings are even greater: A full facelift that
would cost USD 20,000 in the US is about USD 1,250 in South Africa .
- A PET/CT scan performed in Melbourne inclusive of airfare and
accommodation in a 4-star hotel is cheaper than what it costs in Singapore,
with some pocket money to spare.
Although neither medical city nor medical tourism are new
concepts, the scale and volume has exploded beyond expectations. In the last
great wave of “globalisation,” in the 18th and 19th century, there were people
on the move, seeking out the ultimate cure for various ills not available in
the health care system in Britain. What we’re now seeing and experiencing is
the development of a second wave of medical tourism . More and more people
from all over the world are travelling to other countries not only as tourists
who come for sightseeing and shopping but also to get medical, dental, or
surgical services from hospitals and other healthcare destinations.
Medical tourists are typically residents of the
industrialised nations of the world; the countries they travel to are often
less developed with favourable currency exchange ratios. This second global
wave of medical tourism is creating new players and companies that are not
health specialists, but promoters or brokers between the international patient
and the hospital networks. They help arrange surgeries, travel arrangements and
tours. However, the Internet also enables increasingly knowledge-rich patients
to seek out service providers and make comparisons for themselves, or for
specialist firms to expand and include brokerage and specialist services to
Change is always difficult but perpetual and spiralling
change is numbing . One would question whose interests have been served by
all these advances? This is a complex and emotionally charged issue, with
international organisations (WTO), leaders, politicians, economists, lawyers,
professional organisations (Royal College of Radiologists, American College of
Radiology, etc.), consumers, advocates and antagonists contributing to the
The developments are said to threaten the healthcare system
in some of the developed countries and will, if not already, redefine the
landscape of medical practice. The clinical procedures that are most heavily
promoted in medical tourism and most actively consumed by Westerners are almost
all elective in nature and regarded as being the most profitable. This is
regardless of where they are provided in Delhi, Denver or Dubai. In purely
economic terms, it has been suggested health tourism will therefore result in
the increasing outsourcing of the most profitable procedures to offshore
suppliers. This carries the fear of a further weakening of the primary-care
system in the developed countries, where procedure-based specialties are
heavily subsidised. Consequently, fewer resources will be available to
aggressively implement the preventive practices to lessen the burden of chronic
diseases such as diabetes, heart disease, etc. Medical tourism may also damage
the financial and human foundations of the US healthcare system  where a
less-remunerative career path for medical students may mean that more of the
best and brightest will turn away from healthcare careers.
For the developed countries, part of the problem with
medical tourism may also be the rate of investment in healthcare information
technology. The US has fallen behind other developed countries, as much as a
dozen years, in implementing healthcare information technology with little
central government involvement . The burgeoning cost of radiology services
in the US and the increasing trend towards self-referral also led an editorial
 to consider the threat of lower-cost overseas teleradiology by advocating
both a protectionist approach running in parallel with high-quality medicolegal
Foreign medical graduates and particularly foreign-born
nurses play a vital role in the western healthcare system, especially in the USA,
Canada, Britain and Australia. As career opportunities in their home
countries improve along with the local economies, moving will seem less
attractive. Furthermore, although some countries, such as the UK, the US and a
few Asian countries, have an overall shortage of consultants in clinical
radiology, this position is not reflected throughout the world; some EU
countries, India, etc., hold an excess of qualified radiologists. These
overseas radiologists, whether working individually or within larger private
companies, are ready and available to undertake overseas reporting.
One is now able to buy healthcare services from other
countries, at a considerably lower cost. If governments are to stop their
citizens from availing this advantage, they must offer sound reasons to do so.
The question that must be answered is this: Is healthcare so different that the
basic commonsense argument of gain from trade doesn’t hold good here? The
inherent inconsistencies, conflicts, discrepancies and inefficiencies of
healthcare systems that have evolved over time may no longer financially or
economically sustainable. While there are some horror stories and quacks, the data
are sparse and the evidence does not support any broad-based significant
increase in risk although the legal issues have yet to be resolved.
People, organisations and countries will find a niche where
they’re most competitive. No speciality will be spared, from the medical
physicists, to bioengineers to surgeons to radiation oncologists, etc. For some
countries it will be good quality health care at low cost, for others, it will
be the highest quality health care at a higher cost, and for those like Bangkok,
Dubai Buenos Aires it will be a geographical advantage. What is happening is
the globalisation of trade in health, where individual countries with certain
strategic competitive advantages, be it quality, cost or geographical
convenience, are exploiting them to the fullest. Health tourism centres/clinics
are actively seeking First World ''customers'' by increasingly pursuing and
adopting American and other international best practices to maintain the
quality of services.
If medical information, images and diagnosis become mere
“commodities” which can be sought, bought, traded and sold over the Internet,
then the only real option left is for the medical specialists is to add value 
by synthesizing all the disparate pieces of information in the context of each
individual patient locally, to optimise the selection of treatment and
therefore outcomes. Additionally, the doctor must continue to be protective,
guiding and showing care for the patient.
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| Received 26 May 2006; accepted
29 May 2006
Correspondence: Department of Biomedical Imaging,
Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur,
Malaysia. Tel: +603-79492069; Fax: +603-79581973; E-mail:
Please cite as: BJJ Abdullah, Ng KH,
The sky is falling, Biomed Imaging Interv J 2006; 2(3):e29
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