MEDICAL TOURISM STATISTICS

Over the last few years, a new trend in the healthcare industry known as Medical Tourism is gaining popularity among highly industrialized countries like the United States and Canada. Varying reports containing medical tourism statistics put the number of American patients seeking healthcare abroad at over 1.3 million in 2008.

These figures indicate a significant growth in the Medical Tourism industry, currently a $20 billion market, which is expected to reach $100 billion by 2012, with over 2 million people seeking care. While exact statistics for medical tourism are difficult to confirm, these estimations indicate a strong potential for medical tourism in the future.

The following lists facts and relevant information related to medical tourism and its impact on the global healthcare industry. Why do people go abroad to get medical treatment? While most would think that medical travelers seek cheap and fast medical attention, some facts in a May 2008 McKinsey and Company report regarding medical tourism indicated otherwise. The report states that 40% of medical travelers seek advanced technology, while 32% seek better healthcare. Another 15% seek faster medical services while only 9% of travelers seek lower costs as their primary consideration.
A lack of health insurance or insurance not covering an illness is the most common factor for medical travel.

• Thailand’s prestigious Bumrungrad International Hospital, 58,000 U.S. patients sought treatment in their facilities in 2005, which increased to 64,000 Americans the following year.

• Singapore benefited with the increase in medical tourists from 270,000 in 2004 to 410,000 foreign patients annually. It is estimated that this will increase to a million patients by 2012.

• Latin America, particularly Costa Rica and Panama, are fast becoming tourist spots for medical travelers with close to 30,000 foreign patients seeking healthcare in Costa Rica in 2006.

• Due to its close proximity to the U.S., Mexico has become a top medical tourism destination with 40,000 to 80,000 American seniors spending their retirement there with a considerable number receiving healthcare.

• Malaysia is also becoming a famous destination with 300,000 medical travelers in 2006, most coming from Europe.

• India has also benefited with the increase in medical tourists from 150,000 in 2002 to 450,000 in 2007.

Satisfied American patients reported gaining savings from 25% to 90%, depending on the type of services required. Savings vary per country and depend on the type of procedure required.

Most U.S. citizens traveling abroad for medical services usually choose the following categories of medical tourism procedures:
• dental
• cosmetic
• orthopedic
• cardiovascular

Americans prefer Mexico, Costa Rica or Panama for dental services, cosmetic surgeries and orthopedic procedures due to the expertise in these fields and their proximity to the USA.

THE OUTLOOK IN MEDICAL TOURISM

These medical tourism facts indicate a bright future for this industry. Companies like Hannaford Bros. Co. located in Maine are considering saving up to 70% on medical costs by offering offshore medical treatments for their employees. In a similar manner, insurance companies like Basic Plus Health Insurance at Roswell are collaborating with global healthcare companies to provide overseas options to members with fixed benefit maximums.

Although these medical tourism statistics show favorable figures, patients traveling abroad should research facts about the facilities and services regarding U.S. accreditation. Whether you are receiving surgery in the US or abroad, there are always risks involved. Reviewing a doctor's credentials and talking with previous patients is highly recommended when seeking quality healthcare.

WHAT IS ACCREDITATION?

At a very general level, accreditation is a voluntary process by which institutions meet standards established by an external accrediting body. In the context of healthcare and medical tourism, the referred to “institutions” would usually be hospitals and clinics, and the “accrediting body” would refer to an organization such as the Joint Commission International (JCI) , Trent Accreditation Scheme, Accreditation Canada or another agencies that are recognized by the International Society for Quality in Healthcare.

DOES IT REALLY MATTER IF THE MEDICAL TOURISM HOSPITAL I CHOOSE IS ACCREDITED?
Chances are you would not consult with an unlicensed surgeon, right? The whole idea with “accreditation”, or licensing, for that matter, is to offer interested parties a process of external quality evaluation against consensus healthcare standards. In other words, medical tourism patients are ensured of standardized healthcare practices, regardless of whether a facility is located in the United States, Costa Rica or Malaysia.
In referring to its own accreditation process the JCI website says: “The accreditation process focuses on the functions and processes that support quality, safe care, and thus facilitates the use of the best science and professional knowledge and skills. Standardization through accreditation is a powerful risk reduction strategy proven effective around the world”.

Although the Joint Commission International is by far the most recognizable accrediting organization, there are currently eight other country specific organizations that are also IS QUA members. These are:

• The Australian Council on Healthcare Standards
• Canadian Council on Health Services Accreditation
• Australian General Practice Accreditation Limited
• Irish Health Services Accreditation Board now HIQA
• Council for Health Service Accreditation of Southern Africa
• Taiwan Joint Commission on Healthcare Accreditation
• Quality Improvement Council, Australia
• CHKS Healthcare Accreditation Quality Unit, UK
• Joint Commission International, USA

WHAT ARE THE BENEFITS OF ACCREDITATION?
For medical tourism patients it is an assurance that high standards of safety and quality of care are in place. Accreditation shows that a hospital or clinic cares about delivering quality services to its customers. It’s kind of a guarantee that the organization's services have been awarded accreditation because they have delivered positive results.

HOW DO I KNOW IF THE MEDICAL TOURISM HOSPITAL I AM GOING TO IS ACCREDITED?
Most hospitals will usually display accreditation information prominently on their websites. In the case of Joint Commission International accreditation, you can check to see if a hospital is accredited at http://www.jointcommissioninternational.org.

IF THE HOSPITAL IS ACCREDITED DOES THIS MEAN MY PHYSICIAN IS ACCREDITED?
No it does not. In the first place, most accrediting organizations do not accredit individuals. Doctors will need to be licensed by local medical boards or similar entities. However, using an accredited hospital or clinic greatly increases the chances that you doctor is properly licensed.

LEGAL ISSUES & MEDICAL TOURISM

WHAT ARE MY RIGHTS IN CASE OF MEDICAL COMPLICATIONS? Most hospitals, wherever they are located, will not cover the cost of medical complications. Therefore it is important to speak to your international medical provider to see their definition of what constitutes a “medical complication”. Is it simply a surgical procedure that, due to unforeseen but manageable difficulties, takes a little longer than expected? Or, is it an additional problem that arises following a procedure, treatment or illness and is secondary to it, as Medicinenet.com defines it.
The differences may seem minor; however, they become all too real, for example, if you are a morbidly obese medical tourism patient who requires additional surgical equipment and time to get a breathing tube down your trachea and are later charged one thousand five hundred dollars extra for it.
Will my insurance cover the cost of complications? The correct answer to this question will depend on the type of policy you hold, however, don’t count on your insurance covering complications related to non elective procedures such as cosmetic surgery and weight loss surgery.

WHAT IF I DECIDE NOT TO HAVE MY SURGERY, WILL I BE ABLE TO GET MY MONEY BACK?
Again, this will depend on the policy of the hospital you have chosen, as well as when you cancel your procedure. Make sure to have the answer to this question in writing. However, most international hospitals I have spoken to will refund a majority if not all of the money you have paid.

IF THE HOSPITAL DECIDES NOT TO PERFORM THE SURGERY WILL I RECEIVE MY MONEY BACK?
If you are dealing with a recognized medical provider then the answer is almost sure to be an unqualified yes. Nevertheless, you need to talk with your particular hospital or medical tourism facilitator for full cancellation policy details, particularly if you are dealing with lesser known or non-accredited medical providers. You need to be extremely careful of the hospital and clinic you choose, as some may refuse to give back your money and therefore you must make sure you are using a hospital or clinic that is reputable and trustworthy. Many hospitals and clinics throughout the world promote themselves to American, Canadian and UK medical tourism patients that should not be.

WHAT IS A MEDICAL TOURISM FACILITATOR?
Sometimes referred to as medical tourism agencies, or a medical travel facilitator, these are companies that, as their name suggests, act as facilitators or middlemen for medical tourism patients engaging in medical tourism.

Medical Tourism Facilitators have played an important role in promoting the growth of medical tourism, and for many medical tourism patients, represent their first face to face contact with the concept of medical tourism.

Over the last three or four years, thousands of these companies have popped up, most sporting names synonymous with health and travel. They function much like a travel agency, requesting and obtaining passports, booking flights, and arranging a medical tourism patient’s lodging, transportation and tours. The key difference, of course, is that they also serve as the liaison or mediator between you and the international hospital and doctor. In effect, it is the facilitator’s job to repackage the medical provider’s service offering, make it more appealing, and then guide you along the medical tourism process. For those trying to decide whether or not to use a facilitator, it is important to weigh both the advantages and disadvantages they provide.

WHAT ARE THE ADVANTAGES OF USING A MEDICAL TOURISM FACILITATOR?

ONE-STOP MEDICAL TOURISM SHOPPING:
The convenience of being able to choose and access information about a variety of destinations, hospitals, procedures, and services. Users can come to a medical tourism facilitator’s website and request a price estimate for a particular procedure from several different hospitals or clinics, and then choose which provider better serves their needs and budget. In addition, once you have made a decision on where to travel, the medical tourism facilitator can usually take care of all your travel logistics such as flights, lodging, and transportation.

ESTABLISHED RELATIONSHIPS WITH INTERNATIONAL PROVIDERS:
Medical Tourism Facilitators, at least in theory, have already done the groundwork to make sure your chosen hospital and doctor are accredited and safe to work with. The best case scenario is that they have visited your chosen hospital and already have a system in place to make your Medical Tourism Trip process is a smooth one.

CONVENIENT TRANSFER OF MEDICAL INFORMATION:
Most medical tourism facilitators have a mechanism in place for quickly transferring your medical information including large files such as CT’s and MRI’s.

LANGUAGE AND CULTURE BARRIERS ARE USUALLY NOT AN ISSUE:
Contacting some international hospitals can be challenging due to time zone differences, language barriers, and cultural differences. As shown above, medical tourism facilitators already have the right contacts and a medical tourism process in place with your international hospital.

WHAT ARE THE DISADVANTAGES OF USING A MEDICAL TOURISM FACILITATOR? QUALITY OF SERVICE MAY VARY GREATLY FROM ONE MEDICAL TOURISM FACILITATOR TO ANOTHER:
Medical tourism facilitators come in all shapes and sizes, and, looking at their websites, it is difficult to accurately determine the real scope and quality of the services offered. As with most emerging industries, there will be a multitude of companies, some little more than one man operations, promising the world, without a regulatory entity making sure they deliver the goods. The internet only amplifies this problem as one website looks as good as another.

BIAS TOWARDS CERTAIN HOSPITALS AND DESTINATIONS:
Obviously medical tourism facilitators do not have the time or resources to visit every medical tourism destination or work with thirty different international hospitals. They must choose wisely from a limited number.

SHOULD I PAY MY MEDICAL TOURISM FACILITATOR OR THE HOSPITAL FOR MY MEDICAL TOURISM TRIP?
This will depend on the policy of the hospital and facilitator. Some facilitators will request an advance deposit and ask that you pay the balance at the hospital. Others will have you pay the hospital.

HOW SOON SHOULD I EXPECT A HOSPITAL/CLINIC TO RESPOND TO ME ONCE I EMAIL OR CALL THEM?
This will obviously vary from hospital to hospital, but 48 hours or less is a pretty normal response time for facilities that receive a large influx of international patients. If you have not received an answer within 48-72 hours, then try again, or think of calling the hospital.
To make international calls look into using Skype which is an internet based phone service where international calls can be made for literally pennies per minute anywhere in the world.

A growing number of hospitals and clinics are incorporating 1-800 numbers, which makes it very easy for U.S and Canadian medical tourism patients to get in touch. A hard to contact hospital that does not respond quickly is usually a sign that, either international patients are not a high priority, or that the hospital’s current process for handling international patient enquiries is not up to snuff.
Neither possibility is particularly reassuring for a medical tourism patient who is contemplating travel to an unknown destination for a serious surgical procedure.

HOSPITAL RESPONDS BY REQUESTING ADDITIONAL INFORMATION
In order to determine the real needs and related costs involved in your case, the hospital/clinic’s physicians will need to know more about your condition and medical history. The type of information you will be required to submit will vary depending on your procedure and your physician. However, at the very least expect to fill out a medical questionnaire of some sort that includes some of the following questions:

What are your age, height, and weight?
What type of surgery or treatment are you interested in, and the reason you wish to have this procedure?
Have you had previous surgery? And if so, what procedure(s) and on what date(s)?
How is your general health?
Please describe any chronic conditions you are or have suffered from in the past.
Are you allergic to any medication?
What medications do you presently take?
Do you use tobacco?
Do you drink alcohol?

HAVE YOU SEEN A PSYCHOLOGIST IN THE LAST FIVE YEARS?
It is in the best interest of your wellbeing and success of your procedure that you answer these questions as truthfully as possible. Providing incorrect information about your weight, withholding details about medication you are taking, or not mentioning that you suffer from hypertension, may necessitate postponing your surgery, or at the very least may lead to a more expensive procedure. Not good news if you are on a budget or have spent the last eighteen hours on a transatlantic flight trying to reach your surgery destination.

Depending on your procedure, you may also be asked to send photos (usually when cosmetic surgery or plastic surgery is involved) and/or provide medical reports concerning your condition. Most often these include blood tests, electrocardiogram reports, and diagnostic images/reports such as X-rays, CT scans and MRI’s. In certain instances you may also be required to send in pathology reports and your primary physician’s treatment plan.

WILL MY MEDICAL RECORDS BE SECURE?
That is a good question and one that should be asked of any hospital, clinic or doctor that has requested your medical information. Specifically you should ask what protocol or safety measures are in place to protect the privacy of your medical information while it is in transit over the internet, as well as when it arrives at the hospital.

HOSPITAL AND MEDICAL STAFF WILL REVIEW YOUR MEDICAL INFORMATION
This is not always a one step process. There may be some back and forth between you and your hospital contact while all the necessary information is gathered and the medical staff confirms the procedure (and price) or recommends another procedure. This is a good time to ask questions and perhaps even schedule a conference call with your doctor.

NEXT YOU WILL RECEIVE A PRICE ESTIMATE FOR YOUR SURGERY AND RELATED SERVICES
The price estimate will usually specify what the procedure includes and does not include, as well as any clauses or restrictions. Make sure you read the fine print and understand what is and what is not covered by the procedure (airfare, transportation, and lodging?). At this time the hospital may also send you additional information about your procedure and the services available to international patients.

PAYMENT FOR PROCEDURE
The payment process varies from hospital to hospital, but expect to pay a down payment of anywhere from ten to fifty percent of your procedure package. This usually takes the form of a credit card transaction or wire transfer. Make sure the hospital sends you a receipt once payment has been made. Full payment is usually made once you have arrived at the hospital. However, payment policies vary, so please contact your international medical provider for details.

FORMAL ITINERARY
At this point the hospital or clinic may submit to you a formal itinerary. This may take the form of a detailed day by day description of the surgical process including hotel information and pick-up time, or may just briefly describe the time and location of your pre-operative exams and surgery.

You may also wonder how long it will take for your procedure to be confirmed. This depends on several factors including the type of procedure, how quickly you provide information, your doctor’s schedule, and hospital availability. Expect a couple weeks on average, however, some international hospitals will schedule medical tourism patients in a matter of days when necessary. Remember, many international hospitals are intentionally trying to attract foreign patients and will therefore likely have a way to fast track your procedure.

After weeks or even months of research your mind is finally made up. You’ve selected an international hospital that you feel comfortable with, and you are now ready to go into the actual trip planning stage. An obvious first question is:

Will my insurance cover this? Most elective procedures such as cosmetic surgery, plastic surgery and weight loss surgery will not be covered by your insurance carrier. For other procedures, it’s best to check directly with your insurance carrier. Some international hospitals can do this for you if you provide them with your health insurance policy information. Additionally, some health insurance carriers are now offering a medical tourism program that will allow you to choose from various destinations for your procedure.

TOURISM
As mentioned before, you will require certain preoperative exams before your surgery. Depending on your age, health, and the type of procedure you are undergoing, you may require simple tests like a blood exam and an electrocardiogram, or more in-depth analyses that could include a thorax X-ray, ultrasound, gastro copy and an evaluation by a psychologist among other things.

Ideally you should try to get your tests done before leaving for your Medical Tourism Trip. This will allow your overseas physician to be absolutely sure that you are fit for your surgery. Finding out that you’re not a candidate for a hip replacement after flying half way around the world, can be an emotionally devastating experience. The truth of the matter, however, is that many medical tourism patients will opt for the convenience and lower cost of getting their preoperative exams done at the international hospital.

SHOULD I MAKE SURE MY DOCTOR AT HOME WILL PROVIDE AFTERCARE FOR ME ONCE I RETURN?
That is the ideal situation, unfortunately it is not always possible due to the stigma that medical tourism has for some doctors. As mentioned earlier, making your doctor an active participant in the medical tourism process is the best way to get him or her involved in your after care once you have returned home.

SHOULD I BRING A COMPANION ON MY MEDICAL TOURISM TRIP?
Yes, by all means do so if at all possible. The moral and physical support of a family member or a friend can do wonders for your spirit and probably even help speed up your recuperation time as well. For more invasive procedures such as heart surgery and hip and knee replacements, it would be ill advised not to.

Most international hospitals can provide various levels of assistance depending on your surgery and your particular needs. Moreover, a companion is not absolutely necessary for every type of procedure, and depending on your level of independence you can, in certain instances, get along fine without one. Make sure to check with your hospital liaison or medical tourism facilitator in order to see the type of assistance you will be receiving before and after your surgery and whether or not they believe you will require someone to accompany you. If in doubt, bring someone along.

WILL I NEED TO PAY EXTRA TO HAVE A FAMILY MEMBER ACCOMPANY ME OVERNIGHT IN MY HOSPITAL ROOM?
Many international hospitals allow companions to stay overnight free of charge. However, check with your particular provider for details such as if meals will be included or not.

Where should I stay before and after surgery (hotels / recovery retreats)? Most international hospitals and some clinics will provide you with a list of accommodation options suited to your needs as a surgery patient, sometimes referred to as recovery resorts or recovery retreat.
Hospitals with good international patient programs may go so far as arranging your lodging for you.

When choosing an accommodation, ask yourself the following questions: ARE THE FACILITIES AND SERVICES CONDUCIVE TO YOUR WELLBEING AND OPTIMAL RECOVERY? Depending on your condition this could mean limited or 24-hour nursing assistance, access to special diets, availability of handicap friendly facilities such as roll-in showers, a raised toilet seat, horizontal and vertical bars, and large spaces to move around easily with a wheelchair. Spotless sanitary conditions should also be a top priority.

HOW FAR IS THE HOTEL OR RECOVERY RESORT FROM THE HOSPITAL?
If you do have a complication, you want to make sure you can get to the hospital as quickly as possible. Ask your hospital liaison or medical tourism facilitator what contingency plans are in place for this. Traffic and driving conditions at some medical tourism destinations are not always optimal to say the least, so you will want to know how long it should reasonably take for you to get to and from your hotel. At the same time, you will want your hotel to be located in an area that is conducive to rest and relaxation, or simply safe for strolling about.

Some countries offer medical tourism patients the option of staying at so-called recovery retreats. These are usually all-inclusive facilities, sometimes located in the mountains or by the beach, that cater specifically to surgery patients. Costa Rica has been a pioneer in this type of aftercare concept, for many years attracting a large number of cosmetic surgery and dental tourism patients. In recent years, medical tourism patients undergoing more invasive procedures have also begun to explore this option.

This type of facility (recovery resort) is attractive for medical tourism patients who prefer personalized care and the opportunity to socialize with other people who are in a similar situation as they are. Are you sporting the results of an unsightly two day old facelift? Who cares, you’re sitting across the table from three others who look just as bad as you do. Not standing out from the crowd and the camaraderie that develops from exchanging stories, tips, and gossip, is for obvious reasons, an irresistible draw for cosmetic surgery patients.

You may ask, is this a good option for medical tourism patients with more invasive procedures, such as a total knee replacement? It depends, some recovery retreats may be located in mountainous areas, have limited wheelchair access, and require medical tourism patients to walk up and down stairs. Other retreats will not have these limitations and can be an excellent option for medical tourism patients who have undergone more invasive procedures.

When choosing between a regular hotel and a recovery retreat, keep in mind that the former was not built with medical tourism patients in mind, nor will it offer the personalized care and attention of the latter. Some people prefer this and are okay with the anonymity of a regular hotel. At the same time, a recovery retreat’s relative isolation from the “outside” world is sometimes seen as a drawback by some medical tourism patients and their family members.

WHAT SHOULD I BRING WITH ME ON MY MEDICAL TOURISM TRIP?
What you need to bring will be dependent on your destination (weather), accommodations and other variables associated with a normal trip or vacation. However, traveling for surgery does require some important extras:

• Your medical information and/or lab tests
• Copy/originals of all medical reports and medication details
• CD copies of any scans like MRI/CT/ECHO
• Any referral notes from your doctor
• Passport
• Eye Glasses/Contact lens equipment
• International Calling Cards Credit Cards
• Contact Information for friends, family, hotels, physicians, embassies, and airlines

SHOULD I BRING MY MEDICAL RECORDS?
The more medical history information you can bring the better. Remember, you will be meeting a new doctor who may know precious little about your condition except for what you’ve told him or from what you may have sent. The extent of information you should bring will depend on your condition and the type of procedure you will be undergoing. Therefore it is best to check with your primary and international physicians for their advice and requirements.

SHOULD I BRING A LAPTOP WITH ME ON MY MEDICAL TOURISM TRIP?
This is usually a good idea if you don’t mind lugging one around from place to place. Most hotels and hospitals catering to overseas guests will offer free or cheap internet access. This may take the form of a non descript room with computer terminals, a full-fledged business center, or possibly even wireless internet access throughout the hotel or hospital facility. Either way, a laptop will at least offer you some entertainment options if not a convenient way to stay in touch with friends, family, and business associates.

HOW MUCH SHOULD I BUDGET FOR MY MEDICAL TOURISM TRIP?
Your particular lifestyle, the medical tourism destination, and the type of medical tourism procedure you will be undergoing will dictate, to a large degree, how much money you will be spending. In general, the farther away your medical tourism destination the more you will pay for airfare. So, for example, expect to pay more if you are flying from Dallas to Bangkok, Thailand, than you would for a flight to Costa Rica or Monterey, Mexico. At the same time you also need to take into account that some medical tourism destinations are more expensive than others. So even if a particular country is cheaper to travel to, you will need to factor in the relative cost of “living”, in comparison to another medical tourism destination.

What about your lifestyle preferences? Do you plan to stay at a five star hotel or are you comfortable “roughing” it at a local bed and breakfast? Some adventurous souls prefer to immerse themselves in the local culture and will literally live on a shoestring budget. Most everyone else though will tend to fall somewhere between the Holiday Inn and Club Med.

The type of medical tourism procedure or medical tourism treatment you are undergoing will also play a large part in your decision of where to stay and what you will do. A medical tourism patient undergoing open heart surgery or a knee replacement will require extra care and very comfortable conditions after leaving the hospital. Not the case for someone coming for a dental bridge or an eyelid lift. Wherever you decide to stay, make sure it serves your needs as a medical tourism patient.

Many of the expenses of a medical tourism trip will be the same as those of a “normal” trip or vacation. At the very minimum you will need to budget for airfare, hotel accommodations, transportation requirements and meals. Sightseeing tours and souvenirs are also a real possibility, particularly if you are traveling with a companion.

Although there are exceptions, expect to pay more if you plan to use the services of a medical tourism facilitator than you would if going at it alone. They will assist you with obtaining your passport, booking a flight, coordinating your lodging and pretty much helping you arrange every detail of your medical tourism trip (by the way, some hospitals provide these services as well). Note that most medical tourism facilitators and some international hospitals will include many of the above elements within a total package price (minus the tours and souvenirs). You will still be paying for these services but having everything packaged together will make your life much easier.

HIDDEN COSTS
Whether purchasing a home or eating at a restaurant, none of us likes to be confronted with unexpected charges. With a process as complex as medical tourism, where so many parts come into play, what are potential hidden costs when planning for your medical tourism trip? (You do need to anticipate some potential hidden costs that could put a damper on your experience)

UNEXPECTED COMPLICATIONS:
We don’t like to think about this one but it is a possibility for every procedure at any hospital. The important thing is to understand the potential risks and complications associated with your procedure, lower these risks wherever possible, and know what the hospital or clinic’s policy is when these occur.

LONGER HOSPITAL STAY:
Sometimes you just don’t heal as quickly as expected. Whether this is due to a complication, or, is simply a matter of your particular physiology, does not really matter, as you will have to pay for the additional care.

EXTRA MEDICATION OR TREATMENT AT THE HOSPITAL:
Before, during or after your procedure, your physician may find it necessary to prescribe additional medication, not normally associated with the price of your procedure. Normally, in these circumstances, you will be charged extra for this. However, it is still a good idea to check with your international medical provider or medical tourism facilitator for details.

MEDICATION YOU MAY NEED TO PURCHASE TO BRING BACK TO YOUR HOTEL OR EVEN TAKE HOME WITH YOU:
The hospital or clinic will usually provide you with medication once you leave the hospital. This usually consists of pain medication and antibiotics, but can also include anti-clotting drugs or a medication protocol specific to your surgery. This may or may not be covered in the price of your surgery so make sure you read the fine print.

EXTRA CHARGES SPECIFIC TO HOTELS, RECOVERY FACILITIES AND TRANSPORTATION SERVICES:
So what happens if your hotel bed sheets get soiled, or if you require additional transportation or meals? Although some surgery packages do include, lodging, meals, and transportation services, it is important that you check with your international medical provider – or even go directly to the hotel to see its policy on these issues. Facilities and companies used to working with medical tourism patients will tend to have more flexible policies regarding these issues.

MEDICAL TOURISM FACILITATORS OR HOSPITALS PROVIDING INACCURATE PRICE ESTIMATES:
Though rare, this can happen and there is no real way to prepare for it. You can, however, minimize the possibility of this occurring by submitting accurate information about your condition and general health. Your legal rights and recourse options will depend on the laws of the particular country you are in. However, it goes without saying that this type of situation is not good for the hospital and medical tourism facilitator – not to mention medical tourism in general, and it is a good bet that they will do everything possible to resolve the situation to your satisfaction.

ADDITIONAL TREATMENT REQUIRED DUE TO MEDICAL TOURISM PATIENTS NOT BEING FORTHCOMING ABOUT THEIR MEDICAL HISTORY:
For whatever reasons, some people prefer to withhold information about their previous medical history. This is a big mistake that can lead to the physician having to prescribe additional medication or treatment, canceling the surgery, or to a potentially dangerous complication during or after the surgery. A typical example might be that of a medical tourism patient who hides the fact that he or she suffers from hypertension, which may necessitate the physician prescribing additional medication or tests. In another case, a medical tourism patient may not disclose to the physician that he or she has had a previous surgery, which could cause difficulties or complications during the surgical procedure. Both of these circumstances will probably generate additional costs not normally covered by your surgery package.

PREOPERATIVE exams:
These are the tests and exams that must be performed in order for the hospital and physician to make certain that you are a good candidate for your procedure. As the name suggests, they must be done before your surgery, sometimes even before traveling to the international hospital, and are oftentimes included in the price of your surgery. However, some medical tourism patients, due to their medical history or a chronic condition, may require additional exams not covered by the quoted surgery price. Therefore it is important to speak to your overseas physician and hospital liaison, in order to see which tests are covered in the price of your surgery.

To reduce the chance of nasty surprises, make sure that your hospital liaison or medical tourism facilitator provides you with a detailed list of the various costs you will need to pay (including potential ones). As stated previously, your surgery may be part of a package so you may not be able to request an itemized breakdown. However, you do have the right to know exactly what your expenses are likely to be, and if you will need to pay for anything else before, during, or after surgery.

MEDICAL TOURISM DESTINATION QUESTIONS
Where do I get information on travel requirements, vaccinations and safety in different countries? Most international hospitals and medical tourism facilitators will provide you with the necessary information about your medical tourism destination and requirements for your trip. You can also find country specific information and health alerts at the U.S State Departments website and the Centers for Disease Control and Prevention (see websites below):

www.travel.state.gov/travel/cis_pa_tw/cis/cis_1765.html
www.cdc.gov
PASSPORT
If you are thinking about traveling internationally for your medical procedure then you will need to have a valid passport. According to the US State Department, if you are a first time applicant then you will need to file in person at an “acceptance facility” (usually a post office or public library) or Passport Agency. There you will need to submit proof of U.S. citizenship (certified birth certificate, consular report of birth abroad, naturalization certificate or certificate of citizenship) and a DS-11 form which can be downloaded at http://travel.state.gov/passport/get/first/first_830.html. If you are in a big hurry (you need your passport in less than three weeks), then you can also request that your passport be expedited. Though a little more expensive, the peace of mind you’ll experience is well worth the extra cost. For more information about obtaining a passport, visit http://travel.state.gov/passport/passport_1738.html.

VISAS
Depending on your medical tourism destination you may also require a visa. Currently most popular medical tourism destinations do not require U.S. citizens to possess a visa. Some notable exceptions are: Brazil, India, Jordan and Turkey. For more information about country specific visa information, visit http://travel.state.gov/travel/cis_pa_tw/cis/cis_1765.html.

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YOUR MEDICAL TOURISM TRIP WHAT TO EXPECT
Most international hospitals and medical tourism facilitators will either include transportation and pick-ups in the cost of your procedure, or at the very least can point you in the right direction as to how to arrange this on your own. In most cases you will either go directly to the hospital for tests and/or consultation with your doctor, or to your hotel.

Are there risks of engaging in “tourism” activities before or after surgery? Whether alone or with a companion, there is a good chance that you’ll want to acquaint yourself with a country’s culture and attractions. If so, try to schedule your trip so that you have a few days before your medical tourism procedure to go sightseeing. Most international hospitals and medical tourism facilitators can assist you with making arrangements for tours. As far as touring after surgery, this will depend on your medical tourism destination, type of procedure, and the recommendations of your physician.

The fact is that some medical tourism destinations are simply better suited for touring than others. They have the infrastructure, services and experience to provide you with an enjoyable and safe trip – whether you’re a medical tourism patient or not. If you’ve undergone a relatively “mild” procedure such as a laparoscopic hernia repair or an eyelid lift, chances are you’ll be ready to engage in some light sightseeing tours after a few days of rest. No matter what your procedure, however, make sure to get your physician’s permission before engaging in any activities after surgery.

What kind of food will I be served while overseas? Are toasted locust and crispy larvae just a little too far off for your taste buds? Never fear. Most hotels and international hospitals will offer you a choice of various menu options including Western, vegetarian, and more exotic local fare. If you dislike or are allergic to certain types of food, then talk to your hospital liaison or medical tourism facilitator to make sure they know and are able to make proper arrangements.

DURING YOUR HOSPITAL/CLINIC STAY
How do I stay in contact with friends and family at home? Apart from a positive surgical outcome, there are few things more sacred to an international patient than the ability to remain in constant contact with family members and friends. Fortunately, with the dizzying advances in telecommunications technology, this isn’t hard to do.

For starters:
• You can purchase pre-paid calling cards at home
• Purchase calling cards at your overseas destination
• Bring a roaming cell phone
• The overseas hospital or medical tourism facilitator may provide you with a pre-paid cell phone
• Through your laptop or a hospital computer you can send emails or talk to people using an internet phone service such as Skype.
• Some hospitals even offer international patients free long distant calling
WILL THE HOSPITAL I AM STAYING HAVE INTERNET ACCESS OR TV?
What should I expect my room to be like? This will depend on your particular international hospital. As I discussed in a previous section, hospitals at popular medical tourism destinations are going all out to attract medical tourism patients so expect nicer rooms than you are used to at home. In general, you will probably have the opportunity to choose from several room-types (with different price ranges) including: shared rooms, spacious private rooms, suites, and in some cases luxury suites. These may include some or all of the below amenities:

• electronically adjustable beds
• Computerized personal nurse call system
• Bedside room light and TV controls
• Individual cable television
• Guest couch
• Personal telephone for local and international calls
• individually controlled room air conditioning
• Complimentary premium bathroom amenities
• Personal medication cabinet


What kind of care will I receive after my surgery? In many ways the medical tourism process is very similar to what you may be used to at home. If your surgery is an inpatient procedure, expect to be taken to back to your room for recovery and for monitoring by the hospital nursing staff. Different hospitals will display varying post-surgery care protocols, however, expect the standards of care to be just as rigorous – if not more so, than at many North American hospitals. Don’t be surprised if your care is highly personalized either, as many international hospitals will have a higher nurse to patient ratio than you will normally find in the U.S or Canada.

The traditions and culture of your medical tourism destination will also play a role in the type of care you receive. The people of many third worlds, developing nations often exude a sense of warmth and friendliness that goes way above what you may be used to at home. By this I don’t mean to say that nurses in first world nations are cold or unfriendly, it’s simply that one’s behavior and mannerisms are often dictated by your cultural background and traditions. Those of us from Anglo-Saxon and Germanic descent, tend to be a little more aloof and rigid than many of our Latin American or Asian brethren.

Some international hospitals may even have an area dedicated to international patients, where you will be cared for by an English speaking nursing staff experienced in attending to medical tourism patients like yourself. Whereas surgeon visits in North America tend to be few and far between, expect your overseas surgeon to check up on your progress quite often. Rehabilitation therapy will also be available if you’ve undergone a procedure that requires scheduled therapy.

What if I require a blood transfusion?
No matter where you have your surgery there is always a risk that you may require a blood transfusion. For minimally invasive procedures the risk is very lower, however, the more invasive the procedure the higher the possibility that a transfusion could be necessary. This is especially true for medical tourism procedures such as open heart surgery or joint replacement surgery.

Whether or not you feel you are at a high risk for requiring a blood transfusion, you should ask your chosen hospital what type of safeguards they have in place to ensure an uncontaminated blood supply, and, what type of viruses are screened. Presently most blood banks screen for the following diseases: HIV-1 and HIV-2 (the viruses that cause AIDS), hepatitis B, hepatitis C, human T-cell lymph tropic viruses (HTLV-I and HTLV-II), ALT (the level of a liver enzyme), and syphilis.

Does the hospital have air conditioning?
Electricity – Do I need Adaptors for different voltage?
Will I be able to use VOIP? (Voice over IP) to call home through the internet?
What paperwork should I take when I leave the hospital?

What personal stuff will I be able to buy in the hospital?
At most international hospitals expect to have access to a pharmacy and /or convenience shop where you can purchase toiletries and other personal items such as shampoo, soap, toothpaste

AFTERCARE & MEDICAL TOURISM
What will the aftercare be like overseas after my surgery? Depending on your particular hospital and or surgery package, you will either spend most of your recovery time at the hospital, or more likely, you will transfer to a hotel or a recovery facility for the remainder of your stay. This only makes sense as a night in the hospital may cost two or three times more than one at a hotel or recovery retreat. Studies also suggest that longer hospital stays increase your risk of infection or contracting an illness. Bottom line, if your doctor says you are good to go – then go.

Will I have to pay for hotel costs after surgery? This will depend on the medical tourism procedure package you purchase through your international hospital or medical tourism facilitator. Even if your package does include the cost of post surgery lodging, it doesn’t hurt to check and see if you can save money by purchasing your lodging separately.

Will rehabilitation therapy be included in my medical tourism procedure package? Again, this will depend on the particular hospital you choose. Orthopedic procedures such as hip and knee replacements will require extensive rehabilitation therapy, so make sure to ask if this will be included as part of your procedure package.

What if a complication happens while I am overseas? In the event of a medical tourism complication, your international hospital and physician will arrange for proper action to be taken. It is therefore important to have a list of hospital contacts with you while you are recovering at your hotel. Some medical tourism complications may be very minor and require nothing more than a short doctor or nursing visit to your hotel. Other complications may require that you be interned again in the hospital.

What are the risks of flying after surgery? As discussed above, the principal dangers of flying after surgery are deep vein thrombosis and pulmonary embolism. Please refer above to “What are the risks of medical tourism” for more information.

Do I need to fly business or first class after my surgery? Depending on the type of surgery you have undergone, it may be wise to purchase tickets in first or business class. This is especially true for orthopedic procedures such as hip and knee replacements, cardiac surgery, and neurosurgery – where you need to be comfortable and require extra space.

What do I do if I have complications upon returning home? The ideal scenario is to have an aftercare protocol arranged with your doctor before you leave for your surgery trip. Some international hospitals may offer aftercare options. If you have traveled under a medical tourism program with your insurance carrier or employer, then your primary doctor will be the first person to call. He will then arrange to speak to your international doctor if he requires more information about your condition. If you have initiated your Medical Tourism Trip on your own, or through a facilitator, and do not have a primary doctor at home, then, you will want to contact your overseas physician and hospital for their recommendations (assuming the complication is not life threatening in which case you should immediately seek local emergency care).

Can I speak to my international provider after I come home? Many international providers will follow-up with you periodically to make sure you are doing well. They should also provide you with a contact in case you have any questions or concerns. This may be someone from the hospital’s internationals office or even your overseas physician.