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Sun, sand and surgery
Thu, May 05 2005

Frustrated with having to wait a year for an operation, a popular Vancouver entertainer heads to India to fix his knee, joining a growing number of Canadians who are being lured to Asia by... sun, sand and surgery.

Robert Stuart Smith
Vancouver realtor Robert Stuart Smith just could not wait anymore.

Despite his friends telling him not to do it, the 72-year-old boarded a plane for Kerala, India with his wife to fix his knee.

"I landed here on April 7 and my surgery was on April 15. I expect to be discharged anytime now because I have started walking. I would like to spend time in my hotel near Kovalam. I expect to fly back by the middle of May," Smith said after his surgery.

The surgery and travel cost Smith about C$25,000--money he says was well spent.

He could have had the surgery done for free in B.C.

But that would have meant a one-year wait for the popular Vancouver crooner who was a mainstay at the George V Pub in Vancouver's Hotel Georgia for seventeen years.

Like him, many Canadians frustrated with the growing waiting times for surgery are heading to Asia which is cashing in on the growing medical tourism industry.

So-called medical tourism has boomed in recent years, especially in Malaysia, Thailand, Singapore, the Philippines and India with foreign patients travelling both for those nations' famed beaches and routine medical procedures that are often cheaper and get done quicker than in their home countries.

In Canada, especially in B.C. several local companies with names like OneWorld Medicare, Medextra and Timely Medical Alternatives have also begun cashing in on the trend by setting up brokerages that arrange speedy off-shore health service.

Fuelling the industry are Canada's lengthy waiting lists for many medical procedures. A study last year found Canadians waited an average of 8.4 weeks from their general practitioner's referral to an appointment with a specialist in 12 different medical specialties, then waited another 9.5 weeks for their treatment. Those wait times are almost double what a similar study found in 1993.

Bumrungrad Hospital in Thailand: outdoor decor like a five star hotel
India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries.

India's National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." Government and private sector studies in India estimate that medical tourism could bring between C$1.2 billion and C$2.5 billion US into the country by 2012. The reports estimate that medical tourism to India is growing by 30 per cent a year.

India's top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year.

The largest of the estimated half-dozen medical corporations in India serving medical tourists is Apollo Hospital Enterprises, which treated an estimated 60,000 patients between 2001 and spring 2004.

Apollo's business began to grow in the 1990s. The first patients were Indian expatriates who returned home for treatment; major investment houses followed with money and then patients from Europe, the Middle East and Canada began to arrive. Apollo now has 37 hospitals, with about 7,000 beds.

Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation.

This month Ujjal Dosanjh, the Canadian health minister met Panjab Chief Minister Amarinder Singh to talk about health tourism and cultural cooperation.

"A number of non-resident Indians from Canada visit Panjab every year and the Chief Minister discussed the potential of medical tourism with their Health Minister. Punjab is upgrading its medical infrastructure and would soon have state-of-the-art facilities," Punjab government officials said after the meeting.

In Thailand, the tourism authority is pumping millions to lure Canadians and others with a refined sun, sand and surgery mantra.

In 2003, the burgeoning medical tourism industry generated more than C$1.8 billion for Thailand's 400-plus private hospitals which saw over 630,000 overseas patients.

Source: BC Ministry of Health
In 2003, over 5,600 Canadians sought medical treatment at Bumrungrad Hospital in Bangkok.

With an atmosphere more akin to a five-star hotel than a hospital, Bumrungrad is not only the largest private medical institution in Asia, but also the first hospital in Asia to become internationally accredited.

The Thai Trade Centre in downtown Vancouver is among the missions worldwide that is actively promoting medical tourism with a target to reach 1 million patients by 2005.

Malaysia is another country on the health-tourism bandwagon.

Capitalizing on its Western-trained medics and a favourable exchange rate (neighbouring Singapore's treatments cost twice as much), Malaysia's wards now proffer everything from laparoscopic surgery to liposuction.

And patients are flocking: the Association of Private Hospitals of Malaysia (APHM) claims that in 2002 nearly 85,000 medical tourists checked themselves in to Malaysian clinics, mostly from Indonesia and other Asian countries but also many from Europe. "We're multicultural and multilingual," says the association's Dr. Ridzwan Bakar. "And we're the most competitively priced country in the Asia-Pacific region, bar India."

Malaysia's other major selling point is its ability to perform difficult treatments. Among the most popularly requested operations are cardiac bypass surgery--the National Heart Institute is a leading center in the region--and fertility treatments, with the country's premier Damansara Fertility Centre claiming in vitro success rates that match top U.S. clinics.

To compete with Malaysia and Thailand, a major private hospital in Singapore slashed prices recently for a slew of common operations as part of city-state's drive to lure tourists and expatriates seeking inexpensive health care.

The private 380-bed Raffles Hospital is hoping to treat up to 300,000 foreign patients a year by then, said Dr. Loo Choon Yong, executive chairman of the Raffles Medical Group, one of Singapore's top health care providers.

Loo said Raffles was offering prices that are competitive and comparable to the Thai and Malaysian hospitals. "We can you guarantee you, when you take blood from our blood bank in Singapore it is safe, 100 percent safe," Loo added.

"We can also assure you in Singapore, the level of training and professionalism is among the best in the world."

The hospital is now discounting 10 standard operations and procedures ranging from having a baby and treating a cataract to undergoing a heart bypass.

The downtown hospital offers comprehensive packages for those going under the knife--and for their family members who travel with them. Dr. Prem Kumar Nair, general manager of the group, said staff could arrange airport transfers, book relatives into nearby hotels, and even help to arrange a local tour.

"That's why they call it medical tourism: we do everything," Nair said.

As the medical tourism industry booms in Asia, the medical industry in North America which is increasingly becoming agitated is sending word out about the risks associated with seeking medical care or surgical procedures elsewhere.

Realizing that it will only take one-botched operation to destroy the industry, countries like India, Malaysia, Singapore and Thailand have imposed strident measures to ensure their new money-maker does not get a black eye.

Ruben Toral, marketing director at Bumrungrad Hospital, in Thailand cautions that when going abroad for medical care, people need to be smart consumers. They need to realize that they are taking their health in their own hands and "understand where [they] are going to, and make sure this is an accredited facility with management standards, care standards, quality standards that [they] would expect in [their] home country."

Experts have identified a number of problems with medical tourism:

  • Government and basic medical insurance, and sometimes extended medical insurance, often does not pay for the medical procedure, meaning the patient has to pay cash.
  • There is little follow-up care. The patient usually is in hospital for only a few days, and then goes on the vacation portion of the trip or returns home. Complications, side-effects and post-operative care are then the responsibility of the medical care system in the patients' home country.
  • Most of the countries that offer medical tourism have weak malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.
  • There are growing accusations that profitable, private-sector medical tourism is drawing medical resources and personnel away from the local population, although some medical organizations that market to outside tourists are taking steps to improve local service.

But Vancouverite Robert Stuart Smith who got a new knee in India said that if you do enough research and planning, the risks are minimized.

"Believe me, we are certainly elated and pleased with the excellent treatment and the love and care we have got from this hospital, and certainly I will tell everyone about this place once I am back in Vancouver," Smith told Indian media from his hospital bed.

"I spent a lot of time on the Internet for this. I zeroed down on the Kerala Institute of Medical Sciences hospital here and thought it would be the right place to get my weak knee replaced.After landing here, I had several discussions with the doctor prior to my surgery.

"I also spoke to several patients who had undergone knee replacements," said Smith.