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Medical Tourism: An Australian Plastic Surgeon's Perspective

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Medical tourism has become increasingly popular in the last few years. However, It has financial, social and political ramifications that need further scrutiny. Some recommendations and guidelines for regulation have been suggested to make medical tourism a safer and ethical option for patients.

Published in: Health & Medicine, Healthcare
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Medical Tourism: An Australian Plastic Surgeon's Perspective

  1. Dr Tim Papadopoulos Plastic & Cosmetic Surgeon President ASAPS MEDICAL TOURISM SUMMIT 20-21 November 2014, Melbourne DOES MEDICAL TOURISM TRIVIALISE PLASTIC SURGERY?
  2. Dr Tim Papadopoulos Plastic & Cosmetic Surgeon President ASAPS MEDICAL TOURISM SUMMIT 20-21 November 2014, Melbourne DOES MEDICAL TOURISM TRIVIALISE PLASTIC SURGERY? COSMETIC
  3. HELL YEAH!
  4. Medical tourism is complex…
  5. and confusing.
  6. DJKSLNZJSSSJKEOEADNFHR OM184646483022EGNDLWY Z6304NFLK72BSIWBT30567 QLHEBH093B78193GRK3740 EJZJDLEJEV98734NHHJDLO LE9SN3395B5I5B5IDRURBRU RBRURRUIDHEBDMORHDGR N3203865940403NDUDBE3 74VDHDICNDENDJNEJH49S BWI39BXICDEI44908645202 BCYVBEV429364VW820Y4TV There are a lot of senseless data.
  7. It’s cross border. It’s regional. Rarely global.
  8. 15,000 AUSTRALIANS PER YEARTRAVEL ABROAD FOR COSMETIC SURGERY Meredith Jones UTS 2013
  9. YEAH, THAT’S A $300 MILLION INDUSTRY! Meredith Jones UTS 2013 15,000 AUSTRALIANS PER YEARTRAVEL ABROAD FOR COSMETIC SURGERY
  10. YEAH, THAT’S A $300 MILLION INDUSTRY! Meredith Jones UTS 2013 15,000 AUSTRALIANS PER YEARTRAVEL ABROAD FOR COSMETIC SURGERY $6-20K per patient
  11. and yes its a headache for us back home.
  12. and yes its a headache for us back home. Seriously!
  13. Is it the health-care providers (me) that are the problem?
  14. or is it our health-care system that sucks?
  15. Need to learn the ‘good, the bad and ugly’ from the medical tourism industry…
  16. and its social, economic and political impact on society.
  17. 1. Why is this happening & what can we do about it…
  18. QUESTIONS WE NEED TO ASK OURSELVES 7
  19. WHY TRAVEL ABROAD? 1
  20. It’s not only about cost.
  21. It’s not only about cost. It’s about access, quality, service and…
  22. for the diaspora or ‘expats’ it’s familiarity.
  23. Yes, there are other reasons too…
  24. Yes, there are other reasons too… Lower transport costs, trade liberalisation, reduced language barriers etc. etc. etc.
  25. WHO TRAVELS? 2
  26. Medical tourism suggests pleasure and relaxation…
  27. DR FOAD NAHAI PAST PRESIDENT ISAPS “MEDICALPROCEDURESABROAD”
  28. Erik Cohen 2008 TYPES OF MEDICAL TOURISTS
  29. MEDICATED TOURIST Erik Cohen 2008
  30. MEDICATED TOURIST MEDICAL TOURIST PROPER E Cohen 2008
  31. MEDICATED TOURIST MEDICAL TOURIST PROPER VACATIONING PATIENT E Cohen 2008
  32. MEDICATED TOURIST MEDICAL TOURIST PROPER VACATIONING PATIENT MERE PATIENT E Cohen 2008
  33. MEDICATED TOURIST MEDICAL TOURIST PROPER VACATIONING PATIENT MERE PATIENT DIASPORA OR ‘EXPAT’ TOURIST E Cohen 2008
  34. MEDICATED TOURIST MEDICAL TOURIST PROPER VACATIONING PATIENT MERE PATIENT DIASPORA OR ‘EXPAT’ TOURIST E Cohen 2008 MAJORITY OF MEDICAL TOURISTS
  35. WHICH DESTINATIONS? 3
  36. No systematic collection of data to indicate the global size of the market, and estimations are wide and varied.
  37. No country has a monopoly on the ‘best health-care providers’ and ‘top medical facilities’ in the world.
  38. PHILIPPINESTHAILAND MALAYSIA SINGAPORE STH KOREA INDIA OUTBOUND MEDICAL TOURISTS 2011 Deloitte Access Economics 2011
  39. PHILIPPINESTHAILAND MALAYSIA SINGAPORE STH KOREA INDIA OUTBOUND MEDICAL TOURISTS 2011 Deloitte Access Economics 2011
  40. REASONS FOR COSMETIC SURGERY? 4
  41. MAINLY 4…
  42. 1. CORRECT Nature “missed a beat”
  43. 1. CORRECT Nature “missed a beat” 2. REPAIR Nature “took a toll”
  44. 1. CORRECT Nature “missed a beat” 2. REPAIR Nature “took a toll” 3. ENHANCE Nature “didn’t match desires”
  45. 1. CORRECT Nature “missed a beat” 2. REPAIR Nature “took a toll” 3. ENHANCE Nature “didn’t match desires” 4. INVESTMENT Career & relationships
  46. 6 ANY REGULATIONS?
  47. Government agencies can only regulate businesses in own country.
  48. Medical tourism companies subject to little oversight.
  49. Medical tourism companies subject to little oversight. Not obliged to undergo accreditation.
  50. ‘REGULATORY VACUUM’
  51. They must conform to legal standards.
  52. SOME STANDARDS FOR CONSIDERATION Leigh G Turner UM 2011
  53. 1. Accreditation review. Leigh G Turner UM 2011
  54. 1. Accreditation review. 2. International accreditation of destination facilities. Leigh G Turner UM 2011
  55. 1. Accreditation review. 2. International accreditation of destination facilities. 3. Informed patient consent. Leigh G Turner UM 2011
  56. 1. Accreditation review. 2. International accreditation of destination facilities. 3. Informed patient consent. 4. Continuity of care. Leigh G Turner UM 2011
  57. 1. Accreditation review MTC. 2. International accreditation of destination facilities. 3. Informed patient consent. 4. Continuity of care. 5. Addressing waiver of liability forms. Leigh G Turner UM 2011
  58. 1. Accreditation review MTC. 2. International accreditation of destination facilities. 3. Informed patient consent. 4. Continuity of care. 5. Addressing waiver of liability forms. 6. Privacy and confidentiality of patient information.Leigh G Turner UM 2011
  59. WAIT, THERE’S MORE!
  60. 7. Professional standard of care and health services eligible for marketing. Leigh G Turner UM 2011
  61. 7. Professional standard of care and health services eligible for marketing. 8. Training and certification. Leigh G Turner UM 2011
  62. 7. Professional standard of care and health services eligible for marketing. 8. Training and certification. 9. Medical travel and complications insurance. Leigh G Turner UM 2011
  63. 7. Professional standard of care and health services eligible for marketing. 8. Training and certification. 9. Medical travel and complications insurance. 10.Contribution to compensation funds. Leigh G Turner UM 2011
  64. 7 WHAT ABOUT COMMERCIALISED MEDICINE?
  65. ‘PANDORA’S BOX’
  66. ‘EARLY TO BED, EARLY TO RISE, WORK LIKE HELL AND ADVERTISE’ B J Palmer Selling Yourself 1926
  67. Commercialisation of cosmetic surgery threatens our efforts to convince the public that medicine is not a commodity or a trade.
  68. Advertising and PR boost demand for cosmetic surgery. Appeals to dominant cultural values of youth, beauty, sexuality, status, happiness and control. Exploit’s people’s anxieties and fantasies. It personalises the problem of perceived appearance imperfections.
  69. It emphasises positive outcomes and downplays the pain and risks of medical intervention.
  70. Claims of expertise, ease, safety and desirable outcomes are occasionally exaggerated to the point of misrepresentation to increase sales. Sometimes prospective patients are persuaded to expand their perception of their appearance problems…
  71. This raises ethical questions about the exploitation of vulnerable patients by those who have the fiduciary responsibility to act in patient’s best interests. Sometimes they are pressured to commit to surgery by offers of discounts for an immediate decision or for multiple procedures.
  72. PROBLEMS WITH COMMERCIAL, FREE-MARKET DELIVERY SYSTEM. 1. Deregulation of marketing has made cosmetic surgery a lucrative business, dependent on marketing. 2. Minimal state regulation of surgery in private office facilities. 3. Lax oversight of individual doctors’ practices by their own licensure boards.
  73. It leads to certain challenges…
  74. SERVICE ETHIC CHALLENGED
  75. Unlike a commercial trade, medicine has a service ethic that prohibits the exploitation of patients for profit.
  76. Unlike a commercial trade, medicine has a service ethic that prohibits the exploitation of patients for profit. The foundation of trust characterises a good patient- doctor relationship.
  77. AUTHORITY CHALLENGED
  78. Media give a public voice to patients who question their personal doctor’s competence and ethics.
  79. AUTONOMY CHALLENGED
  80. Doctors’ autonomy rests on their experience and their fiduciary relationship with patients, a relationship that is strained by the emphasis on profit that is inherent in commercialism.
  81. ‘Knowing when to stop in surgery is a hard lesson to learn. Knowing when to begin may be even harder.’
  82. 2. Addressing some risks
  83. Patient Safety
  84. Patient Safety Patients are more savvy. Providers paid for selling services & procedures, not necessarily improve health. Facilitators promote these services.
  85. Should problems arise, there may be few if any legal remedies to address them.
  86. Threat to Public Health Systems
  87. Cosmetic surgery holidays revealed a shocking 16.5% complication rate with nearly 1 in 10 (9%) patients needing assistance from the NHS when arriving home. Study Leeds University 2013
  88. Public health system stretched even further.
  89. Price increase in both public & private sectors.
  90. Cross-Border Spread of Diseases
  91. Singapore’s 1st case of drug resistant TB (XDR-TB) arrived from Indonesia. Ebola alert in Queensland with several patients quarantined after arriving from West Africa with fever.
  92. CRICKEY!
  93. 3. Story of medical tourism…
  94. VICTIM
  95. Patient
  96. Patient Sold hope for happiness. Poor outcomes downplayed. Little recourse if something goes wrong.
  97. Doctor Opposed deregulated restrictions on marketing professional services. Most practice responsibly. Few corrupted by profits from commercialised medicine.
  98. VILLAIN
  99. Appearance
  100. Appearance Stereotypic expectations & different treatment. Diminish less attractive people’s opportunities & contribution to society. It’s a lose-lose outcome
  101. Commercialisation of medicine
  102. To understand what makes commercialism in medicine problematic…
  103. Commercialism is an ‘excessive emphasis on profit’ and ‘exploit for profit.’ Synonymous with ‘average or inferior quality’ and refers to something that is ‘designed for a large market’ and ‘supported by advertisers.’ Webster’s Dictionary
  104. Advertising can be used to create a perception of ‘need’ that can be exploited for profit.
  105. ‘CAVEAT EMPTOR’ (BUYER BEWARE)
  106. LET’S RECAP…
  107. MEDICAL TOURISM IS EVOLVING BUT SCARY!
  108. We can’t afford to be naive about things anymore.
  109. Commercialisation of cosmetic surgery threatens our efforts to convince the public that medicine is not a commodity or a trade. but a few doctors have exposed themselves… as profit driven.
  110. We’re not the only ones.
  111. We’re not the only ones. Governments and medical tourism companies have a lot to answer for…
  112. Whilst medical tourism provides revenue source for national economies, it may disrupt domestic public health systems by redirecting scarce resources to the private sector.
  113. Globally there’s promise of exchange opportunities and resources but also perhaps the dissemination of problems most notably infectious diseases.
  114. Inadequate oversight and regulation of this medical tourism industry makes it more difficult to identify and address such problems. Documentation of medical travel is haphazard and fragmentary.
  115. Need to fight back and deliver a bigger punch.
  116. Need to figure a way we can compete in this ‘global health bazaar.’
  117. INBOUND MEDICAL TOURISTS 2011 ? ? ? ? ? 12,800 Deloitte Access Economics 2011 0.23% of all tourists to Australia (0.001% medical tourists worldwide)
  118. INBOUND MEDICAL TOURISTS 2011 ? ? ? ? ? 12,800 Deloitte Access Economics 2011 0.23% of all tourists to Australia (0.001% medical tourists worldwide) 14%annual growth rate 2005-2010
  119. INBOUND MEDICAL TOURISTS 2011 ? ? ? ? ? 12,800 Deloitte Access Economics 2011 0.23% of all tourists to Australia (0.001% medical tourists worldwide) 14%annual growth rate 2005-2010$4K per patient & stay 2 weeks (mainly East coast)
  120. Specialise in body contouring following bariatric surgery and corrective plastic surgery after complications arising from procedures abroad.
  121. We can’t compete on price. We need government support. Our quality of healthcare is world class. Deloitte Access Economics 2011 SCORECARD COMPARISON
  122. We need to renew and reinvigorate our campaign both here and abroad. How and why Australia is a destination country of choice for quality cosmetic surgery.
  123. We should try and make Australia both a departure and destination point for medical travellers.
  124. Spread the word now…
  125. GO ON!!!
  126. But remember…
  127. the problems arising abroad from medical tourism can equally apply here in Australia. Be careful what you ask for!
  128. the problems arising abroad from medical tourism can equally apply here in Australia. Be careful what you ask for! After all…
  129. We all just want smiling, happy patients!
  130. Please share this presentation. Together we can improve medical tourism globally. Dr Tim Papadopoulos twitter.com/readDrTim linkedin.com/in/drtimpapadopoulos facebook.com/DrTimCosmeticPlasticSurgeon THANK YOU. Inspired by Jesse Desjardins

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