The document discusses the economic, social, surgical, moral and quality of care issues surrounding the outsourcing of surgical procedures to Asia. It provides cost comparisons for common procedures in countries like Singapore, Thailand, India, and the US. Key concerns include ensuring high ethical and quality standards given lower costs abroad and shorter wait times for transplants. International goals aim to reduce medical errors and improve patient safety globally.

1. The Outsourcing of Surgical Procedures to Asia: Economic, Social, Surgical, Moral and Quality of Care Issues Claire Langham, Ph.D. Dennis M. Richmond, M.D., F.A.C.S Michele A. Rubin, Ph.D., MHMS

2. Sociological Aspects of Medical Outsourcing Monetary benefit to nation Savings passed on to other needs Additional income revenue Lower Costs Country Receiving Patients Country Sending Patients ECONOMIC

3. Sociological Aspects of Medical Outsourcing More tourism promotion in effect Opportunity for family to visit abroad Increased cultural exchanges Greater respect to host nationals Opportunity to encounter others Appreciation given host nation Country Receiving Patients Country Sending Patients SOCIAL

4. Sociological Aspects of Medical Outsourcing Internationalization of practices Potential for redefining of malpractice suits Greater international legal ties Promote development of agreements Country Receiving Patients Country Sending Patients LEGAL

5. Sociological Aspects of Medical Outsourcing Inspections by international medical regulatory boards Concerns for medical standards Reputation importance Questions of safety in follow up Raise issues of international medical ethics Less control of medical practices Increased prestige in medicine for host nation Increased contacts in exchange of people and information Country Receiving Patients Country Sending Patients MEDICAL

6. The Outsourcing of Surgical Procedures to Asia: Note: Angioplasty in Malaysia averages $4,000 - $6,000 Cardiac: $13,000 $10,000- $11,000 $9,000- $10,000 $160,000 – $281,000 Heart Valve (single) $20,000 $12,000 $4,000-$10,000 $100,000 –$123,000 Coronary Artery Bypass $13,000 $13,000 $4,000-$11,000 $35,000 –$83,000 Coronary Angioplasty Singapore Thailand India USA Procedures& Services

7. The Outsourcing of Surgical Procedures to Asia: Singapore Thailand India USA Procedures & Services $12,000 $9,000 $7,000-$8,000 $23,000-$35,000 Mastectomy $5,000 $4,000-$5,000 $3,000 $20,000-$30,000 Hysterectomy $15,000 $15,000 $11,000-$17,000 $48,000-$70,000 Gastric Bypass $390,000 $350 $250-$300 $5,000 Hernia Repair $11,000 $10,000 $8,000-$10,000 $20,000-25,000 Gall Bladder Removal Gastrointestinal and General Surgical:

8. The Outsourcing of Surgical Procedures to Asia: Singapore Thailand India USA Procedures & Services $200 - $300 $1,000-$3,000 Radiology Reading

9. The Outsourcing of Surgical Procedures to Asia: $10,000 $90,000 Spinal Disc $9,000 $7,000 $5,000-$6,000 $63,000-$91,000 Spinal Fusion $8,000 $7,000-$8,000 $4,000-$6,000 $17,000-$20,000 Knee (ACL) Repair Orthopedics: $8,000 $8,000 $4,000-$7,000 $40,000-%60,000 Rotator Cuff $13,000 $10,000 $8,000-$9,000 $40,000-$61,000 Knee Replacement $12,000 $12,000 $9,000 $44,000-$64,000 Hip Replacement Singapore Thailand India USA Procedures & Services

10. The Outsourcing of Surgical Procedures to Asia: Cosmetic: Singapore Thailand India USA Procedures & Services $3,000-$5,000 $3,000-$5,000 $2,000-$3,000 $6,000-$12,000 Breast Reduction $3,000-$5,000 $3,000-$5,000 $2,000-$3,000 $6,000-$12,000 Breast Augmentation $3,000-$5,000 $3,000-$5,000 $2,000-$3,000 $10,000-$20,000 Face Lift

11. The Outsourcing of Surgical Procedures to Asia: $3,000 $3,000 $2,000-$3,000 $7,000-$12,000 Tummy Tuck $3,000 $3,000 $2,000-$3,000 $7,000-$12,000 Nose Surgery $3,000 $2,000-$3,000 $1,000-$2,000 $7,000-$12,000 Liposuction Procedures & Services Cosmetic (continued): USA India Thailand Singapore

12. The Outsourcing of Surgical Procedures to Asia: *Cost of Dialysis can exceed $1,000,000 $21,000-$28,000 $10,000-$18,000 Up to $500,000* Liver $15,000-$20,000 $10,000-$15,000 Up to $500,000* Kidney PRC India USA Transplant Procedures Costs (Dollars)

13. The Outsourcing of Surgical Procedures to Asia: Altruistic Donation PRC India USA Transplant Procedures Yes/No No Yes Liver Yes/No No Yes Kidney

14. The Outsourcing of Surgical Procedures to Asia: Waiting Time PRC India USA Transplant Procedures Weeks (3-5) Weeks (3) Months Liver Weeks (3-5) Weeks (3) Months to Years Kidney

15. The Outsourcing of Surgical Procedures to Asia A. Are the surgeons skilled? Yes B. Are the results satisfactory? Yes = Western Results C. Ethical Considerations: 1. Is XS waiting time unethical? Yes 2. Is “XS” cost unethical? Yes 3. Indications for Transplant Surgery: Age and Diagnosis 4. Altruistic vs. Non-Altruistic Organ Donation “Eye of the Beholder”

16. Quality of Care Issues More than 500,000 U.S. residents in 2005 traveled abroad for medical and dental treatment. Source: National Coalition on Health Care

17. Quality of Care Issues Health care errors seriously harm 1 in every 10 patients around the world. Source: World Health Organization (WHO)

18. Quality of Care Issues Goals: Reduction in high numbers of serious medical injuries. Strengthen and improve patient safety and quality of healthcare worldwide. Spread and reinforce proven best practices .

19. Quality of Care Issues – International Patient Safety Goals Goal 1 – Identify Patients Correctly

20. Quality of Care Issues – International Patient Safety Goals Goal 2 – Improve Effective Communication

21. Quality of Care Issues – International Patient Safety Goals Goal 3 – Improve the Safety of High-Alert Medications

22. Quality of Care Issues – International Patient Safety Goals Goal 4 – Eliminate Wrong-Site, Wrong-Patient, Wrong-Procedure Surgery

23. Quality of Care Issues – International Patient Safety Goals Goal 5 – Reduce the risk of health care-acquired infections.

24. Quality of Care Issues – International Patient Safety Goals Goal 6 – Reduce the risk of patient harm resulting from falls.

25. Quality of Care Issues “ The belief that one day it may be possible for the clinical error suffered by a patient in one part of the world to be a source of transmitted learning that benefits future patients in many countries is a powerful force…” Sir Liam Donaldson, MD, Chair of World Alliance for Patient Safety

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