Medical tourism: approach plastic surgery abroad with caution
The trend of going out of the country to receive plastic surgery continues to increase. According to Patients Beyond Borders (www.patientsbeyondborders.com) over 1 million United States citizens traveled outside of the United States for medical procedures. The most common procedures are cosmetic dentistry, cardiovascular surgery, joint replacement surgery, fertility procedures, weight loss/lap band, and cosmetic surgery. Some of the most common countries that people travel to receive these surgeries are Costa Rica, India, Malaysia, Mexico, Thailand, Taiwan, and Turkey. The medical tourism industry continues to increase as healthcare costs in the United States increase. Deductibles for insurance are higher so patients are responsible for a larger portion of their medical costs, surgical facilities and hospitals are charging more for overnight stays and medication, visitation fees, nursing care, and postoperative care costs all continue to increase with time.
This discussion is not intended to disparage any other country or international physicians as there are a lot of great hospitals and great physicians locally and internationally, it is intended to educate you regarding the major risks of having procedures outside of the United States from my perspective.
Let us review some of the positives regarding hospitals, surgery centers, and physicians in the United States. Hospitals are regularly monitored by the government bureau called JAHCO. This agency will conduct surprise inspections, monitor infection rates, monitor patient volumes and readmission for complications. The hospitals in the United States must be accredited and certified in order to perform surgeries on patients with health insurance. Surgical centers whether inpatient or outpatient, must undergo similar accreditation by JAHCO and a separate surgical center accreditation to become an insurance certified surgery center. Physicians in the United States are monitored by their individual and respective boards, have to do continuing medical education in order to maintain their board certification, and can be researched on their state medical board website for certifications and disciplinary action. These are all safeguards put in place through the government and state agencies to ensure that the best safety measures and quality are provided to the patients in each state.
Internationally, there has been a movement to use the same American criteria for hospitals and surgery centers as an international standard. Our JAHCO will have its international version called Joint Commission International and the international surgical centers will also have a separate accreditation that should be closely equivalent to American standards. This criteria has been met by some international facilities. Physician certification in other countries varies by country. India and England for example follow a similar structure and certification, while some Asian countries have a completely separate way of certifying physicians as specialists that would perform surgery.
There are some risks outside of accreditations and certifications that patients should also be aware of. First and foremost is having to travel after having surgery. The postoperative recovery period varies for each type of surgery, but can range from a week to three months depending on how involved your surgery. Traveling on an airplane a short period of time after surgery can increase your risk of blood clots in the legs and may predispose you to bleeding or infection at a time while you are traveling and not able to reach a physician quickly. Additionally, postoperative complications are possible for months after your surgery. Most complications occur within the first three months, but it is possible to have new pain, infection, or an issue with an implantable device months to years after that surgeries been performed. If your physician is located outside of the country it will be difficult for you to find postoperative care especially for an immediate complication while you were traveling. Lastly, most health insurance plans now have provisions in their policies that they will not cover any complications from surgery performed outside of the United States. This means if you have a complication such as bleeding, infection, or a problem with an implantable device, any emergency services that you received in the United States afterwards maybe denied through your health insurance policy. Your health insurance wants you to have surgery at a contracted, accredited facility with a board-certified surgeon that has been vetted by your insurance company as an approved and credentialed physician in that specialty.
In conclusion, the motivation for having procedures outside of the United States is usually a financial motivation as it is less expensive in general to have procedures performed in other countries. However, safety is the utmost priority when it comes to your health and this should be your first and foremost consideration when making the choice to have an operation. There is no system that is perfect, including the healthcare system in the United States, but it is no coincidence that important figures from across the world travel here to have their surgeries performed, why would you go somewhere else?
– Dr. Timothy Janiga