Medical Tourism has become increasingly popular. It is the practice employed by tens of thousands of Americans who have inadequate or no medical or dental insurance coverage or even those who seek therapies that are not approved by insurance carriers. I personally know of people who fall into all of the categories. I ask again, Is Medical Tourism failing all of us?
As insurance providers and the U.S. healthcare community fall into an increasingly contentious relationship, more and more procedures are not covered or require an exorbitant amount of money before any kind of deductible is reached. It’s not just the procedure costs that are troublesome but medications, hospital and/or clinic space and the fees of the providers and staffs themselves.
Sometimes the procedures go well, sometimes there are catastrophic problems.
This is not a post that will discuss credentials or procedures per se but is asking a question about the ethics of providers in foreign lands – additionally, why the U.S. medical and dental communities have not taken a firmer position.
Tijuana, Mexico
It has been reported that at least six patients who had recently traveled to a weight loss clinic for invasive surgical procedures were exposed to an antibiotic-resistant strain of the bacteria, Pseudomonas aeruginosa. The patients included two Arkansas residents and four from Utah.
Antibiotic-resistant bacteria are extremely dangerous and troublesome to treat. The health departments of Utah and Arkansas along with the Centers for Disease Control and Prevention (CDC), have issued a warning for any patients who may have had surgery at the Grand View Hospital (and nearby centers) in Tijuana, to undergo screening for hepatitis C, hepatitis C, and HIV.
The surgical procedures were performed during and after August 2018 and no one believes that only six patients have been affected. Once the infection takes hold it can lead to life-threatening illnesses and death. The initial side-effects may include swelling, redness, and pus at the incision sites.
The CDC response
When the Mexican health officials were informed of these problems they sent in a team of inspectors and closed down the facility. They found poor infection control practices at the facility including a failure to follow proper sterilization procedures. They ordered the facility closed. The latest reports show that the facility has since reopened as is performing surgeries once again.
The CDC, as we might expect, recommends any American who is considering surgery in another country to consult with their physicians. As might be expected, most physicians recommend against it.
According to the CDC “Antibiotic resistance is a global problem, and resistant bacteria may be more common in other countries than in the United States.”
While the CDC may be correct, it does not relieve the ethical dilemma that many patients encounter. It is a two-tiered problem.
The overseas facilities, be they dental, surgical or even diagnostic centers, understand that patients coming to them from the U.S. may be modestly cash-rich, but insurance poor. The American healthcare patient falling into this category is stepping into the unknown. While foreign facilities often deliver a high level of medical care, it is somewhat easier for those facilities to seize an opportunity to cut a few corners or have a slightly lower set of expectations of their support personnel.
Certainly, there are always risks no matter where a surgical or rather complex set of dental procedures may take place, but recourse, if something goes wrong in a foreign facility, is rather limited. While patients may rationalize that a modest level of risk is worth the trade-off for an otherwise expensive and/or uncovered surgery, they may not be aware that even a level of risk that they perceive to be “just a little higher” is dangerous. Certainly, if the CDC recognizes that the infectious agents in these clinics could also include HIV and Hepatitis, the little higher risk envisaged by the patient may be an extremely high risk.
However, I talked about two tiers. Many patients needing elective surgery to fall into the gray area between having “some money” so they are not considered indigent, but not enough insurance coverage to explore a U.S. surgical option. What are they to do under most circumstances? Unfortunately, many patients must fall into debt in order to have a surgical or reconstructive dental procedure. Is Medical Tourism failing all of us?
Though the issue (obviously) does not fall into the CDC’s purview, it is difficult to not believe that ethically, more could be done to help patients for whom the only option is medical or dental tourism. As the insurance companies and the U.S. healthcare system seem to be at an impasse with outrageously high rates, what would be the harm of teams of American healthcare professionals visiting facilities such as Grand View Hospital in an advisory role? While there are many pitfalls with “certifications,” I can see no problem with foreign facilities inviting consultants into their operations to give advice on improving techniques. It is the least that could be done.
