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Medical tourism from a European perspective
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Medical tourism is not a new phenomenon. Some patients, with inadequate finances to fund their medical care, or where advanced surgical techniques are unavailable in their own country, have always sought treatment elsewhere. The advent of cheaper air travel has merely accelerated this trend.
In Europe, the pattern of medical tourism differs somewhat from the financially driven American model described in the story in this issue of Orthopaedics Today International (See “Various countries offer services catering to patients traveling abroad for surgery.”) Here, long waiting lists fuel the drive towards seeking treatment in other member states for many common elective procedures, particularly in orthopaedics and ophthalmology.
The legal basis for obtaining medical care in other countries of the European Union was established in 1971 and first required home-country authorization for non-emergency procedures. Some governments used this process extensively in the early 1990s to reduce unacceptable waiting times, often exceeding 2 years, while they increased domestic capacity. Notable examples included Norway’s Treatment Abroad Project and the British government’s much publicized but short-lived project to offer patients surgical treatment in Belgium, France and Germany.
Drastic change
The situation changed radically in 1998 when the European Court of Justice ruled that patients could receive treatment elsewhere and still get reimbursed without prior authorization, provided they could demonstrate undue treatment delays in their own country.
Despite these rulings, the acceptance of treatment abroad has been small, although the situation could change dramatically with the entry of the new member states of Eastern Europe.
At present, many of these countries lack the hospital and staff resources to satisfy the demands of their citizens, and they could face very large medical bills from their wealthier neighbors with the introduction of free movement within the enlarged European Union.
A new but imperfect trend
Now, another modified form of “reversed medical tourism” is emerging in Europe, where teams of surgeons from one country with excess capacity can travel to another with a shortage of elective resources to provide short-term care to solve waiting list problems. Both models create difficulties for the patient and the health care system, including the following:
- Treatment and training standards may differ by country.
- Transfer of medical information is difficult or absent.
- Adequate postsurgical follow-up is deficient.
Expect the medical risks to the patient to remain significant until there are universal clinical standards for blood transfusion products and graft materials, as well as quality control for implants.
Finally, from a more general ethical standpoint, there are concerns that the process could result in an increasing loss of skilled medical and nursing staff from the care of their own indigenous populations who desperately need them.
Solutions must be found to these problems, but it may take some time before “tourism” can return to its true meaning of travel for pleasure and culture.
For more information:
- David L. Hamblen, PhD, FRCS, is emeritus professor of orthopaedic surgery at the University of Glasgow and is a Consulting Editor with Orthopaedics Today International.