Stephanie Spicer looks at the recent trend towards health tourism and asks whether getting treatment abroad will become par for the course
Opinion is divided as to how popular health tourism is.
Health tourism does not include emergency treatment abroad, but is when individuals actively opt and arrange to go abroad to have their hip replaced or their heart bypass operation.
It still exists, for the rich who want a better view from their hospital bed, or the not so rich, who do not have private medical insurance (PMI) and do not want to wait in an NHS queue.
At one time, health tourism was all about an escape from NHS waiting lists.
There is still an element of that today - or why else would one travel further away from home than was strictly necessary to go to a hospital? But improvements in the NHS are making the need to travel less necessary.
Pitfalls abroad The NHS itself gave health tourism something of a boost in publicity a few years ago when a series of pilot schemes to send NHS patients abroad for treatment found "patients reactions to be very positive." The Department of Health (DoH) claims treating patients in the European Economic Union is comparable with patients being treated in the UK private sector.
Now, NHS primary care trusts can arrange for NHS patients to receive treatment in the EU if they think that this is the best way to help reduce waiting times for their local population.
Almost 600 NHS patients were referred for treatment in France, Germany and Belgium, between 2002 and 2004 - the majority for orthopaedic and some cardiac procedures.
The choice of location is indicative of the concern that travel times be kept to a minimum in order to prevent post-operative complications.
The DoH suggests a three-hour maximum flight time.
However, the DOH says the number of patients being sent abroad has dropped, as capacity and capability has improved in the UK.
Private provision is a different matter it seems.
Norwich Union (NU) recently reported 74% of GPs admit British patients who travel abroad for medical treatment do so because they are fed up with UK waiting lists.
NU also reports the treatment these patients are seeking are hip replacements and cardiac surgery.
However, it lists popular destinations that are a little more exotic and include India, Costa Rica, South Africa, Germany, America and Thailand.
NU encapsulates the objections often cited against opting for treatment abroad.
Firstly it can be difficult to obtain information about foreign hospitals and consultants, and language barriers could be a problem especially when discussing complicated medical procedures.
Travelling with an existing condition could also increase the risk of developing further symptoms such as thrombosis and if there are complications, patients could be stranded for longer than they had intended to stay.
Also, unless the patient is going to travel alone, there is the cost of catering and accommodation for a friend or the family to travel.
Finally, on return to the UK it may not be easy for the individual's GP to provide care if they are unaware of the treatment the patient has had, if they are not able to decipher foreign medical records or get easy access to x-rays or blood test results.
Insurers are, on the surface, relaxed about the competition created by patients taking their custom abroad.
They argue if an individual has PMI they do not need to go abroad to seek treatment.
And people generally take out PMI to ensure they can get treatment quickly and easily.
Having that treatment in the UK has to be the preferable option, they argue.
Some insurers will still be flexible enough to cover the costs, the medical costs at any rate, if a policyholder can make a case for going abroad.
PatientChoice says its policyholders have complete freedom to source their treatment overseas and it will help them source that treatment if they want to.
This obviously adds an extra level of security for the policyholder.
"We are happy for people to go abroad," says Thom van Every, chief medical officer at PatientChoice, "We reserve the right to decline to let them go to a certain hospital if we do not think it is up to standard." PatientChoice uses third parties who specialise in outsourcing treatment for people who do not have insurance.
Van Every says these companies have experience of the hospitals and have an interest in maintaining that the hospital is all right.
Such treatment sourcing companies are Medplex, which sources treatment to Singapore and Medical Care Direct, which has arranged treatment in France and South Africa.
Choosing the right packager will obviously depend on the operation needed and preferred location for treatment.
While treatment costs may compare attractively with private costs in the UK, the additional costs of travel and accommodation will also have to be met.
WPA and Clinicare will pay for operations abroad.
Policyholders thinking of going overseas cannot rely on their insurer helping out however.
BUPA, for example, will not provide cover, although it is looking into the situation and may add a bolt on option in the future.
However even those willing to cover treatment costs admit the need has rarely arisen.
When it has, it has been because the treatment or specialist care they require is not available in the UK.
Charlie MacEwan, head of communications at WPA confirms: "The only reason our customers go abroad is because the treatment they need is not available in the UK. One of our customers had a brain tumour that could not be sorted anywhere in the world other than Germany. The German consultant talked to our medical adviser about the likelihood of success. The patient had several trips to Germany, with WPA paying for the medical treatment and the operation was a success." Clinicare is in a slightly different situation.
Perhaps due to its French parentage it has many international policyholders, from Germany, France, Korea and Japan living in the UK as expats.
"For Europeans, the French in particular, we allow them to return home for treatment and cover it within the Carte Blanche plan," says Stuart Scullion, sales and marketing director at Clinicare.
But Scullion also cites the case of a policyholder who needed a complex chest operation, which the policyholder claimed was best carried out by a US surgeon.
Clinicare made its own checks and covered the medical treatment costs.
But Scullion is keen to point out there is no set commitment to overseas care.
"We don't have a plan that says you can source treatment anywhere in the world as long as the costs are less or equivalent to the UK charges we will pay," he says, "It tends to be more informal than that.
"We are not encouraging people to seek treatment abroad. This is mainly because we don't have any hospital scales or details of specialists abroad, while we do in the UK. There are potential insurance implications for us if we are seen to be promoting using someone abroad in the event something went wrong." Clinicare policyholders who want to go abroad are obliged to sign a declaration to confirm they wanted treatment in another country and it was at their own volition.
Cutting costs Of those individuals with medical insurance, the ones most likely to consider getting an operation abroad are those with an interest in saving costs, such as those with a shared responsibility or self-pay policy.
"With traditional indemnity insurance the policyholder has no interest in how much the treatment costs, there is no incentive for them to get as good quality treatment at a lower price overseas," says van Every, "But policies that allocate a budget for the policyholder to spend on their respective operations and allow them to keep what they don't spend, changes the dynamic completely." MacEwan agrees: "People with medical insurance generally won't go abroad but treatment overseas is fantastic for those that don't have private medical insurance and are shopping around.
I can see why people with shared responsibility may go in that direction because they are footing part of the bill," he says.
Van Every says his company is seeing quite a high percentage of people going to the NHS for treatment.
"It shows the NHS, in some parts, is getting it right. I don't think it is a concern about travelling abroad as much as a change in the attitude to the NHS." One of the key reasons for private health insurance in the first place was to offer choice to individuals and a bit of luxury to the medical experience.
There will continue to be companies offering packages to countries with hospitals with spare capacity to fill.
There will always be individuals who want to beat the queues where the weather is warmer.
It is unlikely the flow of patients abroad will grow so treatment overseas becomes the norm, nor that advisers will be an integral part of the process.
But it is sufficient the choice is there - thankfully for most patients it is not the only choice.
