The tragedy involving four Americans who were recently kidnapped — and two of them murdered — while seeking cosmetic surgery in Mexico has renewed the discussion of “medical tourism,” a term that, in my mind, implies that their travel was recreational and fun. I prefer the term “outward medical travel” and would argue that these Americans’ trip abroad should remind us of how inaccessible health care is here and the lengths to which people will go to get the care they want or need.
I prefer the term “outward medical travel” and argue that their trip abroad should remind us of how inaccessible health care is here.
It’s not just about plastic surgery: Americans go looking for a wide range of treatments abroad, from dental care and hip replacements to fertility treatments, organ transplants and cardiovascular care. For the 30 million Americans without health insurance, such procedures may be out of their price range here in the States.
And even those who have insurance may find that they can get the care they seek cheaper or more quickly in another country.
A root canal in Hungary or Vietnam, for example, may be a quarter of the cost of the procedure in the U.S. The same goes for an angioplasty in Malaysia.
My cousin, Jessica Koller Gorham, a bariatric surgeon at Ochsner Health in New Orleans, told me Louisiana’s state plan only covers bariatric surgery for 300 state plan-insured employees per year for the entire state. The waiting list for weight-loss surgery, already three years long, is growing. “It’s insanity,” she said. “And so what do some of these folks do? Mexico isn’t far away.” Traveling for medical care is often a desperate measure for those who have tried the regular route and found only barriers.
However, outward medical travel can carry numerous risks. Quality and safety standards, licensure, credentialing and clinical criteria for receiving procedures are not consistent across countries and hospitals. If surgeries are conducted in substandard conditions, for example, the risk of poor results or complications is higher. Some people may leave the U.S. seeking treatments that have not been approved in the U.S. because they’re considered experimental and risky.
But those risks don’t start or end with the surgery itself. A patient’s medical records won’t necessarily be accessible to a surgeon abroad, and doctors here who treat those who’ve had surgeries abroad won’t always have a full understanding of what a patient got done abroad and whether there were any known complications. People who get procedures done close to home generally have a scheduled follow-up with the surgeon or clinic that performed that procedure. Post-op appointments aren’t always possible for those who traveled abroad.
Americans may find that they have little legal recourse if a medical team abroad makes an error during surgery.
Americans may find that they have little legal recourse if a medical team abroad makes an error during surgery. Surgery can put a patient at risk for blood clots, as can sitting still for hours in, say, a car or plane. Traveling abroad for surgery, then, increases the risk of such a complication. In other words, traveling for medical care has many more implications than lower costs and more inconvenience. It means taking on a host of risks, and the costs of those risks have an impact on individuals seeking care, their families and our health care system. Even before the recent kidnapping and murders in Mexico, health care communities in the U.S. had been talking a good deal about establishing guidelines around medical tourism to improve standards and patient safety. The Centers for Disease Control and Prevention already has a number of guidelines for people considering outward medical travel. They include researching the reputation and quality of the health facility, discussing the planned care with health providers here, traveling with a full set of medical records, purchasing travel insurance that includes emergency evacuation back to the U.S., if necessary, obtaining medical records from the treating facility prior to return to the U.S., and arranging follow up care at home prior to the procedure. During post-procedure travel, it is important to prevent blood clots by keeping in motion, for example, doing arm or leg exercises or taking walks up and down the aisle. And, as the tragedy that befell the Americans who sought care in Mexico reminds us, it is also important to look up any safety warnings for travel to the region where care is being sought. Outward medical travel is already a global industry valued at hundreds of billions of dollars and is projected to grow dramatically over the next five years, particularly for cardiovascular and bariatric procedures. Obviously, most of those who go abroad won’t become crime victims, but we should still count it tragic that the inaccessibility and high cost of health care at home will continue to push so many Americans to take such extraordinary measures in seeking care.
Dr. Esther Choo
Esther Choo, M.D. M.P.H., is an emergency medicine physician, health policy researcher and founding member of Equity Quotient, a company that advises organizations on building cultures of equity. She has provided commentary on the pandemic and other health care topics through appearances on MSNBC, CNN, the BBC and Yahoo! Finance and editorials published in The Lancet, the British Medical Journal, The Washington Post, NBC Think and USA Today. 
