Cross-Border Healthcare: The Risks We Don’t See
The state of a country’s healthcare system has more impact on the actions of its citizens than meets the eye. Medical tourism, a rapidly growing phenomenon, occurs when consumers choose to travel across international borders with the intention of receiving non-emergency, high-quality medical treatment. This treatment may span the full range of medical services, but most commonly includes dental care, cosmetic surgery, elective surgery, and fertility treatment. In East Africa, about 97% of Kenyan patients who seek medical treatment abroad go to India, whereas in Uganda, more than 2,500 patients travel to India to seek specialised medical care. These statistics are evidence of the dependence of citizens on other countries for specialised healthcare.
Bargain or Burden? The unplanned hassle
Although highly considered by many citizens, medical tourism is associated with many disadvantages that are often ignored. The commonest problem faced by patients is the unexpected expenditures made while abroad.
One of the main causes of unexpected expenditures is the exaggeratedly low pricing by hospitals and medical brokers. To entice consumers, charges like specialised test fees, hospital accommodation, and post-treatment care fees are left out, causing many patients to become stranded overseas. This sort of budgeting also doesn’t leave room for complications, which call for longer stays and an increase in the number of healthcare specialists required. This eventually leads to a spike in the final bill paid to the hospital. Ignorance of the currency differences and fluctuations between the East African currencies and other countries’ currencies, like India, the USA, or the UK, can also set patients up for unforeseen costs upon arrival. The difference in insurance coverage availability in East Africa and beyond its borders also leaves people with no choice but to rely on out-of-pocket expenses to gain medical treatment.
Travelling miles for healthcare is a process that is supposed to be made easier by middlemen, commonly referred to as medical brokers, and yet they largely contribute to the uncertainties associated with medical tourism. The goal of these modern-day brokers has become to acquire clients by any means necessary. This leads to a continuous trail of exaggerated success rates, ignored additional fees, inflated broker commissions, and biased referrals.
Furthermore, the risks do not automatically cease once a patient finishes receiving treatment. Back home, the danger of post-treatment complications looms. Recovery from surgery requires quality post-operative care, which is usually missed by medical tourists due to travel deadlines and insufficient funds. This may result in fatal health outcomes that may not be properly handled by regional hospitals because they are understaffed, have already overwhelming patient numbers, and lack up-to-standard facilities. The lack of proper documentation from foreign hospitals also makes it difficult to treat complications, considering that decisions are made based on the shortcomings of the prior surgery. Inadequate treatment or incorrect diagnosis may result from this discontinuity in medical documentation. Overseas treatment also places a burden on regional doctors to fix botched-up procedures, especially with no proper records of the earlier procedures done.
Additionally, each country has a unique set of laws and policies concerning medical services and foreign patients. In the event of medical negligence or malpractice, medical tourists are left vulnerable and may find it hard or impossible to obtain compensation. The process of documenting medical licenses or insurance becomes complex and ambiguous, affecting the overall stay of patients.
Lack of globally recognized accreditation standards makes it difficult for patients to evaluate the safety and quality of healthcare facilities abroad. This increases the possibility of selecting substandard healthcare facilities. Also, specific medical procedures and practices may not be subject to the same regulations in certain nations as those with more developed healthcare systems. Due to this lack of regulation, patients may be at risk when dangerous medical procedures are used.
On the other hand, some patients do not conduct a thorough hospital evaluation before deciding to seek medical treatment overseas. This results in traveling for a medical service that is provided in one’s home country. This can, however, also be due to poor advertising by regional hospitals. It is also important for patients to carry out a preoperative assessment before a medical procedure. The pre-operative assessment is an opportunity to identify co-morbidities that may lead to patient complications during the anaesthetic, surgical, or post-operative period. It usually includes a history of previous use, physical examination, and relevant laboratory data. This reduces the risk of post-treatment complications and surgical errors.
Another key drawback of medical tourism is cultural and communication barriers. Ineffective communication between patients and medical professionals can result in miscommunications and misunderstandings, reducing the quality of the patient experience or leading to subpar treatment. Cultural variations in medical procedures and patient care may impact patient experience and treatment satisfaction. Additionally, linguistic and cultural differences can directly influence patients’ decisions in choosing their treatment destination. Healthcare professionals are advised to learn the languages spoken by their most frequent international patients and to also employ professional medical interpreters. This demonstrates a commitment to providing holistic care to the patients. Ensuring that medical documents, such as patient records, informed consent forms, and treatment plans, are translated accurately is also crucial for effective communication and can actively reduce the risk of avoidable surgical errors.
It is also important to explore the psychological and emotional toll exerted by seeking treatment overseas. Being treated far away from home causes anxiety when left to navigate foreign systems alone. Language and cultural barriers also cause a sense of isolation in a country far from home. Individuals may also be pressured to keep up with media trends and hide any complications on return.
The impact of medical tourism on domestic healthcare systems is also critical. The wealthier individuals in a country, including leaders, tend to travel overseas for medical treatment, seeking comfort and privacy. This creates a trend of mistrust among the citizens for household healthcare institutions. Local specialists also lose income as international specialists are preferred by the majority of the population.
Moving Forward: What is being done?
The main way in which a country can control the number of people who travel annually for medical treatment is by directly seeking the advancement and modernisation of its own healthcare systems. In Uganda, C-Care, a leading private healthcare network, has assembled dozens of top specialists and is widening its network across the country to provide an alternative to seeking treatment abroad. “We want to change the perception that for a Ugandan to get cured from certain illnesses, it requires a passport,” said Dr. Aleesha Adatia, an internationally renowned consultant clinical oncologist at the C Care International Hospital of Kampala. Initiatives like this provide citizens who can’t afford cross-border healthcare with the same quality options as those who can, improving health equity.
Kenya, which has positioned itself as East Africa’s healthcare hub, has also advanced its healthcare industry, redirecting the mass numbers that usually seek medical care in the Middle East, India, or the West to itself. Receiving around 5000 patients from African countries each year, Kenya not only boosts its economy but also saves patients from the problems associated with travelling outside Africa.
Rwanda has also taken various initiatives to become a medical tourism hub where people from various parts of the continent and the world can access advanced healthcare services and training. Examples include: the upgrade of King Faisal Hospital, and the expansion of the new University Teaching Hospital of Kigali (CHUK) site in Masaka, Kicukiro district. Additionally, the construction of Biopharmaceutical New Technologies (BioNTech), a next-generation immunotherapy company pioneering novel therapies for cancer and other serious diseases, has also boosted the healthcare industry.
Conclusion
Globally, medical tourism is a rapidly growing sector in the healthcare industry, contributing to economic development. However, the rise of medical tourism in East Africa brings tangible challenges to both citizens' health and the quality of domestic healthcare systems. It creates financial burdens for patients, often due to misleading advertising, currency fluctuations, and exploitative medical brokers. Post-treatment complications are also worsened by cross-border healthcare because of differences in specialists and available equipment.
Moving forward, citizens must stay vigilant and conduct proper research when pursuing cross-border healthcare. Medical tourism is not just about choosing the most attractive option; it involves careful budget planning, extensive evidence-based research, and evaluating different medical policies and legal protections in various countries. It should not be treated as casual tourism but rather as an urgent measure to save lives. The government is therefore tasked with the advancement of the healthcare industry, the primary reason behind medical tourism.
