LAW OF MEDICAL TOURISM

MEDICAL TOURISM
• Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this usually
referred to those who traveled from less-developed countries to major medical centers in highly
developed countries for treatment unavailable at home. However, in recent years it may equally refer to
those from developed countries who travel to developing countries for lower-priced medical treatments.
The motivation may be also for medical services unavailable or non-licensed in the home country: There
are differences between the medical agencies (FDA, EMA etc.) world-wide, whether a drug is approved in
their country or not. Even within Europe, although therapy protocols might be approved by the European
Medical Agency (EMA), several countries have their own review organizations (i.e. NICE by the NHS) in
order to evaluate whether the same therapy protocol would be "cost-effective", so that patients face
differences in the therapy protocols, particularly in the access of these drugs, which might be partially
explained by the financial strength of the particular Health System.
• Medical tourism most often is for surgeries (cosmetic or otherwise) or similar treatments, though people
also travel for dental tourism or fertility tourism. People with rare conditions may travel to countries
where the treatment is better understood. However, almost all types of health care are available,
including psychiatry, alternative medicine, convalescent care, and even burial services.

• Health tourism is a wider term for travel that focuses on medical treatments and the use of healthcare
services. It covers a wide field of health-oriented, tourism ranging from preventive and health-conductive
treatment to rehabilitational and curative forms of travel. Wellness tourism is a related field.
WMA STATEMENT ON MEDICAL TOURISM
• PREAMBLE
• Medical tourism is an expanding phenomenon, although to date it has no agreed upon
definition and, as a result, practices and protocols in different countries can vary
substantially. For purposes of this statement, medical tourism is defined as a situation
where patients travel voluntarily across international borders to receive medical
treatment, most often at their own cost. Treatments span a range of medical services,
and commonly include: dental care, cosmetic surgery, elective surgery, and fertility
treatment (OECD, 2011).
• This statement does not cover cases where a national health care system or treating
hospital sends a patient abroad to receive treatment at its own cost or where, as in the
European Union, patients are allowed to seek care in another EU Member State
according to legally defined criteria, and their home health system bears the costs.
Also not covered is a situation in which people are in a foreign country when they
become ill and need medical care.
• Medical tourism is an emerging global industry, with health service
providers in many countries competing for foreign patients, whose
treatment represents a significant potential source of income.
• A medical tourist is in a more fragile and vulnerable situation than that
of a patient in his or her home country. Therefore, extra sensitivity on
the part of caretakers is needed at every stage of treatment and
throughout the patient’s care, including linguistic and cultural
accommodation wherever possible. When medical treatment is sought
abroad, the normal continuum of care may be interrupted and additional
precautions should therefore be taken.
• Medical tourism bears many ethical implications that should be
considered by all stakeholders. Medical tourists receive care in both
state-funded and private medical institutions and regulations must be in
place in both scenarios. These recommendations are addressed primarily
to physicians. The WMA encourages others who are involved in medical
tourism to adopt these principles.
REGULATION AND LEGISLATION IN MEDICAL
TOURISM
Medical tourism has often been berated for being unregulated, uncontrolled and dangerous. Any
treatment has an element of risk. A rush of stories on the dangers of cosmetic surgery, the need
to regulate medical spas, proposals for controlling ayurvedic hospitals, are all concerned with
domestic treatment, not medical tourism. Any media scares or discussion of regulation also
effects medical tourism, as does a new app for the Iphone that scarily turns cosmetic surgery
into a game, and American proposals to tax all cosmetic surgery.
Some problems on alleged risk can arise from differences in interpretation in differing countries,
and problems in translation – particularly when Asian and South American clinics and agencies
refer to plastic surgery that in Europe and elsewhere would be called cosmetic surgery. In the US,
some surgeons make the distinction; others refer to everything as plastic surgery. Cosmetic
surgery, sometimes called aesthetic surgery is purely elective, a lifestyle choice undertaken to
enhance physical appearance, improve self-esteem and boost confidence. It is a treatment for
want rather than for need. Cosmetic surgery differs from plastic surgery, which is generally
surgery to repair or reconstruct tissue or skin damaged by congenital (inherited) disease, injuries
or burns. The primary role of plastic surgery is to restore function, and aesthetic improvement is
secondary.
Governments are rarely enthusiastic about any legislation on cosmetic surgery,
unless they see income. $5.8 billion over ten years is what a new tax that has
suddenly appeared within US healthcare reform proposals, expects to generate. The
White House-backed plan would impose a five-percent tax on all elective cosmetic
surgery in the US. The measure exempts plastic surgery done to remedy a deformity
arising from, or directly related to, a congenital abnormality, a personal injury
resulting from an accident or trauma, or disfiguring disease.

Individuals who seek purely elective procedures, typically paid for directly out of
patients' pockets, would have to pay the new tax from January 2010. Recession has
not dented US demand for cosmetic surgery procedures, up three percent in 2008 to
12.1 million procedures, according to the American Society of Plastic Surgeons. But
breast augmentations were down 12 percent from 2007, to 307,230, while botox
injections were up eight percent to just over five million procedures.
The tax would be paid by the patient receiving the cosmetic procedure and collected by
the doctor. If the patient fails to pay the tax, the medical professional who performed
the procedure would be liable. The tax would apply to all, including medical tourists to
the US.

Alternative health is rarely regulated, but in India, the Department of Ayush is

preparing a voluntary scheme in collaboration with the Quality Council of India (QCI)
on accreditation of AYUSH hospitals similar to the highly successful hospital
accreditation programme under its National Accreditation Board for Hospitals and
Health Care Providers (NABH).

Medical tourism agencies need to keep up with new and proposed legislation in
countries where they send patients. Although hospitals and larger clinics may have
national and international accreditations, many smaller clinics, and much of the health
and wellness industry remains unregulated with no real international benchmark to
judge by.
LEGAL ISSUES IN MEDICAL TOURISM
• WHAT ARE MY RIGHTS IN CASE OF MEDICAL COMPLICATIONS?
• Most hospitals, wherever they are located, will not cover the cost of medical
complications. Therefore it is important to speak to your international medical
provider to see their definition of what constitutes a “medical complication”. Is it
simply a surgical procedure that, due to unforeseen but manageable difficulties, takes
a little longer than expected? Or, is it an additional problem that arises following a
procedure, treatment or illness and is secondary to it, . The differences may seem
minor; however, they become all too real, for example, if you are a morbidly obese
medical tourism patient who requires additional surgical equipment and time to get a
breathing tube down your trachea – and are later charged one thousand five hundred
dollars extra for it. The moral of the story is: ask questions and get everything in
writing first – before your procedure. Will my insurance cover the cost of
complications? The correct answer to this question will depend on the type of policy
you hold, however, don’t count on your insurance covering complications related non
elective procedures such as cosmetic surgery and weight loss surgery.
• WHAT IF I DECIDE NOT TO HAVE MY SURGERY, WILL I BE ABLE TO GET MY
MONEY BACK?
• Again, this will depend on the policy of the hospital you have chosen, as
well as when you cancel your procedure. Make sure to have the answer to
this question in writing. However, most international hospitals I have
spoken to will refund a majority if not all of the money you have paid.
• IF THE HOSPITAL DECIDES NOT TO PERFORM THE SURGERY WILL I RECEIVE
MY MONEY BACK?
• If you are dealing with a recognized medical provider then the answer is
almost sure to be an unqualified yes. Nevertheless, you need to talk with
your particular hospital or medical tourism facilitator for full cancellation
policy details, particularly if you are dealing with lesser known, or non-
accredited medical providers. You need to be extremely careful of the
hospital and clinic you choose, as some may refuse to give back your
money and therefore you must make sure you are using a hospital or
clinic that is reputable and trustworthy. Many hospitals and clinics
throughout the world promote themselves to American, Canadian and UK
medical tourism patients that should not be.