The Nomadic Patient

Photo Credit: In Praise of a Nomadic Life, Wall Street Journal

Much has been written recently in the popular press on medical tourism, medical travel, health tourism, or global healthcare, which all basically pertain to the fact that many people are traveling outside of their country to receive medical treatment for one of three reasons:

1. The treatment is not available in their home country
2. The treatment in the destination country is (perceived to be) superior
3. The treatment in the destination country is cheaper

My own personal experience with medical tourism occurred back when I was still a clinician. I was on an extramural maxillofacial surgery rotation at Mass General Hospital of Harvard University in the summer of 2006, when a Kuwaiti patient and his brother were brought into one of the patient rooms.

“Nothing is too expensive, please do everything you can for my brother,” was a phrased constantly echoed. My patient had been in a motor vehicle accident resulting in a compound fracture of his mandible (lower jaw) that had subsequently cartilaginized since it had been almost three months since his traumatic accident.

Here I was, an aspiring Kuwaiti surgeon treating a Kuwaiti patient 3,000 miles away from Kuwait in a Harvard hospital as an extern, I was completely shocked and dismayed by the situation afoot. Was it that my patient could not receive adequate care in Kuwait? At least some form of treatment that would prevent his wounds from attempting to heal in the wrong position? Or was it the long and tiresome process of applying for overseas healthcare for three months that resulted in his complicated medical state?

This is just one example of medical tourism and how it fits neatly with the trends towards globalization.

More and more Middle Eastern patients are traveling for both acute, chronic and cosmetic healthcare. According to most calculations, the Gulf Cooperation Council (GCC) governments alone spend well over ten to 20 billion US dollars on sending their citizens abroad for healthcare.

Complicating the matter further, different government agencies typically send their own employees abroad. The following is a brief outline:

1. Ministries of Health
2. Local Health Authorities — this is the case in Abu Dhabi and Dubai
3. Military — including the Army, Navy, Police and National Guard
4. Foreign Ministry
5. Oil Sector
6. Amiri Diwan/King’s Decree — official ministry (office) of the ruler of the country

As to which countries patients are sent to. The top countries usually include the US, UK, France, and Germany, with Germany the top country in the case of Saudi Arabia and the UAE, versus the UK for Kuwait. Surprisingly enough, the Bahraini Ministry of Health sends close to 2/3rds of its overseas patients to neighboring Saudi Arabia, whereas the Omani Ministry of Health prefers to send the majority of its patients east to India. The Kuwaiti government for example, used to rely on the foreign offices of the Kuwait Airways Corporation to manage the international patient flow and overseas healthcare budgets. Today, the Kuwaiti Ministry of Health has its own Overseas Health Offices in New York, London, Paris, and Frankfurt, which work closely with the Kuwaiti Ministry of Foreign Affairs to assist patients in their treatment abroad both administratively and financially.

Even though there will always be a need for GCC governments to send patients abroad for specialized care, it is widely accepted that the current model of overseas healthcare is not sustainable. Local GCC governments are increasingly investing in the local healthcare infrastructure and encouraging free market dynamics to stimulate private investment in healthcare.

Privately, an increasing number of GCC patients are seeking treatment along the (ancient) Silk Route — traveling to India, Thailand and as far as China for cheaper healthcare that is perceived to be of better quality.

I believe that a private-sector solution to overseas healthcare may provide an optimal interim solution — governments in the GCC should outsource the administration of their overseas healthcare to experience third party administrators (TPA) with an international network and experience as many global companies already do for their own healthcare needs. However, it is imperative that the government actively monitor the TPA by setting key performance indicators and targets to ensure that a quality service is delivered to its citizens. This efficiency will allow the GCC governments to not only send more patients (in the near future) but to also control both its cash flow and overall cost of sending patients abroad. Such measures will hopefully reduce the projected ten to 20 billion dollars of spending by 2020 to a mere fraction.