It is no longer surprising that over 7 million people travel abroad yearly to seek medical treatment for various reasons such as seeking more affordable treatments, or shorter waiting times. In recent years, companies in the US and even insurers in Australia have been enticing their employees and customers to head abroad for quality medical treatments, without the hefty price tag that’s usually associated with it in their home countries.

ABC News wrote an article about the experiences of Joy Guion, a 39-year-old utility worker from Hickory in North Carolina was travelling to Hospital Clinica Biblica in Costa Rica to undergo weight loss surgery; and Gary Harwell, a 65-year-old retired Manager who was travelling to Costa Rica to undergo a knee replacement at the same hospital.

Travelling to Costa Rica was Ms Guion’s first time abroad. She had never boarded an airplane before and became emotional thinking about her experience because she said she was relieved that she was able to afford the health care she needs, instead of being overwhelmed by it. Even with their insurance policies, both Harwell and Guion said they would each have had to pay USD$3,000 out of pocket should they have had their procedures done in the US – an amount Guion said she wouldn’t have been able to afford. But in having undergone their procedures in Costa Rica, they both pay nothing – their company picked up the entire bill – even the flights, their 4-star hotel, their chauffeur and their post-op recovery.

Guion and Harwell both work for HSM, a furniture and auto parts manufacturer in western North Carolina. HSM gave Guion a choice for this surgery. She could either pay a co-payment of USD$3,000 to undergo the weight loss procedure in the US, or undergo the procedure abroad for free. Guion and Harwell both said that they did their research and decided the benefits outweighed the potential risks. Post-operation, neither had complications during their surgeries and both spent the next several days recuperating at their resort hotel with daily visits from a nurse and a physical therapist. They then flew back home to North Carolina and received further post-operative care – all of which was covered by HSM.

Both Guion and Harwell are amongst a growing wave of Americans, Australians and Brits frustrated by the rising costs and wait times of their respective health care systems. And are instead heading abroad for medical procedures. Over 1.4 million Americans, 15,000 Australians and 70,000 Brits went overseas to undergo medical treatments in 2016 according to the US Centers for Disease Control and Prevention and Patients Beyond Borders 2016. A greater number of Middle Easterners and Chinese citizens are also travelling overseas to seek better quality health care with the US, Australia, Turkey, Malaysia and Germany being their preferred destinations.

Savings and price difference

Outsourcing medical care has saved HSM nearly USD$10 million in health care costs between 2008-2013, according to the company. Close to 250 of its employees have traveled abroad so far for medical care, and more are scheduled to go.

In North Carolina, Guion’s gastric sleeve surgery would have cost about $30,000, but in Costa Rica, the bill totalled $17,386. In the US, Harwell’s knee replacement would have cost more than $50,000. In Costa Rica, it costs half that amount at $23,531. Both were placed in pristine rooms in state-of-the-art hospitals, and 4-star hotels for their accommodation during the time they were not in hospital.

And when the bandages come off, both will get a bonus check for at least $2,500 from their company, a percentage of the corporate savings in insurance costs.

Risk of complications and medical errors

While it all sounds too good to be true, medical experts cautioned that there are serious concerns about medical tourism and having procedures done overseas. Glenn Cohen, co-director of the Petrie-Flom Center for Health Law Policy at Harvard University, said there is a risk of complications after post-op and said there have been documented cases of people dying or developing infections after having surgeries in foreign countries. The risk of post-operative complications and medical errors are present regardless where a surgery is performed in the world, which is why research to minimise the risk is crucial when deciding on which surgeon and hospital you choose to undergo your procedure at. Whilst there are no solid studies or statistics readily available comparing the risk of post-operative complications and medical errors from one country to another (and in some countries data on post-operative complications is not formally collected), we have collated some available data and studies presented below.

Medical errors in the US – third leading cause of death in the US

An article published by the CNN in December 2013 cites that medical errors kill more than 200,000 people every year in the United States, according to a study published by the Journal of Patient Safety in September 2013.  Medical error is “probably the third leading cause of death” in the US according to Dr. Peter Pronovost, Senior Vice President for patient safety and quality at Johns Hopkins Hospital told CNN during a 2012 investigation into common medical mistakes.

Deaths resulting from post-operative complications in Australia

A study conducted by David A Story in 2013 which compared patient data from three Melbourne hospitals in Australia – Austin, Alfred and the Royal Melbourne Hospital to data from 20 institutions in all the capital cities across New Zealand and Australia, as well as smaller centres in Tasmania and rural NSW; found that 20% of patients from the set of data examined experienced complications within 5-days of admission, with 10% of those patients being admitted to critical care, of which around 50% were admitted within 5-days. 5% of the patients died within 30-days, and there were around 30 complications per 100 patients, with many developing more than one defined complication. A national audit conducted by the Australian and New Zealand Audits of Surgical Mortality in 2015 shows delays in treatment or decisions by surgeons to perform futile surgeries are still the most common problems linked to surgical deaths. The national audit has also found that more than one in 10 deaths during or after surgery involved flawed care or serious injury caused by the treatment, 32% of patients who developed an infection died with a clinically significant infection, 5% of patients admitted had an adverse event whilst in patient care, and 59% of infections were acquired during admission (data excludes NSW).

Post-operative complications in Ethiopia

A study published in the Journal of Anesthesia & Clinical Research whose aim was to determine morbidity and mortality rate from postoperative pulmonary complications and factors associated among surgical patients that were operated in Gondar University Hospital, Ethiopia from January to April 30, 2013. The study found that out of 84 patients that underwent head and neck procedures, 20 developed post-operative pulmonary complications (23.8%). From 44 lower abdominal cases 11, developed post-operative pulmonary complications (25%). With regard to lower abdominal procedures, out of 240 cases, 56 developed pulmonary complications (23.3%).