DR VINAY S. RANE

MBBS, LLB, LLM, BMEDSCI(HONS), PDLP, FACLM, MFFLM, RCP(UK), MHSM, MRANZCOG

FORENSIC PHYSICIAN

OBSTETRIC REGISTRAR

BARRISTER AND SOLICITOR (VIC)

“Medical Tourism”

• Is this really a thing?

• Is it really a holiday?

• Is it safe?

• Is it cheaper?

• Why?

• What‟s on the menu?

• What happens if?

• Ethical Considerations

Is this really a thing?

• $100 billion industry

• 20-30% growth per year

• Australian spend is $350 million per year

• 300,000 people travel to India alone each year for medical treatment

Top Countries by Spend

• 5. India

• 4. Singapore

• 3. USA

• 2. Mexico

• 1. THAILAND

Why Thailand?

• Location

• Experience of friends

• Perceived Safety

• Excellent Marketing

• Hospitality

• Cost

• Not so much because it‟s a holiday

• Access to services

Reasons for Medical Travel

• Cost

• “get a holiday on the beach” – Not really

• Volume / Safety

• Self Esteem Issues for some procedures

– “Escape”

What Kind of Procedures

• Cosmetic

– Breast, Tummy Tucks, Face Lifts, rhinoplasty

• Dental

• Is that all?

What Kind of Procedures

• Bariatric

– Types

– Follow up

– Comps

– Prosthesis

– Escape

– Wait List

What Kind of Procedures

• Orthopaedic

– Infection

– Medicare

– Prosthetic Cost

– Wait List

What Kind of Procedures

• Coronary Artery Bypass Grafts

– Cost in USA

– Cost in India

– Volume

– Indian Genes

– Indian Doctors

What Kind of Procedures

• Infertility – Cost

– Access

– Emotional and

Psychological Factors

– Laws : • surrogacy,

• sex selection,

• multiple pregnancy

What Kind of Procedures

• Organ Transplant

– Access

– Laws

– Safety?

Safety

• Regulation of doctors in Australia

• Varied regulation overseas

• Cheaper must

mean worse

• Case Volume

• Local Perceptions

Complications

• Incidence

• Impact on initial rationale

• Impact on Medicare

• Impact on private health funds

• No audit data

When it goes wrong

• Often no recourse

• NIB “12 month guarantee”

• Local laws

Baby Gammy

Baby Gammy

• Dec 2013 Thai commercial surrogate gives birth to twins

• Baby Girl Pipah and a boy Gammy (T21)

• Australian biological parents returned to Australia with Pipah leaving Gammy behind.

• Suggested TOP at ~k28; Thai laws

• Became news in mid 2014

Baby Gammy

• Recourse for the Australian Couple – Thai law – birth mother is the legal mother

– Comodification of medicine

• Confounders – PHx, TOP, Age

• Fallout – Other families stopped from leaving Bangkok

– Approval of draft law banning surrogacy

Other ethical considerations

• Exploitation

• “Brain Drain” Reversal

• Impact on local medicos

What can we learn?

• “Can‟t beat „em join „em”

• Australia as a destination – Quality Health Care

– Falling Australian Dollar

– Safety

– We too have great beaches and

resorts and drinks

with little umbrellas in them!