Stacy Brethauer, MDBariatric and Metabolic
Institute
Medical Tourism for Bariatric Surgery
The Issue
• Large number of patients who travel long distances for medical care– International– Across states or regions– Over 1.1 million Americans traveled abroad for
medical care in 2009• Interest has spurred a medical tourism
industry– Match patient, procedure, destination
Motivations for Medical Tourism
• $$$• Can offer medical care and surgical procedures
at prices 40-80% less than in patient’s home region
• Long wait times at home• Lack of surgical expertise at home• Procedure/device not available at home due
to regulatory issues
• Some employers and insurance company offer incentives to patients who are willing to travel for medical care
• Developed healthcare systems haven’t dealt with this yet
• Prior to ASMBS position statement, no formal guidelines regarding medical tourism for bariatric surgery
Medical Tourism
Other Medical Societies
• American Medical Society• American College of Surgeons– Emphasize accreditation of facilities– Board certification of physicians– Documentation available for physician providing
follow-up– Proper informed consent policies– Protecting privacy and confidentiality– Insurance coverage for f/u and complications– Recognize risks of traveling for surgical procedures
International Accreditation Bodies
• Joint Commission International (JCI)• Trent International Accreditation Scheme (UK)• International Society for Quality in Healthcare• International Organization for Standardization
(ISO• International Bariatric Surgical Review
Committee (IBSRC)
• 1000% increase in JCI accredited hospitals in last 5 years
• 250 JCI hospitals in 36 countries, up from 25 hospitals in 2004
International Accreditation Bodies
Bariatric Surgery
• Treating a chronic disease• Preoperative education• Medical optimization prior to surgery• Continuity of care• Long-term follow-up• Procedure-specific risks • Need for revisional procedures
Medical Tourism and Bariatric Surgery
• Who pays for the complications?
ASMBS Recommendations
• Medical tourism/extensive travel for bariatric surgery should be discouraged unless appropriate f/u and transfer of information arranged
• Opposes mandatory referral over long distances if expertise available locally
• Opposes creation of financial incentives that make this the only viable option for the patient
• If patients choose to travel long distance for bariatric surgery– JCI or bariatric surgery COE– Board certified or equivalent surgeon– Investigate surgeon outcomes– f/u care covered by insurance or supplemental plan– Ensure transfer of medical records– Establish plan for f/u care and nutritional monitoring– Recognize increased risk for VTE– Recognize risk of endemic infectious diseases– Recognize limitations in preoperative education, preparation– Recognize legal redress for medical errors across international
boundaries is very difficult
ASMBS Recommendations
Thanks