All around the world, health tourism has become a big business. The overall value of so-called ‘wellness tourism’ – any travel activity where the direct or indirect goal is to improve one’s health – is estimated at US $563 billion.
Out of that total, the medical tourism sector – people travelling overseas to receive medical treatment of one kind or another – is valued at between US $60 and 70 billion.
The reasons and motives for people to leave their home country to seek medical treatment vary greatly. Looking at surgery alone, the reasons can range from seeking a better price for cosmetic procedures, all the way to patients travelling for life-saving operations abroad where there is not the necessary resources or expertise at home.
As common as this has become, it raises some important questions both for the healthcare profession and for patients. Fundamentally, is it in patients’ best interests to have to travel to access treatment abroad? How safe is it to undergo major surgery and then have to travel, perhaps a long distance, to rest and recuperate back at home? How does aftercare work, and what if there are complications?
It is important also to examine why people are driven to travel to seek treatment in distant places in the first place. In an ideal world, it is common sense to believe that every patient would prefer, given the option, to get medical treatment in their own local area. That they cannot raises the question of why – what are the barriers which are preventing equal access on a local level? And if we can identify those barriers, can they not be removed?
The answer is, with modern networking and communications technologies, yes. With innovative applications of technologies like Augmented Reality (AR), the need for patients to travel to find the right resources and expertise can be turned on its head. Thanks to the virtual collaborative spaces we can create and connect with on everyday devices like smartphones and tablets, medical expertise can travel to the patient.
Focusing on surgery in particular, let’s take a closer look at how this can work in practice.
Why people seek surgery overseas
In the UK, the concept of health tourism has attracted negative media attention, often being spun by journalists as a trend describing migrants coming into the UK to take advantage of free healthcare on the NHS.
This is a distortion of the true picture. Certainly, a country with a well developed healthcare system like the UK attracts its fair share of inbound medical tourism. But there is a more or less equal amount of movement the other way, as UK citizens travel overseas for medical care. Nor is the inbound arrival of health tourists entirely detrimental to the country’s healthcare system. As stated already, medical tourism is big business, and UK service providers benefit financially the same as their peers all over the world.
Looking at both the inbound and outbound movement of people to access surgery in other countries, the motives for doing so can be broadly divided into two categories.
On the one hand, a lot of so-called health tourism is down to personal choice. The obvious association is people seeking surgery as part of a lifestyle choice, for example to undergo cosmetic or weight loss procedures. The motive is then often looking for cheaper services in other countries. But price is also increasingly a factor for private patients requiring surgery for health reasons, as premiums in countries like the UK and USA rise. Added to that, anywhere between 60,000 and 200,000 UK patients are estimated to look at travel options for non-essential procedures as a way to avoid lengthening NHS waiting times.
On the flipside of this, patients are having to travel for essential and even life-saving surgery for the stark reason that they cannot find a surgeon to carry out the procedure they need at home. There are numerous and frequent examples of patients from all over the world coming to the UK to benefit from the world-class resources the country enjoys in the form of highly skilled and specialist surgeons.
But equally, available expertise in the UK does not cover every critical condition. There was a recent case of a mum-of-two from Rochdale needing to raise funds to fly to the US for life-saving surgery to treat the rare spinal condition Ehlers Danlos Syndrome (EDS). Only three surgeons in the world have the expertise to carry out the operation she needs to save her life.
In a similar story, a few years ago it emerged that pancreatic cancer patients in the UK were having to fund their own trips to Germany to access life-saving surgery after the treatment was refused on the NHS.
How AR can help
To summarise, then, the reasons people travel for surgery, whether low or high priority, boil down to cost and access to the right kind of expertise.
Given advances in communication technologies, the need for patients to travel for surgery because they cannot find a surgeon locally to perform a procedure should be eradicated within a generation. Applications like Proximie are already demonstrating how time and space are no longer barriers to accessing surgical expertise.
Via an internet connection, a tablet or smartphone, and a piece of AR software, a specialist surgeon can mentor and guide a local practitioner through a procedure from anywhere in the world. Instead of the EDS patient from Rochdale having to travel to the US to be treated by one of the world’s few qualified experts, the specialist could come to her, virtually at least.
Being guided remotely via AR is little different to a specialist mentoring another practitioner in the theatre. Such is the sophistication of the technology, they are able to talk, guide, point, annotate, describe and sketch out a procedure step-by-step on a screen much the same way as they would do in person. And a key point here is, the easier it is to share specialist knowledge and experience through a virtual platform like Proximie, the less rare it becomes. Bit by bit, the need to travel is reduced.
The cost of surgery is a more complex area. What we might call the ‘consumer’ market for optional cosmetic and lifestyle surgery is always likely to remain open, with regional variations in resource costs creating fluctuations in the prices paid at the point of delivery. That will always drive a certain degree of medical tourism for surgical procedures.
But in cases where patients are making difficult choices to travel abroad because of extensive waiting lists at home, or even because organisations like the NHS do not feel it is cost effective to offer it, AR and related technologies can make a difference. Again, it is all about removing barriers.
In pure financial terms, it costs more to fly a patient overseas for surgery than it does to set up a link between their nearest hospital and an overseas specialist, and let a local surgeon carry out the procedure under guidance.
Less directly, over time, the more efficiently specialist knowledge can be shared, the more surgeons there are with experience and insight into a particular procedure, costs come down due to simple economies of scale. If the NHS, say, started to offer surgery for pancreatic cancer at home, with local surgeons guided by specialists in Germany using Proximie, sooner or later the UK would benefit from its own resource of specialists in those procedures. With expertise no longer in short supply, costs would come down, and the need to travel would be removed.