While delineating some negative aspects of medical tourism worldwide, experts in Oman have stressed the need for comprehensive studies on the growing tendency among people to go abroad for medical treatment. Prof. Lamk Al Lamki, chief editor of Sultan Qaboos University Medical Journal (SQUMJ), says that the quality and safety of medical treatment abroad has to be analysed and it should be under the scrutiny of the medical professions and the Ministry of Health in Oman.
Many Omani patients go abroad as "outsourced patients". They are sent abroad by the government, when the necessary treatment or the specialist is not available locally. Sometimes locally available treatment is not trusted by the patients. "Unless we have a good idea of the quality of the care that our patients are receiving abroad, their safety may be at risk.
We need more statistics, better studies and better reporting systems. "The question of who will look after these patients when they return, has not been answered, but it must be tackled," he says. In the latest editorial of SQUMJ, Prof. Lamk points out that there is a major lack of systematic data about health services provided abroad, not only for Omanis, but also for citizens of many other countries. "More organised studies are needed and specifically outcome studies. Research into the delivery of health care has not yet adequately evaluated the case of medical tourism.
The issue of lack of data must be taken very seriously. Medical tourism has some benefits, but there are more problems with it and, as physicians, we have to keep in mind our basic principles of beneficence and non-maleficence." Prof. Lamk explains that there are many problems associated with medical tourism which include poor or no follow-up care. "After being in hospital for a short while and having a vacation, the patient comes home with, perhaps, complications of the surgery or side effects of the drugs. It is a surgical principal that every surgeon looks after his own complications and obviously that does not apply for most, if not all, patients who have been treated abroad.
Many countries have very weak malpractice laws and thus patients have limited ability to complain about poor medical care," he says. Another risk is that patients may not be able to endure travel, or may not have inherent resistance to some of the diseases in the host countries. Prof. Lamk, therefore, underscores the need to have better scientific studies on the impact of medical tourism on the healthcare services of the source and destination countries as well as on the patients themselves. "We need more statistics on the rate of complications," he says. He observes that many medical tourists are satisfied, but satisfaction does not always parallel good outcome. "Often, satisfaction can simply be a result of good service.
The "outsourced patients," or those who are sent by the government, are often dissatisfied with the total experience compared to the true self-financed medical tourists. That is why an institution has to be accredited for good medical care with a good quality assurance programme rather than just good service," he says. Prof. Lamk further clarifies that patients going abroad need to get good advice. According to the World Tourism Organization's Global Code of Ethics for Medical Tourism, medical tourists should have the same rights as citizens of destination countries. Unfortunately, that is not always the case and that is another potential source of problems. According to Prof. Lamk, a further potential problem with medical tourism is that sometimes it impacts the source country's health care system.
A source country may become complacent by being able to send its citizens abroad for certain procedures and thus fail to develop the appropriate national services. He cites the development of positron emission tomography (PET) in Oman as an example of this. One of the major concerns related to medical tourism is the ethical aspects of treatment. These are to be examined and the risks discussed with the patient, but, on the other hand, it is important that patients have their own autonomy in decision-making. Beneficence and non-maleficence are the basis of medical ethics. Prof. Lamk has called for attention to the fact that it is the responsibility of the physicians to promote patients' welfare, treat them with justice and improve their health while avoiding harming them. Another ethical consideration is that each country may have a different standard of medical ethics. For example, what is considered experimental therapy in one country, like stem cell therapy, is routinely used in the private institutions providing care for medical tourists in other countries.
(The writer is a senior editor at the Sultan Qaboos University's public relations department)