2012年4月14日土曜日

現実の医療ツーリズム

医療ツーリズムが現実が報道された。
 外国人向けの国際外来のある「りんくう総合医療センター」が、治療費
約660万円を滞納した中国人男性(故人)の家族を相手取り、今月中にも支払
いを求めて中国で訴訟を起こす方針であることがわかった。

治療費未納者
・中国人男性 当時72才
・2010年9月 観光目的で夫婦で来日
 持病の心臓病が悪化し、手術などを受けたが約2週間後に死亡
・旅行者用保険に加入していたが、持病は適用外
・治療費約674万円。
 妻が約14万円を支払い、残金は分割払いをするとの誓約書を書いて帰国。
 支払い督促にも応じないため、中国での提訴

以前から懸念されていた医療ツーリズム。
道徳が異なれば、契約書を見ても紙切れとしか思わないだろうし、
持病はあったにせよ、旅行をできるほど丈夫だったのに、旅行先の病院で
死んだ(殺された)と思えば、他国の病院と関係を持ちたくないとも思える。
しかし、報道を見る限り、この人達は医療ツーリズムに参加したわけでは
なく、高額治療費の未納者と思える。

多くの医療ツーリズムを実施する国でも支払いの問題だけでなく、病原菌
感染、医療記録の不備、詐欺等の問題も起きている。
満足する医療行為が行われなかった場合、患者が高額な訴訟をする場合も
ある。
高度医療、自由診療で高額治療費獲得を狙っても、医療としての問題が
軽減したわけではない。

世界的に拡散する医療ツーリズム。
アジア地域
 印、タイ、シンガポール、マレーシア、韓国、フィリピン、インドネシア
北米地域
 バルバドス、ケイマン諸島、ジャマイカ、メキシコ、グアテマラ
欧州地域
 ポーランド

NDM1
ムバダラ開発 神戸の医療関係に投資


---治療費未納で帰国続出、中国人家族提訴へ---
2012年4月7日14時42分 読売新聞
http://www.yomiuri.co.jp/national/news/20120407-OYT1T00503.htm

 外国人向けの国際外来のある「りんくう総合医療センター」(大阪府泉佐野市)が、治療費約660万円を滞納した中国人男性(故人)の家族を相手取り、今月中にも支払いを求めて中国で訴訟を起こす方針であることがわかった。
 同センター一帯は今後、観光と最先端治療をセットにした「医療ツーリズム」の拠点として整備し、外国人患者を受け入れる予定で、こうした未収金問題への対応が課題となりそうだ。
 同センターでは外国人が治療費を払わないまま帰国するケースが相次いでおり、経営を圧迫しかねないと判断、異例の提訴に踏み切ることになった。
 センターによると、この中国人男性(当時72歳)は2010年9月、妻と観光目的で来日したが、関西空港近くのホテルに到着後、持病の心臓病が悪化。同センターで手術などを受けたが約2週間後に死亡した。
 男性は旅行者用の保険に加入していたが、持病は適用外で、治療費約674万円全額を支払う必要が生じ、男性の妻が約14万円を支払い、残金は分割払いをするとの誓約書を書いて帰国。だが、その後は支払い督促にも応じないため、中国での提訴を決めたという。


---Medical tourists have cash, will travel---
By Elaine O'Connor, Postmedia News April 9, 2012
http://www.timescolonist.com/travel/Medical+tourists+have+cash+will+travel/6427473/story.html

VANCOUVER - When Robert Stuart Smith's left knee gave out, the resident of the Vancouver bedroom community of White Rock was a busy realtor, avid golfer and occasional Scottish singer who had no time to wait a year or two for surgery to replace his 72-year-old joint.

Rather than putting his active life on hold and adding his name to a wait list, Smith took his business abroad and outsourced the surgery to India.

He contracted a medical tourism company based in Kelowna, B.C., to book the trip, travelled with his wife to Kerala and for $20,000 he had his knee replaced in less than a month. After the surgery, he spent two weeks recovering in hospital with a private nurse, then moved to a five-star hotel while his wife went sightseeing.

Their every need was attended to, right down to a "get well" message written in rose petals on his bed.

"We were concerned (about going abroad for surgery), but we were treated first-class," says Smith, now 79.

"To me, they had a better system there than they did here."

"The knee's still good today. To me, instead of having to wait a year-and-a-half to get something done, if you could afford it, why wouldn't you?"

When he signed on for surgery abroad in 2005, Smith became one of a rapidly growing number of international health consumers who are fuelling the global medical tourism boom.

The U.S. research firm Frost & Sullivan expects the industry to hit $100 billion this year, and to increase by 20 per cent a year across 50 countries.

For some patients, the cost of surgery is cheaper than in their home country. Others don't want to wait, or they may be seeking procedures not available in their own country.

A growing number of developing countries now have top-notch doctors, facilities and equipment that reassure Westerners, and the Internet makes it easy to book procedures overseas and allows countries to heavily market their services to consumers.

But there are concerns about the medical tourism industry. In 2010, the World Bank reported the sector has "considerable implications for public health." There is potential for abuse. Hospital accreditation with the U.S.-based Joint Commission International is voluntary, and medical tourism "facilitators" - brokers - are unregulated and often work on commission.

Then there's the impact on countries where health resources are being funnelled into private hospitals, possibly depriving local patients of expertise. Some governments give tax breaks to for-profit health centres in countries that lack basic care for their poor.

There is little or no research about how many Canadians travel abroad for medical procedures, the impact of medical tourism on our health-care system, or the effect on destination countries, says Simon Fraser University associate professor of geography Valorie Crooks.

Crooks has spent four years trying to determine the real cost of medical tourism through her SFU Medical Tourism Research Group.

"I think people would be surprised to know that people are choosing to go abroad for medical care more often than they'd think," said Crooks, who won the first Canadian Institutes of Health Research grant in 2008 to study the issue.

"There's a lot of public discussion of wait times as the reason people go abroad for surgery, but from our research we know the things prompting Canadians to go abroad are much more diverse."

The government doesn't track medical tourists, which leaves researchers and policy-makers in the dark. And although shopping abroad for medical care is perfectly legal, Crooks is concerned with its consequences.

"There's no international regulation scheme for the industry that assesses things like surgical outcomes and safety," said Crooks, a health geographer.

"There are a lot of health and safety risks involved . . . the industry is growing so rapidly and there is such a need to know more about what is happening."

She cites concerns about safety of blood supplies, incomplete medical records, and the risk of flight following surgeries. There can also be pressure on the health system in patients' home countries to provide follow-up care, especially in the case of organ transplants, and some patients have returned to Canada with hospital-acquired superbugs.

Crooks and her team will visit Mongolia this month and will conduct studies in Mexico, Guatemala, Barbados and India to examine the role of caregivers and the impact of medical tourism on local health care in developing countries.

Crooks hopes more data will lead to ethical buying guidelines for medical consumers to help them minimize their risk. At the moment, Canadians have to fend for themselves or turn to unregulated brokers to arrange surgeries for a fee.

One of the biggest medical facilitators in B.C. is Vancouver's Surgical Tourism Canada, which has arranged to send more than 1,500 clients abroad since it was founded in 2005. Most of the clients are Canadian; 30 per cent are British Columbians.

"Many people need and want the option of medical specialists to get treatment faster than waiting in line here," said the company's spokesman Glenn Sergius.

"People want to go to a place where they get the best medical treatment immediately, if they can afford it."

Sergius argued patients are as safe abroad as when they undergo procedures at their local hospital.

"The risks faced for those needing medical treatment and surgery - with or without travel - are much the same, perhaps less, because the hospitals have more trained staff per patient," Sergius said, adding that by using a medical facilitator, the risks are reduced "because an experienced expert . . . is looking after the details relating to choice of physicians and hospitals, travel and accommodations."

Shaz Pendharkar, of Kelowna, B.C., is the first to admit he isn't a trained medical professional. He is a retired school principal who connects patients to doctors he knows in India and works part-time as a facilitator. His business, Meditours, is small; he said he's arranged 60 surgeries since he started the company in 2003.

"I'm not a medical broker," Pendharkar said. "I really know the doctors well that I send my clients to. I'm more of a niche marketer."

He arranges all travel details, exchanging medical information with doctors and organizing accommodations. He says he can get a patient into a hospital bed in India in as little as two weeks. Patients generally pay $10,000 to $12,000 for the package, depending on the surgery and not including airfare, and Pendharkar charges a fee of 10 to 15 per cent.

He stresses he doesn't offer medical advice - just logistical support - and that he's never had a patient who had a surgery go wrong, save a Vancouver woman who wasn't entirely happy with her butt-lift.

Pendharkar doesn't see the need for regulation, but admits patients do take risks, especially dealing directly with foreign hospitals.

"My biggest problem with that sort of system is not knowing the doctors," he said. "You don't know what you are getting."

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