‘Superbugs’ Could Pose Threat to Medical Tourism


By Bill Leonard September 3, 2010

Just as “medical tourism” plans have begun to gain more acceptance from employers as a viable way to reduce medical costs, the risk of spreading antibiotic resistant bacteria is again raising concerns that traveling abroad for medical treatments is a safe health care option.

In August 2010, the potential health care threats from antibiotic resistant bacteria or “superbugs’ grabbed headlines when the British medical journal, The Lancet Infectious Diseases, published the results of a study that identified a new enzyme in bacteria called the New Delhi metallo-beta-lactamase, or NDM-1. The enzyme, according to the study, makes bacteria highly resistant to most antibiotics used by doctors to combat infections, and these new strains of superbugs were beginning to spread in India, Bangladesh and Pakistan. Researchers for the study concluded that medical tourism had a major role in spreading the bacteria around the globe.

“India provides cosmetic surgery for many Europeans and Americans, and it is likely NDM-1 will spread worldwide,” the study stated.

After the study was released, dozens of newspaper articles and discussions on the Internet appeared on the threat that these new strains of bacteria posed to patients in Western Europe and the United States. The initial furor over the Lancet report led the government of India and the country’s tourism bureau in Canada to issue statements that the study was misleading and unfair.

“The Government of India has strongly refuted the naming of this enzyme as New Delhi-metallo-beta-lactamase and also refutes the reports that hospitals in India are not safe for treatment including medical tourism,” stated a press release from Indiatourism Toronto.

A press release issued from the Indian Council for Medical Research called associating the bacteria with India “misleading” and said that antibiotic resistant bacteria with a similar enzyme have appeared in Greece and Israel.

While the initial reaction to the report produced a lot of chatter, the furor has since died down, and medical experts and health care consultants suggest that reports of the threats might be overstated and that the bug should have minimal impact on medical tourism programs.

Threat Overstated?

“Interest is definitely growing in medical tourism plans, because they do offer a very attractive cost savings,” said Dr. Ronald M. Johnson, chief medical officer for Satori World Medical in San Diego. “While a report on antibiotic resistant bacteria is bound to raise concerns and certainly will cause people to ask questions, the overall impact on travel overseas for medical treatments will be negligible.”

Johnson, who has helped to set up medical tourism programs around the globe, said the doctors and hospitals that provide medical tourism services in other countries are held to the same rigid standards as their counterparts in the United States.

“If they don’t meet the same standards and certifications, then these hospitals and providers won’t become part of the network,” Johnson said.

He said the results from patients who travel out of the U.S. for surgeries and treatments compare favorably to those for patients who remain in the U.S.

“The risks of infections and post-operative complications are virtually the same, and this is data that we examine and track closely,” he said.

Johnson concedes that medical tourism is not for everyone. Research has shown consistently that only 40 percent of American patients would consider traveling outside the United States for surgery or medical treatment.

“That knocks out 60 percent of patients right there,” Johnson said. “So you begin with a limited appeal, but for those who have tried it the satisfaction rates are very high. The cost effectiveness of the programs also makes it very attractive and worthwhile for many.”

Reports like the one in the Lancet can, however, create hurdles for organizations that might be considering medical tourism as an option.

“It certainly will create an additional barrier and raise concerns,” said Joe Marlowe, senior vice president for the health and benefits practice of Aon Consulting.

The number of patients traveling to India from the U.S. for medical treatment is considerably lower than patients who travel to India from Great Britain and Canada. Most U.S. patients are traveling to India for cosmetic and elective surgeries, which normally aren’t covered by health insurance plans.

“While there has been some discussion and questions about the risk of antibiotic resistant bacteria, the actual impact on employers and their health care plans has been minimal,” Marlowe said.

The interest among U.S.-based employers in medical tourism programs is growing, but the interest level remains at the discussion phase, according to Marlowe.

“There’s a lot of talk about medical tourism, but the number of employers who have plans in place is fairly limited right now,” he said.

While growth potential in the international market exists, he said, “domestic” medical tourism plans are an option that a growing number of employers are considering.

“These plans look at lower-cost options at hospitals and health care providers that are outside an employer’s local area or network,” he said. “These type plans can offer more options when it comes to pricing medical treatments.”

Bill Leonard is senior writer for SHRM.

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