Dental tourism...Let's work together

The Irish Dental Association is the most recent medical professionals body to publish a "survey" raising doubts about medical tourism.
In a recent press release from the Irish Dental Association, they state that "3 out of every 4 Irish dentists are treating patients for problems arising from treatment abroad. Let's take a look at the background to the survey, and examine some of the real concerns that are raised.
The Consumers’ Association of Ireland has published research about the high costs of dental treatment in Ireland. The Irish Dental Association accepts that Irish dentists are not immune from the wider economy and the bottom line is that Ireland is a high-cost economy. As a result, significant numbers of Irish dental patients travel for treatment to minimise treatment costs. Some of these are cross border dental tourists. Many services carried out in Northern Ireland are between 25% and 45% cheaper than the same services in the Republic, according to the study published in the Consumers’ Association of Ireland’s magazine Consumer Choice. And of course, many Irish patients take advantage of low cost treatment in countries such as Hungary and Poland. Several Budapest dental treatment providers have offices or representatives in the Republic of Ireland.
According to the Irish Dental Association survey, 76% of Irish dentists in private practice [more than 3 out of 4] have had to treat patients for problems linked to the dental treatment they received abroad.
First, we need to examine the basis of this claim.

• There are approximately 1,700 dentists in private practice in Ireland at present.
• 440 Irish dentists responded to the survey.
• 334 said that they are treating problems arising from treatment overseas.
• So.... in fact 334 out of 1,700 said that they were seeing problems which is 20%. Obviously, this assumes that those who didn't bother are not seeing problems.

When reviewing such surveys conducted by on or on behalf of professional associations, we have to bear the following in mind:

• Inbuilt sample bias: People who see a problem are more likely to respond to a survey on that issue, than those who don't. We've seen similar bias built into surveys conducted by a PR agency in behalf of the British Association of Plastic Surgeons.
• Motivation: We always need to remember that professional associations represent the interests of their members. Losing patients to Belfast or Budapest hits the pockets of private dentists.

Nevertheless..... the Irish Dental Association has made some valid points. Are there concerns for dental patients who travel for treatment? Yes. Are the problems as big as the Irish Dental Association suggests. No.

At the end of the day, the Irish Dental Association also has the best interests of Irish dental patients at heart. Dr Donal Blackwell of the Irish Dental Association says that that one of the problems is that when considering travelling abroad for dental treatment, patients tended to focus on short term, aesthetic results rather than the long term quality of the care they receive and suggests that people travelling abroad for dental treatment actually don't know what they need when they enquire about costs. He's certainly right in some cases.

So, what's the solution and what's in the best interests of dentists and patients?

I'd like to see the following:

1. The Irish Dental Association issuing guidance for dentists and patients when considering dental tourism. See the UK General Dental Council's Dental Tourism Checklist on Treatment Abroad.
2. Irish dentists providing assessment and follow up of patients who travel abroad for treatment.
3. Irish dentists visiting some overseas dentists to get an understanding of how they work and their clinical skills and quality.
4. Irish dentists forming partnerships with overseas dentists, so that patients who need extensive treatment but can't afford Irish treatment have access to the treatment they need under the supervision of their own dentist.
5. Overseas dentists communicating with the patient's Irish dentist when a patient turns up in Budapest or Krakow - informing the patient's Irish dentist what work is to be undertaken, and providing post treatment reports on the work that has been carried out.

Common sense really. So, let's work together!

McKinsey and the medical tourism numbers game...

According to a new report on medical tourism from McKinsey (login required):

• "Between 60,000 and 85,000 people annually travel abroad for inpatient hospital care, a number.....far lower than commonly assumed".

According to the Wall Street Journal:

• ... the McKinsey report "contrasts sharply" with common assumptions and with figures often used by those who market medical tourism. "There's been an enormous amount of hype" regarding people traveling abroad to receive necessary procedures at a lower cost, Mango (from McKinsey) said.

So what are we to make of this "authoritative" report.....?

One industry insider who has compiled a comprehensive review of medical tourism suggests:

• "The McKinsey figures are nonsensical......looking just at figures from Asia for travellers from Asia and the Gulf, they are way way out."

One problem with the McKinsey data is that it relies heavily on government statistics, and few governments record medical travel. Even where figures are collected then they do not include home nationals who work overseas going back for treatment, or US and other residents returning to a country of origin for treatment.

It's also a strange method of counting medical tourists, if you decide to leave out:

• people travelling across borders for treatment, which would include UK to France or Belgium, Canada to the US, the US to Mexico, Mexico to the US , China to Taiwan or Hong Kong, central Africa to South Africa , Ireland to the UK, etc etc.
• people travelling back to their homeland for treatment.
• people travelling to the homeland of their parents/grandparents
• expatriates working overseas
• people who decide to mix travel and treatment eg UK travellers to Spain, South Africa
• people who mix business travel and treatment
• people who live in two countries eg UK and Spain
• And..all outpatients

Other oddities...

If they reckon the number of medical tourists are 60,000 to 85,000 worldwide, how does this stack up against other reported data:

• 70,000 - 100,000 UK medical tourists (from our own Treatment Abroad medical tourism research and the UK International Passenger Survey data)
• Last year, 92,000 patients from the UAE visited the Philippines.
• One dental clinic alone in Budapest that is treating over 4,000 patients from abroad each year.
• 10,000 visitors to Korea last year for medical treatment, according to the Korean Tourism Organisation.
• Singapore Tourism Board says 555,000 tourists received medical treatment in 2006.

And overall... it is a little strange to say that someone travelling overseas for a hip operation is a medical tourist, but someone travelling for a dental extraction or cosmetic surgery is not.

Whatever the real numbers are, McKinsey did conclude:

• "Medical travel is a highly relevant market ........ The acceleration of unsustainable health care costs in many developed economies, the advent of advanced technologies in just a few locations, and the increasing concentration of wealth in developing economies are only a few of the factors fueling it. Over the next couple of decades, these trends may largely dispel the idea that health care is a purely local service"

So... good news for the medical travel industry!