Medical Tourism and the Libyan National Health Services

Medical tourism is a term that is used frequently by the media and travel agencies as a catchall phrase to describe a process where people travel to other countries to obtain medical, dental, and/or surgical care [1, 2]. Leisure aspects of traveling are usually included on such a medical travel trip [1]. The term is also used to describe a situation where doctors travel to other places to deliver services to endogenous populations [3]. Many factors have led to the recent increase in popularity of medical tourism. Among these factors are the absence of a particular service and the high cost of health care in some countries of origin on one side, and the ease and affordability of international travel, and the improvement of technology and standards of care in host countries on the other side. This phenomenon cannot be separated from globalization and tendency for a more liberal world trade. In countries that operate from a public health-care system, it can take a considerable amount of time to get needed medical care. In Britain and Canada, for example, the waiting period for a hip replacement can be a year or more, while in Bangkok or Bangalore, a patient can be in the operating room the morning after getting off a plane [2]. The post-surgery mortality rate in the 15,000 heart operations done every year in Scots Heart Institute and Research Centre in Delhi and Faridabad is only 0.8%, which is less than half of most major hospitals in the United States or Europe [2]. However, the real attraction is price [2]. The cost of surgery in India, Thailand or South Africa can be one-tenth of the price of comparable treatment in the United States or Western Europe [2]. A heart operation as an example costs €32000 in the United States, €16000 in Europe, but less than €3000 in India. A full facelift that would cost $20,000 in the U.S. runs at about $1,250 in South Africa [2]. In addition, clinics in these countries provide single-patient rooms that resemble guestrooms in four-star hotels [2]. Interventions aimed at medical tourism include cancer treatment, neurosurgery, organ transplantation, aesthetic treatment, dental treatments, eye surgery, kidney dialysis, « preventive health screening» and hip resurfacing [2]. Other opportunities are constantly being exploited. Examples include different services as aphaeresis tourism in India [4] and climatotherapy in Egypt [5]. Medical tourism is a rapidly growing industry in many countries. India is becoming a «global health destination». Encouraged by the government, India is promoting the «high-tech healing» of its private healthcare sector as a tourist attraction [1, 2]. More than 100 000 foreigners visited India for medical treatment in the year 2005. India estimates that medical tourism could bring as much as $2.2 billion per year by 2012. Besides India, popular international medical travel destinations include Singapore and Thailand. About 374, 000 visitors came to Singapore purely to seek healthcare in 2005, half of them from the Middle East [2]. South Africa promotes an attractive «medical safari» catchphrase: Come to see African wildlife and get a facelift in the same trip. Other countries include Tunisia which is attracting Italians, British and French besides the so- called traditional visitors from Libya and Algeria [6]. The list of countries currently promoting medical tourism include many others such as Argentina, Bolivia, Brazil, Cuba, Costa Rica, Jamaica, Jordan, Hungary, Latvia, Lithuania, Malaysia and the Philippines [2, 3]. Some hospitals in certain countries are gaining the confidence of their customers by obtaining hospital accreditation from international bodies in the United States [2]. Dubai, already known for its festival and other luxury attractions, is planning to open the Dubai Healthcare City by 2010. This is expected to be the largest international medical centre between Europe and Southeast Asia and it is hoped to become an internationally recognized location of choice for quality healthcare and an integrated centre of excellence for clinical and wellness services, medical education and research [2]. An international medical travel conference (IMTC) was held in December 2006 and some web sites such as ArabMedicare.com were established to accompany the needs of this growing market. In spite of the aforementioned rewards, medical tourism is not without risks [3]. Medical tourism can do harm to national health services of the host as well as the country of origin. Besides cultural and language issues, there are risks inherent in traveling as accidents, exposure to different infectious diseases, risks from traveling soon after surgery, impossibility of treating chronic disease after a single consultation, the non familiarity of how a certain specialty applies to other communities, the on-off consultations, the limited possibility for follow up, the absence of record of the consultation [3], and most importantly fraud and abuse. The total amount of money spent by Libyans on both forms of medical tourism is difficult to estimate. It ranges between $100-200 millions per year for treatment abroad, but the accurate figures are not available. The form of medical tourism where doctors rather than patients travel, gained a momentum with the increased role of private practice in health service delivery. There is a real threat from the growing market of medical tourism in the region on the public health oriented national health system in Libya. The two neighboring countries that are mostly visited by Libyans have a lower performance of National Health Service in comparison to Libyan National Health services with an objective assessment as revealed by infant mortality rate, life expectancy at birth, maternal mortality ratio and proportion of low birth weight [7]. Giving the non-popularity of tourism among the Libyan population, traveling in itself is an important event in one's life. We should not deny that in many cases quality of care, communication skills of health-care givers and patient satisfaction are better in visited countries. Demands are rarely seen to be an important element in the predominantly centralized planning of health services in Libya. Initial visits to these «tourist» private clinics are seen as means to attract other clients. This goes usually through undermining National Health Services in Libya. In many instances there is no justification for that. In addition to our tendency to idealize others, many of the criteria used by patients are very subjective and represent demands rather than needs. Some of these subjective criteria that we met were related to quality of food or clothes offered in hospitals or certain procedures that are seen as novel experience. It is unlikely that this phenomenon of medical tourism will decrease in magnitude. It is also unreasonable to think that a country with a small population will be able to deliver all service demands and needs of the population. For example, the cost-benefit analysis of some interventions as hepatic transplantation would not permit the minimum number of transplantations needed to insure quality unless these interventions are organized at the regional level. Solutions are multifaceted. These would include; improving hospital based services and ambulatory care; increasing responsiveness of national health services to patients’ needs as basic amenities that are highly valued by the consumers such as clean waiting rooms or adequate beds and food in hospitals; partnership with the private sector; delivering quality care with continuous evaluation by different indicators related to structure, process and outcome of healthcare services, and using clinical governance, performance management and SMART objectives and targets to evaluate performance of health establishments. Health insurance schemes can also play an important role in controlling this phenomenon as well as supervising treatment processes and ensuring stewardship.

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