Medical Tourism and Obesity Surgery: Who Pays?

Caroline E Sheppard, BSc, Erica Lester, BSc, MD, David Kim, BSc, Daniel W Birch, MSc, MD, FRCSC, Shahzeer Karmali, MD, FRCSC, FACP, Christopher J de Gara, MB, MS, FRCS, Ed, Eng, C, FACS. University of Alberta, Centre for the Advancement of Minimally Invasive Surgery.

Introduction: The objective of this study was to determine the financial impact that bariatric medical tourism has on a public healthcare system. Due to long wait times for weight reduction surgery services, Canadians are leaving to expedite treatment by venturing to private clinics in other provinces or countries. Consequently, postoperative care is facilitated in their original province. This not only burdens the provincial health system with the cost of interventions required for patients with complications, but also detracts from time allotted to patients in the public clinic. Minimal to no literature exists describing the cost and denominator of returning medical tourists.

Methods and procedures: A chart review was performed of 62 patients deemed to be bariatric medical tourists to determine intervention costs between February 2009 and June 2013. As well, a survey was conducted to estimate the frequency of bariatric medical tourists presenting to general surgeons in Alberta, and the associated costs were determined. These costs were placed on a logarithmic curve to compare costs to our own institution.

Results: At our institution a conservative cost estimate of $1.8 million CAD was calculated for all interventions for these 62 medical tourists. This amount is similar to the estimated cost elicited from the survey, which deduced that general surgeons in Alberta consult an estimated 300 medical tourists in a year, with an average of $20,000 in intervention costs per patient. The cost of conducting 300 primary bariatric surgeries in Alberta is approximately $1.7 million less than the cost of treating 300 medical tourists presenting postoperatively in Alberta.

Conclusions: Medical tourism has a substantial impact on the cost of bariatric programs in Alberta. We have calculated the cost of bariatric medical tourism in Alberta to be, on average, $6 million CAD per year. This cost is a summation of funding the follow up and interventions due to complications or failure. It does not include the cost of subsidized externally conducted surgeries. As well, it does not take into account the cost of maintained obesity suffered by those on the wait list for bariatric surgery, whose surgery was not completed due to resources being directed to medical tourism surgical revision. Therefore, this cost is a broad yet conservative approximation. Thus, we conclude that it is more cost effective to conduct bariatric surgery in Alberta than to fund patients to seek surgery out of province/country.