By: Ahmad Khan
People engage in medical tourism for various reasons, such as seeking advanced and specialized medical services that are not available locally or people engage it to lower healthcare services’ cost. For example, uninsured individuals or patients from the United States who are unwilling to wait for a long time for an elective procedure might seek care in Mexico. A patient from Canada might go to Thailand for cosmetic surgery for a lower price. Moreover, wealthy and middle-class individuals from developing countries such as Afghanistan are attracted by medical tourism institutes’ bold marketing statements to seek medical care in countries ranked higher in development than their home countries (Hanef et al., 2014).
Globally, there is not valid and sufficient data on the number of patients, cost, and health outcomes for patients seeking care abroad (Fottler et al., 2014). We do not have sufficient data on medical tourism parameters that might vary from country to country.
In general, healthcare facilities do not follow universal strict, and transparent laws to regulate their healthcare facilities’ efficiency, leading to the violation of the patient’s rights (Hanefeld et al., 2014).
Healthcare delivery standards vary among healthcare systems, making it difficult to determine if care through medical tourism is ethical and standard. Common concerns that question medical tourism’s ethicality includes quality of care, responsibility, patient-centered care, and equity. Medical tourism clinics and companies mislead the patients with buzzwords and fancy advertisements.
Also, they foster a lack of trust in local healthcare efficacy by pushing the patient from developing countries toward the understanding that their home-based providers do not have enough medical knowledge, that they have given the patient the wrong medication and misdiagnosed the problem.
Lack of adequate health outcome reports can call into question the efficiency of healthcare quality. A study from a Canadian Brookhurst site showed that 47.1% of the sites were not compliant in alluding to a procedure’s risks (Penney et al., 2011). Suppose health institutes involved in medical tourism do not provide the patient enough information on the disease’s procedures and course.
The patient receives care with a lack of understanding. In that case, it violates patients’ informed consent.
Besides ethical issues, healthcare provided through medical tourism is less regulated. It can cause post-procedure complications and infection, leading to a financial burden on the patient’s home-based country. A study indicated a $1.3 billion financial burden to America from complications caused by medical tourism procedures outside the US (Adabi et al., 2017).
Most Afghan patients believe that every disease should have a cure with one or two prescriptions. In medicine, most chronic diseases are not curable, such as liver failure, heart failure, chronic obstructive lung disease, chronic kidney disease, Alzheimer’s, dementia, diabetes mellitus, sequelae of stroke, and other chronic conditions common among people. All these diseases are not curable; patients need continuous management to improve their quality of life and prevent or delay their complications. When they start treating heart failure, most patients feel better, but when their medications end, they start having the symptoms again, such as shortness of breath.
Holding the belief that the disease should disappear with one or two prescriptions, they start circling different providers locally.
They see that each provider prescription helps when they are on medication, but the symptoms start again once the pill ends. If the patient’s disease progresses to the end-stage, they might not see a visible change in their health status even when on medication. For example, when a patient has heart failure initially, the drug will significantly improve patient symptoms such as edema and shortness of breath. Still, once the patient gets to the end-stage heart failure, the patient’s symptoms do not visibly improve with medication.
We can point to many precursors that result in Afghan patients seeking care in foreign countries such as India or Pakistan.
The common ones are lack of patient awareness about their disease and some doctors’ unprofessional marketing for their business, leading to patient mistrusting all clinicians in the area.
For example, when a patient goes from doctor A to doctor B, the first thing for doctor B to get patient attention would say, oh, Doctor A does not know anything, and he/she has given you the wrong medications.
Lack of a well-established system and governing bodies to investigate such claims to prove if the doctor has given a wrong medication or just an unprofessional claim for marketing results in more chaos and confusion for patients. Furthermore, the claims that Afghan doctors do not provide standard care is boosted with unprofessional claims by the providers in Pakistan and India. They want the patients as a regular customer for their businesses, and they reiterate the same thing to the patient, that the Afghan doctor has given them the wrong medication.
A solution to Medical Tourism:
To decrease medical tourism and the drainage of cash from communities, we need a multi-disciplinary approach and integration of many departments in establishing strategies to improve quality of care, continuum of accessible care, and optimal equity of care across the country.
Focus on primary care and payment system: people in Afghanistan grapple with having access to primary health care services.
The essential barriers to primary healthcare services are lack of healthcare providers and facilities across the country, as well as poverty.
Based on a Medicine Sans Frontiers survey (MSF), 89% of the patients delayed seeking healthcare services due to financial problems (MSF, 2020).
According to the constitution of Afghanistan article 52, “The state shall provide free preventative healthcare and treatment of diseases as well as medical facilities to all citizens in accordance with the provisions of the law.” In practice, a patient receives free care in inpatient settings only in government hospitals. For example, if a patient has acute appendicitis and he/she is admitted to a government hospital, the patient will not be charged for the hospital’s services.
On the other hand, we do not have an organized system to provide consistent free care in outpatient settings for patients. The majority of chronic conditions such as chronic obstructive lung disease, heart failure, diabetes, chronic kidney disease, chronic liver disease, and other chronic conditions need continuity and coordination of care to improve patients’ quality of life.
Primary health care is a model where a designated doctor provides care to a certain number of patients consistently. The primary health care model has been successful in both developed and developing countries.
It has many benefits: through this model, patients have consistent interaction with their providers that can lead to increasing the knowledge of patients regarding their diseases and how to change their lifestyles if needed, as well as take their medication in a reconciled way to improve the quality of life and slow the progression of their diseases (Bindman, 2019).
Furthermore, worldwide studies have indicated that countries with a healthcare system oriented toward primary health care can enhance the higher quality of care, equity, and care delivery with lower expenses.
For example, a 2003 Lancet study showed that 63% of child deaths in the 42 countries that make up 90% of worldwide child mortality could be avoided each year by applying effective primary care (WHO, 2017).
The primary health care model can foster care, improve preventive medicine, enhance care coordination, engage patients in their care, and increase patients’ awareness of managing chronic diseases. Studies have indicated that countries with less focus on the primary care model, such as the United States, even with a higher per capita health care cost, have sub-optimal health outcomes compared to the other industrialized countries (Bindman, 2019).
In conclusion, I would like to point out that there is no perfect health care system in the world. Even healthcare systems in industrialized countries such as Canada, America, United Kingdom, Australia, Sweden, and Germany have flaws in their healthcare systems that can result in health care inequity, medical errors, and sub-optimal healthcare quality. But this does not mean that we cannot make changes in the improvement of health care services for the community. Doctors by themselves cannot ensure the delivery of health care with high efficiency. We need a sound integrative and collaborative system where everyone’s responsibility is addressed. This can align everyone involved in health care on the right track and provide the best possible healthcare services with available resources.