Operation travel abroad

When it comes to your health, Caroline Maddenasks, is it worth taking a leap into the unknown and becoming a medical tourist, or is it a case of better the devil you know than the devil you don't?

From tummy tucks in Thailand to porcelain veneers in Budapest, hip replacements in Bombay to laser eye surgery in Kusadasi, the popularity of medical tourism is growing at a phenomenal rate, particularly among Irish consumers.

Tempted by cut-price costs and short waiting times - and disillusioned with our own ailing healthcare system - it's easy to understand why more and more people are looking further afield for solutions to their medical problems.

But when it comes to your health, is it worth taking a leap into the unknown or is it a case of better the devil you know?

From a financial standpoint, patients willing to travel for their treatment can certainly make astounding savings - just as long as nothing goes wrong.

Take the largest (and at the moment the most controversial) sector of the Irish medical tourism market - dental work.

Traditionally, those in search of cheaper dental services simply hopped over the Border to the North, where prices are still 30 per cent lower than in the Republic, but consumers are now becoming far more adventurous.

According to Irish medical tourism company RevaHealth.com, 10,500 people are travelling from the Republic each year to get dental work carried out in countries other than the UK, with Hungary the most popular destination.

The majority of these patients are travelling for the more expensive - and high-risk - cosmetic procedures such as implants, crowns and veneers.

The argument has been made that Irish dentists have brought this exodus of lucrative clients upon themselves.

According to a recently-published Competition Authority report on the dental healthcare sector, the cost of visiting the dentist has soared by 171 per cent since 1990. This compares with overall inflation of 69 per cent during the same period.

"Consumers are paying too much for dental services in Ireland," concludes Competition Authority chairman Bill Prasifka in the report.

The fact that dental procedures can be up to 70 per cent cheaper in Hungary seems to confirm this.

However, Irish dentists argue that you get what you pay for, and have raised some valid points on the inherent risks of dental tourism.

In a report released this week, Prof Brian O'Connell of the Dublin Dental Hospital issued the following warning on the importance of aftercare. "Many dental tourists believe that their treatment is a 'once-off' event. However, in order to ensure the longest survival of their teeth, it is in the interest of patients to undergo a proper maintenance phase of treatment. The more complex the treatment, the more important it is to maintain regular contact with their dentist."

WHAT COULD GO WRONG?

Cautionary tales abound of patients getting perfectly healthy teeth extracted, and even one unlucky individual whose new crowns fell out on the flight home to Ireland.

The Irish Dental Association has encountered many incidents of patients being overtreated, and complex procedures being condensed into very short periods without sufficient time allowed for healing.

And then there is the issue of recourse. What rights do you have if something goes wrong?

Dentistry is not a perfect science, says Ciara Murphy, chief executive of the association. Things can and do go wrong. But at least if the procedure is carried out in the Republic the patient can raise their complaint with the Dental Council, which will investigate it on their behalf. The dentist who did the damage may then have to carry out corrective treatment or else pay another dentist to do so. This safety net is not available for treatments carried out overseas.

Some eastern European clinics offer guarantees, but consumers should examine them carefully as they often have get-out clauses.

For example, the guarantee may be invalidated if the patient does not return once a year for a check-up, or if they gain or lose too much weight. Also consider whether you are prepared to travel back and forth if corrective treatment becomes necessary.

A spokesman for Dental Hungary, an Irish-based agency that provides access to dental clinics in Budapest, says that the Hungarian clinics are by no means "bargain basement".

"There is no compromise on quality whatsoever," he says.

He argues that one million Austrians would not cross the border into Hungary for dental treatment each year if the service provided was not top class.

NIP AND TUCK

After dentistry, cosmetic surgery is now the most popular sector with Irish medical tourists.

A conservative estimate from RevaHealth.com indicates that at least 5,000 people are now travelling overseas each year to get nipped and tucked.

Face lifts, tummy tucks and liposuction are all popular procedures, and are often combined with a holiday in an exotic location.

Given that laser eye surgery has becoming increasingly affordable in this country in recent years, it is somewhat surprising that people still go overseas in search of twenty-twenty vision.

"It's absolute madness in my opinion," says Prof Michael O'Keefe, ophthalmic surgeon at the Mater Private Hospital, who has encountered a number of patients who returned home with severe problems after undergoing eye surgery in Greece and other countries.

"A huge part of medicine is the follow-up, the aftercare," he explains. "There's no aftercare for these clinics. They just discharge you and that's it."

Laser surgery is a fantastic operation for many people, but it is not risk-free. "If you get a problem in these places, who's going to look after it when you come home?" he asks. "Who's going to take over the complications that may arise?"

Despite the risks associated with medical tourism, the number of Irish patients taking the plunge is growing exponentially.

"There's a marked increase in the proportion of our customers seeking to have their treatment conducted overseas," observes Deirdre Ashe, marketing director with health insurance company Vivas. In the main, these requests relate to surgical procedures.

INSURING BEST CARE

Vivas customers are covered for the same treatment overseas as they are locally, so cost is not the main driving factor behind this trend. Instead people tend to be motivated by a perception that better levels of treatment are available elsewhere or the possibility of shorter recovery times.

"Business people, for example, want to address their medical needs on a more urgent timeline," says Ashe.

According to the European Consumer Centre, very few people are aware of their entitlement to seek healthcare in other European countries through the E112/Treatment Abroad Scheme.

However, this scheme only applies if the treatment is not available in the Republic, so typically only very unusual or rare conditions are covered.

For those seriously considering becoming a medical tourist, Philip Boyle of RevaHealth.com advises that the most important thing is to be fully informed.

"We would recommend that anyone thinking of travelling should consult with their own doctor or dentist first," he continues.

"There is no point in planning a trip if the treatment you are interested in is not suitable for you."