Health tourism claims are a distraction from NHS’s real problems | Letters

We know of no good evidence that “health tourism” – individuals travelling to England solely to access NHS services – is a significant burden on the NHS (Hospitals to check patients’ right to care, 6 February). Such patients are seen very rarely, if at all, in clinical practice.

Assurances that individuals with infectious diseases and those requiring “emergency treatment” will not be turned away fundamentally misunderstand how healthcare is delivered. People present with symptoms, not diagnoses. Unless people can access routine investigations, communicable diseases and life-threatening conditions will go undiagnosed. Case studies show that, even under the existing charging regulations, individuals are coming to harm.

The NHS in England sees around a 650,000 patients every 24 hours. The administrative costs involved in accurately assessing whether each patient is “lawfully resident” would be substantial. Everyone would be inconvenienced by the requirement to carry means of identification. As Nye Bevan wrote, “if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody.”

It is not naive to suggest that the NHS should offer treatment to everyone regardless of immigration status and that the task of policing our borders be left to the immigration authorities. This is the approach taken in Scotland, in Wales, and in a number of other European countries. The media noise about health tourism is a distraction. The primary reason the NHS is struggling is that we choose to spend a much lower proportion of gross domestic product on healthcare than other high-income countries.
Dr Tom Yates CT1 doctor in acute medicine, London, Ibrahim Abubakar Professor of infectious disease epidemiology, University College London, Dr Rob Aldridge ST5 doctor in public health, University College London, Dr Alex Armitage Paediatric registrar, Lewisham Hospital, London, Dr Peter Baker Public health speciality registrar (ST4), Imperial College London, Dr David Barr Specialist registrar in infectious diseases, Glasgow, Dr Sunil Bhopal Wellcome Trust research training fellow, London School of Hygiene & Tropical Medicine, Dr David Biles GP Trainee, London, Dr David Blane Academic GP, Maryhill Health Centre, Glasgow, Dr Mike Brown Consultant, Hospital for Tropical Diseases, University College Hospital, London, Dr James Chan ST2 doctor in emergency medicine, West Yorkshire, Dr Jim Cole General practitioner, Tower Hamlets, London, Dr Rosie Crane Paediatric registrar, Oxford, Dr Jonny Currie GP and public health specialty registrar, Liverpool, Dr Angharad Davis Neurology registrar, National Hospital for Neurology and Neurosurgery, London, Dr Delan Devakumar ST5 doctor in public health, University College London, Dr Chris Dugan Specialist registrar in infectious diseases, London, Dr Chi Eziefula Consultant in Infection, Brighton and Sussex University Hospitals, Dr Catherine Isitt CT1 Doctor in Haematology, London, Dr Søren Kudsk-Iversen LAS senior house officer in anaesthetics, Reading, Dr Michael Marks Infectious diseases registrar, Guy’s Hospital and St Thomas’ Hospital, London, Dr Lizzie Moore ST2 doctor in public health, Oxford, Dr Miriam Orcutt Research associate, Institute for Global Health, University College London, Dr Tom Parks ST3 registrar in general medicine and infectious diseases, University College Hospital, London, Dr Erica Pool Academic clinical fellow (CT3) in HIV/genitourinary medicine, Brighton, Dr Helen Preston ST4 doctor in obstetrics and gynaecology, North West Deanery, Dr Carl Reynolds Specialist registrar in respiratory medicine, Imperial College Healthcare NHS Trust, London, Dr Jenny Riches ST2 doctor in obstetrics and gynaecology, North West Deanery, Dr Rafi Rogans-Watson Specialist registrar in geriatrics, London, Dr Partho Roy ST3 doctor in public health, Croydon, Dr Adam Sandell General practitioner, Cumbria, Dr Deepa Shah General Practitioner, London, Dr Catherine Sikorski ST3 doctor in paediatrics, London, Dr Vasundhara Verma GP trainee (ST2), Brighton, Dr Stephanie Wilmore Specialist registrar in microbiology, London, Dr Christopher Wood Consultant HIV physician, North Middlesex University hospital, London, John S Yudkin Emeritus professor of medicine, University College London

• The proposal detailed in your report adds “action to recoup treatment costs from overseas visitors” to an already expanding list of government “responses” to the current healthcare crisis. This now includes: sundry restructurings; experiments with private/public partnerships; periodic “efficiency” drives; reallocating existing limited funds between cash-strapped services; increasing calls upon the voluntary sector; and blaming health workers and managers for their ineffectiveness, patients for their lifestyles and obesity, and relatives for failing to observe their in-family care responsibilities. Indeed, it includes anything but the establishment of a properly weighted, fully progressive system of taxation that can alone provide the fundamental human and material resources needed to solve the problem, and expand much-needed services, jobs, incomes and purchasing power among the poor and needy in deprived areas.

As the vast majority of us have made clear our willingness to contribute appropriately to this, it is difficult to see how the government can avoid the obvious conclusion; except for the fact that it would (at last) involve people like themselves and their wealthy friends making a full and proper contribution to society’s needs. As things get increasingly desperate, either we increase public pressure to an extent necessary to force them to take effective action and give a true moral lead, or we replace them with people more morally and humanly inclined.
Bernard Cummings
London

• We can all see that the government’s proposal to make foreign nationals show proof of ability to pay before receiving NHS treatment is monstrous; but have they realised it is also misplaced? If the problem is that too many travellers to Britain fail to acquire adequate health insurance before departing, surely the fault is not with our hospitals but the airlines? If the carriers were to be made liable for the NHS costs for any uninsured passenger that boarded one of their planes, they would take steps to ensure no one flew to Britain without insurance; which would mean no proof of payment at the hospital entrance would be necessary and also that the problem would be addressed before rather than after the passenger fell ill. Problem solved.
Ian Mackillop
Ilminster, Somerset

• The harrowing case of Iris Sibley and her family, reported on your front page (Six-month hospital ordeal exposes crisis in social care, 6 February), highlights the complexities and confusion that exist in relation to the long-term care of vulnerable elderly people, which no doubt adds to any stress and strain experienced by those caught up in the system.

In this case it was the lack of appropriate healthcare sector resources, not of those in social care, that created the so-called bed-blocking scenario, given that Mrs Sibley was assessed initially as needing continuous professional healthcare in a nursing home rather than in a residential care home. Most nursing home care of this type, ie continous healthcare provision, is not subject to financial assessment, while residential – ie social – care is subject to means testing and financial contributions from residents. There are also a variety of in-between “hybrid” options, as reported in your story, that can create further uncertainty and distress at very difficult times in people’s lives.

The mantra from ministers for greater integration of health and social care continues to ring hollow when, in addition to the problem of massive under-funding, the two systems are funded and resourced, commissioned, provided and managed so differently. Until these issues are addressed in their totality, the cracks in the creaking systems will just get bigger, adding to the current lamentable situation. I see no evidence of any coherent strategy, let alone the political will from this government to tackle these fundamental structural problems – time now for a royal commission, maybe?
Colin Biggins
Dedham, Essex

• Few people deny that the NHS and social care are underfunded. As a Conservative MP has pointed out, recent increases in funding have been less generous than ministers claimed. In the recent autumn statement, the chancellor declined to allocate more money for the adequate provision of social care for frail or lonely people leaving hospital.

It is not well enough realised that a major loss of funds from the health service arose in 1991 when the then government resolved to manage it as though it were a market, with “providers”, eg hospitals, “selling” their services to “purchasers”, eg health authorities.

For the market to work, tenders, contracts, invoices and payments from one part of the service to another were necessary, causing huge increases in administrative costs. Before the market, these costs were about 5% of the NHS budget. By 1997 they had risen to 12% of the budget, and by 2010 to 14%.

With the market comes competition, which many politicians thought would improve performance. Complex medical care needs cooperation, not competition. With a commercialised market hospital, managers have to consider the hospital’s income from a treatment, as well as what treatment the patient needs.

Parliament is soon to debate the NHS reinstatement bill, one of whose aims is to get rid of the expensive competitive market. All voters should write to their MP urging support for this bill. This is not a political matter because all political parties in government have supported this market, though individual MPs have not. MPs may change their minds, and their votes, when they consider the evidence and the views of their constituents.
Dr Richard Gunstone
Rugby, Warwickshire

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Health tourism claims are a distraction from NHS’s real problems | Letters

Poland"s healthcare tourism clinics offer you half-value treatment method to the planet

The services would make any NHS manager envious. The medical doctors are experts with globe-class achievement charges. The costs are often half what you’d pay at property. Why, then, are a lot more of us not travelling to Poland to have routine health care treatments carried out?

For many many years expat Poles have been returning property to get costly dental perform, plastic surgical procedure and procedures this kind of as hip replacements carried out at 30% to 60% of the expense they would pay in their adopted country.

Now a Polish government-backed initiative is advertising medical tourism into the nation, targeting non-Poles from across the globe, especially people in Scandinavia, Germany, eastern Europe – and the United kingdom. These behind the plan hope Poland’s location at the heart of Europe – along with its plethora of reduced-cost flights, low-cost accommodation, and desirable tourist cities such as Krakow – will be enough to tip the more and more competitive battle for health-related tourism in Poland’s favour.

The EU directive that came into force final yr giving buyers the correct to use overall health services in other European countries will only more its bid to turn into the health care tourism centre of Europe, officials hope.

At the really swish Dentestetica dental clinic on the outskirts of Krakow, one particular of the owners, Dr Krzysztof Gonczowski, tells his multilingual staff that their mission is to “drill, fill, and bill”. He has designed a one-quit-store company model that other Polish clinics are increasingly adopting.

His clinic is packed with the extremely most current products that can make your correspondent’s Hertfordshire NHS dentist search like one thing out of the dark ages – products, says Gonczowski, that permits his workers to provide the most sophisticated procedures in a five-day window. Customers from abroad usually save £2,500, creating the £100 Ryanair flight seem like an incidental expense.

“We offer clientele the comprehensive package deal – we pick them up at the airport and they can stay in our apartments up coming to the clinic,” he says. “They can pay a visit to the beautiful city of Krakow although obtaining their treatment method done by staff, who are absolute professionals in their discipline. The therapy prepare is made to match fully close to the consumer.”

Implants that cost close to £2,500 in the United kingdom can be had at Dentestetica for under £1,000, while ceramic veneers are half the £600 United kingdom cost.

Maciej Szarek, a economic adviser who has lived in Edinburgh for 12 years, was going to last week and programs to return to the clinic later on in the year to have his problematic wisdom teeth eliminated: he expects to shell out half the Uk expense for the treatment, which will need the elimination of element of his jaw.

“My regional clinic in Edinburgh is fine for schedule work, and the personnel are wonderful, but you just have to seem at the facilities right here – it really is like yet another globe. And financially it makes every sense.”

At the occupied Carolina Healthcare Centre, a 3-hour train ride away in Warsaw, Adam Tarnawski displays off the clinic’s state-of-the-art MRI scanner, which has aided to make the centre – owned by Bupa – the go-to facility for the nation’s skilled athletes.

The site specialises in treating anterior cruciate ligament injuries, which have ended a lot of footballers’ careers, and carried out 266 knee surgeries and 60 hip replacement final year. It will normally deal with victims for close to a third of the UK’s private treatment price, but, in spite of that, Tarnawski is not keen to concentrate on the price tag.

“We are all about delivering the highest-top quality remedy, which also transpires to be at a decrease price,” he says. If you want the lowest costs you will usually uncover other clinics that will charge much less. Our aim is to give the best top quality – but with savings.”

Across Warsaw at the Swedish-owned Medicover centre – recently named Polish international hospital of the yr – the services are even a lot more plush, but there is curious absence of patients. The French managing director and other executives make a excellent perform of how they have started out benchmarking the 180-bed facility against the very best US hospitals, to “drive requirements to the highest level they can perhaps be”. Their reduced infection charges, they say, are tremendously assisted by the fact that hospital is under 5 years previous and was function-built to be straightforward to clean. So far most of their non-Polish clients have largely come from Norway and Sweden.

In accordance to Magdalena Rutkowska, who heads Poland’s medical tourism growth programme, which is 75% funded by EU cash, around 320,000 individuals visited the country for treatment in 2012 – of which 42% came for plastic surgery, notably breast implants. A third came to use dentists, even though 9% came for obesity-connected therapies this kind of as gastric bands, which in Poland usually price forty% of the €10,000 EU regular.

“We realize that people have outdated pictures of Polish health-related amenities but we are here to say we now have world-class facilities,” she says.

“It amazes me that folks can be asked to shell out $ one hundred,000 for heart bypass surgical treatment in the US, but they can fly nine hours to us, they can have as good or far better remedy, and pay out just $ 15,000.”

She says success charges at Poland’s Bocian IVF clinic are 10% greater than rivals in Spain, Germany and in the Uk. IVF, which can be ruinously costly in Britain, expenses between €2,000 and €3,000 per cycle – all around a third of the value of the less costly Uk suppliers.

Across the country clinics are becoming developed, even though Rutkowska admits that locating clientele will be tough as nations all around the world vie to grab healthcare tourism bucks. Turkey is moving quickly into this arena, and there is previously competition from India, Thailand, Malaysia and Lithuania. As a end result her subsequent target is Uk health-related insurance firms, which have so far been reluctant to get involved. In July she is foremost a trade mission to London in a bid to persuade insurers to supply Poland as a location.

The writer travelled as a guest of Polandmedical tourism.com

Poland"s healthcare tourism clinics offer you half-value treatment method to the planet

Will Belgium"s Legalized Child Euthanasia Set off Death Tourism?

Starting this week, Belgium gets the 1st country in the world to lift all age restrictions on euthanasia – which presently has been legal there for twelve many years.

The controversial law took impact soon after King Philippe signed it on Sunday. Even though widely opposed by religious groups throughout Europe, it was supported by a powerful vast majority of Belgians regardless of the truth that the nation is predominantly Roman Catholic.

The bill, which was passed in parliament by an overpowering vast majority last month, allows for terminally and incurably sick young children to request euthanasia if they are near death, and struggling “constant and unbearable physical” ache with no accessible treatment. Parental consent, as nicely as the agreement of medical professionals and psychiatrists, is needed.

Despite the fact that no age limits are set, the law says that the little one should show “a capability of discernment and be conscious at the moment of the request,” and psychologists should test them to confirm they understand the gravity of the circumstance and what they are carrying out.

Related legislation exists in the Netherlands, though only for young children above the age of 12.

Opponents of the contested legislation, which includes religious leaders from distinct denominations, a quantity of medical organizations and politicians mostly from conservative events, fret that the new legislation will contribute to the  trivialization of euthanasia and will take the country down a perilous ethical path.

Physicians opposing the law argued that contemporary medicine can alleviate the struggling of terminally unwell individuals.

The Belgian Catholic Church has described the law as a “step also far,” and various organizations of European Catholics had petitioned the king to veto the bill. A conservative Spanish lobby delivered a petition final month with far more than 200,000 signatures mainly gathered from other countries.

“We are saddened and fearful for the long term soon after this law to lengthen euthanasia to children with no any age limit,” explained the Catholic bishops’ conference, in accordance to the Catholic Information Support. “We completely uphold the rights of the little one, of which enjoy and respect are the most essential. But the right of the little one to demand his own death is a stage too far. It transgresses the prohibition of killing, which is the foundation of our human society.”

Speculation on whether Belgium will become a new location for what is known as “death tourism” has also been raised by representatives of political events opposed to lifting age restrictions for medically assisted deaths.

They argue that as cultural distinctions and moral motives avert most other nations from legalizing euthanasia, people will travel to nations that let the practice. They be concerned that Belgium has opened its doors to death-in search of site visitors.

Switzerland is acknowledged for the quantity of foreigners who travel there to finish their lives, mostly at the pro-euthanasia nonprofit organization Dignitas. The vast majority are British, German and French.

Belgian legislators counter that the strict guidelines of the new law will not allow that variety of tourism.

The process is extended and complicated and “can take weeks or months,” Gerlant van Berlaer, a pediatric essential care expert at University Hospital Brussels told the British day-to-day The Guardian.

The request for euthanasia have to very first be produced in writing and the decision to proceed with each proposal have to be agreed by a treating physician and confirmed by a 2nd opinion from an outside peidatrician. The little one have to be interviewed by a pediatric psychiatrist or psychologist to figure out “the capability of discernment,” which then must be certified in writing.

The child’s physician must meet the parents or legal representatives to inform them of the outcome of the consultation and make sure their agreement with the choice, which also have to be written.

Official reports indicate that there are 1,400 cases of euthanasia in Belgium per 12 months.

Will Belgium"s Legalized Child Euthanasia Set off Death Tourism?

China"s Outbound Tourism 2014: The Young And The Old Joining The Middle Aged Abroad

In the autumn of 1989 I identified myself for a amount of complicated reasons organising the first ever German festival of Maltese literature (yes, beside falcons they also have literature on that minor island in the Mediterranean Sea) in West-Berlin. With my six guests I also ventured for a day-trip to East Berlin, where they were “flabbergasted” to comprehend that from the platform of the tower of the French Cathedral they could in fact see the creating in West-Berlin exactly where our festival was taking place, but that the East German citizens standing following following to us would be shot if they attempted to reach it. I, getting grown up with the Berlin Wall cutting my kin into two halves on the two sides of it, even so assured them that this was a properly standard, if unfortunate, predicament which was not about to alter anytime soon. So there was little need for me to be reminded by the popular guide by N.N. Taleb that a “Black Swan”, an unforeseen and unprecedented event, can occur at any time and that stability in the past does not ensure stability in the future. Nevertheless, assuming that the new 12 months in China will be the Year of the Horse, not the 12 months of the Black Swan, we can forecast that nearly all developments described in my last website about China outbound tourism trends in 2013 will continue in 2014.

China will nonetheless be the biggest supply industry for worldwide tourism, very easily surpassing 110 million border crossings, even more supported by the Chinese government exploiting the Soft Energy policy possibilities coming with it. The push variables pollution and overcrowding will continue to motivate Chinese tourists to make the switch from domestic to outbound traveller, even however it is to be hoped that pollution levels will not continue to rise as substantially as in 2013.

The wish of Mr. Huang Ping, director-basic of the Department of Consular Affairs in the Chinese Foreign Ministry, that a lot more countries must signal bilateral visa-free agreements with China, as reported in the January 2014 concern of the COTRI magazine China Outbound Marketplace Intelligence, will almost certainly turn into fulfilled as countries hasten to steer clear of dropping out in the battle for the affluent Chinese guests.

A lot more self-organised travellers will flip up in new areas all above the world from Denver to Turku to Dunedin and the large cash will join the enjoyable each in type of Chinese and global investment aiming at the Chinese outbound market.

Additionally some additional developments need to be pointed out, which are largely linked to the “Long tail” of the Chinese outbound industry. Next to the nonetheless prevalent bundle excursions providing second and third tier city dwellers their first taste of global travel, the officials spending discreet but heavily and the smartphone-wielding (each and every third smartphone in the planet is supposed to be offered in China in 2014) self-organised travellers uploading their minute-by-minute visual report of their trip, niche markets will grow. Is there a want to remind you, dear reader, that every thing is large in China, so niche markets can even now suggest hundred 1000′s of customers? Almost certainly not.

Going on an international ocean cruise will be among these developing niches, as will equipment-based mostly outside pursuits like skiing or diving. Less evident pursuits will have to be extra to this listing, which will probably be triggered by a celebrity, praising on WeChat or Sina Weibo the coolness of walking along beaches in the snow or staying on a houseboat or visiting small workshops making steampunk couture.

Another massive trend for 2014 will be the widening of the age band of Chinese outbound travellers. International travel currently being much less and much less perceived by frequent travellers as unique or dangerous, far more kids can be expected to join their dad and mom or travel in youth travel groups with their classmates or pals. At the other end welcome the Chinese affluent pensioners, a group just beginning to come into existence. Most of them will be still rather in the age group fifty five-65 than over and almost certainly even now be involved in a bit of genuine estate trading and stock markets, but not like the vast majority of middle-aged affluent travellers they are not “time-poor” and can afford to go on journeys which are significantly less frantic, last numerous weeks and are significantly less driven by the question what the other individuals will believe about my trip.  

So if you encounter this year Chinese vacationers at sudden areas performing surprising things – or asking you for the following steampunk couture store – don’t fear, it is all completely typical. Hopefully you can even earn some money from it.

China"s Outbound Tourism 2014: The Young And The Old Joining The Middle Aged Abroad