When cosmetic surgery abroad goes wrong… Who pays?

What happens when cosmetic surgery from overseas goes wrong.

Today’s “You and Yours” programme on BBC Radio 4 highlighted the continuing problem of handling complications that arise when a medical tourist returns to their home country. (You can listen to the interviews with a surgeon and a patient at 32 minutes into the programme.)

The programme featured a plastic surgeon at London’s Royal Free NHS Hospital who has collected data on British patients who have travelled abroad for cosmetic surgery. Over 2 years, he identified 21 patients who were treated under the NHS at one hospital – the Royal Free, for complications that had arisen from cosmetic surgery abroad.

When a UK medical tourist returns home after surgery abroad and complications arise, things are not straightforward:

• The clinic abroad may say… “Sorry, you’re back home, it’s not our problem, go to your local doctor.”
• The clinic abroad may say… “Fly back and we’’ll fix the problem for free”. The patient understandably does not want to do this.
• If there’s an agency or facilitator involved, they may offer help and to pay for it, but I can’t say I’ve heard of many (if any) instances where this is the case.

So, what happens? The patient ends up going to the Accident and Emergency department at their local NHS hospital, and the NHS inherits the problem. In the recent study, the Royal Free monitored the cost of correcting the issues that had arisen for surgery abroad. A total of over £300,000… an average of £13,500 per patient.

The BBC programme also features a patient interview – a woman from Brighton who went to Turkey for a tummy tuck. She saved up for four years to pay the £3,800 for the operation abroad; she had been quoted three times as much to have the surgery in the UK. On her return to the UK, complications arose, and things went from bad to worse. The Turkish clinic offered to put things right for free but the patient was told she would have to pay for flights and accommodation herself. Who picked up the bill? The NHS.

How do we fix the problem?

Whether cosmetic surgery takes place in the UK or in a foreign country, complications can arise. Hematoma and post-operative infection may give rise to complications in around 1% of breast augmentation patients (Plast Reconstr Surg. 2009 Dec;124(6):2127-33). So, for every 100 cosmetic surgery tourists, we might expect one patient to have complications that require further treatment. It’s the handling of this 1% that wrecks the reputation of the medical tourism sector, damaging the business of both the good and the not so good providers. Cosmetic surgery abroad has a poor reputation in the UK media… “cosmetic surgery gone wrong” stories frequently appear in the UK press and on TV programmes such as “Botched Up Bodies”. We rarely hear about patients who have surgery that goes well, without complications, whether treated in the UK or abroad.

So, what can we do? Here are some thoughts.

Remedy 1… take responsibility

Hospitals and clinics abroad need to take full responsibility for the post treatment care of the patient…. that means providing support for patients in their home country, rather than telephone or email support from abroad. Patients are not willing to fly back to the clinic to get the problem resolved. So, the overseas clinic either establishes a local support operation or finds a partner -a surgeon or clinic – in the patient’s home country that will deal with any issues that arise, AND fully funds the cost of this.

Remedy 2… compulsory insurance

Make insurance for medical and surgical complications compulsory. Despite several attempts by insurers to introduce specific policies aimed at medical tourism, the idea of insurance for medical tourism still hasn’t really taken off. Patients may be unaware that it exists. Patients may be unwilling to pay extra for insurance when their prime driver is saving money. And agencies, facilitators, hospitals and clinics seem reluctant to encourage purchase, perhaps because it will increase the price.

Remedy 3… get it right, be transparent!

The criticism of overseas clinics by representatives of British Association of Aesthetic Surgeons (BAAPS) is twofold:

1. Surgeons and clinics abroad avoid their responsibility for aftercare.
2. Some surgeons and clinics abroad just aren’t good enough. As the Royal Free surgeon states in the interview,

“As long as the clinics abroad are well regulated and match the high standards that apply in the UK”…. it’s up to the patient to make the choice. It’s their decision.
Of course, the challenge for the patient is working out which surgeons, hospitals and clinics they can trust. How many surgeons, hospitals and clinics involved in cosmetic surgery tourism publish outcome data, infection rates and complication rates? Take a look at a few web sites of those operating in the sector. You will find plenty of before and after pictures… but you will struggle to find anything that says… “we did this many of this operation last year, and in n% of cases there were complications” and… “when there are complications, this is how we will ensure that things are put right.”

Until the agencies, facilitators and providers in the cosmetic surgery tourism business get it right, the industry will continue to be blighted by horror stories. You can’t expect a market to grow when the product has some fundamental flaws.