1. Dr Tim Papadopoulos
Plastic & Cosmetic Surgeon
President ASAPS
MEDICAL TOURISM SUMMIT
20-21 November 2014, Melbourne
DOES
MEDICAL TOURISM
TRIVIALISE
PLASTIC SURGERY?

2. Dr Tim Papadopoulos
Plastic & Cosmetic Surgeon
President ASAPS
MEDICAL TOURISM SUMMIT
20-21 November 2014, Melbourne
DOES
MEDICAL TOURISM
TRIVIALISE
PLASTIC SURGERY?
COSMETIC

3. HELL YEAH!

4. Medical tourism is complex…

5. and confusing.

6. DJKSLNZJSSSJKEOEADNFHR
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LE9SN3395B5I5B5IDRURBRU
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There are a lot of
senseless data.

7. It’s cross border. It’s regional. Rarely global.

8. 15,000 AUSTRALIANS PER YEARTRAVEL ABROAD FOR COSMETIC SURGERY
Meredith Jones UTS 2013

9. YEAH, THAT’S A
$300 MILLION INDUSTRY!
Meredith Jones UTS 2013
15,000 AUSTRALIANS PER YEARTRAVEL ABROAD FOR COSMETIC SURGERY

10. YEAH, THAT’S A
$300 MILLION INDUSTRY!
Meredith Jones UTS 2013
15,000 AUSTRALIANS PER YEARTRAVEL ABROAD FOR COSMETIC SURGERY
$6-20K
per patient

11. and yes its a headache
for us back home.

12. and yes its a headache
for us back home.
Seriously!

13. Is it the health-care
providers (me) that
are the problem?

14. or is it our health-care
system that sucks?

15. Need to learn the ‘good, the bad and ugly’
from the medical tourism industry…

16. and its social, economic and
political impact on society.

17. 1.
Why is this
happening
& what can we
do about it…

18. QUESTIONS
WE NEED
TO ASK
OURSELVES
7

19. WHY
TRAVEL
ABROAD?
1

20. It’s not only about cost.

21. It’s not only about cost.
It’s about access,
quality, service and…

22. for the diaspora or ‘expats’
it’s familiarity.

23. Yes, there are other reasons too…

24. Yes, there are other reasons too…
Lower transport costs, trade liberalisation,
reduced language barriers etc. etc. etc.

25. WHO
TRAVELS?
2

26. Medical tourism suggests
pleasure and relaxation…

27. DR FOAD NAHAI
PAST PRESIDENT ISAPS
“MEDICALPROCEDURESABROAD”

28. Erik Cohen 2008
TYPES OF MEDICAL TOURISTS

29. MEDICATED
TOURIST
Erik Cohen 2008

30. MEDICATED
TOURIST
MEDICAL
TOURIST
PROPER
E Cohen 2008

31. MEDICATED
TOURIST
MEDICAL
TOURIST
PROPER
VACATIONING
PATIENT
E Cohen 2008

32. MEDICATED
TOURIST
MEDICAL
TOURIST
PROPER
VACATIONING
PATIENT
MERE
PATIENT
E Cohen 2008

33. MEDICATED
TOURIST
MEDICAL
TOURIST
PROPER
VACATIONING
PATIENT
MERE
PATIENT
DIASPORA
OR ‘EXPAT’
TOURIST
E Cohen 2008

34. MEDICATED
TOURIST
MEDICAL
TOURIST
PROPER
VACATIONING
PATIENT
MERE
PATIENT
DIASPORA
OR ‘EXPAT’
TOURIST
E Cohen 2008
MAJORITY OF
MEDICAL TOURISTS

35. WHICH
DESTINATIONS?
3

36. No systematic collection of data to indicate the global size of
the market, and estimations are wide and varied.

37. No country has a monopoly on the ‘best
health-care providers’ and ‘top medical
facilities’ in the world.

38. PHILIPPINESTHAILAND
MALAYSIA
SINGAPORE
STH KOREA
INDIA
OUTBOUND MEDICAL
TOURISTS 2011
Deloitte Access Economics 2011

39. PHILIPPINESTHAILAND
MALAYSIA
SINGAPORE
STH KOREA
INDIA
OUTBOUND MEDICAL
TOURISTS 2011
Deloitte Access Economics 2011

40. REASONS
FOR
COSMETIC
SURGERY?
4

41. MAINLY 4…

42. 1. CORRECT
Nature “missed a beat”

43. 1. CORRECT
Nature “missed a beat”
2. REPAIR
Nature “took a toll”

44. 1. CORRECT
Nature “missed a beat”
2. REPAIR
Nature “took a toll”
3. ENHANCE
Nature “didn’t match desires”

45. 1. CORRECT
Nature “missed a beat”
2. REPAIR
Nature “took a toll”
3. ENHANCE
Nature “didn’t match desires”
4. INVESTMENT
Career & relationships

46. 6
ANY
REGULATIONS?

47. Government agencies can only
regulate businesses in own country.

48. Medical tourism companies subject
to little oversight.

49. Medical tourism companies subject
to little oversight.
Not obliged to undergo accreditation.

50. ‘REGULATORY
VACUUM’

51. They must conform to legal standards.

52. SOME STANDARDS
FOR CONSIDERATION
Leigh G Turner UM 2011

53. 1. Accreditation review.
Leigh G Turner UM 2011

54. 1. Accreditation review.
2. International accreditation of
destination facilities.
Leigh G Turner UM 2011

55. 1. Accreditation review.
2. International accreditation of
destination facilities.
3. Informed patient consent.
Leigh G Turner UM 2011

56. 1. Accreditation review.
2. International accreditation of
destination facilities.
3. Informed patient consent.
4. Continuity of care.
Leigh G Turner UM 2011

57. 1. Accreditation review MTC.
2. International accreditation of
destination facilities.
3. Informed patient consent.
4. Continuity of care.
5. Addressing waiver of liability
forms.
Leigh G Turner UM 2011

58. 1. Accreditation review MTC.
2. International accreditation of
destination facilities.
3. Informed patient consent.
4. Continuity of care.
5. Addressing waiver of liability
forms.
6. Privacy and confidentiality of
patient information.Leigh G Turner UM 2011

59. WAIT, THERE’S MORE!

60. 7. Professional standard of care
and health services eligible
for marketing.
Leigh G Turner UM 2011

61. 7. Professional standard of care
and health services eligible
for marketing.
8. Training and certification.
Leigh G Turner UM 2011

62. 7. Professional standard of care
and health services eligible
for marketing.
8. Training and certification.
9. Medical travel and
complications insurance.
Leigh G Turner UM 2011

63. 7. Professional standard of care
and health services eligible
for marketing.
8. Training and certification.
9. Medical travel and
complications insurance.
10.Contribution to compensation
funds.
Leigh G Turner UM 2011

64. 7
WHAT ABOUT
COMMERCIALISED
MEDICINE?

65. ‘PANDORA’S BOX’

66. ‘EARLY TO BED,
EARLY TO RISE,
WORK LIKE HELL
AND ADVERTISE’
B J Palmer Selling Yourself 1926

67. Commercialisation of cosmetic surgery
threatens our efforts to convince the public
that medicine is not a commodity or a trade.

68. Advertising and PR boost demand for cosmetic surgery.
Appeals to dominant cultural values of youth, beauty,
sexuality, status, happiness and control.
Exploit’s people’s anxieties and fantasies. It personalises
the problem of perceived appearance imperfections.

69. It emphasises positive outcomes and
downplays the pain and risks of medical
intervention.

70. Claims of expertise, ease, safety and desirable outcomes
are occasionally exaggerated to the point of
misrepresentation to increase sales.
Sometimes prospective patients are persuaded to expand
their perception of their appearance problems…

71. This raises ethical questions about the exploitation of
vulnerable patients by those who have the fiduciary
responsibility to act in patient’s best interests.
Sometimes they are pressured to commit to surgery by
offers of discounts for an immediate decision or for
multiple procedures.

72. PROBLEMS WITH COMMERCIAL,
FREE-MARKET DELIVERY SYSTEM.
1. Deregulation of marketing has made cosmetic surgery a
lucrative business, dependent on marketing.
2. Minimal state regulation of surgery in private office
facilities.
3. Lax oversight of individual doctors’ practices by their own
licensure boards.

73. It leads to certain challenges…

74. SERVICE ETHIC
CHALLENGED

75. Unlike a commercial trade, medicine
has a service ethic that prohibits the
exploitation of patients for profit.

76. Unlike a commercial trade, medicine
has a service ethic that prohibits the
exploitation of patients for profit.
The foundation of trust
characterises a good patient-
doctor relationship.

77. AUTHORITY
CHALLENGED

78. Media give a public voice to patients who question
their personal doctor’s competence and ethics.

79. AUTONOMY
CHALLENGED

80. Doctors’ autonomy rests on their
experience and their fiduciary
relationship with patients, a
relationship that is strained by the
emphasis on profit that is inherent in
commercialism.

81. ‘Knowing when to stop in
surgery is a hard lesson to
learn. Knowing when to
begin may be even
harder.’

82. 2.
Addressing
some risks

83. Patient Safety

84. Patient Safety
Patients are more savvy.
Providers paid for selling services &
procedures, not necessarily improve health.
Facilitators promote these services.

86. Should problems arise, there may be few
if any legal remedies to address them.

87. Threat to Public
Health Systems

88. Cosmetic surgery holidays revealed
a shocking 16.5% complication rate
with nearly 1 in 10 (9%) patients
needing assistance from the NHS
when arriving home.
Study Leeds University 2013

89. Public health system stretched even further.

90. Price increase in both
public & private sectors.

91. Cross-Border
Spread of Diseases

92. Singapore’s 1st case of drug resistant
TB (XDR-TB) arrived from Indonesia.
Ebola alert in Queensland with several patients quarantined
after arriving from West Africa with fever.

93. CRICKEY!

94. 3.
Story of medical
tourism…

95. VICTIM

96. Patient

97. Patient
Sold hope for happiness.
Poor outcomes downplayed.
Little recourse if something
goes wrong.

98. Doctor
Opposed deregulated restrictions
on marketing professional services.
Most practice responsibly.
Few corrupted by profits from
commercialised medicine.

99. VILLAIN

100. Appearance

101. Appearance
Stereotypic expectations
& different treatment.
Diminish less attractive people’s
opportunities & contribution to society.
It’s a lose-lose outcome

102. Commercialisation
of medicine

103. To understand what makes commercialism
in medicine problematic…

104. Commercialism is an ‘excessive emphasis
on profit’ and ‘exploit for profit.’
Synonymous with ‘average or inferior
quality’ and refers to something that is
‘designed for a large market’ and
‘supported by advertisers.’
Webster’s Dictionary

105. Advertising can be used to create a
perception of ‘need’ that can be
exploited for profit.

106. ‘CAVEAT EMPTOR’
(BUYER BEWARE)

107. LET’S RECAP…

108. MEDICAL
TOURISM IS
EVOLVING
BUT
SCARY!

109. We can’t afford to be
naive about things
anymore.

110. Commercialisation of cosmetic surgery threatens our
efforts to convince the public that medicine is not a
commodity or a trade.
but a few doctors have
exposed themselves…
as profit driven.

111. We’re not the
only ones.

112. We’re not the
only ones.
Governments and medical
tourism companies have a
lot to answer for…

113. Whilst medical tourism provides
revenue source for national economies,
it may disrupt domestic public health
systems by redirecting scarce resources
to the private sector.

114. Globally there’s promise of exchange
opportunities and resources but also
perhaps the dissemination of problems
most notably infectious diseases.

115. Inadequate oversight and regulation
of this medical tourism industry makes
it more difficult to identify and address
such problems. Documentation of
medical travel is haphazard and
fragmentary.

116. Need to fight back and
deliver a bigger punch.

117. Need to figure a way we can compete in
this ‘global health bazaar.’

118. INBOUND MEDICAL
TOURISTS 2011
?
?
?
?
?
12,800
Deloitte Access Economics 2011
0.23% of all tourists to Australia
(0.001% medical tourists worldwide)

119. INBOUND MEDICAL
TOURISTS 2011
?
?
?
?
?
12,800
Deloitte Access Economics 2011
0.23% of all tourists to Australia
(0.001% medical tourists worldwide)
14%annual growth rate
2005-2010

120. INBOUND MEDICAL
TOURISTS 2011
?
?
?
?
?
12,800
Deloitte Access Economics 2011
0.23% of all tourists to Australia
(0.001% medical tourists worldwide)
14%annual growth rate
2005-2010$4K per patient
& stay 2 weeks (mainly East coast)

121. Specialise in body contouring
following bariatric surgery and
corrective plastic surgery after
complications arising from
procedures abroad.

122. We can’t compete on
price.
We need government
support.
Our quality of healthcare
is world class.
Deloitte Access Economics 2011
SCORECARD COMPARISON

123. We need to renew and reinvigorate our
campaign both here and abroad.
How and why Australia is a destination country
of choice for quality cosmetic surgery.

124. We should try and make Australia both
a departure and destination point for
medical travellers.

125. Spread the word now…

126. GO ON!!!

127. But remember…

128. the problems arising abroad from
medical tourism can equally apply here
in Australia. Be careful what you ask for!

129. the problems arising abroad from
medical tourism can equally apply here
in Australia. Be careful what you ask for!
After all…

130. We all just want smiling, happy patients!

131. Please share this presentation.
Together we can improve medical tourism
globally.
Dr Tim Papadopoulos
twitter.com/readDrTim
linkedin.com/in/drtimpapadopoulos
facebook.com/DrTimCosmeticPlasticSurgeon
THANK
YOU.
Inspired by Jesse Desjardins