The Hidden Cost of Medical Tourism

Without proper regulation or oversight, medical tourism can end up costing the public, rather than being a source of income for hospitals.

Israel’s booming but shadowy medical tourism industry has started raising the attention of regulators, including the Israel Tax Authority and the Health Ministry, who are looking into claims that top doctors demanded sums beyond what the hospital officially charges medical tourists.

But the lack of regulation in the industry also affects the patients themselves. The story of Eva [not her real name], a cancer patient from Nigeria, is one example of how things can go wrong.

Eva, 42, has been hospitalized for almost a month in the internal medicine department at Bnei Zion Medical Center, Haifa, in serious condition. Eva ended up at the hospital without advance coordination, and the hospital had no idea how serious her condition was when she arrived.

Yet Eva is not receiving the operation she thought she’d come for, as doctors there determined that her condition was too serious, and the money the family raised isn’t enough for her treatment.

Her daughter, Maria, says her mother – who was hospitalized in Nigeria last October – hired a medical tourism company from Haifa via a relative who's an orthopedic surgeon.

“The goal was to carry out a laparoscopic operation, which practically doesn’t exist in Nigeria. They do only open surgery [in Nigeria], and there’s only one hospital that carries out laparoscopic operations, and it’s very expensive,” explains Maria.

The family sent CT scans and MRI test results to the company in Haifa, and was told that the treatment would cost $17,000. “We pulled together money from friends and family, and barely made that sum. We were already in tough financial straits after the months of hospitalization,” says Maria.

Eva came to Israel accompanied by her daughter and her surgeon relative, and was sent to the Bnei Zion emergency room. “She arrived with no coordination with us from the medical tourism company, and without receiving our approval in writing in advance,” said a senior official at the hospital. “An informal inquiry might have been conducted for her, but we always make sure an agreement is in place – in order to protect ourselves from complications – and we receive a formal opinion regarding treatment before approving. This is the first time a patient arrived via the emergency room without advance coordination.”

As soon as Eva was admitted, it was clear she was in serious condition.

“She was very sick,” says the official. Eva had CT scans and two biopsies, which determined that she had a cancerous growth large enough to make a stomach operation too complicated. Doctors considered sending her to Rambam Medical Center (also in Haifa) for the operation, but she was too sick to be moved.

So Eva stayed hospitalized in Bnei Zion, and the family’s money soon started to dry up.

“We paid $14,000 for the tests and the hospitalization, and we realized our money wouldn’t be enough," says Maria. "The company demanded we pay $21,500, but we don’t have any more money.”

In the meantime, Maria checked out of the hotel where she was staying and is now sleeping next to her mother in the hospital.

“We found out that the hospital doesn’t even do these kinds of [laparoscopic] operations, and then we were told that the growth was very big and couldn’t be operated on. So why did we come to Israel?” asks Maria rhetorically.

Ultimately, the hospital came to a compromise with Eva’s agent, under which the company would bear the cost of Eva’s hospitalization.

Yet such cases demonstrate how medical tourism, when conducted without proper regulation or oversight, could actually pose a burden on public funds and the health system, instead of being a source of money for the hospitals.

The Health Ministry, which both owns and oversees Bnei Zion, was shocked to hear about the case. “This case is almost certainly not the only one of its kind, and this could even be a phenomenon that expands if we don’t hold the medical tourism companies responsible,” said Health Ministry director general Ronni Gamzu.

Asked whether the hospitals are protected in any way against medical tourism patients showing up without coordination and without proper funds, Gamzu noted that hospitals are required by law to treat patients regardless of their means.

The Health Ministry is looking into the option of suing medical tourism companies for damages, he added.

In response, the CEO of the medical tourism company stated that a doctor had prepared a report on behalf of Eva, and that it had been reviewed by two experts. The company had recommended that she undergo some tests and possibly surgery at a private hospital, not at Bnei Zion.

Eva ended up at Bnei Zion's emergency room at the request of the doctor accompanying her because she showed signs of dehydration following the flight to Israel, said the CEO.

He noted that Eva is still receiving medical treatment, even though she isn’t paying for it.

Hagai Frid