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The Economic Impact of Medical Tourism on the United States Health Care System
Kian Adabi, BA, Carrie S. Stern, MD, Katie E. Weichman, MD, Evan S. Garfein, MD, Oren M. Tepper, MD.
Montefiore Medical Center/Albert Einstein College of Medicne, Bronx, NY, USA.
Purpose: Every year, 15 million US patients seek medical care abroad, representing a 370 million dollar cost for US clinicians. There is almost no data on outcomes, follow up, and complication rates of these procedures. The purpose of this study is to identify, evaluate, and survey patients presenting with complications from aesthetic procedures abroad and to estimate the cost of complications to our health care system.
Methods: A single center retrospective review was conducted using Clinical Looking Glass, a software application that minds medical records. A cohort of patients presenting with complications from aesthetic procedures performed abroad was generated. Patient demographics, surgical complications and cost data were compiled. Financial payments to the hospital were reviewed and cost analysis was based on billing codes using Clinegrity. Patients were surveyed to assess their overall experience.
Results: Over a 24-months, 32 patients met inclusion criteria (1M, 31F), with an average age of 35 (range 20-60; SD = 11.4). Comorbities included 4 current smokers, 2 patients with hypertension, and 1 with diabetes. Average BMI was 29 (range 22-38, SD = 4.4). Procedures included abdominoplasty (n= 21), liposuction (n=14), buttock augmentation (n= 10), and breast augmentation (n=6), with several patients having combined procedures. Patients presented with complications an average of 4.2 weeks after their procedure (range 0.9 – 12.9; SD = 3.1). Twenty-one patients presented with infections, 6 had an abscess, and 5 presented with wound dehiscence. Four of the nine patients who were surveyed were not pleased with their results and 5 would not go abroad again for subsequent procedures. The average cost of treating the complications was $18,211 with an estimated total cost to the US health care system of 1.33 billion dollars. The main payer group was Medicaid.
Conclusions: Complications from patients seeking aesthetic procedures abroad will increase as medical tourism continues to grow. We believe patients interested in cosmetic surgery should be encouraged to have cosmetic surgery in the US to improve patient outcomes and satisfaction while at the same time economically advantageous to both the patient and plastic surgeons. Further studies are needed to determine if complication rates are truly higher compared to the US. In addition, we feel continuity of care is important and medical tourism in general does not allow for this.
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