title: Medical tourism and bariatric surgery: who pays?
abstract: BACKGROUND
  The objective of this study was to determine the short-term cost impact that medical tourism for bariatric surgery has on a public healthcare system. Due to long wait times for bariatric surgery services, Canadians are venturing to private clinics in other provinces/countries. Postoperative care in this population not only burdens the provincial health system with intervention costs required for complicated patients, but may also impact resources allotted to patients in the public clinic.
  
  
  METHODS
  A chart review was performed from January 2009 to June 2013, which identified 62 medical tourists requiring costly interventions related to bariatric surgery. Secondarily, a survey was conducted to estimate the frequency of bariatric medical tourists presenting to general surgeons in Alberta, necessary interventions, and associated costs. A threshold analysis was used to compare costs of medical tourism to those from our institution.
  
  
  RESULTS
  A conservative cost estimate of $1.8 million CAD was calculated for all interventions in 62 medical tourists. The survey established that 25 Albertan general surgeons consulted 59 medical tourists per year: a cost of approximately $1 million CAD. Medical tourism was calculated to require a complication rate ≤ 28% (average intervention cost of $37,000 per patient) to equate the cost of locally conducted surgery: a rate less than the current supported evidence. Conducting 250 primary bariatric surgeries in Alberta is approximately $1.9 million less than the modeled cost of treating 250 medical tourists returning to Alberta.
  
  
  CONCLUSIONS
  Medical tourism has a substantial impact on healthcare costs in Alberta. When compared to bariatric medical tourists, the complication rate for locally conducted surgery is less, and the cost of managing the complications is also much less. Therefore, we conclude that it is a better use of resources to conduct bariatric surgery for Albertan residents in Alberta than to fund patients to seek surgery out of province/country.
authors: Faculty of Medicine & Dentistry, Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada.
authors: Caroline E
authors: CE
authors: Sheppard
authors: Erica L W
authors: EL
authors: Lester
authors: Anderson W
authors: AW
authors: Chuck
authors: David H
authors: DH
authors: Kim
authors: Shahzeer
authors: S
authors: Karmali
authors: Christopher J
authors: CJ
authors: de Gara
authors: Daniel W
authors: DW
authors: Birch
mesh_terms: D000416:Alberta; D050110:Bariatric Surgery / Q000191:economics*; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D057193:Medical Tourism / Q000191:economics*; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D011182:Postoperative Care / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics* / Q000628:therapy; D011300:Preoperative Care / Q000191:economics; D012189:Retrospective Studies