ITIC Global 2024 | Travel for treatment – when cosmetic surgery becomes problematic

The ITIJ team have been reporting live from ITIC Global in Vienna this week (November 2024) sharing the discussions that took place at the conference. Read all reports

Andrew Ziardis, Head of Consular Prevention and Engagement, Foreign, Commonwealth & Development Office (FCDO)

Andrew Ziardis from the UK’s foreign office began his session by considering medical tourism, specifically travelling for cosmetic surgery, in a global context.

The industry is worth US$100 billion globally, which is forecast to increase by 25% in the next 10 years, Ziardis said. The Office for National Statistics (ONS) estimates that 430,000 UK residents travelled abroad for medical treatment in 2022, an increase of over 100,000 compared with both 2019 and 2021, he added.

According to Ziardis, patients typically seek different types of treatment in domestic private settings from those they travel for. He said the main types of treatment that people are seeking overseas are not all routinely available on the NHS.

Ziardis shared research commissioned by the FCDO into British citizens seeking to have gastric surgery overseas to understand why people travel overseas for weight loss surgery. According to the research, these travellers are usually women aged 20 to 50 years old who have tried to lose weight for many years. He pointed out that people travelling for weight loss surgery are often desperate and vulnerable, and therefore highly motivated to go through with the surgery. They are often influenced by slick campaigns with sometimes questionable marketing tactics, Ziardis said, blocking out negative information about the risks and seeking instead reaffirmation of their decision.

One member of the audience touched on the issue of full disclosure to the patient in advertising, noting that many companies withhold certain aspects of research when running marketing campaigns to boost the appeal of their services.

Ziardis said that the FCDO aims to tackle this issue by strengthening communication with the British public, working with host governments and the UK Advertising Standards Authority.

Ziardis concluded his presentation by saying that allowing individuals to travel for treatment could help alleviate NHS waiting lists for certain elective procedures. It also provides dentistry access for those who may not be able to afford private treatments in the UK, he added.

Vered Lobel, CEO, OneBefore

Lobel started her presentation with an overview of the medical tourism market. Between 150,000 and 250,000 UK residents travel overseas annually for treatments such as cosmetic surgery, fertility services and dental procedures, she said.

This number continues to increase due to restricted access to certain procedures on the NHS, a desire for privacy, the perception of better-quality care abroad, lower costs and NHS waiting lists, Lobel explained.

The most popular destinations for medical tourism are Turkey, India, Hungary and Spain, she added.

Alongside the usual trip concerns, Lobel stressed the importance of selecting cover that includes complications. She emphasised that most travel insurance policies do not provide any cover if the insured is travelling for a medical procedure, and recommended individuals consult medical tourism specialists or speak directly to providers, asking them to fully disclosing planned treatments. In terms of pricing and underwriting, according to Lobel, baggage and personal possessions risk should not be any higher than for non-medical related travel. Past claims experience can be used to price this part of the risk.

Insurers ask the question of whether a claim counts as an emergency and considers if they could have travelled home for treatment, she said.

The risk of requiring emergency medical expenses abroad is higher than for non-medical-related travel, Lobel said, because of the possible life-threatening complications that can arise from any surgery. Furthermore, she said, past claim experience for people travelling with pre-existing medical conditions is used as a proxy to underwrite the additional risk.

The moderator, Marc Banting, COO of Voyageur Group, asked the panel how the insurance industry could work with the government to improve services. Lobel suggested that if an individual had an issue, they need to understand the insurance covers that might be available to them. Ziardis then stressed the importance of raising awareness. He added that the government communicates with the insurance industry to make sure the correct message is being sent out.

Helen Wolstenholme, Barrister, 2 Temple Gardens

Wolstenholme began today’s session with an introduction to the UK legal landscape.

Looking at clinical negligence claims in the UK, she highlighted that the volume of claims against the private sector is increasing, including “medical tourists” to the UK.

Wolstenholme said that the volume of claims in England and Wales arising out of medical treatment overseas is also increasing and will inevitably continue to do so.

She pointed out that whether a person can bring a claim to England and Wales depends on whether the court has jurisdiction.

Despite the value of damages and costs per claim increasing over time, discount rate change is expected in England and Wales by January 2025. It is likely to lead to a reduction in damages for future losses, she added.

She highlighted that common specialties include cosmetic surgery, bariatric surgery and dental treatment, and the most common demographic is women. The countries that often feature include Poland and Turkey, she said.

Looking to the future, Wolstenholme predicts broader specialties, more claims brought by men and from a wider geographical area, and she queried whether medical treatment could count as tourist services under the Package Travel Regulations.

She noted that the scope and value of damages depends on whether the Court finds that English or foreign law applies.

She considered this in the context of the NHS, highlighting the principle of reasonable mitigation of loss. A person does not act unreasonably if they choose to pay for private healthcare (and not rely on the NHS), she said.

She noted that a tariff and cap are applied that depend on the date of treatment and the number of days in hospital. For example, she said, in 2024 it cost £256 per ambulance and £1,042 per night in hospital, and the cap is £62,272.

Wolstenholme rounded off her session by looking at ways to stem the tide, including providing clarity in terms and conditions, managing expectations, offering informed consent, maintaining surgical standards and providing aftercare.