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Surgeries & Procedures

Dr. Dagi Medical Tourism Interview

Teodoro Forcht Dagi M.D., an academic physician at the Harvard/MIT Division of Health Science and Technologies, talks about the about reasons for the growth in medical tourism and concerns people should have when undertaking surgeries and procedures abroad.

MedToGo: What are the major reasons for the increase in medical tourism in recent years?

Dr. Dagi: The three major reasons why Americans are going abroad for surgeries are cost, the type of surgery undertaken and the regulatory environment. The biggest factor overall is cost. There are many places in the world that provide medical care at a substantially less amount than what you would have to pay in the U.S. In the case of Mexico, people have been going for dental care and medications, which are said to be analogous to that in the U.S. But if it is truly cheaper depends on the insurance coverage you are provided.

MedToGo: How is the U.S. regulatory environment different from that in other countries?

Dr. Dagi: The U.S. has some of the strongest standards in the world. The Food and Drug Administration (FDA) regulates the marketing of drugs and devices. Medical practices and procedures are self-regulated by the profession. State medical societies license physicians who have demonstrated competence and their peers provide oversight. And the professional standards in the U.S. are very high.

MedToGo: Could you tell us about the different technologies and operations overseas?

Dr. Dagi: Technologies drive operations. In the U.S. the regulatory environment is very rigorous for ensuring safety and efficacy. In other parts of the world, the situation is different. Certain technologies that have not passed the criteria in the U.S. may be offered in other countries. In some places, it is up to the surgeons themselves to determine whether or not to provide a surgery. In the U.S., operations are regulated by written and informal standards and practice. For example, bariatric surgery, or weight-loss surgery has very rigorous criteria for approval. So many patients that are turned down in the U.S. may go elsewhere. Procedures and techniques frowned upon in the U.S. due to risk are available elsewhere. In some cases, this can result in a tension between the recommendations of a surgeon and the autonomy and requests of a patient. For example, silicon banned in the U.S. is provided in other countries.

MedToGo: What about new experimental procedures and techniques?

Dr. Dagi: For life-saving procedures, the regulatory process is accelerated. But there are few procedures that are actually life-saving. And life-saving does not occur with medical tourism. Certain cancer treatments involve experimental surgeries in another country. And a patient, either out of desperation or bad advice, may undertake such an operation. But what is more common is that there is an expert in a procedure who is recognized around the world but does not reside in the U.S. For example, there was a Swiss doctor who was a specialist in operating on aneurisms.

MedToGo: How does one find out about who is a good physician in another country?

Dr. Dagi: Just to find out who is a good doctor in the U.S. is very difficult. Ways to determine a good physician include recommendations, publications, and the institution he or she works. Many Mexicans in the U.S., for example, have contacts in the Mexico and thus can provide recommendations. I am not an expert in Mexico’s medical institutions but know that there are surgeons in Mexico that are superb. However, there are also certain places along the border that just operate as mills in which the standards of care may be sub-standard.

MedToGo: What concerns should people have when considering medical tourism?

Dr. Dagi: One of the main concerns is follow-up care. This is always an important thing to discuss. It is a professional standard to provide care in case there is any complication after the fact. But if you are in another country in which you did not carry out the operation, this could be a problem.