Cosmetic surgery tourism

But what happens if something goes wrong and are patients properly insured in case of disaster? Richard Dyson examines the booming phenomenon of medical tourism.

ANNEMARIE Jones loves her five children, but her joy has come at a price. Having them within nine years has played havoc with her figure. The 29-year-old became self-conscious about her weight and no amount of dieting could shift the overhang of her stomach.

Her partner, health and safety manager Edward Turnbull, 30, kept telling her he loved her as she was. 'But it wasn't enough for me,' she says. 'I wanted to look 29.'

Annemarie's condition triggered a bout of depression and also hindered her work as a paramedic. No treatment was available on the NHS and a private consultant told her that the operation to cut away the excess flesh, an abdominoplasty, would cost her £12,000.

Through a friend, she learned of Surgery Abroad International, a company that helps people to find suitable medical centres and prepares them for the operation.

Late last year, Annemarie, from Dudley, West Midlands started corresponding with a surgeon in India. She described her condition and sent photographs, records and other information. In January, she flew to New Delhi and from there to Mohali, an hour's flight north.

She arrived on a Saturday and on the Monday underwent eight hours of surgery, during which two stones of fat were removed from her stomach.

Two weeks later, having satisfied the surgeon that she was fit to travel, she was sitting in a business class seat on the nine-hour flight home. Three weeks after that, she was back at work. The trip and treatment had cost £3,000.

Annemarie, whose children are aged between eight and one, says: 'I look my age again. I feel young and attractive. My whole shape has changed and my self-esteem is back. Of course, there are risks --there are risks with all surgery. But they didn't outweigh the problem of my condition.'

As well as the Britons who go abroad for cosmetic surgery or for operations to beat the NHS queues, some have dental treatment, ranging from root canal work to infills or denture fitting.

Most go to the Continent, but a growing number travel farther afield, to countries such as India or South Africa. And the savings are huge.

An operation in one of the cheaper destinations, such as the popular Apollo hospital in New Delhi, India, could be a fraction of the cost of the equivalent private treatment in the UK, even with flights and accommodation.

A knee replacement in Britain might cost £14,000 compared with about £6,000 in Poland, while a spinal fusion operation to ease acute back pain might cost £18,000 in Britain compared with £5,500 in India, including travel.

Another of SAI's clients is widow Wendy Jaggers, 62, who earlier this year flew to Mohali for a pioneering form of cosmetic surgery known as 'contour threading', where plastic threads are inserted into the face through tiny incisions, then drawn up to lift skin tissue and counter the effects of sagging.

'Until recently, this process was not available in the UK,' says Wendy, a retired hairdresser from Birmingham. 'You could do it in France or the US or India, but not here. India appealed most. I'd always heard that the quality of surgery over there was fantastic, and after all, lots of the NHS's top surgeons are Indian.'

She spent one week in Mohali and the entire trip, including business class travel, cost £3,000. 'I'm extremely pleased,' she says. 'I'd recommend it to anyone, provided they've got the right skin. It's not drastic, it's subtle.'

Though Annemarie and Wendy are delighted with their treatment, Fiona Harris, head of personal markets at health insurer Bupa, warns: 'There are several medical issues. First, it is hard to assess the quality of a surgeon or clinic, especially when they are in another country. Second, there are real concerns around the health aspects of travelling so soon after surgery.'
The British Association of Aesthetic Plastic Surgeons, which seeks to educate the public about the advantages and risks of cosmetic surgery, goes further. Its member surgeons have doubts about the quality of some practices and suggest that in several cases, botched operations are left for the NHS to sort out.

Insurance

NO specific travel insurance is available for patients going abroad for surgery. Most general travel insurers exclude cover for trips where the policyholder is undergoing a planned operation. That means cover will not apply for any aspect of the trip, even if the policyholder suffers an accident unrelated to the surgery.

Specialist provider MakeSure Insurance of Burgess Hill, West Sussex, which offers travel cover to older people or those with medical conditions, will cover people going abroad for surgery but will not cover anything related to the surgery itself.

Brian Warburton, the owner, says: 'Our cover costs about 50 per cent more than a general policy and gives the usual benefits of travel insurance, stopping short of the operation itself.'

There is no insurance available for policyholders to protect them against bungled or badly performed-surgery. Instead, they must rely on the surgeon's or clinic's own indemnity cover.

Some companies based offshore are marketing 'cosmetic surgery insurance' to UK patients, but as they are unregulated and fall outside the remit of the Financial Ombudsman Service, they should be avoided.

Who pays if things go wrong?

SO far, there are few stories of foreign surgical disasters. Most people who travel abroad for surgery have their trips and treatments arranged by third party agents or introducers. If these do their job properly, they should always look into the insurance arrangements of the surgeons and clinics they recommend.

Even so, limits may apply to the sums payable by the clinic - or their insurer - in the event of proven malpractice. Some of these limits, says Gary Miller, founder of SAI, may be £100,000 or lower. That might be inadequate to compensate for injuries resulting from botched procedures.

'These are serious questions that need addressing,' says Miller, who is trying to set up a trade association to maintain standards among foreign surgery 'agents'.

There are also doubts about how British patients would fare, legally and financially, if they had to pursue a surgeon or clinic through foreign courts.

Your money and the middleman

THERE are about 200 individuals or companies acting as advisers to UK patients seeking surgery abroad - and most have no medical qualifications. They are not travel agents and are not subject to any financial regulation.

Some may be reliable and helpful, others are anything but. Lorraine Melvill of Surgeon & Safari in Johannesburg, which arranges for Britons to have surgery in South Africa, says: 'There is a growing problem with people presenting themselves as qualified advisers.

There are dolly birds who have found a surgeon somewhere to give them a free facelift and who in return are running around the UK trying to drum up paying custom.'

Linda Briggs, founder of a company bearing her name that advises people who want cosmetic surgery, agrees. 'We need to warn against fly-by-night advisers,' she says.

She urges UK patients not to pay agents or advisers for the operations, but to do the financial part of the deal direct with the clinic.

'I make it clear to patients that the contract is between them and the surgeon or clinic,' she says. 'I am paid by the surgeon or hospital for the time I've taken to help the

patient through the process.' This is also the model adopted by The Taj Medical Group, another major firm established to link UK patients with Indian hospitals.