When a doctor in Vancouver told Margaret Khor it would cost $5,000 to remove a mole from her eyelid and he couldn’t guarantee his work wouldn’t leave a scar, she looked into an increasingly popular alternative — having the procedure done abroad.

So-called “medical tourism” usually combines a tropical vacation with cosmetic or dental work. But other, more necessary procedures — especially those with long waiting times, such as hip or knee replacements — are also drawing interest from Canadians.

So, if you have clients like Khor who are considering tapping their investments to pay for an out-of-country procedure, you’ll want to discuss financial issues such as reimbursement with them, as well as the risks of receiving medical services outside Canada.

Medical tourism has become a multibillion-dollar industry in Southeast Asia, Cuba, Costa Rica, Hungary, Lithuania, Turkey, Israel and Jordan, where some governments are promoting the practice to boost economic growth.

According to the Tourism Authority of Thailand’s office in Ottawa, in 2005, low prices and short waiting lists drew more than 1.25 million visitors to Thailand for medical services. More than 18,000 of them were Canadians.

Travel agents, too, are getting involved. A growing number are putting consumers in touch with services in countries in which the cost is much lower.

This past fall, Khor went to Malaysia. SunClub Travel Inc., a Vancouver-based travel agency that arranges medical packages to Thailand, Singapore and Malaysia, put Khor in touch with a surgeon at a private hospital in Kuala Lumpur.

“There are no waiting lists in Southeast Asia,” says Wayne Hansen, vice president of marketing at Sun Medical Group, a division of SunClub Travel. “You can literally walk in without an appointment and have surgery scheduled in a few days.”

The surgeon told Khor the mole could be removed by laser surgery for slightly more than $300 — and there would be no scarring. So, Khor had the mole removed — and took the doctor’s suggestion of Botox treatments to erase lines around her eyes and on her forehead. That cost a few hundred dollars, compared with $800 or more in Canada.

For another few hundred dollars, she had dental work done: a root canal, two porcelain crowns, five fillings and her teeth cleaned and whitened. At home, that would have set her back a few thousand dollars.

Had she wanted a hip replacement in Malaysia, it would have cost around $7,000, Hansen says, including full hospital stay but excluding airfare.

Being treated outside Canada will clearly be more expensive than waiting to have the hip-replacement procedure performed in Canada, where it is covered under provincial health plans. But compensation for medically necessary services is available under some provincial plans. Under the Alberta Health Care Insurance Plan, for instance, physician services received by Albertans outside Canada are paid at the same rate as would be paid for the same or similar services in Alberta. Hospital services, however, are paid at lower rates; there is a maximum of $100 a day for hospital in-patient care and a maximum of $50 for one outpatient visit a day.

The Ontario Health Insurance Plan covers the cost of medical care outside Canada, but these services must be recommended by an Ontario physician and pre-approved by OHIP. Cosmetic and dental work received outside Canada are generally not covered.

Travel expenses may qualify for the Canada Revenue Agency’s medical tax credit if a Canadian medical practitioner clearly establishes that an equivalent medical service was not available in the claimant’s local area and that the person travelled to the destination for the express purpose of obtaining this service. The claimant also needs to take “a reasonably direct travel route,” according to government guidelines.

According to Hansen, many hospitals and clinics that cater to the tourist market are among the best in the world: “They have state-of-the-art equipment, Western-trained doctors and top-notch service.”

But there is little follow-up care. Patients spend a few days in hospital, then recover at a resort or go home. It’s a big reason why some medical experts advise approaching medical tourism with caution.

“You’re putting yourself in a situation in which the quality of care — including pre-care and post-care — is largely unknown,” says Pamela Fralick, president and CEO of the Canadian Healthcare Association in Ottawa and chairwoman of the Health Action Lobby. “What happens if these people are not competent? Even so-called ‘elective’ treatments pose a risk.”

@page_break@Hospitals abroad that specialize in serving foreigners prefer that patients’ family doctors are involved. “A referral from a Canadian doctor isn’t necessary,” Hansen says, “but we always recommend that a client’s doctor be involved in the decision to have a procedure performed abroad. It will be important for the client’s doctor at home to continue to monitor [the client’s] recovery.”

Hansen also views medical tourism as a solution to Canada’s long waiting lists. “If our governments took a trip to these countries,” he says, “they would quickly realize that Canada could solve waiting-list problems virtually overnight by outsourcing medical treatment to these countries. The costs end up being 30%-50% lower, even factoring in airfare and accommodation, than waiting for treatment here.”

But, Fralick says, medical tourism undermines the values of the Canadian health system: “We’re trying to nurture a system that gives Canadians equal access to medical care, not based on ability to pay.”

However, unless there is a dramatic improvement in waiting times soon, more of your clients may be looking at treatment abroad. For those who already are, you can suggest they ask if the doctor who will be operating on them is qualified to work in Canada, Britain or the U.S. and what would happen if complications arose. They should also find out beforehand what, if anything, they are entitled to under their provincial health plans.

Having determined and weighed these factors, they may still decide to travel abroad. Khor was so satisfied with her experience, she is considering returning to Malaysia later this year for a tummy tuck. With the money she saved, she treated herself to a beach holiday.

Says Khor, who is 52: “I came back looking 10 years younger.” IE