Health Tourism

The HOS carries a front -page story today of a tourist with active, drug-resistant TB who arrived in the country and was admitted to hospital a few days after. Eventually, a plane had to be charted to take her home.

“The flight, organised by the New Zealand Immigration Service and Ministry of Health, took off at 3am to “avoid media scrutiny” and cost $330,000, according to a paper written on the case by Dr Margaret Wilsher, the president of the Auckland medico-legal society.

“She wrote that the woman had “extremely drug-resistant tuberculosis and was untreatable and hence incurable – and worse she was highly infectious”. The woman spent nearly three months in hospital – care for such cases costs about $2700 a day – taking the bill to more than $500,000.”

Tony Ryall comments that taxpayers would like to know whether the $330,000 flight was the cheapest option. I would second that. TB is not a “highly infectious ” disease at all, having a very low infectivity. This is why it is mostly found in crowded communities with poor sanitation and poor nutrition. You need to be exposed to it over a long period in order to catch the disease. It is not like the common cold or the ‘flu. I am not an infectious disease expert, but I suspect that this woman could have safely flown on a commercial airline, as long as she wore an N95 mask – the sort of mask advocated for the SARS epidemic that never happened. 

I also wonder exactly why it is New Zealand footing the bill for what is essentially a “mercy flight”. If we had a tourist stranded in  Korea, would we be expecting Korea to foot the bill for repatriation? 

The vast majority of tourists who come to New Zealand are fit and healthy and have adequate travel insurance, but there is a significant, if small, minority that have neither good health nor good insurance. To be fair, many of these are elderly and cannot get insurance, particularly insurance for their current medical problems. Heart disease is an especially common problem, as the sudden change of time zones stresses the body and can precipitate a heart attack.

I have some sympathy for these people. They do not appear to be purposefully rorting the system and appear genuinely upset that they are being ” a nuisance”. They usually have little to gain except a ruined holiday and a large medical bill.

There are a few, however, who would best be described as “medical tourists”. They enter the country knowing they are ill, and then promptly enter the hospital system, knowing that they will get full access to our first-world health care. They are not all from the third world. I have seen Americans and Europeans here, presumably because they are uninsured and cannot afford to access healthcare in their own country.

Medical tourism is found in every first-world country. To be honest, there is a small influx of medical tourists from New Zealand to Australia every year. They are usually trying to access elective surgery, most commonly gall bladder surgery and coronary artery bypass grafts.

Medical tourism is an inevitable consequence of the various differences between health systems. It could be solved quite easily with a medical accord between countries, but this is very unlikely to happen anytime soon (such an accord would severely disadvantage poorer countries). 

As medical tourism is an inevitable feature of a first-world health system, we may as well get used to it. Doctors and nurses have a moral obligation to treat anyone who needs medical care, regardless of race or nationality. I believe that this moral obligation extends to the nation. The alternative is turning sick people away at our borders, or, worse still, from our hospitals.

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