ITIC Americas 2024 | Repatriation vs treatment in situ – centres of medical excellence in the Caribbean/Central America

The ITIJ team have been reporting live from ITIC Americas in Panama this week (4 March 2024) sharing the discussions that took place at the conference. Read all reports

Lidia C Acosta Suarez, International Service Manager at the Hospital General Plaza de la Salud, started her talk by saying that medical repatriations are rarely simple. There are multiple decisions to be made during the process, which involves many significant choices that determine the outcome of the medical treatment. Things to consider are:

• The health condition of the patient (air ambulance or commercial flight)

• The cost (insurance or self pay)

• Distance (the further, the higher the risk and the cost).

She then said that medical tourism in Latin America is on a positive path, and its future is emerging as a sector in constant development, offering high-quality health services in an attractive and touristic environment.

Acosta Suarez said health tourism in the Dominican Republic is characterised by a unique combination of:

• Quality medical services
• Accessibility with international health insurance/third-party administrator (TPA) providers
• Growing medical infrastructures/latest technology/air ambulance evacuation (Helidosa)
• A variety of medical specialties including dental, plastic surgery, orthopaedics; urology; cardiology; and fertility treatments.

“The proximity of health centres to charming tourist attractions, such as beaches and wellness resorts, provides visitors with a comprehensive experience that combines medical care and relaxation, thus consolidating the position of the Dominican Republic on the map of health tourism,” Acosta Suarez said.

She added that over the past five years, medical tourism in the Dominican Republic has experienced notable growth, with an average annual increase of 15%. In 2019, the country welcomed more than 150,000 medical tourists, marking a significant milestone.

Acosta Suarez said that tourist and health attractions in the Dominican Republic converge to create a unique experience that motivates medical tourism. These attractions not only contribute to the quality of life of medical tourists but also emphasise the idea that health and wellbeing can be combined with tourist experiences.
She added: “The medical infrastructure in the Dominican Republic stands out for its significant growth and the adoption of international standards – with a growing number of modern hospitals and clinics backed by recognised certifications.” The country offers quality facilities covering various medical specialties. This solid infrastructure, Acosta Suarez said, contributes to positioning the Dominican Republic as “a reliable and attractive destination for those seeking excellent medical services”.

Acosta Suarez finished by sayingthe Dominican Republic has established strong international collaborations in the field of health tourism, partnering with medical institutions and globally recognised health insurance and travel insurance companies as well as TPAs. These alliances not only strengthen the quality of medical care, but also contribute to raising the international standards of the services offered, thus consolidating the country’s position as a reliable and competitive destination for health tourism.

Ilan Geva, Senior Director of Strategy, Head of Americas, at Vmarsh Healthcare, started his talk by considering what makes a centre of excellence (COE).

He said the following aspects define a COE:

• Specialisation
• Highly specialised staff
• Advanced technology and resources
• A multidisciplinary approach
• High success rates.

He explained why patients would choose a COE, and said that:

• There is an increased chance of successful treatment
• Patients would have access to advanced therapies
• There would be comprehensive care
• Patients would have experienced and skilled staff
• There would be a streamlined patient experience.

Geva said that aspects patients should consider are:

• The availability and location of the COE
• The cost
• That some COEs require referrals from primary care physicians or specialists
• That outcomes should be looked at
• Accreditation, and whether the institution is recognised by global accreditation providers
• That there is a different status between private and public hospitals when it comes to insurance.

Geva added that patients need to do research before travelling to South American hospitals. He said that public hospitals are generally required to provide emergency care to any patient, regardless of nationality or insurance status. He said that for non-emergency care, the situation varies: some public hospitals might provide care to foreigners without insurance, often at a higher cost than insured patients. Others may prioritise insured patients or require upfront payment from uninsured individuals.

Private hospitals generally prioritise insured patients and are less likely to accept foreigners without insurance. If they do accept them, Geva said to expect higher costs compared with insured patients or local residents.

Geva then posed the question “What is ‘expensive’ in healthcare?” and said it is important to note that cost estimates can vary depending on the specific procedure required. He said that patients with comprehensive health insurance plans might face lower out-of-pocket expenses than those without insurance or with limited coverage; but, ultimately, whether the hospital is ‘expensive’ depends on individual perspective and financial situation.

Geva finished by saying that if you require specialised care that is unavailable elsewhere or prioritise access to advanced technology, the costs might be justified. However, if budget is a primary concern, exploring other options within the global healthcare system might be prudent.

Soraia Arroyo Lynch, Vice President of Business Development & Client Accounts, GMMI, gave three examples of repatriation versus treatment in situ for the audience.

The first was of an elderly couple vacationing in the Galápagos Islands. The wife was diagnosed with a cerebrovascular condition and transferred to mainland Ecuador for treatment. The diagnosis on arrival was that of a brain aneurysm requiring emergent surgical intervention. She was then in the intensive care unit for eight days.

There was then coordination of an air ambulance transfer to the US for further care. The final outcome was successful surgery and stabilisation in Guayaquil, Ecuador, followed by transfer to the US. She had continued care in the US including physical and speech therapy. The smooth transition of care was covered by domestic insurance due to contractual agreements.

The second example Lynch gave was that of a woman who suffered a severe spinal injury in Jamaica. The diagnosis was a compression fracture of the L1 vertebrae requiring surgical intervention. A consultation with treating physicians showed the local facility’s inability to provide the necessary surgery. A decision was made for an air ambulance repatriation to Colombia. She then underwent successful spinal surgery and extensive rehab in her native Colombia. The patient returned home with no deficits, avoiding further risky activities. Upon arrival in her home country, the local insurer picked up the costs of care.   

The third example Lynch gave was of a woman celebrating her 60th birthday in the Pacific coastal city of Puerto Vallarta, Mexico, where she sustained a complex hip fracture. The local facility was unable to perform surgery promptly, leading to the decision for repatriation to Guatemala. The woman was stabilised and prepared for repatriation via air ambulance. The Hospital Herrera Llerandi in Guatemala City was chosen for surgery due to its proximity and cost-effectiveness. There was swift repatriation and surgical intervention within 24 hours of the initial injury. This was a cost-effective transfer and led to successful surgery close to the patient’s home.

To finish, Lynch said they are managing more and more cases in the region, with a high level of success.