…an overlooked - and possibly underserved - market
Constantine Constantinides, M.D., Ph.D.
(Chief Executive, healthCare cybernetics)
pediatric surgeon, Dr Constantine Constantinides from healthCare cybernetics looks
at how medical tourism has developed within the field of children’s healthcare
and how the EU Directive may stimulate an increase in cross border healthcare
I am a pediatric surgeon by training, so it
was only a matter of time before I would turn my attention to the issue of
“treatment abroad for children”.
As a young Pediatric Surgeon at the Great
Ormond Street Hospital for Children in London, I was constantly involved in the
treatment of children from across the world, including my home country, Greece.
Great Ormond Street” was then and continues
to be an international center of excellence. It has a thriving international
and private patient service based in the Harris International Patient Centre.
The hospital generates over £25 million from its private and international
Treating these children from abroad was
medical tourism, but we did not regard or refer to it as such.
Why did these “medical tourists” come to Great Ormond
It certainly was not because treatment was
cheaper than “back home”. In fact, when all expenses were factored in, it
turned out to be quite a bit more expensive (although in quite a few instances,
the government or health fund “back home” picked up the bill, as payer or
To get the best treatment
To get treatment that was not available
To get treatment that was not
provided “just as well” at home
Internal medical tourism for children
Recently we started hearing (again) about
“internal” or “domestic” medical tourism (see Medical Tourism and the West's Revenge).
Well, there was and still is domestic
medical tourism for children. For example, Great Ormond Street is a referral
hospital receiving young patients from all over the UK.
Children’s hospitals and services
…for small adults?
Children are not small (i.e., scaled down)
adults (although, we surgeons – when in a humorous mood, would say that
Diseases and surgical conditions in
children have considerable and fundamental peculiarities whose management
requires specific knowledge and training which “adult doctors” do not have. This
is the reason that Pediatrics and Pediatric Surgery (and now its several
sub-specialties) came into being.
The appropriate management of children’s
diseases requires age-specific knowledge and experience. And acquiring
knowledge and experience requires “large number of cases” and dealing with many
“same case cases”.
Practically every country has children’s
hospitals and services. But, not all countries have children’s hospitals with
the required expertise and resources to offer services at the “best practices”
and “excellence” levels.
This may be due to budgetary constraints or
a small population (which precludes the accumulation of experience and
expertise). In such cases, children with complex or rare conditions (rare and
orphan diseases) are best treated at Reference Centers and Centers of
Excellence, which may be abroad.
The rational distribution of Centers of Excellence for
…and European Crossborder Healthcare
One of the arguments for the existence of
the European Healthcare Cross-border Scheme, which makes perfect sense, is the rationalization
and distribution of Centers of Excellence for the management of rare and
This will ensure that rare and complex
cases can be treated by expert teams who see and handle many “same case cases”.
Many of these conditions manifest themselves at an early age.
Children going abroad for what?
What do (and will) children go abroad for?
This (as an indicative listing) includes
such complex or rare conditions as:
nephroblastoma and adrenal gland neuroblastoma, lymphomas and leukemias, requiring
bone marrow transplant)
Separation of conjoined twins
Rare and orphan diseases such
as muscular dystrophy
Congenital heart disease
Other complex congenital
abnormalities requiring surgery (e.g., esophageal atresia, anorectal agenesis,
Hirschsprung’s Disease, intersex – ambiguous genitalia)
Congenital ophthalmic conditions
related to spinal fusion abnormalities
It must be pointed out that some congenital
conditions require urgent and immediate management, which precludes “treatment
But even these can become candidates for “specialist
treatment abroad” once they have been “stabilized”, or when the urgent “first
stage management” is provided locally.
Where can they go?
Without endorsing any destination or
facility, the following are some destinations which come to mind:
Israel (Pediatric malignant diseases)
Turkey - Istanbul (for bone marrow
The United Kingdom - London
(for practically all complex and rare diseases in children)
USA - Boston (for malignancies
South Africa - Cape Town (for pediatric
cardiac surgery, expertise developed many years ago by the “Barnard” brothers of
heart transplant fame - Chris and Marius)
cybernetics has created a non-commercial site devoted to the subject of Health Tourism for
Children. The site may currently be password-protected whilst it is being
Dr Constantine Constantinides runs healthCare cybernetics, a “think and do tank” with a recognized competency in Health Tourism Integration and Development. His home base is on the island of Samos in Greece.
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