Medical Tourism Inpatient Care

One blood clot for every 4,656 long-haul flights. The risk is highest in the first two weeks after flying and fades to normal by eight weeks.

Traveling to another country for a hospital admission adds one thing that treatment at home does not have, and that is the journey. A study that followed 8,755 employees of international organizations for six years found that symptomatic clots in the veins were 3.2 times more frequent in the eight weeks after a flight of four hours or longer (Kuipers and colleagues, PLoS Medicine, 2007). Surgery and bed rest raise the same risk, so the two have to be planned together. This page looks at medical tourism inpatient care with that in mind. It covers which treatments travel well, what to ask any hospital abroad, how to time flights around an operation, and how an admission to Biruni Hospital in Istanbul is organized for a patient who will go home to another health system.

What it means

The phrase sounds more cheerful than the reality. Nobody is on holiday. People travel for treatment because a procedure is unavailable at home, because the wait is long, because they want a particular team, or because of cost, and a scoping review of 216 sources found that those four motives dominate the literature (Crooks and colleagues, BMC Health Services Research, 2010). The same review found something less comfortable. Of all those sources only five reported original research with patients, and the authors concluded that very little was known of how travelers weigh the risks. Much of what a prospective patient reads online comes from marketing or journalism. Hard questions follow from that, and a well-run hospital welcomes them.

Travel adds three risks of its own, namely the flight, the handover between two health systems, and distance from the surgeon if something goes wrong at home.

Which treatments travel well

Some treatments suit a journey and some do not. The grouping below is a starting point for a conversation with a doctor.

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

No list replaces an individual opinion. A patient's age, other illnesses and the length of the journey shift a treatment from one row to another.

Questions for any hospital abroad

Flying before and after

Long flights and surgery both slow the blood in the leg veins. Together they call for planning.

1. Arrive early. Land at least a day or two before a major operation, so that you go to the operating room rested, hydrated and mobile.
2. Tell the team about risk factors. Previous clots, clotting disorders in the family, hormone tablets, cancer, obesity and recent long journeys all change the plan.
3. Follow the prevention prescribed. Blood thinner injections, compression stockings and early walking are chosen for your operation and your risks.

In the cohort study, clots were most frequent in the first two weeks after a flight, rose with the number and length of flights, and were more common in women taking oral contraceptives and in people who were overweight, very tall or very short.

1. Wait for the written fit-to-fly. The date depends on the operation. After major surgery it is often weeks.
2. Choose an aisle seat and move. Walk every hour or two and flex your calves in between.
3. Drink water, skip alcohol and sleeping tablets. Both keep you still for hours.
4. Know the warning signs. A swollen, painful calf, sudden breathlessness or chest pain in the weeks after travel needs an emergency department that day. Say that you have flown and had surgery.

At the busiest airport in France, severe lung clots on arrival occurred in 1.5 passengers per million after flights longer than 5,000 kilometers, 4.8 per million beyond 10,000 kilometers, and 0.01 per million on shorter routes (Lapostolle and colleagues, New England Journal of Medicine, 2001).

The plan in two halves

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

If something goes wrong at home

Most recoveries are uneventful. For the rest, speed matters more than geography. A wound that reddens or leaks, a fever, a swollen calf, breathlessness, bleeding or pain that worsens after it had been improving all need a doctor the same day, and that doctor will be a local one. Go to the nearest emergency department or to the doctor who agreed to follow you, take the discharge summary and the operation note, and say exactly what was done and when. Then message the hospital that treated you. The surgeon who operated can tell the local team what was found, which implant or technique was used and what the usual remedy would be, and that conversation between doctors achieves far more than a patient trying to relay technical details from memory. Whether further treatment happens at home or back in Istanbul depends on the problem, on fitness to travel and on cost, and the written plan you agreed before the first trip should already say how complications are handled.

Keep every document together in one folder, on paper and on your phone.

How Biruni Hospital organizes it

One coordinator from the international patients office is assigned with your first message, stays with you through discharge, and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages. It arranges accommodation near the hospital for relatives, airport transfers, daily transport and the invitation letter that consulates request with a visa application. Ward rooms have a companion bed so that one relative can stay overnight. The kitchen prepares halal, vegetarian and diabetic meals, a prayer room is on site, and a request for a female physician goes to the department and is met wherever the rota allows. Chemotherapy and radiotherapy are given on the same site, which matters for cancer patients whose treatment combines surgery with either. None of this replaces the medical questions above. It removes the practical obstacles so that the medical questions get proper attention.

Start with the file. Everything else follows from the specialists' reply.

Cost

Compare total cost, which means treatment, flights for two, accommodation for the full stay including the days after discharge, insurance, and time away from work for patient and companion alike, because a low procedure price combined with a long stay in a hotel easily exceeds a higher price with a short one.

Hospitals in this market issue a written estimate after reviewing the reports and state what it covers. Standard travel policies exclude planned treatment abroad unless they state otherwise, so ask an insurer about a policy written for medical travel and read what it says about complications.