The International health service: is medical tourism ethical?

DENTISTRY

Where they go Hungary, Turkey, Poland

Why?

* It's hard to find an NHS dentist, and private treatment can cost thousands.

* Polish dentists are now advertising in Ryanair's in-flight magazine.

* A Turkish company, Dental Tourism, has been set up to match patients with dentists.

* Hungary, long a destination for German health tourists, is keen to attract British clients.

Pros

* Robert Wootton from South Wales was quoted £3,000 for dental work in the UK. Treatment in the Turkish city of Izmir cost him one-third of that. He said: "I met the dentist on the first evening , and after a week I was the proud owner of a new set of teeth."

n The NHS is employing dentists from Eastern European countries to plug staffing gaps, so they are obviously considered well-trained.

Cons

* Dental work is not a one-off; further treatment is often needed, so you will have to go abroad again. Your NHS dentist may strike you off his list.

* Shoddy treatment may end up costing you more for corrective care in the UK.

FERTILITY TREATMENT

Where they go Slovenia, Turkey, South Africa

Why?

* Despite a government pledge that infertile patients would be entitled to at least one cycle of free treatment on the NHS, many trusts restrict eligibility. There are also long waiting lists.

* Private treatment can cost up to £4,000 per IVF cycle in Britain, compared with about €2,400 (£1,800) in Slovenia.

* Secrecy; some do not want it known they are receiving treatment.

* Some procedures banned in the UK, such as implanting more than two embryos to boost pregnancy chances, would be available.

Pros

* Much cheaper than private treatment here.

* Looser limits on the number of embryos that can be implanted mean that the chances of pregnancy are higher; one Turkish clinic boasts of a 40 per cent success rate among women aged 38 to 40, compared with a 28 per cent in the UK.

* Pregnancy rates in Slovenia from one cycle of IVF are 36 per cent.

* Fertility treatment is known to be more effective if the couple are less stressed, so combining a holiday with IVF could help.

Cons

* Stringent UK regulations ensure that treatment is safe. You will not have the same guarantees abroad, particularly about screening of sperm and eggs for genetic conditions or diseases such as HIV.

* Implanting more embryos raises the risk of multiple births and, with them, associated serious health problems.

COSMETIC SURGERY

Where they go Czech Republic, Venezuela, South Africa

Why?

* Availability on the NHS is scarce and clinics abroad can perform procedures for half the cost of private providers in Britain.

* Ten years ago, there was just one cosmetic surgery clinic in Prague treating foreigners; now there are 100 providers.

* South American countries such as Brazil and Venezuela have some of the highest rates of cosmetic surgery, so boast experienced surgeons and top-class clinics.

* Some clinics in Prague now offer all-inclusive health breaks that combine spa treatments and shopping with surgery.

* Men are keen, too; 5 per cent of enquiries about cosmetic surgery in the UK are from men. The Treatment Abroad website says 10 per cent of its enquiries about procedures are male-orientated.

Pros

* Cost, obviously; breast enlargement surgery that will set you back £4,000 in Britain could cost £2,300 in the Czech Republic.

* Patients are able to go under the knife and recuperate away from family, friends and colleagues and return home looking transformed.

* Some foreign clinics now send doctors and nurses to Britain for a few days a month so patients can have initial consultations here.

Cons

* Cosmetic surgery can be invasive and there are risks. According to some experts, one in three patients who have abdominoplasty - a "tummy tuck" - abroad will suffer complications.

* Not speaking the language may be distressing. You may have no recourse for complaints or compensation.

* Surgeons may be unregulated. If you want corrective surgery for surgery that was done abroad, you may not be eligible for the treatment on the NHS.

KNEE SURGERY

Where they go India, Spain, France

Why?

* An ageing population, coupled with other factors such as obesity, means that demand for knee surgery is expected to grow by 60 per cent in the next five years.

* Patients have been refused surgery on the NHS on the grounds that they are too young (prosthetic knees wear out) or overweight, and many feel they are being denied treatment because of cost.

* Chronic conditions may not be covered by private insurance.

* Some people have cited the high prevalence of infections such as MRSA in British hospitals as a reason for foreign treatment.

Pros

* India offers cheap surgery with an exotic location, while French providers can reduce the risk of DVT by allowing patients to travel by ferry or Channel tunnel to hospitals in cities such as Lille.

* Knee replacement surgery in a Bombay hospital costs about £3,600, compared to about £10,000 in Britain.

* The British-based company People Logistics takes up to 50 people a month to France for knee and hip surgery.

Cons

* NHS doctors have complained of having to fix shoddy treatment.

* There are ethical considerations. The Indian health service is spending millions on state-of-the-art hospitals to attract foreign patients, while government clinics that treat the country's huge population are still seriously under-equipped and poorly staffed.

* The British Medical Association has raised concerns about the risks of the long-haul return flight after surgery and the problems GPs can encounter with providing continuity of care when dealing with foreign medical records.

KIDNEY TRANSPLANTS

Where they go Moldova, China, India

Why?

* About 400 people a year die while on the official list for a kidney transplant; the average wait is 506 days.

* It is illegal to buy or sell organs in the UK and nearly everywhere else in the world, but in some countries, recipients can pay donors for expenses and loss of earnings incurred, so more kidneys may be more widely available where desperately poor people are prepared, in effect, to sell them for money.

* Rates of kidney problems are high in the Asian community in Britain, and donor organs from this group are also especially low.

* A 2002 survey of British transplant units found that 29 patients had travelled abroad for the surgery.

Pros

* Waiting for a new organ must be psychologically and physically debilitating; at end-stage renal failure, it's a life and death matter.

* Some wealthy patients who've gone abroad argue that by coming off the UK transplant list, they are helping someone else.

Cons

* Huge ethical considerations. By travelling abroad patients are probably buying a kidney; that means a desperately poor person is putting their health at risk with little certainty of any aftercare.

* Last year, it was reported that up to 10 British patients had travelled to China, where it is known that organs are taken from executed prisoners, for a kidney transplant.

* Then there's the risk of infection from the operation or the kidney itself if stringent screening of the organ is not carried out.

* Of the 29 patients from the 2002 survey who went abroad, more than half the organs failed and one-third of the patients died.

OBESITY SURGERY

Where they go

Belgium, Tunisia, France

Why?

* As with cosmetic surgery and fertility treatment, patients who opt for weight-loss surgery such as having a gastric band fitted often do not want friends, colleagues or even family to know what they are doing.

* Surgery is available on the NHS but only for extreme cases. Private medical insurance can exclude these kinds of procedures.

* European clinics are popular because they involve short-haul journeys and have lower rates of antibiotic-resistant infections.

Pros

* Gastric band surgery at a private British hospital will cost about £8,000; in a Belgium clinic the bill will be £3,200. For £3,750 inclusive, patients can fly to a clinic in Tunisia, undergo surgery and recuperate at a hotel with a pool.

* There are no waiting lists. The company Gastric Band Service International offers operations in France followed by aftercare in Britain.

Cons

* This surgery should be preceded by counselling about what changes patients should make to their diet and behaviour afterwards.

* As with all surgery, there is the chance of infection and complications, particularly because this group of patients are already going to be high risk as a result of their obesity.

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