Dr Vinay Rane - Medico-Legal Society of Victoria - Controversies in Obstetric and Reproductive...
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Transcript of Dr Vinay Rane - Medico-Legal Society of Victoria - Controversies in Obstetric and Reproductive...
![Page 1: Dr Vinay Rane - Medico-Legal Society of Victoria - Controversies in Obstetric and Reproductive Medical Tourism](https://reader033.fdocuments.us/reader033/viewer/2022060120/5591b0261a28ab21518b466e/html5/thumbnails/1.jpg)
DR VINAY S. RANE
MBBS, LLB, LLM, BMEDSCI(HONS), PDLP, FACLM, MFFLM, RCP(UK), MHSM, MRANZCOG
FORENSIC PHYSICIAN
OBSTETRIC REGISTRAR
BARRISTER AND SOLICITOR (VIC)
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“Medical Tourism”
• Is this really a thing?
• Is it really a holiday?
• Is it safe?
• Is it cheaper?
• Why?
• What‟s on the menu?
• What happens if?
• Ethical Considerations
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Is this really a thing?
• $100 billion industry
• 20-30% growth per year
• Australian spend is $350 million per year
• 300,000 people travel to India alone each year for medical treatment
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Top Countries by Spend
• 5. India
• 4. Singapore
• 3. USA
• 2. Mexico
• 1. THAILAND
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Why Thailand?
• Location
• Experience of friends
• Perceived Safety
• Excellent Marketing
• Hospitality
• Cost
• Not so much because it‟s a holiday
• Access to services
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Reasons for Medical Travel
• Cost
• “get a holiday on the beach” – Not really
• Volume / Safety
• Self Esteem Issues for some procedures
– “Escape”
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What Kind of Procedures
• Cosmetic
– Breast, Tummy Tucks, Face Lifts, rhinoplasty
• Dental
• Is that all?
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What Kind of Procedures
• Bariatric
– Types
– Follow up
– Comps
– Prosthesis
– Escape
– Wait List
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What Kind of Procedures
• Orthopaedic
– Infection
– Medicare
– Prosthetic Cost
– Wait List
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What Kind of Procedures
• Coronary Artery Bypass Grafts
– Cost in USA
– Cost in India
– Volume
– Indian Genes
– Indian Doctors
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What Kind of Procedures
• Infertility – Cost
– Access
– Emotional and
Psychological Factors
– Laws : • surrogacy,
• sex selection,
• multiple pregnancy
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What Kind of Procedures
• Organ Transplant
– Access
– Laws
– Safety?
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Safety
• Regulation of doctors in Australia
• Varied regulation overseas
• Cheaper must
mean worse
• Case Volume
• Local Perceptions
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Complications
• Incidence
• Impact on initial rationale
• Impact on Medicare
• Impact on private health funds
• No audit data
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When it goes wrong
• Often no recourse
• NIB “12 month guarantee”
• Local laws
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Baby Gammy
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Baby Gammy
• Dec 2013 Thai commercial surrogate gives birth to twins
• Baby Girl Pipah and a boy Gammy (T21)
• Australian biological parents returned to Australia with Pipah leaving Gammy behind.
• Suggested TOP at ~k28; Thai laws
• Became news in mid 2014
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Baby Gammy
• Recourse for the Australian Couple – Thai law – birth mother is the legal mother
– Comodification of medicine
• Confounders – PHx, TOP, Age
• Fallout – Other families stopped from leaving Bangkok
– Approval of draft law banning surrogacy
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Other ethical considerations
• Exploitation
• “Brain Drain” Reversal
• Impact on local medicos
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What can we learn?
• “Can‟t beat „em join „em”
• Australia as a destination – Quality Health Care
– Falling Australian Dollar
– Safety
– We too have great beaches and
resorts and drinks
with little umbrellas in them!