Bariatric surgery is an increasingly popular intervention for severe obesity, offering significant health benefits, including weight loss, improved metabolic health, and reduced morbidity and mortality (Rubino et al., 2022).

However, in the UK, patients seeking such procedures face long NHS waiting lists or costly private treatment. Consequently, an increasing number opt for medical tourism, undergoing bariatric surgery abroad. This blog entry examines the advantages and disadvantages of this trend, alongside its implications for the NHS, considering both short-term and long-term impacts.

The Drivers of Bariatric Surgery Tourism

Medical tourism is driven by a combination of economic, systemic, and personal factors. Many patients seek surgery abroad due to:

• Cost Savings: Bariatric surgery in the UK can cost upwards of £10,000 in private clinics, whereas overseas procedures can be available for half that amount (Hanefeld et al., 2015).
• Waiting Times: NHS waiting lists for bariatric surgery are often prolonged due to funding constraints, prompting some patients to travel abroad to access care more quickly (Oliver et al., 2020).
• Perceived Quality and Availability: Some international hospitals actively market high-quality services with shorter waiting times, particularly in countries with well-established medical tourism sectors such as Turkey, Poland, and Lithuania (Johnston et al., 2019).

Benefits of Bariatric Surgery Abroad

Patients can undergo surgery much sooner than if waiting for NHS treatment, potentially mitigating the health deterioration associated with prolonged obesity.

Earlier intervention can improve comorbid conditions such as type 2 diabetes, hypertension, and sleep apnoea, leading to a better quality of life (Puzziferri et al., 2014).

Limited availability and stringent eligibility criteria for bariatric surgery within the NHS have led many UK patients to seek procedures overseas. Countries like Turkey and those in Eastern Europe offer more accessible options with shorter waiting times, enabling timely interventions for individuals struggling with obesity (Royal College of Surgeons, 2024).

The financial burden of private bariatric surgery in the UK drives patients to consider international alternatives. Procedures abroad often come at a fraction of the cost, with packages that include surgery, accommodation, and postoperative care, making treatment more affordable for a broader population (Royal College of Surgeons, 2024).

If patients fund their own surgery abroad, the NHS may benefit by reducing the demand for bariatric surgery funding.

Early intervention may reduce long-term NHS expenditures on obesity-related complications (Cawley & Meyerhoefer, 2012).

When patients opt for self-funded surgery abroad, it may reduce the demand on NHS services, potentially shortening waiting lists and allowing resource reallocation to other critical areas within the healthcare system (Royal College of Surgeons, 2024).

Risks and Challenges of Bariatric Surgery Abroad

Patients returning from overseas procedures sometimes develop complications, leading them to seek emergency NHS care.

Common issues include infections, leaks, nutritional deficiencies, and the need for surgical revisions (Smith et al., 2016).

NHS resources are then required for managing complications that may have arisen due to varying surgical standards or inadequate follow-up care (Healy et al., 2019).

A study analyzing international bariatric surgery tourism highlighted deficits in accreditation and perioperative care, underscoring the need for thorough research and patient education (PMC, 2023).

Surgical techniques and postoperative care protocols differ internationally, with some facilities lacking accreditation from recognised bodies such as the International Federation for the Surgery of Obesity (IFSO).

Variability in qualification standards of surgeons and postoperative guidelines can result in increased risks for patients.

Many UK-based healthcare providers do not have established pathways to integrate post-surgical patients who received care abroad, leading to gaps in monitoring and long-term management.

Patients may not receive adequate guidance on dietary adjustments, micronutrient supplementation, or physical rehabilitation (Mulligan et al., 2017).

NHS treatment for complications from overseas surgery raises ethical concerns regarding the fair allocation of resources.

Some argue that patients knowingly taking risks should bear responsibility for their care, while others maintain that all individuals deserve emergency medical intervention regardless of treatment origins (Lunt et al., 2015).

Implications for the NHS:

Positive Implications

Patients opting for private overseas surgery free up NHS slots, allowing those on waiting lists to receive care more quickly.

This may help address the backlog of cases exacerbated by the COVID-19 pandemic (Petersen et al., 2021).

If procedures are well-executed and postoperative care is sufficient, the NHS benefits from reduced obesity-related comorbidities, lowering expenditure on chronic disease management.

Negative Implications

Patients with postoperative complications may require extensive NHS interventions, sometimes including corrective surgeries.

This can result in increased hospital admissions and intensive care requirements, diverting resources from other patients.

NHS healthcare providers often lack established protocols for managing patients who received surgery abroad, leading to fragmented care and increased administrative burden.

Patients dissatisfied with their overseas experiences may hold UK healthcare providers responsible for their complications, leading to increased medico-legal concerns.

Negative experiences may erode trust in healthcare systems and encourage unrealistic expectations about postoperative management within the NHS

What does this all mean?

Bariatric surgery abroad presents both advantages and challenges for patients and the NHS. While cost savings and reduced wait times benefit individuals, the variability in surgical standards and the burden of complications on the NHS present significant concerns.

A balanced approach, including enhanced patient education, improved regulatory oversight, and structured NHS support, is essential for optimizing outcomes. Future research should examine long-term patient outcomes and NHS cost implications to inform policy improvements and ensure that bariatric surgery tourism does not compromise public health priorities.

References

Cawley, J., & Meyerhoefer, C. (2012). The medical care costs of obesity: An instrumental variables approach. Journal of Health Economics, 31(1), 219-230.

Hanefeld, J., Horsfall, D., Lunt, N., & Smith, R. (2015). Medical tourism: A cost or benefit to the NHS? PLOS ONE, 10(8), e0134585.

Johnston, R., Crooks, V. A., Snyder, J., & Kingsbury, P. (2019). What is known about the effects of medical tourism in destination and departure countries? International Journal for Equity in Health, 18, 28.

Lunt, N., Smith, R., Exworthy, M., Green, S. T., Horsfall, D., & Mannion, R. (2015). Medical Tourism: Treatments, Markets, and Health System Implications: A scoping review. OECD Health Working Papers.

Oliver, C., Jacobson, B., & Powell, S. (2020). Barriers to bariatric surgery: NHS perspectives. British Medical Journal, 369, m1311.

Royal College of Surgeons. (2024). The impact of medical tourism on UK healthcare. Bulletin of the Royal College of Surgeons.

Rubino, F., et al. (2022). Metabolic surgery: An overview. The Lancet Diabetes & Endocrinology, 10(2), 89-102.