Wednesday, February 27, 2008

Reverse Medical Tourism

There has been a lot of buzz about losing patients overseas to other cheaper venues to deliver care, but we must not lose sight that America still has significant expertise in areas where world leaders come to gain access to our healthcare system, especially when it involves expensive devices or therapies.

Lech Walesa, Poland's former President and Nobel Peace Prize winner who was instrumental at struggling against communism, has sought treatment at Houston's Methodist Hospital for congestive heart failure. The Houston Chronicle reports:
Former Polish President and Nobel Peace Prize winner Lech Walesa is scheduled to be fitted with a pacemaker at a Houston hospital today, a day after tests left doctors hopeful he won't need a heart transplant anytime soon.

Walesa, 64, underwent tests at The Methodist Hospital on Tuesday for advanced heart failure. He traveled to Houston from Mexico, suffering from shortness of breath and fatigue that had caused some doctors to suggest he might need a transplant.

"The struggle with communism took a lot out of my health," said Walesa, speaking through a translator. "But to be part of the discussion regarding remaining questions, I need to be healthy."

Walesa also has significant lung disease, Methodist doctors said.

They didn't rule out that Walesa might eventually need a heart transplant but said such a scenario isn't on the horizon now. Emphasizing that they think Walesa's heart can be strengthened, they said most patients who get a pacemaker don't go on to need a transplant. Only if his heart worsens will they evaluate whether he needs a new heart, they said.

The doctors said they hope Walesa can be discharged from Methodist early next week
My bet is he won't receive just a pacemaker, but a biventricular implantable cardiac defibrillator in hopes that he'll gain benefit in his left ventricular function and shortness of breath. Data from the MIRACLE trial using biventricular pacing for severe heart failure in patients with markedly reduced ejection fractions and widened QRS complexes demonstrated symptomatic improvement in about 66% of patients. The CARE-HF trial also demonstrated a mortality benefit with biventricular pacing alone, while the COMPANION trial demonstrated superior mortality benefit to biventricular pacing coupled with a defibrillator when compared to beventricular pacing or drug therapies alone.

Who'll pay for this device and his care is another question: will it be former-President Walesa, the State Department, or Methodist Hospital? Will his device be donated by a device company for PR purposes?

I wonder how this is handled in these cases? Should VIP healthcare be different than that received by the average Joe here in the States?


UPDATE: 1 Mar 08: An ICD it was.

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