For years, medical tourism has consisted of patients jetting abroad for voluntary cosmetic procedures such as tummy tucks, dental work and face lifts.
But ballooning NHS waiting times and the sky-high cost of going private in Britain are fuelling a boom in demand for more foreign surgical procedures.
Clinics across Europe, from Belgium to the Baltics, are reporting a surge in interest for elective procedures.
Among the most popular are knee and hip operations, which is no surprise given the current backlogs. More than 60,000 NHS patients were waiting more than a year for elective trauma and orthopaedic surgery in February 2022, compared to 436 in January 2020, according to the British Orthopaedic Association.
Keith Pollard, editor-in-chief at the International Medical Travel Journal, said: “At the Nordorthopaedics Clinic in Lithuania, for instance, 80pc of their patients for hip and knee surgery are Britons. Other clinics around Europe would say the same – in Spain, France, and elsewhere.”
The potential savings from hopping on a flight abroad for treatment can be substantial. Hip operations in some European countries cost half as much as in the UK, even when factoring in the price of travel, accommodation and insurance.
Here, Telegraph Money talks you through how to get the best deal on hip surgery abroad.
How much does it cost to go private in the UK?
For NHS patients with debilitating joint problems facing year-long queues, looking into private surgery options in the UK might be the natural first step to getting the operation you need.
But it doesn’t come cheap. While the average cost of a private hip replacement without health insurance is £13,402, prices vary from £9,400 to £15,800 depending on location, according to consumer information website myTribe Insurance.
The cheapest deals are in Yorkshire & Humberside and north-east England, while the priciest surgeries are in south-west England and East Anglia.
Where can I find the best price abroad?
According to the medical travel website Treatment Abroad, Georgia comes in as the cheapest European(ish) country to have a hip replacement, at just £2,475 on average. The price includes travel, accommodation and insurance.
Next cheapest destinations are Hungary (£4,254), Poland (£5,085), and Lithuania (£5,407).
Lithuania, whose total population is a third of the size of London’s, has become a popular destination for elective surgery thanks to its low prices, relative proximity to the UK, and reputation for high-quality treatment.
Maja Swinder, patient co-ordinator at EuroTreatMed, a medical travel agency with close partnerships with five clinics in Poland, said: “A patient from the UK shared that she was quoted £14,900 just for the private hip replacement surgery itself, which covered only a two-day hospital stay without physiotherapy or follow-up appointments.
“Managing at home the day after such a major operation would be very challenging.”
At the clinics in Ms Swinder’s network, for example, a total hip replacement operation with a 14-day stay in a private hospital room and daily physiotherapy would cost between £7,430 and £7,990.
Can I get the NHS to pay for foreign healthcare?
A reciprocal post-Brexit healthcare agreement, known as “The S2 funding route”, allows patients to undergo planned treatment, such as hip operations, in an EU country or Switzerland through its state healthcare system.
A patient’s home state foots the bill, but you must meet strict criteria to be approved under the scheme – including a doctor confirming that your wait for treatment on the NHS would count as an “undue delay”.
The history of the scheme dates back to a 2006 European Court of Justice ruling. The case was brought by Yvonne Watts, 75, who paid £4,000 for a hip operation in France after facing a delay to her treatment in the UK.
The court ruled the NHS must reimburse patients who travel to another EU country for treatment when they face an “undue delay” for the treatment at home.
Securing S2 funding for treatment abroad can be a lifeline for those who desperately need treatment quickly, but can’t afford to go private.
However, patients have reported a gruelling S2 application process, and have told the Telegraph the process involved jumping through “hoops of fire”, only to be rejected.
In EU countries where healthcare is free at the point of use, as in the UK, an approved S2 will cover 100pc of the costs of your healthcare, although NHS England says it will not reimburse travel or accommodation costs.
In some cases, you may still have to pay for a portion of your treatment. The NHS website states: “If your application under the S2 route is approved, your treatment will be provided under the same conditions of care and payment that would apply to residents of the country you’ll be treated in.
“This could mean you have to pay a percentage of the costs personally (a co-payment charge).
“In some countries, for example, patients cover 25pc of the costs of their state-provided treatment. The state covers the other 75pc.”
It’s important therefore to factor in how healthcare is funded in whichever country you seek to get treatment, as you may still have to foot some or all of the bill.
An NHS spokesman said: “Eligible patients can use S2 funding to access care abroad, with information for English patients on eligibility and how to apply available on the NHS website, including details on how to complain about or appeal a decision.”
How to choose the right clinic
Entering into a health system you don’t understand can make travelling abroad for treatment a daunting prospect.
Fortunately, international clinics tend to have good reputations. Mr Pollard said: “Hospitals and consultants that handle international patients, both abroad and in the UK, are usually the best hospitals and the best consultants.
“I wouldn’t say any one country is better than another. What I would say is that the rehabilitation stage of care abroad is much better than in the UK. In Europe they have a much bigger focus on rehab from the surgery and getting you back to normal as quickly as possible.”
That being said, records and data on surgeries may not be as thorough as what you can find in Britain, so it can be tricky to get the full picture about how some clinics perform.
“The issue is whether there’s any hard data on numbers of surgeries performed and complication rates. In the UK all that data is recorded and published,” said Mr Pollard.
“You should always go for a specialist in hip operations. Ask the clinic: how many operations are they doing each year? How many revisions are they doing? The clinic should send you the data if you ask. If they don’t, don’t go there.”
One way to narrow down your options is to stick to countries in the European Union, as they should all stick to certain standards of healthcare, Ms Swinder advised.
“Hospitals and surgeons hold mandatory liability insurance,” she said.
“Additionally, assessing aftercare options and communication is essential. Is the clinic responsive and willing to address inquiries and questions?
“Check reviews, maybe ask to be put in touch with former patients who could share their experience with you. Ask for a comprehensive cost breakdown, encompassing surgery, implants, medications, and potential hidden fees.
“Most importantly, trust your instincts while making this significant decision and choose a provider or hospital you have faith in,” she added.
While there’s no central database of reviews for surgery abroad, Treatment Abroad has compiled a list of foreign clinics. Not all are reviewed, but treat it as a directory, and it will be a good starting point.
Mr Pollard says that as online reviews are hard to come by, it’s best to speak to the clinic directly to get a feel for whether it’s suitable.
“Many people decide based on a personal reference from someone they know who has been there before. Or they make an assessment based on the relationship they build up with a clinic.”
Not all clinics are reputable, so asking more in-depth questions should help you root out those that may not be reliable.
For instance, you should be wary of booking any treatment abroad if the clinic tries a hard sell, does not provide information you request, pressures you to make a quick decision, does not discuss possible complications or makes no mention of aftercare, according to the NHS website.
What insurance do I need?
When travelling abroad for a medical procedure, it is crucial you have the correct insurance – and it won’t be the same as a policy you might use when you go on holiday.
Mr Pollard said: “One thing people do is buy regular travel insurance to go overseas for treatment, but there’s an exclusion within every regular travel insurance policy for having medical treatment abroad.”
If your usual travel insurer will not cover you, you might need to find a specialist medical travel insurance provider – an insurance broker may be able to help you.
Alternatively, specialist insurers such as Medicaltravelshield.com, offer insurance specifically for medical travellers.
It’s best to check the details of what these policies cover and don’t cover; for example, complications once you have returned home may not be included, but costs of return travel to the clinic for corrective surgery might be.
Another option is to ask your prospective clinic whether it has a form of insurance that you could buy.
According to Felicity Hannah, finances expert at Compare the Market, you should examine specialist medical travel insurance policies very carefully as the level of protection can vary substantially.
“Never assume everything you want is included in any insurance policy,” she said. “You must read the small print and understand what you’re buying.
“There may well be exclusions in terms of covering lengthy aftercare overseas, or the cost of repatriation.
“There may be terms that invalidate your cover if, say, you drink alcohol following your surgery – something you might be tempted to do if you’ve planned a holiday abroad around your treatment.
“And some medical tourism insurance policies may only provide the usual travel insurance protections such as lost luggage or stolen items, and not actually provide any protection if things go wrong with the procedure.”
It’s also important to keep on top of any wider issues that may invalidate your insurance.
“Remember, as with any standard travel insurance policy, this kind of cover is very unlikely to include travel to any country which the Foreign and Commonwealth Office have advised against visiting” Ms Hannah added.
“This kind of policy may also exclude any pre-existing medical conditions, so make sure you fully understand exactly what protection you’re buying if you have additional needs.”
It’s worth remembering that travel insurance can already be trickier and more expensive for older travellers, particularly if you have any existing medical conditions.
And if, because of age or a pre-existing medical condition, you’re struggling to find an insurance policy that will cover you, choosing to have surgery in a location closer to home might improve your chances.
The best travel insurance policies for over-60s
Can you be refused treatment in the UK after getting surgery abroad?
One of the bigger risks of travelling abroad for a hip operation is not being covered if things go wrong later on.
Regular private medical insurers are highly unlikely to cover the cost of future complications. A spokesman for Aviva said that a claim on its medical insurance policy for complications that arose because of surgery abroad would be rejected.
The NHS is also tightening up on providing care for medical tourists, in theory at least.
This month, NHS doctors were sent an advice note reminding them that the service should not be providing any pre or post-operative care for people seeking private surgery abroad.
Mr Pollard said: “The reality is that if you turn up in A&E with a complication, they’re going to treat you.”
However, the possibility of being refused treatment down the line means it’s essential to triple-check what is included in the price your clinic offers before you take the plunge.
The operation itself is only one part of the treatment process, and you’ll need routine care before and after the surgery.
Mr Pollard said: “Get an absolutely firm quote that it’s an all-inclusive package – that the clinic isn’t going to add stuff on – so that if you end up staying in hospital for five or six days instead of two or three, that’s covered and the clinic is bearing the risk.”
Do I need a referral from my GP or specialist?
“Most private hospitals and consultants, in the UK and abroad, will not require a GP referral,” Mr Pollard said.
“Those days have gone. Mainly because if you want a GP referral, you actually have to see your GP. That delays things another three or four weeks.”
It’s not even obligatory to inform your GP if you’re planning to have private surgery abroad, but it’s highly recommended to ask their advice and keep them in the loop.
“It’s always wise to tell your GP what you’re doing. And your GP will have a view on it, positive or negative,” Mr Pollard added.
The medical information foreign clinics require will vary. Typically, patients will first have a remote consultation, you’ll likely also have to fill in a health questionnaire and supply relevant scans and blood test results before you get on a plane.
You should check early on in the process what information is required, so you can request it from your GP or consultant.
How much it costs to skip the NHS queue and get your hip done privately