Welcome to the hotel cardiac bypass

Booked next year's holiday? Why just lie on the beach in Rio or Marbella when you could have your tummy tucked, your nose jobbed, and your eyesight corrected at the same time? Oliver Bennett on the trail of the new health tourists

See Disney World and have a health check-up. Relax in a suite in the Hernia Inn after a few rounds of golf, or take a sun, sea and surgery break in Spain. This is the era of health tourism and no more does travelling for health reasons mean a spin through the rubber doors of the local infirmary. A growing minority of patients around the world are travelling for health, and private hospitals are pitching to rich foreigners for medical treatment in tandem with a holiday. After all, why just have a hedonistic vacation when you can have a heart by-pass in the whispering luxury of a private hospital-cum-hotel? It is the perfect package for neurotic times.

Mixing holidays and medical care is already big business in the US. The Florida Hospital in Orlando, for instance, lays on a family package theme- park holiday with health-screening included. Meanwhile, the nearby Mercy Hospital sells a pounds 3,500 health check package which includes golf and tennis on luxury Fisher Island near Miami. Some hotels have deals with nearby hospitals to look after post-op patients.

When America sneezes Britain catches cold, and these incentives are also growing in the UK. The HCI International Medical Centre on Clydeside is a campus-type affair with a hospital, hotel and restaurant. In a new promotional video it runs through the medical facilities, and also plugs the tourist attractions of Glasgow and the Highlands. "We take on day- trips to Loch Lomond," says Alan Rogers, business development manager.

The HCI is soon to start "executive" health checks and cosmetic surgery: both rich veins of hospital tourism. "The executives will combine an MOT with a holiday," beams Rogers, "and people getting cosmetic surgery will combine it with a six-week holiday, with the first two weeks in the hospital. When they get back, their friends will say 'My, you look well' and suspect nothing." As with US hotels, the HCI has banks of interpreters, an Arabic cafe, Arabic hospital food, a Muslim prayer room and culturally-trained staff: of its 55 per cent of foreign clients, the majority are Middle Eastern. Clients often bring several friends and relatives who stay in the hotel. "Good for the local economy," says Rogers. "You have to work with the local community, otherwise you get resentment."

"Tourism and health are linked more and more," says Peter Fermoy of Bupa. "Companies like ourselves target patients from overseas, and we have arrangements with travel companies." Emirates Holidays, for instance, do a holiday and health-screening package in league with Bupa. "It is a break for the patient, and also for their relatives," says Fermoy, who emphasises that the UK's centre-West geographical location and nonpareil medical expertise are two major selling points.

Another pioneer of British medical tourism is John Terry, director of the National Hospital for Aesthetic Plastic Surgery in Bromsgrove, which linked up with an American travel agent to provide package deals: breast jobs followed by sightseeing in Stratford-upon-Avon, the Cotswolds and Bronte country. Terry has now finished the breast 'n' bard packages, claiming that they detracted from the hospital's core business. "We always asked for a letter from the women's GP at home, saying 'We cannot provide this service here, but will provide aftercare when she gets home'," he says, stressing the rectitude of the treatment. He adds that there are problems about travelling for surgery. "When people leave the jurisdiction of their own legal systems, they are at risk. We had one client who spent pounds 15,000 on a face-lift abroad, and it was a total disaster." British women travel regularly to Marbella in Spain for plastic surgery. London-based reps sell two-week sun, sea and surgery packages - a few days under the knife; the remainder by the pool. Other countries have had their moments for plastic surgery. Brazil has been prominent, though Terry says, "Many a tourist has had a facelift there to bad effect", and adds that their tummy- tucks are geared towards Brazilian swimwear.

"Talk it through," he counsels. "If you're at all passive during your consultation - and Brits tend to be because they're bought up not to question the doctor - you might end up with something completely different." He warns of pounds 120 Russian facelifts, where the surgeons smoke on duty in filthy labs. "Good surgery is not cheap and cheap surgery is not good." Better small breasts than huge, misshapen ones.

Cosmetic surgery tourism may cut corners. For instance, the place to get a quick sex change these days is Beirut, where a wad of dollars will secure your desired gender in a few cold cuts; whereas in Britain such surgery would take years and come with compulsory gender-identity psychiatry.

US hospitals are not only chasing the world's rich, but also the war- wounded. Through diplomatic and military sources, a hospital in Baltimore targeted a skirmish in South America last year and received over 45 wounded soldiers for artificial prostheses at a cost of about pounds 24,000 per head. With this aggressive, ambulance-chasing attitude, many potential patients have bypassed Britain for America. Indeed, despite the consensus that the UK is medically excellent, some Britons travel abroad for treatment, possibly attracted by a high-profile specialist. Or they may elect to have treatment while travelling.

As far as operations abroad are concerned, Dr Paul Clarke of Masta (The Medical Advisory Service for Travellers Abroad), identifies some key issues. Firstly, the reputations of specialist units should be checked, as they often rely on just one or two mobile experts. Another is that many countries may carry a higher risk of infected blood for transfusions; and there may also be a lower standard of secondary care. "You may have a brilliant surgeon in Nairobi, but if the post-operative care is not there, you've got a problem," he says. "One of the great things about Britain is that wherever you are, the medical infrastructure will give you good quality care." We also have an advantage, he adds, in that English is the medical lingua franca.

Columbus Travel Insurance undertook a survey looking at people's perception of treatment abroad, and found that most British holidaymakers perceived foreign hospital treatment as being inferior to the UK, especially in the Far East. It also warned against Spain. "A lot of the private hospitals are near resorts, which is no accident, and the doctors may not be the best, as the public sector standards are kept high," says a spokeswoman.

Most of us would be advised to stay at home for surgery, then. But in the UK, lower-level healthcare has long been linked to tourism. Erna Lowe Consultants, a spa, ski and health travel agency, has a doctor on its books to offer advice, and is able to match ailment to destination. Vichy is good for circulation, for instance. One client went to take the radium- rich waters in Hungary, hoping that it would help her to conceive. It sends clients to Switzerland and northern Italy on doctors orders, and in Austria runs a "ski 'n' spa" - a successor to the Victorian way of sending sick aristocrats to sanatoriums in the Alps. Of course, the miracle tendency remains, with destinations like Lourdes and Fatima besieged by coachloads of the infirm seeking religious intervention for ailments both serious and trivial.

Health tourism has good points. Being able to target specialised expertise is one. On the downside, flying 3,000 miles is not the best pre-operative condition, and putting your life in the hand of an unknown, foreign language speaking physician can be tricky. Other problems could be litigation, and the loss of back-up from friends and relatives. And, if complications ensue, who pays? The major brake on health tourism, however, may well be less a matter of medical safety or ethics than a question of taste. Many potential shoppers in the global health supermarket will find the juxtaposition of medicine and leisure just a little bit too tacky - whether or not they have the money to check into Cardiac Motel.

THE WORLD IS YOUR OPERATING THEATRE ...

United States: patients come from Europe, Central and Latin America to the US for treatment for breast cancer, lung, stomach and prostrate cancer and sexually transmitted diseases. The most likely country in which to find niche specialists.

Latin America: thousands of Americans have travelled to Rio de Janiero for plastic surgery, but the traffic is now abating.

Lebanon: Beirut is the place to go for plastic and gender surgery - with no questions asked.

Spain: Brit- ish women looking for a discreet facelift (and a tan) head for the resort of Marbella.

United Kingdom: suffered in the past decade due to competitive home markets and the US, but the growth of private medicine particularly attracts people from Middle East and, to a lesser extent, Asia. Some cosmetic surgery "tourists" from the United States.

Far East: the region's tiger econ- omies have good medical infrastructures, tapping Singapore, Japan and new money in India and Malaysia.

CIS: the former Soviet Union's eye- sight correction facilities continue to target Western Europeans.

Switzerland: Geneva is the traditional centre for re- laxation and clinical treatments.