Briefly
=======

* Wayne Kondro

*   © 2008 Canadian Medical Association

**Medical tourism:** With US health insurance providers and employers now urging people to seek cheaper medical care abroad, the American Medical Association has adopted guidelines for medical tourism. At their core lie the propositions that care should be voluntary and sought solely from internationally accredited providers ([www.ama-assn.org/ama/pub/category/18678.html](http://www.ama-assn.org/ama/pub/category/18678.html)). An estimated 150 000 Americans sought care overseas in 2006, with nearly half of procedures categorized as medically necessary.

**Checklist:** Mark the surgical site. Count the implements and sponges. The basics are in a 1-page “Surgical Safety Checklist” ([www.who.int](http://www.who.int)) unveiled by the World Health Organization in a bid to prevent complications and deaths during surgery. The WHO estimated at least half of 7 million surgical procedures that lead to complications annually are entirely avoidable.

**Online auctions:** American hospitals have begun using online auctions to sell their patients' debts or accept guaranteed payments for access to unpaid accounts by collection agencies. Thus far, the online auctions (run by ARxChange.com and medipent.com) have typically garnered mere fractions of pennies on dollars owed as hospitals have confined the auctions to older debt. The American Hospital Association estimated in 2006 that some 5000 community hospitals now carry about $31.2 billion in debt from unpaid patient bills or as a result of charity care.

**Obstetric trends:** With 26.3% of children now being born in Canada by cesarean section, the Society of Obstetricians and Gynaecologists of Canada is urging physicians to scale back recommending the operation out of convenience, instead of medical necessity, because it puts more women at greater risk of complications such as infections, obstetrical wounds and cardiac arrest, while financially burdening the health care system.