Medical tourism is the travel of people to a place other than where they normally reside for the purpose of obtaining medical treatment in that country. Traditionally, people would travel from less-developed countries to major medical centers in highly developed countries for medical treatment that was unavailable in their own communities; the recent trend is for people to travel from developed countries to third-world countries for medical treatments because of cost consideration, though the traditional pattern still continues. Another reason for travel for medical treatment is that some treatments may not be legal in the home country, such as some fertility procedures.
Some people travel to obtain medical surgeries or other treatments. Some people go abroad for dental tourism or fertility tourism. People with rare genetic disorders may travel to another country where treatment of these conditions is better understood. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services, is available.
Health tourism is a wider term for travels that focus on medical treatments and the utilization of healthcare services. It spans a wide field of health-oriented tourism ranging from preventive and health-conductive to rehabilitational and curative forms of travel; the latter being commonly referred to as Medical tourism. Wellness tourism is another related field. On the occasion of the 9th National Conference on Health Economy held in Rostock/Germany in 2013, it has been defined as (...) the branch of health and tourism economy that contributes to maintaining and restoring health and well-being in particular by using validated medical services.
The first recorded instance of people travelling to obtain medical treatment dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios.
Spa towns and sanitariums may be considered an early form of medical tourism. In 18th-century England, for example, patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.
Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The avoidance of waiting times is the leading factor for medical tourism from the UK, whereas in the US, the main reason is cheaper prices abroad.
Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in other countries. For example, in the United States, a liver transplant that may cost $300,000 USD, would generally cost about $91,000 USD in Taiwan. A large draw to medical travel is convenience and speed. Countries that operate public health-care systems often have long wait times for certain operations, for example, an estimated 782,936 Canadian patients spent an average waiting time of 9.4 weeks on medical waiting lists in 2005. Canada has also set waiting time benchmarks for non urgent medical procedures, including a 26-week waiting period for a hip replacement and a 16-week wait for cataract surgery.
In First World countries such as the United States, medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
Additionally, some patients in some First World countries are finding that insurance either does not cover orthopedic surgery (such as knee or hip replacement) or limits the choice of the facility, surgeon, or prosthetics to be used.
Popular destinations for cosmetic surgery include: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Turkey, Thailand and Ukraine. According to the "Sociedad Boliviana de Cirugia Plastica y Reconstructiva", more than 70% of middle and upper class women in the country have had some form of plastic surgery. Other destination countries include Belgium, Poland, Slovakia, Ukraine and South Africa.
However, perceptions of medical tourism are not always positive. In places like the US, which has high standards of quality, medical tourism is viewed as risky. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care.
Health tourism providers have developed as intermediaries which unite potential medical tourists with provider hospitals and other organizations. Companies that focus on medical value travel typically provide nurse case managers to assist patients with pre- and post-travel medical issues. They may also help provide resources for follow-up care upon the patient's return.
Circumvention tourism is also an area of medical tourism that has grown. Circumvention tourism is travel in order to access medical services that are legal in the destination country but illegal in the home country. This can include travel for fertility treatments that aren’t yet approved in the home country, abortion, and doctor-assisted suicide. Abortion tourism can be found most commonly in Europe, where travel between countries is relatively simple. Ireland and Poland, two European countries with highly restrictive abortion laws, have the highest rates of circumvention tourism. In Poland especially, it is estimated that each year nearly 7,000 women travel to the UK, where abortion services are free through the National Health Service. There are also efforts being made by independent organizations and doctors, such as with Women on Waves, to help women circumvent draconian laws in order to access medical services. With Women on Waves, the organization uses a mobile clinic aboard a ship to provide medical abortions in international waters, where the law of the country whose flag is flown applies.
The typical process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider, who is commonly referred to as a "facilitator". The facilitator usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information, such as x-rays or diagnostic testing results. Certified physicians or consultants may advise on the medical treatment or recommend an initial consultation with a specialist. The approximate cost of treatment, the choice of doctor and hospital, expected duration of stay, and logistical information, such as accommodation, ground transportation, and flights are discussed as well. A patient may be asked to pay an upfront deposit for treatment. For those destinations which require a visa, the patient will be given recommendation letters for a medical visa for the relevant embassy. The patient travels to the destination country, where the medical tourism provider may assign a case executive, who takes care of on the ground experience, including translation, accommodation, and arranging aftercare. In the cases where patients self-pay for medical treatment, a final treatment bill will be presented upon completion of treatment. If the patient underwent surgery, there may be additional post-operative checks to discharge the patient and deem him or her "fit for flight" for the return home trip.
International healthcare accreditation
International healthcare accreditation is the process of certifying a level of quality for healthcare providers and programs across multiple countries. International healthcare accreditation organizations certify a wide range of healthcare programs such as hospitals, primary care centers, medical transport, and ambulatory care services. There are a number of accreditation schemes available based in a number of different countries around the world.
The oldest international accrediting body is Accreditation Canada, formerly known as the Canadian Council on Health Services Accreditation, which accredited the Bermuda Hospital Board as soon as 1968. Since then, it has accredited hospitals and health service organizations in ten other countries.
In the United States, the accreditation group Joint Commission International (JCI) was formed in 1994 to provide international clients education and consulting services. Many international hospitals today see obtaining international accreditation as a way to attract American patients.
Joint Commission International is a relative of the Joint Commission in the United States. Both are US-style independent private sector not-for-profit organizations that develop nationally and internationally recognized procedures and standards to help improve patient care and safety. They work with hospitals to help them meet Joint Commission standards for patient care and then accredit those hospitals meeting the standards.
A British scheme, QHA Trent Accreditation, is an active independent holistic accreditation scheme, as well as GCR.org which monitors the success metrics and standards of almost 500,000 medical clinics worldwide.
The different international healthcare accreditation schemes vary in quality, size, cost, intent and the skill and intensity of their marketing. They also vary in terms of cost to hospitals and healthcare institutions making use of them.
Increasingly, some hospitals are looking towards dual international accreditation, perhaps having both JCI to cover potential US clientele, and Accreditation Canada or QHA Trent. As a result of competition between clinics for American medical tourists, there have been initiatives to rank hospitals based on patient-reported metrics.
Medical tourism carries some risks that locally provided medical care does not.
Some countries, such as South Africa, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West.
The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. Also, traveling long distances soon after surgery can increase the risk of complications. Long flights and decreased mobility associated with window seats can predispose one towards developing deep vein thrombosis and potentially a pulmonary embolism. Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they sunburn while healing.
Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.
Receiving medical care abroad may subject medical tourists to unfamiliar legal issues. The limited nature of litigation in various countries is one reason for the lower cost of care overseas. While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity. Issues can also arise for patients who seek out services that are illegal in their home country. In this case, some countries have the jurisdiction to prosecute their citizen once they have returned home, or in extreme cases extraterritorially arrest and prosecute. In Ireland, especially, in the 1980s-90s there were cases of young rape victims who were banned from traveling to Europe to get legal abortions. Ultimately, Ireland’s Supreme Court overturned the ban; they and many other countries have since created "right to travel" amendments.
There can be major ethical issues around medical tourism. For example, the illegal purchase of organs and tissues for transplantation had been methodically documented and studied in countries such as India, China, Colombia and the Philippines. The Declaration of Istanbul distinguishes between ethically problematic "transplant tourism" and "travel for transplantation".
Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example, in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system. In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care". Medical tourism centered on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering advanced technologies, such as providing 'unproven' therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation.
Employer-sponsored health care in the US
Some US employers have begun exploring medical travel programs as a way to cut employee health care costs. Such proposals have raised stormy debates between employers and trade unions representing workers, with one union stating that it deplored the "shocking new approach" of offering employees overseas treatment in return for a share of the company's savings. The unions also raise the issues of legal liability should something go wrong, and potential job losses in the US health care industry if treatment is outsourced.
Employers may offer incentives such as paying for air travel and waiving out-of-pocket expenses for care outside of the US. For example, in January 2008, Hannaford Bros., a supermarket chain based in Maine, began paying the entire medical bill for employees to travel to Singapore for hip and knee replacements, including travel for the patient and companion. Medical travel packages can integrate with all types of health insurance, including limited benefit plans, preferred provider organizations and high deductible health plans.
In 2000, Blue Shield of California began the United States' first cross border health plan. Patients in California could travel to one of the three certified hospitals in Mexico for treatment under California Blue Shield. In 2007, a subsidiary of BlueCross BlueShield of South Carolina, Companion Global Healthcare, teamed up with hospitals in Thailand, Singapore, Turkey, Ireland, Costa Rica and India. A 2008 article in Fast Company discusses the globalization of healthcare and describes how various players in the US healthcare market have begun to explore it.
Africa and the Middle East
Jordan through their Private Hospitals Association, managed to attract 250,000 international patients accompanied by more than 500,000 companions in 2012, with a total revenues exceeding 1B US$. Jordan won the Medical Destination of the year award in 2014 in the IMTJ Medical Travel Awards.
Israel is a popular destination for medical tourism. In 2010, Israel treated 30,000 medical tourists, mostly from the former Soviet Union. There are reports that these medical tourists obtain preferential treatment, to the detriment of local patients. Some people come to Israel to visit health resorts at the Dead Sea, and on Lake Kinneret.
In 2012, 30,000 people came to Iran to receive medical treatment. In 2015, It is estimated that between 150,000 and 200,000 health tourists come to Iran, and this figure is expected to rise to 500,000 a year.
Iran is low endemicity for HBV and HCV infections and there is a unique experiences regarding control of these infections that can present to the peoples in Middle East countries. The pharmaceutical companies in Iran produces all of drugs are needed for control of HCV and HBV infection such as Tenefovir, Peg Interferon, Sofosbovir, Ledipasvir, Daclatasvir with very low prizes and high efficiency. Sadeghi F, Salehi-Vaziri M, Almasi-Hashiani A, Gholami-Fesharaki M, Pakzad R, Alavian SM. Prevalence of Hepatitis C Virus Genotypes Among Patients in Countries of the Eastern Mediterranean Regional Office of WHO (EMRO): A Systematic Review and Meta-Analysis. Hepat Mon. 2016;16(4):e35558.
In Brazil, Albert Einstein Hospital in São Paulo was the first JCI-accredited facility outside of the US, and more than a dozen Brazilian medical facilities have since been similarly accredited. Brazil requires visas for US citizens based on a reciprocal arrangement since Brazilians are required to obtain a visa to visit the US.
Canada has entered the medical tourism field. In comparison to US health costs, medical tourism patients can save 30 to 60 percent on health costs in Canada.
In addition, many Americans visited Canada to pose as Canadians and fraudulently use Canada's universal health care system. This became a serious issue in the early 1990s due to the high costs it imposed.
In Costa Rica, there are two Joint Commission International accredited (JCI) Hospitals. Both are in San Jose, Costa Rica. When the World Health Organization (WHO) ranked the world’s health systems in the year 2000, Costa Rica was ranked as no. 36, which was higher than the U.S., and together with Dominica it dominated the list amongst the Central American countries.
The Council for International Promotion of Costa Rica Medicine - PROMED (www.promedcostarica.org) is the primary trade association promoting the country as a medical tourism destination.
Ecuador is becoming more recognized as a Medical Tourism destination and a top retirement destination worldwide. Ecuador has been declared by International Living Magazine, "No. 1 out of the 22 best countries on its Annual Retirement Index for five years running." The World Health Organization (WHO) ranked Ecuador as the 6th most improved healthcare system in the world.
Some clinics may also offer alternative medicine therapies that have been proven ineffective or are banned in the United States. The Mexican government has shut down some of these in recent times, in response to controversial cases like that of Coretta Scott King.
A McKinsey and Co. report from 2008 found that between 60,000 and 85,000 medical tourists were traveling to the United States for the purpose of receiving in-patient medical care. The same McKinsey study estimated that 750,000 American medical tourists traveled from the United States to other countries in 2007 (up from 500,000 in 2006). The availability of advanced medical technology and sophisticated training of physicians are cited as driving motivators for growth in foreigners traveling to the U.S. for medical care, whereas the low costs for hospital stays and major/complex procedures at Western-accredited medical facilities abroad are cited as major motivators for American travelers. Also, the decline in value of the U.S. dollar between 2007 and 2013 used to offer additional incentives for foreign travel to the U.S., although cost differences between the US and many locations in Asia are larger than any currency fluctuations.
Several major medical centers and teaching hospitals offer international patient centers that cater to patients from foreign countries who seek medical treatment in the U.S. Many of these organizations offer service coordinators to assist international patients with arrangements for medical care, accommodations, finances and transportation including air ambulance services.
Asia and the Pacific Islands
Investigations into organ harvesting have been carried out. Investigative journalist Ethan Gutmann estimates that the "organs of 65,000 Falun Gong and 'two to four thousand' Uyghurs, Tibetans or House Christians were 'harvested' in the 2000-2008 period alone".
It is very likely that "each person who travels to China for an organ causes the death of another human". Furthermore, in their announcements to end organ harvesting from prisoners, China only speaks of executed prisoners, but has not acknowledged the organ procurement from non-consenting prisoners of conscience. State-sanctioned organ harvesting continues to this day, according to Doctors Against Forced Organ Harvesting representative Dr. Chen.
Medical tourism is a growing sector in India. India is becoming the 2nd medical tourism destination after Thailand. Chennai is regarded as "India's Health City" as it attracts 45% of health tourists visiting India and 40% of domestic health tourists. India’s medical tourism sector is expected to experience an annual growth rate of 30%, making it a $2 billion industry by 2015. As medical treatment costs in the developed world balloon - with the United States leading the way - more and more Westerners are finding the prospect of international travel for medical care increasingly appealing. An estimated 150,000 of these travel to India for low-priced healthcare procedures every year. Cosmetic surgery, bariatric surgery, knee cap replacements, liver transplants, and cancer treatments are some of the most sought out medical tourism procedures opted by foreigners. Some of the leading hospitals for medical tourism are Apollo Hospitals, Global Hospitals, Narayana Health, Bombay Hospital, Hinduja Hospital, Hiranandani Hospital, Akruti Institute of Plastic and Cosmetic Surgery, Columbia Asia, and Fortis Health Care.
Singapore has a dozen hospitals and health centers with JCI accreditation. In 1997 (published 2000), the World Health Organization ranked Singapore's health care system sixth best in the world and the highest ranked system in Asia.
The Korea Times reported in a series of articles that South Korean hospitals have adopted a discriminatory pricing policy, charging foreigners two to three times more than the full-fee for locals. The paper revealed that the price disparity in medical fees for foreign patients is extremely high, considering that the difference between the lowest and highest fees for the most-sought-after procedures exceeds more than 10 times on average.
It claims the government is overlooking soaring medical fees on foreign patients, who are unprotected from malpractice, discriminatory charging, overpricing and patient privacy rights under the Korean Medical Law. The Korea International Medical Association has been set up to encourage medical tourism.
Thailand has 37 JCI-accredited hospitals. In 1994 The Thai Dental Council was established and is the premier governing body of dental practices in Thailand, and has now formulated uniform competency requirements for dental practitioners, thus directly influencing the medical and dental teaching programs. The Ministry of Public Health plays an important role in developing healthcare to promote scientific based education. In addition, the Thai government has placed a more important role in public health programs for its citizens. Foreigners seeking treatment for everything from open-heart surgery to gender reassignment have made Thailand a popular destination for medical tourism, attracting an estimated 2.81 million patients in 2015, up 10.2 percent. In 2013, medical tourists pumped as much as US$4.7 billion into the Thailand's economy, according to government statistics.
In 2006, it was ruled that under the conditions of the E112 European health scheme, UK health authorities had to pay the bill if one of their patients could establish urgent medical reasons for seeking quicker treatment in another European union country.
On December 9, 2013 the City of Helsinki decided, that all minors under the age of 18 and all pregnant mothers living in Helsinki without a valid visa or residence permit, are granted the right to the same health care and at the same price as all citizens of the city. This service will be available sometime early year 2014. Volunteer doctors of Global Clinic have tried to help these people, for whom only acute care has been available. This means that the Finnish health care system is open for all people coming outside of the European Union. The service covers special child health care, maternity clinics and specialist medical care etc. practically for free. It is still unclear if this will increase so called health care tourism, because all you have to do is come to Helsinki as a tourist and let the visa expire.
British NHS patients have been offered treatment in France to reduce waiting lists for hip, knee and cataract surgery since 2002. France is a popular tourist destination but also ranked the world's leading health care system by the World Health Organization. European Court of Justice said that National Health Service (England) has to pay back British patients.
Serbia has a variety of clinics catering to medical tourists in areas of cosmetic surgery, dental care, fertility treatment and weight loss procedures. The country is also a major international hub for gender reassignment surgery.
The cost of medical treatments in Turkey is quite affordable compared to Western European countries. Therefore, thousands of people each year travel Turkey for their medical treatments. Turkey is especially becoming a hub for hair transplant surgery.
National Health Service (England) is public but some private hospitals and clinics in the United Kingdom are medical tourism destinations, especially London. Nevertheless, as at the present time very few UK private hospitals have gone through independent international accreditation (they only have the mandatory registration with the UK's watchdog, the Care Quality Commission), so they have not as yet measured themselves against the best clinics and hospitals elsewhere in the world.
It is alleged that health tourists in the UK often target the NHS for its free-at-the-point-of-care treatment, allegedly costing the NHS up to £200 million. A study in 2013 concluded that the UK was a net exporter of medical tourists, with 63,000 UK residents travelling abroad for treatment and about 52,000 patients getting treatment in UK. Medical tourists treated as private patients by NHS trusts are more profitable than UK private patients, yielding close to a quarter of the revenue from only 7% of volume of cases. UK dental patients largely go to Hungary and Poland. Fertility tourists mostly travel to Eastern Europe, Cyprus and Spain.
In the summer of 2015 immigration officers from the Border Force were stationed in St George's University Hospitals NHS Foundation Trust to train staff to identify “potentially chargeable patients”. In October 2016 the trust announced that it planned to require photo identity papers or proof of their right to remain in the UK such as asylum status or a visa for pregnant women. Those not able to provide satisfactory documents would be sent to the trust's overseas patient team "for specialist document screening, in liaison with the UKBA (border agency) and the Home Office.” It was estimated that £4.6 million a year was spent on care for ineligible patients.
Greece is a newcomer to the medical tourism market; during the last few years, many tourists have come to Greece for rehabilitaion and disease treatment. Compared to other European countries, Greece has lower rehabilitation prices in combination with its climate and popularity among tourists.
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- Businesses May Move Health Care Overseas (Washington Post)
- CBC News on "Medical tourism: Need surgery, will travel"
- A Cut Below: Americans Look Abroad for Health Care (ABC News)
- Medical Tourism, 60 Minutes (CBS News)
|Wikivoyage has a travel guide for Medical tourism.|