Medical tourism: The impact of travel to foreign countries for healthcare

Abstract

Outsourcing of medical procedures is not new. For many years foreign citizens have travelled to the USA and the developed countries of Europe to seek improved medical care. More recently, citizens of developed countries, including the USA and Europe, have chosen to travel to less developed parts of the world for medical treatment, thereby bypassing services in their own communities. Th is has been termed medical tourism, and has implications for both the developed world and developing countries.1 Th e treatment sought may be obligatory or elective.2 Th e former occurs where the treatments are unavailable or illegal in the country of origin. Th e latter, which is growing apace, includes elective treatments, that can be delivered more quickly or cheaply than in the country of origin. Over twenty years ago this industry developed particularly for dental treatment and cosmetic surgery, but it has now grown and diversifi ed to be valued at sixty billion dollars worldwide in 2006.3 Th e number of Americans travelling overseas for treatment has been estimated at from 50,000 to 500,000.4 Globalization in healthcare has been driven by waiting lists and more particularly by costs. For example a knee replacement in the USA can cost $40,000, compared to $13,000 in Singapore.4 An industry has grown up around medical tourism, advising patients on where they should travel for treatment, handling all their travel arrangements, teleconferencing with physicians and sending medical records.4 American medical insurance programmes have encouraged policy holders to travel to a foreign country for the purpose of seeking treatment.5 Th e current world fi nancial downturn, by increasing waiting list time and pressurising personal fi nances, may further feed this trend. Patients mainly travel for surgical treatments, such as orthopaedics, cancer diagnosis and management, and bariatric surgery. Th e nature of surgical work, however, does not always lend itself to medical tourism. ‘Arthroplasty tourism’, for example, is increasing, motivated by both lower costs and shorter waiting times.5 In comparison to the traditional healthcare model, the practice of patients obtaining their surgical procedure overseas is associated with the risk of patients developing complications when they return to their own country.5 Medical tourism ignores traditional values of patient care that include practice audit and continuity of care. In addition to the safety issues raised by medical tourism, there are potential damaging eff ects on the provider countries. Th e emphasis on technology driven tertiary care for foreigners may impact on basic healthcare for citizens of developing countries.6 It has been suggested that the eff ect of medical tourism in Th ailand and India may potentially have distorted the healthcare landscape, thereby disadvantaging their own populations.7 Growth in medical tourism appears to be inevitable, and as with any consumer driven trend, it has both positive and negative aspects. In addition to considering its impact on our own health systems, the colleges need to consider aspects of medical tourism that should concern them including continuing education, certifi cation services and ethical issues, thereby helping to assure maximum patient safety. Copyright © 1 October 2008 keywords: medical tourism, healthcare Surgeon, 1 October 2008, pp.260-1