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What is Known about the Effects of Medical Tourism in Destination and Departure Countries? A Scoping Review.

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010
Abstract: 

Background:

Medical tourism involves patients intentionally leaving their home country to access non-emergencyhealth care services abroad. Growth in the popularity of this practice has resulted in a significant amount ofattention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort tosystematically synthesize what is known about the effects of this phenomenon. This article presents the findings ofa scoping review examining what is known about the effects of medical tourism in destination and departurecountries.

Methods:

Drawing on academic articles, grey literature, and media sources extracted from18 databases, we followa widely used scoping review protocol to synthesize what is known about the effects of medical tourism indestination and departure countries. The review design has three main stages: (1) identifying the question andrelevant literature; (2) selecting the literature; and (3) charting, collating, and summarizing the data.

Results:

The large majority of the 203 sources accepted into the review offer a perspective of medical tourismfrom the Global North, focusing on the flow of patients from high income nations to lower and middle incomecountries. This greatly shapes any discussion of the effects of medical tourism on destination and departurecountries. Five interrelated themes that characterize existing discussion of the effects of this practice were extractedfrom the reviewed sources. These themes frame medical tourism as a: (1) user of public resources; (2) solution tohealth system problems; (3) revenue generating industry; (4) standard of care; and (5) source of inequity. It isobserved that what is currently known about the effects of medical tourism is minimal, unreliable, geographicallyrestricted and mostly based on speculation.

Conclusions:

Given its positive and negative effects on the health care systems of departure and destinationcountries, medical tourism is a highly significant and contested phenomenon. This is especially true given itspotential to serve as a powerful force for the inequitable delivery of health care services globally. It isrecommended that empirical evidence and other data associated with medical tourism be subjected to clear andcoherent definitions, including reports focused on the flows of medical tourists and surgery success rates.Additional primary research on the effects of medical tourism is needed if the industry is to develop in a mannerthat is beneficial to citizens of both departure and destination countries.

Document type: 
Article

An Industry Perspective on Canadian Patients' Involvement in Medical Tourism: Implications for Public Health

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2011
Abstract: 

Background:

The medical tourism industry, which assists patients with accessing non-emergency medical careabroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to createpolicy, health system, and public health responses to address the associated risks and shortcomings, such as spreadof infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzinginterviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients’involvement in medical tourism and the implications of this involvement for public health.

Methods:

Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on businessdimensions, information exchange, medical tourists’ decision-making, and facilitators’ roles in medical tourism.Thematic analysis was undertaken following data collection.Results: Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number ofclients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical touristsaged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriersincluding affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to usefacilitators’ services were thought to be interested in saving money or have cultural/familial connections to thedestination country. Canadian doctors were commonly identified as barriers to securing clients.

Conclusions:

No effective Canadian public health response to medical tourism can treat medical tourists as aunified group with similar motivations for engaging in medical tourism and choosing similar mechanisms fordoing so. This situation may be echoed in other countries with patients seeking care abroad. Therefore, a call for acomprehensive public health response to medical tourism and its effects should be coupled with a clearunderstanding that medical tourism is a highly diverse practice. This response must also acknowledge facilitators asimportant stakeholders in medical tourism.

Document type: 
Article

Interpreting the Results of a Modified Gravity Model: Examining Access to Primary Health Care Physicians in Five Canadian Provinces and Territories

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2012
Abstract: 

Primary health care (PHC) encompasses an array of health and social services that focus onpreventative, diagnostic, and basic care measures to maintain wellbeing and address illnesses.In Canada, PHC involves the provision of first-contact health care services by providers suchas family physicians and general practitioners – collectively referred as PHC physicians here.Ensuring access is a key requirement of effective PHC delivery. This is because havingaccess to PHC has been shown to positively impact a number of health outcomes.MethodsWe build on recent innovations in measuring potential spatial access to PHC physicians usinggeographic information systems (GIS) by running and then interpreting the findings of amodified gravity model. Elsewhere we have introduced the protocol for this model. In thisarticle we run it for five selected Canadian provinces and territories. Our objectives are topresent the results of the modified gravity model in order to: (1) understand how potentialspatial access to PHC physicians can be interpreted in these Canadian jurisdictions, and (2)provide guidance regarding how findings of the modified gravity model should be interpretedin other analyses.ResultsRegarding the first objective, two distinct spatial patterns emerge regarding potential spatialaccess to PHC physicians in the five selected Canadian provinces: (1) a clear north–southpattern, where southern areas have greater potential spatial access than northern areas; and (2)while gradients of potential spatial access exist in and around urban areas, access outside ofdensely-to-moderately populated areas is fairly binary. Regarding the second objective, weidentify three principles that others can use to interpret the findings of the modified gravitymodel when used in other research contexts.

Document type: 
Article

An Evaluation of Canada's Compassionate Care Benefit from a Family Caregiver's Perspective at End of Life

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background: The goal of Canada's Compassionate Care Benefit (CCB) is to enable familymembers and other loved ones who are employed to take a temporary secured leave to care for aterminally ill individual at end of life. Successful applicants of the CCB can receive up to 55% of theiraverage insured earnings, up to a maximum of CDN$435 per week, over a six week period toprovide care for a gravely ill family member at risk of death within a six month period, as evidencedby a medical certificate. The goal of this study is to evaluate the CCB from the perspective of familycaregivers providing care to individuals at end of life. There are three specific research objectives.Meeting these objectives will address our study purpose which is to make policy-relevantrecommendations informed by the needs of Canadian family caregivers and input from other keystakeholders who shape program uptake. Being the first study that will capture family caregivers'experiences and perceptions of the CCB and gather contextual data with front-line palliative carepractitioners, employers, and human resources personnel, we will be in a unique position toprovide policy solutions/recommendations that will address concerns raised by numerousindividuals and organizations.Methods: We will achieve the research goal and objectives through employing utilization-focusedevaluation as our methodology, in-depth interviews and focus groups as our techniques of datacollection, and constant comparative as our technique of data analysis. Three respondent groupswill participate: (1) family caregivers who are providing or who have provided end of life care viaphone interview; (2) front-line palliative care practitioners via phone interview; and (3) humanresources personnel and employers via focus group. Each of these three groups has a stake in thesuccessful administration of the CCB. A watching brief of policy documents, grey literature, mediareports, and other relevant items will also be managed throughout data collection.Discussion: We propose to conduct this study over a three year period beginning in October,2006 and ending in October, 2009.

Document type: 
Article

What Is Known About The Patient's Experience Of Medical Tourism? A Scoping Review

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010
Abstract: 

Background: Medical tourism is understood as travel abroad with the intention of obtaining non-emergencymedical services. This practice is the subject of increasing interest, but little is known about its scope.Methods: A comprehensive scoping review of published academic articles, media sources, and grey literaturereports was performed to answer the question: what is known about the patient’s experience of medical tourism?The review was accomplished in three steps: (1) identifying the question and relevant literature; (2) selecting theliterature; (3) charting, collating, and summarizing the information. Overall themes were identified from this process.Results: 291 sources were identified for review from the databases searched, the majority of which were mediapieces (n = 176). A further 57 sources were included for review after hand searching reference lists. Of the 348sources that were gathered, 216 were ultimately included in this scoping review. Only a small minority of sourcesreported on empirical studies that involved the collection of primary data (n = 5). The four themes identified viathe review were: (1) decision-making (e.g., push and pull factors that operate to shape patients’ decisions); (2)motivations (e.g., procedure-, cost-, and travel-based factors motivating patients to seek care abroad); (3) risks (e.g.,health and travel risks); and (4) first-hand accounts (e.g., patients’ experiential accounts of having gone abroad formedical care). These themes represent the most discussed issues about the patient’s experience of medical tourismin the English-language academic, media, and grey literatures.Conclusions: This review demonstrates the need for additional research on numerous issues, including: (1)understanding how multiple information sources are consulted and evaluated by patients before deciding uponmedical tourism; (2) examining how patients understand the risks of care abroad; (3) gathering patients’prospective and retrospective accounts; and (4) the push and pull factors, as well as the motives of patients toparticipate in medical tourism. The findings from this scoping review and the knowledge gaps it uncovered alsodemonstrate that there is great potential for new contributions to our understanding of the patient’s experience ofmedical tourism.

Document type: 
Article

Visioning For Secondary Palliative Care Service Hubs in Rural Communities: A Qualitative Case Study from British Columbia's Interior

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009
Abstract: 

Background: As the populations of many developed nations continue to age at rapid rates it is becomingincreasingly important to enhance palliative care service delivery in order to meet anticipated demand. Rural areasface a number of challenges in doing this, and thus dedicated attention must be given to determining how to bestenhance service delivery in ways that are sensitive to their particular needs. The purposes of this article are todetermine the vision for establishing secondary palliative care service hubs (SPCH) in rural communities throughundertaking a case study, and to ascertain the criteria that need to be considered when siting such hubs.Methods: A rural region of British Columbia, Canada was selected for primary data collection, which took placeover a five-month period in 2008. Formal and informal palliative care providers (n = 31) were interviewed. Apurposeful recruitment strategy was used to maximize occupational and practice diversity. Interviews wereconducted by phone using a semi-structured guide. Interviews were audio recorded and transcribed verbatim.Data were managed using NVivo8™ software and analyzed thematically, using investigator triangulation tostrengthen interpretation.Results: Four themes emerged from the dataset: (1) main SPCH features; (2) determining a location; (3) valueaddedoutcomes; and (4) key considerations. It was found that participants generally supported implementing aSPCH in the rural region of focus. Several consistent messages emerged, including that: (1) SPCHs must createopportunities for two-way information exchange between specialists and generalists and communities; (2) SPCHsshould diffuse information and ideas throughout the region, thus serving as a locus for education and a means ofenhancing training opportunities; and (3) hubs need not be physical sites in the community (e.g., an office in ahospice or hospital), but may be virtual or take other forms based upon local needs.Conclusion: Visioning innovation in the provision of palliative care service in rural communities can be enhancedby consultation with local providers. Interviews are a means of determining local concerns and priorities. Therewas widespread support for SPCH coupled with some uncertainty about means of implementation.

Document type: 
Article

Chronically Ill Canadians' Experiences of Being Unattached To a Family Doctor: A Qualitative Study of Marginalized Patients in British Columbia

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2012
Abstract: 

Background: Unattached patients do not have a regular primary care provider. Initiatives are being developed toincrease attachment rates across Canada. Most existing attention paid to patient unattachment has focused onquantifying the problem and health system costs. Our purpose is to qualitatively identify the implications ofchronically ill patients’ experiences of unattachment for health policy and planning to provide policy-relevantinsights for Canadian attachment initiatives.Methods: Three focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city inBritish Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledgethat by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada’shealth care system Focus groups were structured as an open conversation organized around a series of probingquestions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed.Results: Twenty-six individuals participated in the focus groups. The most common chronic illnesses reported were activedrug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identifiedlife transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessfulattempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having atrusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency.One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access topreventative care. Participants were also concerned about having a discontinuous medical record due to unattachment.Conclusions: Participants perceived that there are many benefits to be had by having attachment to a regular familydoctor and that experiencing unattachment challenged their health and access to health care. We encourage moreresearch to be done on the lived experience of unattachment in order to provide on-the-ground insights thatpolicy-makers require in order to develop responsive, patient-centred supports and programs.

Document type: 
Article

What Are The Roles Involved In Establishing And Maintaining Informational Continuity Of Care Within Family Practice? A Systematic Review

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background: Central to establishing continuity of care is the development of a relationshipbetween doctor and patient/caregiver. Transfer of information between these parties facilitates thedevelopment of continuity in general; and specifically informational continuity of care. Weconducted a systematic review of published literature to gain a better understanding of the rolesthat different parties – specifically doctors, patients, family caregivers, and technology – play inestablishing and maintaining informational continuity of care within family practice.Methods: Relevant published articles were sought from five databases. Accepted articles werereviewed and appraised in a consistent way. Fifty-six articles were retained following title andabstract reviews. Of these, 28 were accepted for this review.Results: No articles focused explicitly on the roles involved in establishing or maintaininginformational continuity of care within family practice. Most informational continuity of careliterature focused on the transfer of information between settings and not at the first point ofcontact. Numerous roles were, however, were interpreted using the data extracted from reviewedarticles. Doctors are responsible for record keeping, knowing patients' histories, recallingaccumulated knowledge, and maintaining confidentiality. Patients are responsible for disclosingpersonal and health details, transferring information to other practitioners (including new familydoctors), and establishing trust. Both are responsible for developing a relationship of trust.Technology is an important tool of informational continuity of care through holding importantinformation, providing search functions, and providing a space for recorded information. There isa significant gap in our knowledge about the roles that family caregivers play.Conclusion: The number of roles identified and the interrelationships between them indicatesthat establishing and maintaining informational continuity of care within family practice is a complexand multifaceted process. This synthesis of roles provided serves as an important resource forcontinuity of care researchers in general, for the development of continuity of care qualityindicators, and for the practice of family medicine.

Document type: 
Article

A Method to Determine Spatial Access to Specialized Palliative Care Services Using GIS

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background: Providing palliative care is a growing priority for health service administratorsworldwide as the populations of many nations continue to age rapidly. In many countries, palliativecare services are presently inadequate and this problem will be exacerbated in the coming years.The provision of palliative care, moreover, has been piecemeal in many jurisdictions and there islittle distinction made at present between levels of service provision. There is a pressing need todetermine which populations do not enjoy access to specialized palliative care services in particular.Methods: Catchments around existing specialized palliative care services in the Canadian provinceof British Columbia were calculated based on real road travel time. Census block face populationcounts were linked to postal codes associated with road segments in order to determine thepercentage of the total population more than one hour road travel time from specialized palliativecare.Results: Whilst 81% of the province's population resides within one hour from at least onespecialized palliative care service, spatial access varies greatly by regional health authority. Based onthe definition of specialized palliative care adopted for the study, the Northern Health Authorityhas, for instance, just two such service locations, and well over half of its population do not havereasonable spatial access to such care.Conclusion: Strategic location analysis methods must be developed and used to accurately locatefuture palliative services in order to provide spatial access to the greatest number of people, andto ensure that limited health resources are allocated wisely. Improved spatial access has thepotential to reduce travel-times for patients, for palliative care workers making home visits, and fortravelling practitioners. These methods are particularly useful for health service planners – andprovide a means to rationalize their decision-making. Moreover, they are extendable to a numberof health service allocation problems.

Document type: 
Article

Injury Surveillance in Low-Resource Settings Using Geospatial and Social Web Technologies

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010
Abstract: 

Background: Extensive public health gains have benefited high-income countries in recent decades, however, citizensof low and middle-income countries (LMIC) have largely not enjoyed the same advancements. This is in part due to thefact that public health data - the foundation for public health advances - are rarely collected in many LMIC. Injury dataare particularly scarce in many low-resource settings, despite the huge associated burden of morbidity and mortality.Advances in freely-accessible and easy-to-use information and communication (ICT) technology may provide theimpetus for increased public health data collection in settings with limited financial and personnel resources.Methods and Results: A pilot study was conducted at a hospital in Cape Town, South Africa to assess the utility andfeasibility of using free (non-licensed), and easy-to-use Social Web and GeoWeb tools for injury surveillance in lowresourcesettings. Data entry, geocoding, data exploration, and data visualization were successfully conducted usingthese technologies, including Google Spreadsheet, Mapalist, BatchGeocode, and Google Earth.Conclusion: This study examined the potential for Social Web and GeoWeb technologies to contribute to publichealth data collection and analysis in low-resource settings through an injury surveillance pilot study conducted inCape Town, South Africa. The success of this study illustrates the great potential for these technologies to be leveragedfor public health surveillance in resource-constrained environments, given their ease-of-use and low-cost, and thesharing and collaboration capabilities they afford. The possibilities and potential limitations of these technologies arediscussed in relation to the study, and to the field of public health in general.

Document type: 
Article