Medical Tourism Research Group

Medical tourism refers to the process whereby patients purchase health care abroad, outside of their home health care systems, and pay privately for care. Some reasons patients engage in this form of private health care include: real or perceived wait times, desire to obtain experimental procedures not available at home, and mistrust of the domestic health care system. While the literature provides accounts of the experiences of medical tourists and industry facilitators, the friends and family who accompany medical tourists abroad as informal caregivers are under-researched. In this study, funded by the Canadian Institutes of Health Research, we have uncovered these caregivers' experiences through four datasets collected from different stakeholder groups: i) 32 former Canadian medical tourists interviewed between July and November 2010; ii) 7 Canadian medical tourism facilitators surveyed in 2012; iii) 21 international patient coordinators in destination facilities interviewed in 2012; and iv) 20 Canadian caregivers interviewed between September 2013 and February 2014. Data triangulation enabled us to compare, contrast and augment the results from these separate datasets to arrive at the following findings and recommendations.

Canadians travelling abroad for privately arranged surgeries paid for out-of-pocket are engaging in what  has come to be known as medical tourism. They are often accompanied by friends or family members, who we call caregiver-companions. Caregiver-companions provide care in and across a variety of formal and informal settings, such as in hotels, airplanes and at home. This qualitative study examines the experiences  of informal caregivers in medical tourism to learn more about the lived experiences or ‘experiential  resources’ they draw upon to cope with providing care and avoiding caregiver burden. The care-giving literature has demonstrated that such burden can negatively impact caregivers’ well-being. The unique, transnational context of care-giving in medical tourism and recent growth in popularity of this practice means that there are few supports or resources currently in place to assist informal caregivers. In this article, we report on an analysis that sought to detail how caregiver-companions draw upon their previous lived experiences to cope with providing transnational care and to minimise or avoid the onset of caregiver burden. We conducted semi-structured telephone interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery between September 2013 and January 2014. Thematic analysis revealed the ways that participants had developed practical strategies to deal with the challenges they faced in medical tourism. The interviews revealed three important experiential resources drawn upon by participants: (i) previous experiences of international travel; (ii) previous experiences of informal care-giving; and (iii) dimensions of the existing relationship with the care recipient. Differences in access to and use of these experiential resources related to participants’ perspectives on medical tourism and the outcomes of the trip. By identifying the experiential resources drawn upon by informal caregivers in medical tourism, we  can more effectively identify supportive interventions.

Medical tourism (MT), the practice of traveling to another country to access medical care that is paid for out of pocket, has received considerable attention in the Canadian news media.Media and industry information sources, which are commonly accessed by medical tourists, might inadequately inform Canadians about MT safety concerns. As a result, there is concern among Canadian physicians and health and safety professionals that prospective medical tourists might not be well placed to make informed decisions about their care. As gatekeepers in the health care system and the first source of interaction between the health care system and patients, family physicians are well positioned to inform Canadians about these safety risks.

This paper aims to respond to a knowledge gap regarding the motivations of medical tourists, the term used to describe persons that travel across borders with the intention of accessing medical care. Commonly cited motivations for engaging in medical tourism are typically based on speculation and provide generalizations for what is a contextualized practice. This research paper aims to complicate the commonly discussed motivations of medical tourists to provide a richer understanding of these motivations and the various contexts in which medical tourists may choose to travel for medical care.

Design/methodology/approach – Drawing on semi-structured interviews with 32 former Canadian medical tourists, this study uses the Iso-Ahola's motivation theory to analyze tourists' motivations. Quotations from participants were used to highlight core themes relevant to critical theories of tourism.

Findings – Participants' discussions illuminated motivations to travel related to personal and interpersonal seeking as well as personal and interpersonal escaping. These motivations demonstrate the appropriateness of applying critical theories of tourism to the medical tourism industry.

Research limitations/implications – This research is limited in its ability to link various motivations with particular contexts such as medical procedure and personal demographics. However, this study demonstrates that the three commonly cited motivations of medical tourists might oversimplify this phenomenon.

Originality/value – By providing new insight into medical tourists' motivations, this paper expands the conversation about medical tourists' decision-making and how this is informed by tourism discourse. This insight may contribute to improved guidance for medical tourism stakeholders for more ethical and safe practices.

Developing an understanding of medical tourists' interactions with their health care workers while abroad is important for a number of reasons. Social support has been linked to improved health outcomes for patients (Berkman et al., 2000; Lee and Rotheram-Borus, 2001; Uchino, 2004, 2006), while a lack of social support has been found to lead to higher mortality rates (Brummett et al., 2001; Rutledge et al., 2004). While abroad, medical tourists are not in a position to draw on their usual social support networks as they are away from home. It could be the case that workers in medical tourism facilities are aware of this and work to form a supportive and trusting bond with the patients given that they are away from home and unable to draw on their usual support networks. Furthermore, when patients perceive their relationship with their health care workers as positive, they have been shown to have a higher chance of improved health outcomes (Stewart et al., 2000; Arora, 2003; Beach et al., 2006; Street et al., 2009). There is no reason to think this would be any different for medical tourists. The patient-health care worker relationship can have important implications for patient health and therefore we believe that research into this topic using medical tourists' own experiential accounts can help to identify strategies that can be used to secure and improve this relationship.

This chapter draws on our long term-research program examining medical tourism in Barbados and the wider Anglophone Caribbean. Since 2011 we have undertaken 69 semi-structured interviews and three focus groups with a wide range of health system and tourism sector stakeholders in Barbados, compiled a comprehensive collection of state and media reports discussing medical tourism, and collectively spent over a year conducting on-site ethnographic fieldwork that has included many informal conversations with users of the Barbadian health system from a wide range of backgrounds. Together, these datasets and experiences provide a rich understanding of the potential considerations and hopes arising from the ongoing discussion about medical tourism development in a small island setting. Exploring these considerations and hopes suggests ways in which Barbados and other small island states seeking to develop their medical tourism sectors can negotiate a structure for medical tourism that can best meet their development goals.

This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists.

Medical tourism is a practice where individuals cross international borders with the intention of privately purchasing healthcare. Caribbean countries are increasingly entering into the medical tourism market, which presents both opportunities and dangers. Our previous fieldwork shows that medical tourism requires host countries to balance the interests of private developers and domestic actors, including those accessing healthcare locally. Discussions with stakeholders in Jamaica, Cayman Islands, Barbados and St Lucia demonstrate concrete instances of this problem. Firstly, medical tourism can enhance training and employment opportunities for domestic health-workers. In doing so, it may exacerbate the inequitable distribution of these workers between the public and private sectors. Secondly, the expansion of private medical services can provide locals with more care options. These facilities may also crowd out existing local operators and price out local consumers. Thirdly, medical tourism is hailed as potentially cross subsidizing and strengthening the local public health system. It may also heighten health inequities and distract local attention from the needs of the public health sector. Caribbean stakeholders are aware of the promise and dangers of medical tourism. However, they lack clear advice from medical tourism researchers about how to navigate these issues, and specifically balancing local and foreign interests. We call on researchers to shift focus from highlighting the theoretical problems associated with medical tourism to providing concrete guidance to stakeholders in a position to decide whether or not to pursue medical tourism development and to shape this development when it takes place.

Background: Enabled by globalizing processes such as trade liberalization, medical tourism is a practice that involves patients’ intentional travel to privately obtain medical care in another country. Empirical legal research on this issue is limited and seldom based on the perspectives of destination countries receiving medical tourists. We consulted with diverse lawyers from across Barbados to explore their views on the prospective legal and regulatory implications of the developing medical tourism industry in the country.

Methods: We held a focus group in February 2014 in Barbados with lawyers from across the country. Nine lawyers with diverse legal backgrounds participated. Focus group moderators summarized the study objective and engaged participants in identifying the local implications of medical tourism and the anticipated legal and regulatory concerns.

The focus group was transcribed verbatim and analyzed thematically.

Results: Five dominant legal and regulatory themes were identified through analysis: (1) liability; (2) immigration law; (3) physician licensing; (4) corporate ownership; and (5) reputational protection.

Conclusions: Two predominant legal and ethical concerns associated with medical tourism in Barbados were raised by participants and are reflected in the literature: the ability of medical tourists to recover medical malpractice for adverse events; and the effects of medical tourism on access to health care in the destination country. However, the participants also identified several topics that have received much less attention in the legal and ethical literature. Overall this analysis reveals that lawyers, at least in Barbados, have an important role to play in the medical tourism sector beyond litigation – particularly in transactional and gatekeeper capacities. It remains to be seen whether these findings are specific to the ecology of Barbados or can be extrapolated to the legal climate of other medical tourism destination countries.