Medical Tourism Research Group

Receive updates for this collection

The Medical Tourism Research Group is based at Simon Fraser University (SFU) near Vancouver, Canada. Its research is ongoing, so please check on this collection from time to time to see their latest work. If you have questions about the research, please send an email to: medtour@sfu.ca

Medical tourism involves international travel with the intent of addressing medical care needs of the traveler that occurs outside of arranged cross-border care. Such medical care is usually paid for out-of-pocket. Specific interventions include necessary surgeries, cosmetic surgeries, reproductive treatments, organ transplantation, and travel for experimental treatments such as stem cell transfers and CCSVI treatment for multiple sclerosis. The research team is particularly interested in Canadians’ travel for elective surgeries that do not involve purchased human organs.

Outbound Medical Tourism from Mongolia: a Qualitative Examination of Proposed Domestic Health System and Policy Responses to this Trend

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015
Abstract: 

Background: Medical tourism is the practice of traveling across international boundaries in order to access medical care. Residents of low-to-middle income countries with strained or inadequate health systems have long traveled to other countries in order to access procedures not available in their home countries and to take advantage of higher quality care elsewhere. In Mongolia, for example, residents are traveling to China, Japan, Thailand, South Korea, and other countries for care. As a result of this practice, there are concerns that travel abroad from Mongolia and other countries risks impoverishing patients and their families.

 

Methods: In this paper, we present findings from 15 interviews with Mongolian medical tourism stakeholders about the impacts of, causes of, and responses to outbound medical tourism. These findings were developed using a case study methodology that also relied on tours of health care facilities and informal discussions with citizens and other stakeholders during April, 2012.

 

Results: Based on these findings, health policy changes are needed to address the outflow of Mongolian medical tourists. Key areas for reform include increasing funding for the Mongolian health system and enhancing the efficient use of these funds, improving training opportunities and incentives for health workers, altering the local culture of care to be more supportive of patients, and addressing concerns of corruption and favouritism in the health system.

 

Conclusions: While these findings are specific to the Mongolian health system, other low-to-middle income countries experiencing outbound medical tourism will benefit from consideration of how these findings apply to their own contexts. As medical tourism is increasing in visibility globally, continued research on its impacts and context-specific policy responses are needed.

 

Document type: 
Article
File(s): 

Policy Implications of Medical Tourism Development in Destination Countries: Revisiting and Revising an Existing Framework by Examining the Case of Jamaica

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015
Abstract: 

Background: Medical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in locations where it is not yet established. Numerous governments and private hospitals in the Caribbean have recently identified medical tourism as a priority for economic development. We explore here the projects, activities, and outlooks surrounding medical tourism and their anticipated economic and health sector policy implications in the Caribbean country of Jamaica. Specifically, we apply Pocock and Phua's previously-published conceptual framework of policy implications raised by medical tourism to explore its relevance in this new context and to identify additional considerations raised by the Jamaican context.

 

Methods: Employing case study methodology, we conducted six weeks of qualitative fieldwork in Jamaica between October 2012 and July 2013. Semi-structured interviews with health, tourism, and trade sector stakeholders, on-site visits to health and tourism infrastructure, and reflexive journaling were all used to collect a comprehensive dataset of how medical tourism in Jamaica is being developed. Our analytic strategy involved organizing our data within Pocock and Phua's framework to identify overlapping and divergent issues.

 

Results: Many of the issues identified in Pocock and Phua's policy implications framework are echoed in the planning and development of medical tourism in Jamaica. However, a number of additional implications, such as the involvement of international development agencies in facilitating interest in the sector, cyclical mobility of international health human resources, and the significance of health insurance portability in driving the growth of international hospital accreditation, arise from this new context and further enrich the original framework.

 

Conclusions: The framework developed by Pocock and Phua is a flexible common reference point with which to document issues raised by medical tourism in established and emerging destinations. However, the framework's design does not lend itself to explaining how the underlying health system factors it identifies work to facilitate medical tourism's development or how the specific impacts of the practice are likely to unfold.

 

Document type: 
Article
File(s): 

Medical Tourism in the Tropics: New Regulation is Needed to Tackle Equity and Quality Concerns in Barbados

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015
Abstract: 

Medical tourism is on the rise as many patients travel overseas to seek private medical care that is either more expensive, unavailable or requires long waiting periods in their home country. Barbados, a small Caribbean island actively planning for medical tourism industry development, faces common challenges affecting destination countries such as degraded local access to healthcare, and possible brain drain of domestic medical workers. To address such concerns, the government must navigate both legal and ethical obstacles to develop effective regulatory mechanisms for their emerging medical tourism sector. 

 

Document type: 
Article
File(s): 

“The Major Forces that Need to Back Medical Tourism Were ... in Alignment”: Championing Development of Barbados’s Medical Tourism Sector

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015
Abstract: 

Governments around the world have expressed interest in developing local medical tourism sectors, framing the industry as an opportunity for economic growth and health system improvement. This article addresses questions about how the desire to develop a medical tourism sector in a country emerges and which stakeholders are involved in both creating momentum and informing its progress. Presenting a thematic analysis of 19 key informant interviews conducted with domestic and inter-national stakeholders in Barbados’s medical tourism sector in 2011, we examine the roles that “actors” and “champions” at home and abroad have played in the sector’s development. Physicians and the Barbadian government, along with international investors, the Medical Tourism Association, and development agencies, have promoted the industry, while actors such as medical tourists and international hospital accreditation companies are passively framing the terms of how medical tourism is unfolding in Barbados. Within this context, we seek to better understand the roles and relationships of various actors and champions implicated in the development of medical tourism in order to provide a more nuanced understanding of how the sector is emerging in Barbados and elsewhere and how its development might impact equitable health system development. 

Document type: 
Article
File(s): 

Medical Tourism's Impacts on Health Worker Migration in the Caribbean: Five Examples and Their Implications for Global Justice

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015
Abstract: 

Medical tourism is a practice where individuals cross international borders in order to access medical care. This practice can impact the global distribution of health workers by potentially reducing the emigration of health workers from destination countries for medical tourists and affecting the internal distribution of these workers. Little has been said, however, about the impacts of medical tourism on the immigration of health workers to medical tourism destinations. We discuss five patterns of medical tourism-driven health worker migration to medical tourism destinations: 1) long-term international migration; 2) long-term diasporic migration; 3) long-term migration and ‘black sheep’; 4) short-term migration via time share; and 5) short-term migration via patient-provider dyad. These patterns of health worker migration have repercussions for global justice that include potential negative impacts on the following: 1) health worker training; 2) health worker distributions; 3) local provision of care; and 4) local economies. In order to address these potential negative impacts, policy makers in destination countries should work to ensure that changes in health worker training and licensure aimed at promoting the medical tourism sector are also supportive of the health needs of the domestic population. Policy makers in both source and destination countries should be aware of the effects of medical tourism on health worker flows both into and out of medical tourism destinations and work to ensure that the potential harms of these worker flows to both groups are mitigated.

Document type: 
Article
File(s): 

"You Don't Want to Lose that Trust that You've Built with this Patient...": (Dis)trust, Medical Tourism, and the Canadian Family Physician-patient Relationship

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015
Abstract: 

Background

Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship—a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medical tourism on the therapeutic relationship.

Methods

We conducted six focus groups with 22 family physicians in the Canadian province of British Columbia. Data were analyzed thematically using deductive and inductive codes that captured key concepts across the narratives of participants.

Results

Family physicians indicated that they trust their patients to act as the lead decision-makers about medical tourism, but are conflicted when the information they are managing contradicts the best interests of the patients. They reported that patients distrust local health care systems when they experience insufficiencies in access to care and that this can prompt patients to consider going abroad for care. Trust fractures in the physician-patient relationship can arise from shame, fear and secrecy about medical tourism.

Conclusions

Family physicians face diverse tensions about medical tourism as they must balance their roles in: (1) providing information about medical tourism within a context of information deficits; (2) supporting decision-making while distancing themselves from patients’ decisions to engage in medical tourism; and (3) acting both as agents of the patient and of the domestic health care system. These tensions highlight the ongoing need for reliable third-party informational resources about medical tourism and the development of responsive policy.

Document type: 
Article
File(s): 

“Best Care on Home Ground” Versus “Elitist Healthcare”: Concerns and Competing Expectations for Medical Tourism Development in Barbados

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015
Abstract: 

Introduction

Many countries have demonstrated interest in expanding their medical tourism sectors because of its potential economic and health system benefits. However, medical tourism poses challenges to the equitable distribution of health resources between international and local patients and private and public medical facilities. Currently, very little is known about how medical tourism is perceived among front line workers and users of health systems in medical tourism ‘destinations’. Barbados is one such country currently seeking to expand its medical tourism sector. Barbadian nurses and health care users were consulted about the challenges and benefits posed by ongoing medical tourism development there.

Methods

Focus groups were held with two stakeholder groups in May, 2013. Nine (n = 9) citizens who use the public health system participated in the first focus group and seven (n = 7) nurses participated in the second. Each focus group ran for 1.5 hours and was digitally recorded. Following transcription, thematic analysis of the digitally coded focus group data was conducted to identify cross-cutting themes and issues.

Results

Three core concerns regarding medical tourism’s health equity impacts were raised; its potential to 1) incentivize migration of health workers from public to private facilities, 2) burden Barbados’ lone tertiary health care centre, and 3) produce different tiers of quality of care within the same health system. These concerns were informed and tempered by the existing a) health system structure that incorporates both universal public healthcare and a significant private medical sector, b) international mobility among patients and health workers, and c) Barbados’ large recreational tourism sector, which served as the main reference in discussions about medical tourism’s impacts. Incorporating these concerns and contextual influences, participants’ shared their expectations of how medical tourism should locally develop and operate.

Conclusions

By engaging with local health workers and users, we begin to unpack how potential health equity impacts of medical tourism in an emerging destination are understood by local stakeholders who are not directing sector development. This further outlines how these groups employ knowledge from their home context to ground and reconcile their hopes and concerns for the impacts posed by medical tourism.

Document type: 
Article
File(s): 

"It Was the Best Decision of My Life": A Thematic Content Analysis of Former Medical Tourists' Patient Testimonials

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015
Abstract: 

Background

Medical tourism is international travel with the intention of receiving medical care. Medical tourists travel for many reasons, including cost savings, limited domestic access to specific treatments, and interest in accessing unproven interventions. Medical tourism poses new health and safety risks to patients, including dangers associated with travel following surgery, difficulty assessing the quality of care abroad, and complications in continuity of care. Online resources are important to the decision-making of potential medical tourists and the websites of medical tourism facilitation companies (companies that may or may not be affiliated with a clinic abroad and help patients plan their travel) are an important source of online information for these individuals. These websites fail to address the risks associated with medical tourism, which can undermine the informed decision-making of potential medical tourists. Less is known about patient testimonials on these websites, which can be a particularly powerful influence on decision-making.

 

Methods

A thematic content analysis was conducted of patient testimonials hosted on the YouTube channels of four medical tourism facilitation companies. Five videos per company were viewed. The content of these videos was analyzed and themes identified and counted for each video.

 

Results

Ten main themes were identified. These themes were then grouped into three main categories: facilitator characteristics (e.g., mentions of the facilitator by name, reference to the price of the treatment or to cost savings); service characteristics (e.g., the quality and availability of the surgeon, the quality and friendliness of the support staff); and referrals (e.g., referrals to other potential medical tourists). These testimonials were found either not to mention risks associated with medical tourism or to claim that these risks can be effectively managed through the use of the facilitation company. The failure fully to address the risks of medical tourism can undermine the informed decision-making of potential medical tourists, particularly given the considerable influence on decision-making by patient testimonials.

 

Conclusions

Regulation of these global companies is difficult, making the development of testimonials highlighting the risks of medical tourism essential. Additional research is needed on the impact of patient testimonial videos on the decision-making of potential medical tourists.

Document type: 
Article
File(s): 

Medical Treatment not Approved yet? No Problem! Welcome to Circumvention Tourism

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2015-01-13
Abstract: 

China, Russia and countries in the Caribbean are positioning themselves as destinations for a new kind of medical tourist: the circumvention tourist. Increasingly people are traveling abroad for care that is unapproved by regulators in their home countries. In some cases, these so-called circumvention tourists may be seeking unproven and untested medical interventions.But why would someone want to skirt domestic regulations aimed at protecting patient safety? Our research about medical tourism in the Bahamas offers some insights.

Document type: 
Article
File(s): 

Medical Tourism in the Caribbean: A Call for Cooperation

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2014
Abstract: 

Numerous Caribbean countries have discussed plans for developing medical tourism activities as a means of tourism diversification and economic development. These plans have been encouraged and shaped by outside agencies whose influence might cause a race-to-the-bottom environment between countries competing for the same niche of tourists. This paper provides a call for cooperation between local health officials in the Caribbean region to coordinate plans for the development of a medical tourism industry that enhances regional access to specialized healthcare and facilitates the movement of patients and healthcare resources throughout the region to enhance health equity and health outcomes in the Caribbean.

Document type: 
Article
File(s):