Medical Tourism Research Group

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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.

Regulating Medical Tourism

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2010-10-30
Abstract: 

Letter to Lancet on need for regulation of medical tourism.

Document type: 
Article
File(s): 

Three Academics' Perspective on Medical Tourism: Reflections on a Trip to Southern India

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2010-10-06
Abstract: 

To date, medical tourism has gone relatively unnoticed by academic researchers when compared to other global health services practices such as health worker migration. Amongst the flurry of business briefings, industry reports and news media coverage that have accompanied the rapid growth of the industry over the past decade, only a handful of accounts from an academic perspective exist. Moreover, very few of these academic accounts are from researchers who have personally visited medical tourism facilities. In an effort to address this gap a research team, based at Simon Fraser University in British Columbia, Canada, has started to examine medical tourism from the combined perspectives of bioethics, health geography and tourism studies.

Document type: 
Article

"I didn't even know what I was looking for": A qualitative study of the decision-making processes of Canadian medical tourists

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

BACKGROUND:Medical tourism describes the private purchase and arrangement of medical care by patients across international borders. Increasing numbers of medical facilities in countries around the world are marketing their services to a receptive audience of international patients, a phenomenon that has largely been made possible by the growth of the Internet. The growth of the medical tourism industry has raised numerous concerns around patient safety and global health equity. In spite of these concerns, there is a lack of empirical research amongst medical tourism stakeholders. One such gap is a lack of engagement with medical tourists themselves, where there is currently little known about how medical tourists decide to access care abroad. We address this gap through examining aspects of Canadian medical tourists' decision-making processes.METHODS:Semi-structured phone interviews were administered to 32 Canadians who had gone abroad as medical tourists. Interviews touched on motivations, assessment of risks, information seeking processes, and experiences at home and abroad. A thematic analysis of the interview transcripts followed.RESULTS:Three overarching themes emerged from the interviews: (1) information sources consulted; (2) motivations, considerations, and timing; and (3) personal and professional supports drawn upon. Patient testimonials and word of mouth connections amongst former medical tourists were accessed and relied upon more readily than the advice of family physicians. Neutral, third-party information sources were limited, which resulted in participants also relying on medical tourism facilitators and industry websites.CONCLUSIONS:While Canadian medical tourists are often thought to be motivated by wait times for surgery, cost and availability of procedures were common primary and secondary motivations for participants, demonstrating that motivations are layered and dynamic. The findings of this analysis offer a number of important factors that should be considered in the development of informational interventions targeting medical tourists. It is likely that trends observed amongst Canadian medical tourists apply to those from other nations due to the key role the transnational medium of the Internet plays in facilitating patients' private international medical travel.

Document type: 
Article

Use Of Medical Tourism For Hip And Knee Surgery In Osteoarthritis: A Qualitative Examination Of Distinctive Attitudinal Characteristics Among Canadian Patients

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

Background

Medical tourism is the term that describes patients’ international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients’ decision-making in and experiences of these same procedures in their home countries.

Methods

Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery.

Results

Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives.

Conclusions

Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients’ pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes. Arthritis care providers can use the attitudinal characteristics identified here to better advise osteoarthritis patients who are considering seeking care abroad.

Document type: 
Article
File(s): 

Fly-By Medical Care: Conceptualizing the Global and Local Social Responsibilities of Medical Tourists and Physician Voluntourists

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

Background: Medical tourism is a global health practice where patients travel abroad to receive health care.Voluntourism is a practice where physicians travel abroad to deliver health care. Both of these practices often entailtravel from high income to low and middle income countries and both have been associated with possiblenegative impacts. In this paper, we explore the social responsibilities of medical tourists and voluntourists toidentify commonalities and distinctions that can be used to develop a wider understanding of social responsibilityin global health care practices.

 

Discussion: Social responsibility is a responsibility to promote the welfare of the communities to which onebelongs or with which one interacts. Physicians stress their social responsibility to care for the welfare of theirpatients and their domestic communities. When physicians choose to travel to another county to provide medicalcare, this social responsibility is expanded to this new community. Patients too have a social responsibility to usetheir community’s health resources efficiently and to promote the health of their community. When these patientschoose to go abroad to receive medical care, this social responsibility applies to the new community as well. Whilevoluntourists and medical tourists both see the scope of their social responsibilities expand by engaging in theseglobal practices, the social responsibilities of physician voluntourists are much better defined than those of medicaltourists. Guidelines for engaging in ethical voluntourism and training for voluntourists still need betterdevelopment, but medical tourism as a practice should follow the lead of voluntourism by developing clearernorms for ethical medical tourism.

 

Summary: Much can be learned by examining the social responsibilities of medical tourists and voluntouristswhen they engage in global health practices. While each group needs better guidance for engaging in responsibleforms of these practices, patients are at a disadvantage in understanding the effects of medical tourism andorganizing responses to these impacts. Members of the medical professions and the medical tourism industry musttake responsibility for providing better guidance for medical tourists.

Document type: 
Article

Risk Communication and Informed Consent in the Medical Tourism Industry: A Thematic Content Analysis of Canadian Broker Websites

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

Background:

Medical tourism, thought of as patients seeking non-emergency medical care outside of their homecountries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and manyare helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in makinginternational medical care arrangements for patients. As a key source of information for these patients, brokers arelikely to play an important role in communicating the risks and benefits of undergoing surgery or other proceduresabroad to their clientele. This raises important ethical concerns regarding processes such as informed consent andthe liability of brokers in the event that complications arise from procedures. The purpose of this article is toexamine the language, information, and online marketing of Canadian medical tourism brokers’ websites in light ofsuch ethical concerns.

Methods:

An exhaustive online search using multiple search engines and keywords was performed to compile acomprehensive directory of English-language Canadian medical tourism brokerage websites. These websites wereexamined using thematic content analysis, which included identifying informational themes, generating frequencycounts of these themes, and comparing trends in these counts to the established literature.

Results:

Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourismbroker websites varied widely in scope, content, professionalism and depth of information. Three themes emergedfrom the thematic content analysis: training and accreditation, risk communication, and business dimensions. Thirdparty accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, anddiscussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on theremaining ones. Terminology describing brokers’ roles was somewhat inconsistent across the websites. Finally,brokers’ roles in follow up care, their prices, and the speed of surgery were the most commonly included businessdimensions on the reviewed websites.

Conclusion:

Canadian medical tourism brokers currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication for potential medical tourists. This has implicationsfor the informed consent and consequent safety of Canadian medical tourists.

Document type: 
Article

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

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