The 'Patient's Physician One-Step Removed': The Evolving Roles of Medical Tourism Facilitators

BackgroundMedical tourism involves patients travellinginternationally to receive medical services. This practiceraises a range of ethical issues, including potential harmsto the patient’s home and destination country and risksto the patient’s own health. Medical tourists oftenengage the services of a facilitator who may book traveland accommodation and link the patient with a hospitalabroad. Facilitators have the potential to exacerbate ormitigate the ethical concerns associated with medicaltourism, but their roles are poorly understood.Methods12 facilitators were interviewed from 10Canadian medical tourism companies.ResultsThree themes were identified: facilitators’ rolestowards the patient, health system and medical tourismindustry. Facilitators’ roles towards the patient weretypically described in terms of advocacy and theprovision of information, but limited by facilitators’ legalliability. Facilitators felt they played a positive role in thelives of their patients and the Canadian health systemand served as catalysts for reform, although they notedan adversarial relationship with some Canadianphysicians. Many facilitators described personally visitingmedical tourism sites and forming personal relationshipswith surgeons abroad, but noted the need for greaterregulation of their industry.ConclusionFacilitators play a substantial and evolvingrole in the practice of medical tourism and may be enteringa period of professionalisation. Because of the key roleof facilitators in determining the effects of medical tourismon patients and public health, this paper recommendsa planned conversation between medical tourismstakeholders to define and shape facilitators’ roles.