Medical tourism is much-hyped by its proponents, with high figures for its value and patient numbers published in some industry reports. In 2007, Deloitte estimated American patient outflow at 750,000 and projected this to increase to 6,000,000 by 2010: in reality, the recession hit medical tourism numbers, which a more recent Deloitte report estimated at 648,000 in 2009 and projected to be 1.6 million in 2012. Accurate figures are hard to come by, as numbers are often inflated for political or marketing purposes, and companies pushing medical tourism have a vested interest in hyping the potential. So how much do we actually know about medical tourism: the size of the market, and also the effects on patients and on health care in destination and departure countries? Two recent scoping studies address the current state of knowledge. Johnston et al. (2010), in a paper published on 3 November in the International Journal for Equity in Health, examine the effects in destination and departure countries from a number of perspectives, while Crooks et al. (2010) reviewed patient experience of medical tourism.
203 sources were selected for the review by Johnston et al., found from both academic and grey literature in 18 databases. The literature covered five main themes for medical tourism: (1) a user of public resources; (2) a solution to health system problems; (3) revenue generating industry; (4) standard of care; and (5) source of inequity.
What the review found was that what is known about the effects of medical tourism is minimal, geographically restricted (concentrating on the flow of patients from higher to lower income countries), and mostly based on speculation. It is recommended that empirical evidence and other data associated with medical tourism be subjected to clear and coherent 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 manner that is beneficial to citizens of both departure and destination countries.
A number of points are made for each of the five themes listed above. The effects of medical tourism as a user of public resources include consuming public health care resources in destination countries through redirecting them to the private sector, and in departure countries through the provision of follow-up care for medical tourists. In offering solutions for problems, it has the potential to aid in the development of health care infrastructure in destination countries while reducing wait times and costs for care for residents of departure countries.
The medical tourism industry can generate revenues for destination countries as a form of health services trade. Conversely, it can result in a net loss of capital to departure countries. In setting standards of care, by seeking accreditation, destination countries may develop a Western-oriented standard of care, including in facility aesthetics. Due to low labour costs in destination countries, medical tourists may develop expectations of standards of health human resource provision that are unaffordable, and therefore unattainable, in high-income departure countries. The process of medical tourism can also contribute to the commodification of health care and a perception of the patient as consumer.
Finally, the cumulative effects of medical tourism position it as a source of inequity. Within destination countries, it can contribute to an internal brain drain of trained medical workers from rural to urban areas and from the public to the private sector. Medical tourists can face a significant drain on their own financial resources and, by engaging in travel abroad for medical services, they may contribute to a loss of impetus for reform of their home health care systems.
Reviewing the literature on patient experience of medical tourism, Crooks et al. also found that only 5 of the 216 sources included in the review reported on empirical studies involving the collection of primary data. The four themes identified via the 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 for medical care).
The 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 upon medical 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 to participate in medical tourism. The findings from this scoping review and the knowledge gaps it uncovered also demonstrate that there is great potential for new contributions to our understanding of the patient's experience of medical tourism.
The scoping reviews are both open access articles. Both reviews used CABI's Global Health Database as one of the sources for medical tourism literature. The literature is also indexed on the Leisure Tourism Database, which also carries news articles and research updates on medical tourism.
What is known about the patient's experience of medical tourism? A scoping review. Crooks, V. A.; Kingsbury, P.; Snyder, J.; Johnston, R.; BMC Health Services Research, 2010, 10, 266, pp (8 September 2010), 110 ref.
What is known about the effects of medical tourism in destination and departure countries? A scoping review. Johnston, R.; Crooks, V. A.; Snyder, J.; Kingsbury, P.; International Journal for Equity in Health, 2010, 9, 24, pp (3 November 2010), 98 ref.