Reflections on the ‘medical tourism’ market

Key questions for future research emerging from the forum include:

• Who should be meaningfully involved in identifying and defining categories of those travelling across borders for health services and what risks exist if certain voices are underrepresented in such a process;
• Who does and does not ‘count’ as a medical tourist and what are the implications of such quantitative assessments; why have researchers not been able to address pressing knowledge gaps regarding the health equity impacts of medical tourism;
• How do national-level police and initiatives shape the ways in which medical tourism is unfolding in specific local centres and clinics?

This short report is an important time capsule that summarises the current state of medical tourism research knowledge as articulated by the thought leaders in attendance at the forum while also pushing for research growth.

Some key points

• By ‘medical tourism’, we are referring to the practice whereby patients travel across international borders in order to privately access medical care.
• ‘Medical tourism’, a term widely popularised by the media, inadequately captures the diverse needs and experiences of people travelling outside of their countries of habitual residence to privately access medical treatment.
• A more nuanced categorisation will enable global health researchers to transcend simple documenting of such diversity in order to begin to identify and effectively monitor basic variables that would permit, first, timely assessment of the economic and health equity impacts of travelling patients and, second, evidence-based discussion about and action regarding accountability for addressing these impacts.
• A key question for researchers is: who should be meaningfully involved in identifying and defining categories of those travelling across borders for health services and what risks exist if certain voices are underrepresented in such a process?
• Governments routinely measure – and, with limited critique, both scholars and the media generally report – the number of medical travellers they receive per year as the key indicator of a medical tourism destination’s significance and its healthcare providers’ competence. Yet, such figures communicate very little and, actually serve as hyperbolic obstacles to generating an objective overview of the scale of and diversity within the industry.
• The focus should instead be on calculating medical and non-medical spending and resource use associated with different types of medical treatment, and that this information be accessible for broader study of the industry.
• Significant gaps in our knowledge about medical tourism exist. For example, while data is gathered in some countries on hospital revenue derived from treatment of foreign patients, scarce data is available on the indirect economic impacts of this practice (e.g., revenue for other medical and non-medical sectors, healthcare management innovation, employment generated, etc.
• Despite significant concerns about the role of medical tourism in exacerbating health inequities in both Global South and Global North countries, no research to date has evaluated or established a method with a coherent set of qualitative and quantitative measures to evaluate this exacerbation effect.
• Unlike the conventional tourism industry, there appears to be neither sufficient recognition of the utility among, nor adequate incentive for, public- and private-sector actors involved to align themselves to establish common definitions and data collection and reporting standards in order to identify economic and health equity impacts.
• Numerous governments have allocated significant funds to states, municipalities and medical service providers for the development of services and facilities to attract international patients. Yet the lack of widely-accepted definitions and their operationalisation into reliably and routinely measured variables effectively hinders bodies from measuring the return on their investments (ROI) and, in turn, from critically reviewing policy outcomes and more effectively executing or revising policy.
• It is imperative that researchers more rigorously assess impacts not only at the national level but also at the supra-national level and the sub-national regional and municipal levels by asking nuanced questions such as: how do supra-national- and national-level polices and initiatives shape the ways in which medical tourism is unfolding in specific local centres and clinics?
• International agreements fostering trade liberalization, including the offshoring of medical-related services, have frequently been cited as key to advancing the globalisation of healthcare. The imaginary they conjure of a free market in a flat world has not (yet) come to be. Presentations underscored the continued significance of geographic and cultural-linguistic proximity in shaping transnational flows of travelling patients. Unless travelling for very specific or advanced procedures, long haul travel is rare; people are more likely to seek care in neighbouring countries and places with which they already have established networks.
• A more nuanced grasp of where travelling patients are receiving care, the type of care, how they travel and are accommodated, and how they spend their time in destinations would enable far better destination and patient management.
• A useful question for researchers to explore is: what types of data can help us to articulate such nuanced perspectives and how can they be obtained and meaningfully incorporated into analyses? The outcomes of such analyses can lead to more targeted development and allocation of healthcare and promotional resources and greater capacity to inform and engage local affected populations and supra-national regional bodies about the distribution and management of available healthcare resources and the benefits and challenges this poses.