How changes in the law drive medical tourism

Sometimes, medical tourism is driven by patients seeking lower costs. Sometimes, it’s a desire to access higher quality treatment or a better outcome. But when the laws and regulations on treatment differ from region to region, or from country to country, patients will cross borders to seek the treatment they want or need. IMTJ Editor in chief Keith Pollard looks at recent examples spanning the USA, the EU and India.

In June, we saw the biggest change in legislation on abortion in the USA for fifty years. In 1973, the Roe v Wade case was a legal landmark, protecting women’s rights to abortion across the USA. The case ruled that a woman’s right to terminate a pregnancy was protected by the US constitution and, at that time, prevented two states, Texas and Georgia, from restricting those rights. However, the US Supreme Court has now ended this constitutional right. More than half of the US’s 50 states will now introduce laws that restrict access to abortion services.

The changes in US law will provide a stimulus to domestic medical travel from one US state to another, and possibly to countries outside of the USA. It may put abortion clinics in some US states out of business and create an influx of patients for those elsewhere.

IVF – regulation drives medical travel

The market for cross border assisted reproduction is significantly influenced by the variation in regulation from one country to another. Within the EU, there is no standard approach to who can access IVF treatment and what clinics can deliver. The European Society of Human Reproduction and Embryology (ESHRE) maintains an interactive map that illustrates the variability of ART and IUI  legislation and regulation. The assisted reproduction group IVI provide a useful summary of the different rules and regulations:

• Sperm donation is permitted in 20 of the 27 EU states.
• Egg donation is only allowed in 17 states.
• Donor anonymity varies from state to state. In countries such as Switzerland, Germany, Malta, Finland and the UK, a child can find out the identity of the donor when they reach a certain age.
• There are restrictions in some countries which only permit treatment for heterosexual couples. The rights of single women and lesbian couples also vary.
• There may be age limits on women’s access to treatment.

Inevitably, the difference in regulation between countries encourages infertile couples to travel to a destination where the treatment they want is permitted.

EU legislation on medical travel

Rather than restrict medical travel, back in 2011 the EU’s Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare was intended to establish rules for facilitating access to safe and high-quality cross-border healthcare in the EU, to ensure patient mobility in accordance with the principles established by the European Court of Justice and to promote the member states’ cooperation on healthcare. However, more than ten years on, the impact of this major piece of legislation has probably been less than was hoped, although some attempts have been made to assess the impact on different member states (See: Impact of the Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare: A comparative analysis).

Drug and treatment approval attracts medical travellers

Another example of legislation driving medical travel is where approaches to treatment and new drug developments may be fast tracked in one country compared to another. “Medication tourism” is often driven by the lower costs of drugs in some countries. For example, there is the flow of US citizens across the border into Mexico to obtain drugs, particularly for long term conditions, that are available at significantly reduced prices. However, the pursuit of the “elixir of life” or a lifesaving drug continues to drive medical travel where a “miracle cure” is claimed to be available in a destination. A prime example is stem cell therapy, which is often claimed fix the damage resulting from a disease or life-threatening condition. This clearly presents some dangers when patients seek treatments that are unproven or where the standard of care may be questionable.

Visa facilitation

Some countries have been pro-active in encouraging medical travel by establishing clear processes to support medical travel. India’s medical visa programme is a prime example of this. A Home Ministry report to the Indian Parliament in February 2022 stated that 825,000 medical visas to India were issued to foreigners, mostly from African nations, between 2019 and 2021. More recently, Prime Minister Modi has announced the introduction of a special AYUSH visa category to promote inbound medical tourism for traditional medicine treatment, within the ‘Heal in India’ campaign.

So… it’s not just about lower cost and better quality

Medical tourism is complicated. It is not a single market. It is composed of a multitude of market niches, each of which is made up of disparate patients with varying needs, who may be driven to consider medical travel for a variety of reasons. A change in healthcare regulation and legislation in one country may often present an opportunity for another.