Sometimes I smugly think that I know a reasonable amount about health care in Canada and elsewhere. Well, it is always good to have one’s smug illusions shattered every once in a while.

When in Europe recently, I was at a presentation by the Turkish government about their focus on “medical tourism” – attracting residents from other countries to Turkey to have their medical needs and wants met.

They are convinced that this business will be an important cog in Turkey’s economy, while at the same time providing a valuable service to foreigners. They say they will be successful because of Turkey’s location (at the crossroads of Europe and Asia, with hundreds of millions of people living less than 3 hours flight away), the long wait times for services in some European countries, the quality and relatively low price of Turkey’s medical services (many of their hospitals are accredited by international organizations) and its natural and historical beauty (why not have a holiday with your family after you have your cataract surgery?).

These folks are serious.

The Turkish Medical Tourism Association (yes, there is such a group!) has produced a comprehensive “Turkey Health Care Guide” which lists the large number of hospitals, clinics and spas eager to welcome foreigners. Although a big part of their market is cosmetic services and spa treatments, they also offer medically necessary treatments such as a heart valve replacement (at a price of $16,950), knee joint replacement ($11,200), cataract surgery ($1,000-2,000), and spinal fusion ($7,125).  You can also have any variety of MRI scans, CT scans and other diagnostic tests.

I must admit I had a variety of strong and somewhat conflicting reactions to their presentation; some rational and some emotional.

First, I was amazed by their seriousness and the resources they plan to commit to this. They showed pictures of health care centres in advanced stages of planning that looked liked vacation theme parks – modern medical facilities located beside a sandy beach surrounded by nice hotels, restaurants and amusement parks for the enjoyment of patients and their families. Turkey seems to be taking the thought that health care can be a driver of the economy very seriously.

Second, I wondered about the practicalities of this if I was a patient. The most obvious concern is quality, but my gut tells me that the hospitals involved are of an international standard. And, I would only go there for discrete procedures – I wouldn’t go to have my chronic disease managed. What about the risks and hassle of travel? If I really need a heart valve replacement, I don’t think I would want the stress of even a 2 hour flight. On the other hand, if there was a 6 month waiting list for a hip replacement or cataract surgery in my region and I could afford the cost of the surgery, why not? It sounds a lot cheaper and nicer than Florida. My main concern would be what would happen if I got a complication while there – who would pay for the management of my blood clot after the surgery? I don’t know the answer to that.

Third, why shouldn’t the Ontario Ministry of Health pay for my cataract surgery elsewhere if I pay for my airfare, the facility is accredited, and the cost is cheaper than in Ontario? This may not be as far fetched as it sounds. Narayana Hrudayalaya, which owns and runs hospitals in India known for their high quality and low cost, has announced a plan to build a large hospital in the Cayman Islands, in partnership with Ascension Health Alliance, the largest Catholic healthcare organization in the United States.

One of the groups they are targeting as clients is Americans on the east coast. Why not Ontarians? If Narayana Hrudayalaya can do procedures that are of similar quality to Ontario at a much lower cost, why not take advantage of that? After all, the Ontario government used to pay for Ontarians to have bariatric surgery in the United States, and paid a higher cost than they would have paid in Ontario.

I don't think having surgery in the Cayman Islands is the same as jumping the queue at home. By going abroad for surgery, I would not be delaying access for anyone else in Ontario nor would I be drawing Ontario physicians out of the limited pool in the public system, as would happen if I had my surgery in a private system in Ontario. One could argue that I would be opening up a slot for other Ontarians and saving the government money at the same time.

However, it's not entirely clear to me what the effects of medical tourism will be for hosting countries like the Cayman Islands.  To better understand these effects, has invited researchers from Simon Fraser University's Medical Tourism Research Group to share their insites in a blog later this week.  I look forward to hearing their perspective.

I suspect medical tourism will increase in popularity and become more a part of our lives in the future.  It will be interesting to see if competition from off-shore hospitals changes the way we provide care in Ontario.

Andreas Laupacis is a general internist at St. Michael's Hospital and the editor-in-chief of