When Canadians travel abroad for private medical care they are engaging in what is known as medical tourism. Medical tourism is a global, multi-billion dollar industry. Patients from all regions of the world are traveling to a growing list of countries as medical tourists. Our research group studies medical tourism, with a particular focus on understanding its equity and ethical impacts. As we write this piece we are in the Cayman Islands looking into the development of a large medical tourism hospital here led by Indian and American investors, and next week we will travel to Jamaica to talk to stakeholders there about intentions to develop a medial tourism sector. Our focus on the Caribbean at this very moment is not coincidental as there is considerable medical tourism growth in the region and many existing and planned facilities here are aiming to attract Canadian patients, investors, and even physicians.
Perhaps unsurprisingly, medical tourism is anything but a simple phenomenon. When patients cross international borders to access private medical care complex questions are raised. For example, which country’s laws apply should something go wrong with the procedure? How are home health system resources used to support this global industry (e.g., diagnostic tests prior to departure requested by physicians abroad, filling prescriptions to be taken abroad, travel medicine consultations)? Is the patient’s home health care system responsible for providing follow-up care following surgery abroad? This last question is particularly relevant in Canada where we have a public health care system. If a patient chooses to go abroad for care is she entitled to be treated for complications here? While some people may say yes simply because she would be able to get treatment for complications had she had the procedure here in Canada, what about if she went abroad for surgery that was not approved here or that she had been denied here because she is not a suitable candidate? Answers to questions such as these are not always clear as they may depend on a province or territory’s health system, the severity of complications, and the ability to treat complications locally, among other factors.
Although it is interesting as Canadian researchers to ponder the implications of Canadians involvement in medical tourism abroad, we really want to take the opportunity here to focus on the impacts of medical tourism for countries that patients are traveling to. Three broad arguments are regularly put forth that tout the beneficial impacts of medical tourism for destinations that expand this sector. It is argued that medical tourism can help support the modernization and specialization of health services in developing nations through the additional demand and profits generated by foreign patients. It is also thought that medical tourism will help countries combat brain drain among health workers and assist in retaining physicians and nurses by supporting both higher wages and intellectually engaging specialties. It is further thought that integrated international health service markets will help drive down the cost of health care by increasing competition between care providers.
These arguments in favour of medical tourism are countered by assertions that local patients in destinations may not benefit from the trickle down effects of more health workers and medical facilities in their countries. Medical tourism is thought to reduce the availability of health professionals for local patients due to increased demand for their time and skills by foreign patients. Secondly, medical tourism incentivizes investment into expensive tertiary health care services (e.g., high-end surgeries) that are limited in impact when compared to the cost-effectiveness of investments into primary care delivery (e.g., family medicine, preventative care), especially in low and middle income countries. Finally, the benefits of medical tourism are largely hinged on a commodified conception of medical care that may undermine policies and efforts to advance rights-based frameworks for universal access to health care worldwide.
Both sides of the arguments we have outlined above can be quite compelling. Many people we speak with intuitively understand why medical tourism can be at once harmful and helpful. Unfortunately, what is very much lacking is the evidence or data that can shift the conversation about the equity and ethical impacts about medical tourism beyond speculative debate and towards building an informed understanding of this industry and the ways in which polices and other interventions can be put into place that secure the health of both international patients traveling from abroad and citizens living in destination nations. In our opinion, poor surveillance of international patients, unclear definitions of what constitutes medical tourism, and the relative youth of the sector have all worked against a focused understanding of how the sector impacts the operation of health systems, patients, and citizens. Dialogues about medical tourism are needed in public, government, and research circles in order to identify the most pressing questions about this practice and stimulate awareness about the need for data gathering. There is no indication that the medical tourism industry is fading, and a number of indications that more and more Canadians are becoming aware of its existence and ultimately choosing to go abroad for private medical care. As such, these dialogues need to be undertaken and their messages mobilized to those in decision-making capacities and to individual patients thinking about going abroad.