Shopping for care. Is medical tourism a benefit or risk to our health-care system?

Like many new immigrants settling in rural locations in Canada, I had limited access to publicly funded care and no money to pay for private care to deal with health issues after arriving. So, I did what many of the immigrants I have met do: I received virtual care from professionals in my home country for more than a year and scheduled a surgical procedure there when visiting family.

Luckily for me and the Canadian health-care system, I had no complications. While I wasn’t technically a tourist when receiving that care, it was a similar situation to that experienced by the growing number of Canadians seeking medical care abroad.

Medical Tourism (MT) is the practice of travelling across international borders to purchase medical assistance. This type of service consumption is believed to have started in the 18th century, when Europeans travelled to spas where the waters were thought to benefit one’s health. Since then, the industry has seen its fair share of changes.

At first, affluent people from less developed countries travelled to wealthier nations to take advantage of modern facilities, techniques and highly trained professionals. However, the flow of medical tourists has seen a substantial increase in patients from more developed countries travelling to lower and middle-income ones, driven by higher costs and wait times and serviced by an established international market for medical tourists.

In 2019, the number of cross-border patients worldwide was estimated to be 21 million-26 million. At the same time, the global MT market accounted for more than US $100 billion and is projected to double in value in less than 10 years.

I first came across medical tourism while doing a rural clinical observership in British Columbia. A male patient in his 50s was following up on his vitamin and iron deficiencies with the local family doctor. I wasn’t surprised by this since I knew he had undergone bariatric surgery, and these are known side effects. What I didn’t expect was hearing how he and a group of fellow Canadians had gone to Mexico several years earlier for their surgery. Two months later, I listened to a similar history in an internal medicine specialist’s office in Vancouver. This time, the patient was planning a trip to India for spine surgery.

From 2017 to 2021, Canadians spent as much as $2.3 billion on out-of-country health care.

There are several reasons why Canadians seek MT, but the most cited is the long wait times. For example, while wait lists for hip replacements can stretch to as long as one year here, patients with resources can have it done immediately in India and Thailand. The 600,000 fewer surgeries performed during the first 22 months of the COVID-19 pandemic and the longest wait time ever recorded for specialist care may have sparked an increase in patients pursuing MT. However, although we have anecdotal examples of this, we still lack reliable data.

The exact number of Canadians pursuing MT is unknown, but it’s estimated that 63,459 Canadians received medical care internationally in 2016. And, from 2017 to 2021, Canadians spent as much as $2.3 billion on out-of-country health care. While the number of medical tourism agencies currently working in Canada has not been documented, more than a decade ago, Canada had approximately 18 operational medical tourism agencies. There is a broad spectrum of care services offered, including cardiac, plastic, transplant, orthopedic, dental and other surgeries, and while some offer follow-up care, others even allow patients to fly abroad for the procedure with their Canadian specialists. Among the top destinations for medical tourism are Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey and the United States.

While some advocate that MT might alleviate the Canadian health-care system’s wait times and improve overall access to care, MT also comes with its fair share of concerns and costs. A worrisome complication is the acquisition of drug-resistant organisms after accessing health care abroad and the subsequent cross-border spread. Another is the financial cost related to postoperative MT complications. For example, in Alberta, postoperative bariatric medical tourism alone costs the public system approximately $1 million per year. Across the country, it is estimated that postoperative MT infectious complications might cost $5.9-$17.7 million annually.

Canadian physicians have also expressed concerns that MT disrupts the continuity of care and their ability to provide adequate follow-up care. Focus group participants also worried about legal liabilities should they be asked to clinically support treatments started abroad.

In addition to the thousands of Canadians travelling for medical care, there are also a significant number of foreign nationals travelling to Canada for care, further complicating the analysis of the costs and benefits of MT. In 2015, incoming medical tourists spent US $127 million in Canada. Information tracking is scarce, and analysis is even more rare. Is this a financial windfall and boost to the Canadian medical field or a further burden on a system already facing staffing shortages and long wait times?

The questions and issues brought forth by the flourishing field of MT need to be explored to understand patient flow, motivations, expenditure trends and system impact of outgoing and incoming MT. Policymakers, institutions and patients need to be able to understand and analyze the risks for overall public health as well as the potential benefits of alleviating wait times and costs. The fact is MT is a fast-growing global market, it’s not going away.

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Mariana da Silva Jardim is an internationally trained physician and a family medicine resident at the University of Toronto.

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