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What is medical tourism?

Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable at home. However, in recent years it may equally refer to those from developed countries who travel to developing countries for lower-priced medical treatments. The motivation may be also for medical services unavailable or non-licensed in the home country: There are differences between the medical agencies (FDA, EMA etc.) world-wide, whether a drug is approved in their country or not. Even within Europe, although therapy protocols might be approved by the European Medical Agency (EMA), several countries have their own review organizations in order to evaluate whether the same therapy protocol would be "cost-effective", so that patients face differences in the therapy protocols, particularly in the access of these drugs, which might be partially explained by the financial strength of the particular Health System.

Medical tourism most often is for surgeries (cosmetic or otherwise) or similar treatments, though people also travel for dental tourism or fertility tourism. People with rare conditions may travel to countries where the treatment is better understood. However, almost all types of health care are available, including psychiatry, alternative medicine, convalescent care, and even burial services. Health tourism is a wider term for travel that focuses on medical treatments and the use of healthcare services. It covers a wide field of health-oriented tourism ranging from preventive and health-conductive treatment to rehabilitational and curative forms of travel.

Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The avoidance of waiting times is the leading factor for medical tourism from the UK, whereas in the US, the main reason is cheaper prices abroad. Furthermore, death rates even in the developed countries differ extremely, i.e. UK versus seven other leading countries, including the US. Many surgical procedures performed in medical tourism destinations cost a fraction of the price they do in other countries. For example, in the United States, a liver transplant that may cost US$300,000, would generally cost about US$91,000 in Taiwan. A large draw to medical travel is convenience and speed. Countries that operate public health-care systems often have long wait times for certain operations, for example, an estimated 782,936 Canadian patients spent an average waiting time of 9.4 weeks on medical waiting lists in 2005. Canada has also set waiting time benchmarks for non-urgent medical procedures, including a 26-week waiting period for a hip replacement and a 16-week wait for cataract surgery. In First World countries such as the United States, medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
An authority at the Harvard Business School stated that "medical tourism is promoted much more heavily in the United Kingdom than in the United States". Additionally, some patients in some First World countries are finding that insurance either does not cover orthopedic surgery (such as knee or hip replacement) or limits the choice of the facility, surgeon, or prosthetics to be used. Popular medical travel worldwide destinations include:Iran, Canada, Cuba, Costa Rica, Ecuador, India, Israel, Jordan, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, United States.

History

The first recorded instance of people travelling for medical treatment dates back thousands of years to when Greek pilgrims traveled from the eastern Mediterranean to a small area in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios. Spa towns and sanitaria were early forms of medical tourism. In 18th-century Europe patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.

Risks

Medical Tourism may introduce some risks that patients are less likely to face in their homeland:

• • Some countries, such as South Africa, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West.
• • The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. Also, traveling long distances soon after surgery can increase the risk of complications. Long flights and decreased mobility associated with window seats can predispose one towards developing deep vein thrombosis and potentially a pulmonary embolism. Other vacation activities can be problematic as well, for example, scars may become darker and more noticeable if they are sunburned while healing.
  Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients.
• • Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.
• • Patients traveling to countries with less stringent surgical standards may be at higher risk for complications. If there are complications, the patient may need to stay in the foreign country for longer than planned or if they have returned home, will not have easy access to follow up care.
• • Patients sometimes travel to another country to obtain medical procedures that doctors in their home country refuse to perform because they believed that the risks of the procedure outweigh the benefits. Such patients may have difficulty getting insurance (whether public or private) to cover follow up medical costs should the feared complications indeed arise.

Legal issues
Receiving medical care abroad may subject medical tourists to unfamiliar legal issues. The limited nature of litigation in various countries is a reason for accessibility of care overseas. While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity.
Issues can also arise for patients who seek out services that are illegal in their home country. In this case, some countries have the jurisdiction to prosecute their citizen once they have returned home, or in extreme cases extraterritorially arrest and prosecute. In Ireland, especially, in the 1980s-90s there were cases of young rape victims who were banned from traveling to Europe to get legal abortions. Ultimately, Ireland's Supreme Court overturned the ban; they and many other countries have since created "right to travel" amendments.

Ethical issues
There can be major ethical issues around medical tourism. For example, the illegal purchase of organs and tissues for transplantation had been methodically documented and studied in countries such as India,China, Colombia and the Philippines. The Declaration of Istanbul distinguishes between ethically problematic "transplant tourism" and "travel for transplantation".
Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example, in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system. In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care". Medical tourism centered on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering advanced technologies, such as providing 'unproven' therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation.

Sought after Medical Tourism destinations

The growth of Global Medical Tourism in the last decade has influenced overall growth of health care sector. Hence many countries are actively strengthening their position as medical tourism destination Iran : Due to high quality of medical and beauty services, advancements in medical studies and comparatively lower cost of treatments Iran has become a prominent destination for medical tourism.
Some of the medical tourists come from neighboring countries such as Iraq, Azerbaijan, Afghanistan, Pakistan, Oman and Turkey; These patients are usually after life-saving treatments and plastic surgery operations such as Ophthalmology, open-heart surgery, Infertility treatment, spinal-cord surgery and organ transplants
Iran is also an attractive destination for patients that come from developed countries and are mostly after plastic surgery and beauty operations such as Hair transplant, Breast augmentation, Rhinoplasty, weight reduction surgeries and so on ... .
Low cost and high standard of medical facilities and operation has solidified Iran's position as an important destination for both tourist form neighboring countries and those who come from more developed countries. Brazil : In Brazil, Albert Einstein Hospital in São Paulo was the first JCI-accredited facility outside of the US, and more than a dozen Brazilian medical facilities have since been similarly accredited. Turkey : The cost of medical recourses in Turkey is quite affordable compared to Western European countries. Therefore, thousands of people each year travel to Turkey for their medical treatments. Turkey is especially becoming a hub for hair transplant surgery. Almost 178 thousand tourists visited for health purposes in the first six months of 2018. 67% used private hospital, 24% public hospitals and 9% university hospitals. The Regulation on International Health Tourism and Tourist Health came into force on 13 July 2017. It only applies to those coming specifically for treatment. Mexico : Mexico has 98 hospitals accredited by the country's Federal Health Ministry and seven hospitals which are JCI-accredited. Mexico is most reputed for advanced care in dentistry and cosmetic surgery. Medical care in Mexico saves a patient 40% to 65% compared to the cost of similar services in the US.
In recent years, Los Algodones, a settlement of fewer than 6,000 people located on the US border near Yuma, Arizona, has become a major destination for Americans and Canadians seeking dental services. Roughly 600 dentists practice in the community, catering mainly to tourists, leading the community to be nicknamed "Molar City". Singapore : Singapore has a dozen hospitals and health centers with JCI accreditation. In 2013 medical expenditure generated from medical tourists, mostly from more complex medical procedures, such as heart surgery, was S$832 million, a decline of 25 percent from 2012's S$1.11 billion, as the hospitals faced more competition from neighbouring countries for less complex work. India : Medical tourism is a growing sector in India. India is becoming the 2nd medical tourism destination after Thailand. Chennai is regarded as "India's Health City" as it attracts 45% of health tourists visiting India and 40% of domestic health tourists.
India's medical tourism sector was expected to experience an annual growth rate of 30% from 2012, making it a $2 billion industry by 2015.In August 2019, the Indian government made it easier for foreigners to receive medical treatment without necessarily applying for a medical visa. These initiatives by Indian government will help Medical Tourism market to reach around $9 Billion in 2020. Furthermore, the major reason for foreign tourist to choose India is because it has 38 hospitals accredited by the Joint Commission International.
As medical treatment costs in the developed world balloon—with the United States leading the way—more and more Westerners are finding the prospect of international travel for medical care increasingly appealing. An estimated 150,000 of these travel to India for low-priced healthcare procedures every year.
India is increasingly becoming popular with Africans seeking medical treatment overseas. Treatments are approved by the World Health Organization (WHO) and the US Food and Drug Administration. Many patients from Africa prefer Apollo & Medobal healthcare, which are headquartered in Chennai in India's state of Tamil Nadu. Cosmetic surgery, bariatric surgery, knee cap replacements, liver transplants, and cancer treatments are some of the most sought out medical tourism procedures chosen by foreigners.