Medical Tourism and Global Healthcare - Where Are You Going?

The American Medical Association (AMA) defines medical tourism as "the organized travel outside of one's health care jurisdiction, usually one's country, to enhance or restore health through medical intervention." A less technical definition comes from Harvard Business School, which defines medical tourism as the act of "traveling far and wide for health care that is often better and certainly cheaper than at home." The practice is also known as health tourism, medtrotting, or cross-border health tourism.

Medical tourism is booming and has now become a $40 billion dollar industry. An estimated 10,000 Americans engage in medical tourism annually, not including cosmetic surgery and dental procedures. Other estimates range from 50,000 to 500,000, including all procedures. In 2005, about 150,000 people worldwide were medical tourists. Singapore, Thailand, Malaysia and India are the leading countries in the medical tourism industry.

Though it has become very popular only in recent years, medical tourism is not a new phenomenon. Indeed, hundreds, even thousands of years ago, people have been to known to visit areas known for their healing powers. In England, the World Heritage City of Bath got its name from the numerous heated mineral springs and roman baths that became quite popular with the rich and famous of Europe of the 17th and 18th century. The word "Spa" is taken from a little Belgian town of that name, famous for its thermal springs. The French Riviera has also a history as a wellness getaway for English and Russian nobilities escaping the cold winters of northern Europe,

In more recent history, medical tourism followed advances in medicine as rich people from developing countries travelled to more developed countries such as the US and the UK. Other countries (e.g. Switzerland) specialized in boutique health services, such as cosmetic surgery and rehabilitation clinics.

Globalization and widespread air travel have triggered the rise in medical tourism, bringing about two major trends in health tourism.

(1) Medical tourism has gone mainstream. Whereas before, only the rich and the famous could afford to be medical tourists, medical tourism is now accessible to everybody. Hundreds of travel agencies have specialized in this rather lucrative niche. In Europe, where crossing national borders now have fewer restrictions with the inclusion of eastern European countries to the European Union, medical tourism has become widespread. This is aided by the short distances and the fact that the health care destinations are reachable by car, by train or a short flight. For Americans, medical tourism may entail travelling long distances but with cheaper flights, Central American countries have become favorite destinations.

(2) Medical tourism has changed directions. Medical tourism of 50 years ago mainly consisted of trips from a less developed country to a more developed and medically advanced country. Nowadays medical tourism goes in both directions, but mainly in the direction of developing countries where good quality but affordable healthcare can be found.

The current trends in medical tourism may be due to the following factors:

(1) Rising health care costs. Rising health care costs in developed countries especially the US are forcing their citizens to seek affordable health care elsewhere. Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee replacement can cost $40,000 compared to $13,000 in Singapore. This is even encouraged by health insurance companies and employers offering coverage of medical tourism expenses. One case is that of the insurer WellPoint Inc. and a self-funded, Wisconsin-based specialty graphics business called Serigraph. According to reports, "Serigraph will waive co-pays and coinsurance for any of their 650 employees to fly to India for certain non-emergency medical procedures such as major joint replacement and upper and lower back fusion. In addition, Serigraph will pay for all travel expenses for the employee as well as a companion".

(2) Cross-border medical training. More and more doctors from developing countries have studied and specialized abroad. India, for example, has many doctors trained in the US and the UK who speak excellent English and fully understand the medical needs of medical tourists from Western countries. The same is true for Mexico in relation to the US and Australia in relation to Thailand.

(3) Holistic approach to medicine. The last decade also witnessed the popularity of alternative medicine. More and more people seek out alternative health care such as traditional Chinese medicine, Ayurveda (India), Unani (Arabic), homeopathy, and herbal medicine, among others. Many countries in Asia offer these types of medicine for Western tourists.

(4) Accreditation. To overcome the scepticism of patients, many medical tourism facilities apply for accreditation. Several American organizations conduct inspections, evaluations of and grant accreditation to medical facilities outside the US. One of these is the Joint Commission International (JCI). More encompassing is accreditation by the International Society for Quality in Healthcare which is the umbrella organization for accreditation agencies in many countries including Australia, New Zealand, Japan, Canada and Ireland.

The most popular destinations are in Asia and Latin America. However, it is estimated that about 50 countries in all continents engage in the industry.

India is on top of the list of favorite medical tourism destinations. According a University of Delaware article "India has top-notch centers for open-heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants and cancer therapy, and virtually all of India's clinics are equipped with the latest electronic and medical diagnostic equipment". "For example, hip surgery patients in India can opt for a hip-resurfacing procedure, in which damaged bone is scraped away and replaced with chrome alloy--an operation that costs less and causes less post-operative trauma than the traditional replacement procedure performed in the U.S". Heart bypass goes for $10,000 and a hip replacement for $9,000, compared with $130,000 and $43,000 respectively in the United States".

Aside from the additional attraction of its holiday destination facilities the beaches of Phuket, Thailand is actually well-known for sex-change surgery, which "is one of the top 10 procedures for which patients visit Thailand".

For Americans, Mexico and Costa Rica are appealing because of their proximity. Arizona retirement communities now organize regular bus tours for Mexican dental work and inexpensive drugs. And tiny border communities, some about an hour from Ciudad Juarez, are becoming dentistry boomtowns to handle an ever-growing flow of American patients flying in from as far away as Alaska".

Despite the boom in medical tourism and global healthcare the industry remains controversial in several respects.

(1) Health care disparities. A main objection by those who are opposed to medical tourism is the disparities of care delivered by private facilities catering to medical tourists and public health care for local residents. It is estimated more than half of India's primary health care facilities are not equipped with a labor room, laboratory, or a telephone or stocked with essential medications.

(2) In Vitro Fertilization. In January 2009, a Canadian woman made headlines when she delivered twins at the age of 60. Under Canadian law, the age limit for a woman to have in vitro fertilization (IVF) is 45 to years old. India is the home of the world's oldest first-time mother who delivered a baby girl last November at the age of 70. Laws governing fertility treatments are almost nonexistent in India, and unlike in many countries, there are no regulations limiting the age of the mother or the number of embryos implanted.

(3) Commercial surrogacy or reproductive outsourcing. This is another form of assisted reproduction connected with medical tourism and again India is in the front line. Women whose uteri are not capable of carrying a baby resort to paying other women to be surrogate mothers. In India, women consider this as a respectable way of making money and at the same time help childless women. Commercial surrogacy has been legal in India since 2002, as it is in many other countries, including the United States. But India is the leader in making it a viable industry rather than a rare fertility treatment.

(4) Organ transplantation. One of the shady dealings of medical tourism is organ transplantation. People who are not willing to wait and can afford to pay a lot of money may find other means of getting an organ in developing countries. "Transplant tourism" as it is sometimes called, is thriving in developing countries. In 2006, The Guardian reported that British patients travelled to China to have transplants with organs taken from executed prisoners, "without the prior consent of either the prisoner or their family".

Medical tourism is on the rise and is expected to become more popular and acceptable in the future. According to the American Medical Association, "the global economy and changing rules of trade provide opportunities and challenges for the medical profession and public health". Like in any industry, medical tourism is ruled by supply and demand. There is definitely a lot of demand in developed countries that developing countries willingly supply. However, limits and regulations need to be set in place in order to protect the patients as well as the labor force of the service providers. Only then can the industry be worthy of the term "global healthcare".