Medical tourism is primarily driven by lower health care costs and facilities and health care professionals that are comparable to back home. The added benefit is you get to travel but are you getting your money's worth?

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". The primary reason for medical tourism is to receive "the same or better care at lower cost".¹

The practice is also known as health tourism, medtrotting, or cross-border health tourism. The Harvard Business School, defines medical tourism as the act of "traveling far and wide for health care that is often better and certainly cheaper than at home" — a practice that appeals to patients who needs simple procedures such as a acupuncture or dental work to more complicated interventions like heart bypass and organ transplant.²

Medical tourism is booming and has now become on last count 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.

Most medical tourists are uninsured or are seeking an unapproved procedure, or one that is not covered by their insurance." In 2005, about 150,000 people worldwide were medical tourists. Singapore, Thailand, Malaysia and India are the leading countries in medical tourism industry and Mexico, Costa Rica, Turkey, Israel, Australia and New Zealand are entering the market, to name a few. 

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, e.g. thermal baths, mineral waters, etc.  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 and featured in Agatha Christie novels as the birthplace of the detective Hercule Poirot. Spa was and is still a favorite destination for "wellness"-seeking Europeans. The French Riviera (Cote d'Azur) has also a history as a wellness getaway for English and Russian nobilities who wanted to escape 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 U.S. and the UK for medical treatment that they could not obtain in their home country. One of the most well-published cases is that of Chilean president Alberto Pinochet who went to England for medical treatment but was arrested by Spanish authorities for human rights violations. Other countries (e.g. Switzerland) specialized in boutique health services, such as cosmetic surgery and rehabilitation clinics, have also their own niche for the rich and famous who appreciate the comfort and discretion offered.

Whereas before, only the rich and the famous could afford to be medical tourists, medical tourism is now accessible to everybody and has gone mainstream. 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 Canadians and Americans, medical tourism may entail travelling long distances but with cheaper flights, Central American countries have become favorite destinations. Citizens of states bordering Mexico and Canada, have of course, better access to their neighbors' health care offerings.

Medical tourism has also 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.

Besides globalization and widespread air travel the current explosion in medical tourism may be due to the following factors:

Rising health care costs

The rising health care costs in developed countries especially the US are forcing their citizens to seek affordable health care elsewhere. Here's an example of how much cheaper medical tourism can be: Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee replacement in the United States can cost $40,000 compared to $13,000 in Singapore.³

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." The message is clear: medical tourism is more cost-effective than getting treatment locally.⁴

Cross-border medical training

More and more doctors from developing countries have studied and specialized abroad, thus bring home advanced medical technology and practices. India, for example, has many doctors trained in the U.S. 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.

Holistic approach to medicine

The last decade also witnessed the popularity of alternative and complementary medicine. More and more people opt for a holistic approach to medical treatment and 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.

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 United States. One of these is the Joint Commission International (JCI), which is the international subsidiary of JACHO, the USA focused Joint Accreditation Commission for HealthCare Organisations. 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.⁵

The Lure of Exotic Locations

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. As previously mentioned, India has the advantage of having capable doctors, some of them trained in the West. An additional advantage is the lack of language barrier that many other countries are facing because almost everybody in India speaks English. Finally, India is the understandably the preferred choice of millions of Indians living and working abroad.

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".⁶

It seems that Indian doctors as also open to innovation and offer uncommon but effective interventions. "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".⁷

In addition, assisted reproduction has become a big hit in India where there is less regulation (see below). In 2007, an estimated 150,000 medical tourists from Canada, the United States, UK and other countries visited India. The popularity of India is due to three major attractions:highly trained English-speaking doctors, quick appointments and bargain-basement prices. In India, a 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".

Thailand has several medical facilities with accreditations from the US. 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." Thailand is also a popular destination for assisted reproduction.

For Americans, Mexico and Costa Rica are appealing because of their proximity. According to the Washington Post, Mexico is "quickly transforming its border cities into catch basins for millions of bargain-hunting and uninsured Americans. Arizona retirement communities now organize regular bus tours for Mexican dental work and inexpensive drugs. New hospitals have opened in Tijuana, because some U.S. health plans have begun covering services in Mexico. 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".⁸

But, despite the boom in medical tourism and global healthcare all is not well.

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".⁹

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. Again, taking India as example, according to the World Health Organization (WHO), private expenditure on health as a percentage of total expenditure on health in 2003 was 75%. That contrasted starkly with government expenditure of 25% in the same year, a portion which finances public health facilities that cater to most of India’s population.  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.¹⁰

Circumventing the law: IVF

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. To circumvent this, the Indian-born woman had the IVF procedure performed in India.¹¹

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. The country's "medical culture emphasises the mother's right to create life rather than the rights of a child".¹²

Wombs for hire

Another form of assisted reproduction connected with medical tourism is commercial surrogacy or reproductive outsourcing 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. Experts say it could take off for the same reasons outsourcing in other industries has been successful: a wide labor pool working for relatively low rates".^13,14

Organs

One of the shady dealings of medical tourism is organ transplantation. In Europe and North America, people have to be on a waiting list for organ transplants. Eligibility for organ transplants depends on blood match and how sick a patient is. 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.

A recent report in FoxNews featured young Egyptian adults who sell their kidneys in underground organ trafficking in Cairo. 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," a practice strongly condemned by the British Transplantation Society.^15,16

The Bottom Line

Medical tourism is on the rise and is expected to become more popular and acceptable in the future. Like any other industry, medical tourism is ruled by supply and demand and 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 patients as well as the labor force of the service providers. Only then can the industry be worthy of the term "global healthcare".  

Published May 11, 2009, updated May 18, 2012

References

1. Globalization, AMA Health Care Trends, 2008
2. Lagace M. The Rise of Medical Tourism, Harvard Business School Working Knowledge, Dec 17 2007
3. York D, Medical tourism: the trend toward outsourcing medical procedures to foreign countries, J Contin Educ Health Prof, 2008 Spring;28(2):99-102
4. Insurers Pay fro medical procedures Abroad, Healthcare Financial Management Association, January 1, 2009
5. Watson E, Accreditation of Overseas Hospitals JCI or ISQua, Medical Tourism Magazine, November 24, 2007
6. Medical tourism growing worldwide, U Daily. University of Delaware. Jul 25, 2005
7. For big surgery, Delhi is dealing, Chicago Tribune, March 28, 2008
8. Roig-Franzia M, Discount Dentistry, South of the Border, Washington Post, June 18, 2007
9. Health Care Trends 2008, An Environmental Analysis Report, AMA
10. Medical visas mark growth of Indian medical tourism, Bulletin of the World Health Organization (BLT). Volume 85, Number 3, March 2007, 161-244
11. 60-year-old Calgary mother welcomes twins, CBCnews Canada. February 5, 2009
12. The world's oldest mother, The Guardian UK, March 6, 2009
13. Jones CA et al, Medical tourism and reproductive outsourcing: the dawning of a new paradigm for healthcare, Int J Fertil Womens Med, 2006 Nov-Dec;51(6):251-5
14. Giving birth the latest job outsourced to India, MSNBC, Dec. 30, 2007
15. Egypt Pressured to Act on Underground Organ Trade, FoxNews, March 17, 2009
16. UK transplant patients go to China for organs from executed prisoners, The Guardian UK, 20 April 2006