by Neil Lunt, Richard Smith, Mark Exworthy, Stephen T. Green, Daniel Horsfall and Russell Mannion
1.University of York
2. London School of Hygiene & Tropical Medicine
3. Royal Holloway University of London
The review details what is currently known about the flow of medical tourists between countries and discusses the interaction of the demand for, and supply of, medical tourism services, 10 essential points need to be kept in mind. The following is a summary of the full article titled “Medical Tourism: Treatments, Markets and Health System Implications: A scoping review” Posted by OECD Directorate for Employment, Labour and Social Affairs.
1 Some places may be simultaneously acting as countries of origin and destination in the medical tourism marketplace. High-income countries may service overseas elites whilst at the same time their citizens choose to travel as medical tourists to Lower and Middle-Income Countries for treatments. Thus, Harley Street in the UK and facilities including the Mayo and Cleveland Clinics in the United States have longstanding reputations in the international provision of healthcare. Conversely, the emergence of lower-cost treatments in Thailand, India or parts of Eastern Europe will attract individuals from higher incomes countries who pursue treatments on the basis of cost. In trade parlance, this concerns the services that a country imports (if their patients go overseas to receive care, then effectively they are importing a service). It explores a range of financial, social, political, ethical and legal issues, and implications for the local industry.
2Currently, there is no universal “official agency/group”, such as the United Nations, the World Health Organization, the World Tourism Organization or the World Trade Organization, engaged in either the delivery of accreditation, the coordination of delivery of accreditation, or licensing or studying the existing schemes that deliver accreditation. Mandatory accreditation may appeal to governments and commercial health care purchasers such as third-party payers (e.g. insurance companies and occupational healthcare providers). Accreditation has most often been used as a marketing tool by wealthier provider hospitals, medical tourism facilitators and the governments of provider countries seeking to grow their share of the medical tourism business.
3 The use of IT information by professionals and how patient information flows across national boundaries are further important questions for the regulation of the medical tourism industry. Continuity of care can be facilitated by the sharing of patient records. Data protection regulations among countries – even within the EU, however, make difficult ease of access to medical records. It is not clear to what extent the European Health Card will foster improvements in this regard.
4 Patient satisfaction is an important dimension of healthcare treatment. Relatively little is known about the experience and satisfaction of medical tourists. According to Ehrbeck et al (2008, p.7), patients report generally high satisfaction with the quality of care received overseas but it is not clear that this can be extrapolated outside of the US and to a range of treatments. Patient clinical outcomes and satisfaction do not necessarily go together and satisfaction is not always the primary indicator of some treatments such as dental work.
5 There is a gap in understanding of patient expectations and how these may be raised by individuals paying a market-price and taking responsibility for choosing a provider.
6 There is the likelihood that large numbers of medical tourists will impact on the source country’s own health system, perhaps increasing trends that are encouraged by the current domestic private provision. Outflows of high-income patients will reduce both revenues and dilute political support for developing local services. Such flows also reduce the pressure for investment in particular facilities and technology. Indeed, there is an argument that some types of outflows of medical tourists for treatments that could be provided locally signal a failure of policy and delivery in the sender country.
7 Medical tourism has historically been from lower to higher income countries, with better medical facilities and more highly trained and qualified professionals. However, this trend is now reversing, and most recently “hubs” of medical excellence have developed which attract people regionally (Horowitz et al., 2007, Lautier, 2008).
8 There are also financial costs to be borne by inviting medical tourists into a country. often there are requirements for upgraded infra-structure – either specifically within the health sector (e.g. hospital facilities) and/or outside of that sector, such as roads, telecommunications etc. However, such infrastructural investments will create favourable spillovers for non-medical tourists and the local population. There are also likely to be costs concerned with appropriate staffing of facilities, possible accreditation schemes, and other requirements to attract medical tourists.
9 In the event of an adverse outcome arising from failings in clinical and professional practice, how do patient fare in seeking redress given there is no international regulation of medical tourism? There are warnings that clinics overseas are not necessarily regulated according to source-country standards and regulations. Choosing an overseas treatment centre brings a number of challenges – difficulties in assessing comparative quality and performance of alternative providers, differences in legal liability and knowledge concerning the processes of how to pursue complaints and receive redress (MacReady, 2007).
10 In terms of management of services and treatments, there are continuing questions about the range of information and its quality. Given the role of the internet, how (if at all) the quality of medical tourism information is best addressed is unclear: ranging from codes of conduct, through quality labels, user guidance tool, third-party quality and accreditation labels, to educating users and assisting those wishing to search (Lunt et al., 2010). Frontier medicine and the marketing of biotechnologies present a particular issue (Murdoch and Scott, 2010) given that such treatments may not be based on proven clinical trials.