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A Critical History of Medical Tourism
Medical tourism can save money and your life, but it's important that you do your research

Last Updated: March 21, 2017

I. Medical Tourism in Antiquity

As early as ancient times medical travelers journeyed for their health. The Ancient Greeks erected Asclepia Temples to honored their god of medicine, Asclepius, from whom the medical symbol of the snake entwined around a stick originates. Approximately 5,000 years ago pilgrims traveled to India in search of Ayurvedic medicine—a practice which has intermittently continued ever since. But possibly the first known health complex was constructed around Sumerian hot springs.1


The tradition of seeking out hot springs and mineral waters for their health benefits—purporting to cure everything from pimples, gonorrhea, rheumatic diseases, and nervous conditions2—spread to Europe and earned accolades from famous writers such as Victor Hugo and Michel Eyquem de Montaigne. In fact, the origin of the word “spa” is traced it to the 1326 discovery of iron-rich hot springs near Ville d’Eaux (”Town of Waters”), where the word “spa”, derived from the Roman phrase “salude per aqua” (”health through waters”), was first used.3 A European interest in curative waters continued and spread to the town of Bath, and the late eighteenth century it was one of the richest and most advanced industrial-era cities, being the first in England to enjoy a covered sewage system—a quality which contributed greatly to its attractiveness to early health travelers.


Medical tourism continued to be primarily related to spas or local specializations until the late twentieth century. At this point, differences in the local availability of medical treatments, and wide differences in their prices, began to motivate increasing numbers of prospective patients to board planes and receive services in hospitals and clinics outside of their country of residence. This new class of traveler began to be referred to as “health travelers”, or “medical travelers”, but are now usually called, “medical tourists,”—despite the misleading images implied by the word “tourist”. Most commonly, so-called "medical tourists" are not looking for cultural landmarks or fun in the sun, like other, non-medical, tourists. Rather, medical tourists are more like pilgrims, sojourners, or wayfarers, in search of medical care that is either unavailable or otherwise preferable to what they'd find in their home countries.


Hot Springs
Hot Spring. Image credit Florian Blümm

II. Medical Tourism in Modern Times

Around 2005-2008, enamored with the promise of globalization and facilitated by the Internet, the news media, entrepreneurs, and investors alike appeared obsessed with the potential of medical tourism, describing it as “Outsourcing your health”,4 calling American medical tourists, “America's New Refugees”,5 and hailing it as, “The brave new world of global healthcare”.6 A cottage industry sprung up, filled with “facilitators” that would assist prospective medical travelers with selecting where to receive treatment, make travel plans, and coordinate contact between the patient and care providers. However, as with any rapid business boom, the field was clearly littered with a mix of both shamans and charlatans; i.e. some who genuinely wanted to help other people, and some who mostly wanted to help themselves. A paper published by the European Hospital and Healthcare Federation (HOPE) wrote:

“Going through many websites of healthcare providers or medical tourism facilitators, a lot of them give the impression of being fly-by-night and phony companies, with websites full of errors, ranging from linguistic to content-related ones and leaving the website visitor with mistrust and suspicion. That can be discouraging for prospective medical travellers and dangerous to patient’s well-being, if one decides to purchase the services of fake and not professional providers.” 7

Feeding this frenzy were self-styled industry experts, some of whom made massively optimistic projections, for example claiming that the annual number of Americans traveling abroad for medical care would explode to 6 million by 2010, and then continue to rise to 10-23 million by 2017.8 Pathetically, though this 6 million base figure was quoted repeatedly by industry figures8, 9 the estimate appears to have originated from nowhere more reputable or reliable than an editorial piece published in indiadaily.com, a now out-of-operation Indian news site.8, 9, 10 In reality, data from the U.S. Department of Commerce indicates that in 2011, 150,000 to 320,000 U.S. travelers listed healthcare as a reason for traveling abroad, comprising about 10% of the worldwide total (and between 2-5% of the projected 6 million).11 Ten years later, it's quite clear that the demand for medical tourism failed to meet the industry's ludicrous expectations, and the boom may be charitably described as a bubble.

Hot Springs
Mumbai, India. Image credit Walkerssk

III. Is Medical Tourism Overrated?

Does that mean the promise of, “first-world treatments at third- world prices” is a lie? Absolutely not. While some medical facilities and facilitators were no doubt disappointed that the industry didn't live up to the hype, this turn of events may show to be advantageous for individual medical travelers. Many cautious observers had already raised objections to the questionable ethics of medical tourism facilitators, who were prone to “false, misleading, and aggressive marketing, as well as to potentially unbalanced contractual relationships,”12 and were not required to disclose to their customers that they were making commissions of between 10 and 20% from the hospitals they referred patients to—sometimes amounting to commissions in thousands of dollars.7, 13, 14, 15 If medical travelers did not even know about these kickbacks, how could they be sure they were being referred to the best treatment for them, and not simply to the place that pays out the highest commission? The potential for conflict of interest, and consequential compromise in care, was as alarming as it was inconspicuous. Taking this into account, the fact that many former facilitators appear to have lost interest in the medical tourism industry is no cause for concern.


Furthermore, although the projected growth of medical tourism was vastly exaggerated, the motivation behind medical travel was always valid. The World Health Organization has found that the cost of medical treatment in developing countries can be between 3 and 10% of the cost in the United States.16 Additionally, The World Bank found that the United States could save $1.4 billion if only 10% of patients who needed one of fifteen “highly tradable, low-risk” commonly performed surgeries traveled to receive treatment abroad.17 As far as quality is concerned, top hospitals in countries like India and Thailand boast mortality (failure) rates of less than 1% for common, complex operations, “making it virtually impossible for U.S. hospitals to claim superior quality of care in that regard”.18 When testifying at a Senate hearing, one US American man and his partner who had traveled to India for his cardiac care remarked that there was a noticeable difference between his care in the United States and India: his experience in India was better. The exact words used to describe his care in India were: “impeccable,” “quick,” and “extraordinary."19 In another report, a Canadian said of his out-of-pocket treatment abroad, “I think it’s the best money I’ve ever spent”20 Clearly, as another writer has observed, “Medical tourism offers many benefits to the patient bold enough to travel to receive medical care,”18


What this does mean is that the claims—not to mention the credentials—of any Medical Tourism “expert” cannot be taken at face value. Critical researchers have observed that, “[t]his new era of globalization in healthcare has arrived without the benefit of international standards, government oversight, or ethical or legal review.”21 Further, the highly industry-critical HOPE paper wrote, “this business characterized by speculation-based insight and significant gaps of evidence-based comparable data collection and industry regulation,”7 There are, without a doubt, multitudes of medical tourists who have come back from their trip happy, healthy, and glowing about the top-notch, bottom-dollar treatment they received. There are also, undoubtedly, patients who flew across the world to receive sub-par care at an unaccredited clinic, only to find that their insurance plan did not cover the ensuing complications, and they had no legal recourse. Put bluntly: “Medical tourism is caveat emptor in the purest sense,”12 In other words: it is up to every medical traveler to look out for their own best interests, and not be misled by unscrupulous profiteers.

Doctors working together

IV. Medical Tourism in the Future

What does all of this mean for medical travelers in 2017 and beyond? Hundreds of years ago, the money from spa tourists enabled Bath to fund paved roads, streetlights, and new hotels and restaurants. Similarly, the income from modern medical travelers has enabled destination countries to develop some legitimately world-class medical staff and facilities. Assistant Professor of Law, Nathan Cortez explains, “[t]his does not mean that all hospitals in developing countries meet our standards; on average, the quality of health care in the United States is still superior. Rather, the relevant comparison is between the average U.S. hospital and the hospitals in developing countries that attract foreign patients. Here, the quality gap seems to evaporate.”12 in other words: if a European or North American were to pick any foreign healthcare facility at random, the odds are not good that it would be better than what they can find locally. However, there definitely are some facilities that are equipped to provide equivalent, if not superior, care, at a fraction of the prices than can be found nearby. The challenge and the reward is for every medical traveler who can find these facilities. Fortunately, the average world citizen is significantly more tech savvy now than a decade ago. Just as online booking sites have rendered the traditional travel agent all but obsolete, medical tourism is ready to be updated for citizens of the digital era—people comfortable with performing their own research and managing bookings on their own. The “political win-win”22 of medical tourism is stronger today than it has ever been.



References:

1. Snodgrass, Elizabeth. Archaeologists Find a Classic Entrance to Hell. National Geographic Web site. April 16, 2013. Available at http://news.nationalgeographic.com/news/2013/04/130414-hell-underworld-archaeology-mount-olympus—greece/. Accessed December 17, 2016.

2. Routh, H.B., Bhowmik, K.R., Parish, L.C. and Witkowski, J.A., 1996. Balneology, mineral water, and spas in historical perspective. Clinics in dermatology,. 14(6), pp.551-554.

3. Li H., Cui W. The historical changes of medical tourism. UWOMJ 83:2, Fall 2014

4. Van Dusen, A., 2007. Outsourcing your health. Forbes Web Site, 22. Available at http://www.forbes.com/2007/05/21/outsourcing-medical-tourism-biz-cx_avd_0522medtourism.html Accessed December 17, 2016.

5. Milstein, A. and Smith, M., 2006. America's new refugees-seeking affordable surgery offshore.. New England Journal of Medicine, 355(16), p.1637.

6. Wild R. Global Healthcare. http://www.financial-planning.com, , 2006-11-0.

7. Ruka E. Medical Tourism. HOPE Publications, September 2015.

8. Deloitte, L., 2008. Medical tourism: Consumers in search of value.

9. Rosensweig, J.A., 2007. Medical tourism–health care in the global economy. The Physician Executive.

10. Baliga H. Medical tourism is the new wave of outsourcing from India. India Daily, Dec. 23, 2006.

11. Chambers A. Trends in the U.S. Health Travel Services Trade. USITC Executive Briefing on Trade, August 2015.

12. Cortez, N., 2008. Patients without borders: the emerging global market for patients and the evolution of modern health care. Indiana Law Journal, 83, pp.00-24.

13. Ehrbeck, T., Guevara, C. and Mango, P.D., 2011. Mapping the market for medical travel. .The McKinsey Quarterly, May 2008.

14. Cohen, I.G., 2014. Patients with passports: medical tourism, law, and ethics. Oxford University Press.

15. Cohen, E.C.E., 2008. Medical tourism in Thailand. AU-GSB e-journal, 1(1).

16. Chanda, R., 2002. Trade in health services. Bulletin of the World Health Organization, 80(2), pp.158-163.

17. Mattoo, A. and Rathindran, R., 2005. Does health insurance impede trade in health care services?. World bank policy research working paper, (3667).

18. Bennie, R., 2014. Medical Tourism: A Look at How Medical Outsourcing Can Reshape Health Care. Tex. Int'l LJ, 49, p.583.

19. Smith, G.H., 2006. The globalization of health care: Can medical tourism reduce health care costs. From a Hearing of the US Senate Special Committee on Aging.

20. Crooks, V.A., Kingsbury, P., Snyder, J. and Johnston, R., 2010. What is known about the patient's experience of medical tourism? A scoping review. BMC Health Services Research, 10(1), p.1.

21. Gray, H.H. and Poland, S.C., 2008. Medical tourism: crossing borders to access health care. Kennedy Institute of Ethics Journal, 18(2), pp.193-201.

22. Burkett, L., 2007. Medical tourism: concerns, benefits, and the American legal perspective. The Journal of legal medicine, 28(2), pp.223-245.

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