Medical tourism

Advocates of medical tourism

Supporters of international health-related travel argue that medical tourism promotes patient choice, gives consumers access to treatment alternatives not found in their local communities, permits expedited access to care, fosters global competition, and puts pressure on more expensive health care facilities to lower their prices. As well, say advocates, the practice promotes economic and social development by building health care economies in developing societies.

Within the United States, advocates of medical tourism characterize travel to such places as India and Thailand as a safety net for uninsured and underinsured Americans who cannot afford to purchase expensive medical procedures at local hospitals.8 Many American companies have out-of-country travel options in their health insurance plans.9 West Virginia is considering legislation that will provide financial incentives to state employees willing to travel outside the United States for health care.10,11 In Canada, supporters of medical tourism argue that the practice promotes improved access to care for patients able to pay for treatment and helps citizens who cannot afford to travel abroad by shortening waiting lists at home.

Proponents of medical tourism note that internationally accredited health care facilities are located around the world. Supporters emphasize the high quality of care at private hospitals and clinics in Asia, the Caribbean, Eastern Europe, and South America.

Critical perspectives

Critics of medical tourism have several powerful arguments on their side. Medical tourism raises concerns about health equity. Wealthy citizens can afford to buy immediate access to care, while poorer citizens wait in queues.

Quality of care is a serious concern. Though medical tourism companies typically broker arrangements through internationally accredited hospitals, quality of health care around the world is variable. Some Canadian patients who travel abroad for care will likely receive excellent treatment. Other patients will be at increased risk of receiving substandard care. The modest body of scholarship on patients traveling to China, India, and Pakistan for organ transplants suggests that commercial out-of-country transplantation substantially increases morbidity and mortality rates.12–14 Quality of care and patient safety could be serious concerns with other medical procedures.

Continuity of care is another problem associated with medical tourism. Within Canada, family physicians ideally interact with specialists and remain involved in patient care throughout the course of treatment. Continuity of care is likely to be disrupted when patients travel to other countries for treatment. Some medical tourism companies link family physicians to specialists in the countries where care is to be provided. In other cases, patients travel for hip and knee replacements, kidney transplants, cataract surgery, and other procedures, and return to their family physicians with no documentation concerning the care they received outside Canada. The task of the family physician is made far more difficult when continuity of care is disrupted and patients offer little information about the treatments they received outside Canada.

Legislation, professional codes, and institutional policies place strict legal and ethical duties upon Canadian physicians to disclose risks, benefits, treatment alternatives, and the consequences of not receiving medical care. Physicians in other countries are, of course, not bound by Canadian law. It is possible that Canadian patients will not be fully informed of risks and benefits when they arrange medical care outside Canada. Family physicians might sometimes find themselves providing postoperative care to patients who overestimated benefits and underestimated risks associated with treatment outside Canada.

Finally, Canadian physicians are governed by laws containing standards for determination of negligence and medical malpractice. Canadian courts provide a forum where patients can seek legal redress if they are harmed while receiving care. Patients who leave Canada and receive negligent medical care might find they cannot obtain legal remedies in the countries where they obtained treatment. Furthermore, the medical tourism companies that arrange out-of-country care insist that patients sign waivers of liability. These documents state that medical tourism agencies have no legal obligations if patients are harmed while receiving care at destination sites. Companies will presumably try to use these documents to shield themselves from litigation if their clients are harmed while receiving care outside Canada.