Medical tourism refers to traveling, usually outside one’s home country, in order to obtain medical treatments or care. Although people have traveled in search of medical care for hundreds, if not thousands, of years, for instance to towns where springs were reputed to have healing powers, the term medical tourism usually refers to travel in order to undergo medical or dental procedures that may be unavailable or very expensive in the traveler’s home country, or which may only be available after a long wait.
Although no official statistics are kept on how many individuals seek healthcare abroad every year, for the United States in 2006 estimates range from 150,000 to 400,000. These numbers are expected to increase as more of the public becomes familiar with the concept, and as more companies specializing in medical tourism enter the market. Such companies serve as a combination travel agent and medical services coordinator, arranging everything from airplane flights and accommodations to medical and surgical procedures and posttreatment care.
In addition, the Joint Commission International, the international arm of the accrediting organization for U.S. hospitals (JCAHO, the Joint Commission on Accreditation of Healthcare Organization) has begun granting accreditation to overseas hospitals, which will aid medical tourists in selecting hospitals that meet the standards of care available in their home countries.
Economic factors are the main driving force behind medical tourism. Most medical tourists come from industrialized countries such as the United States, Canada, Japan, Israel, and from the countries of Europe and the Middle East. The medical services are usually offered in countries such as Costa Rica, India, and Thailand, which have a cadre of well-trained doctors and nurses and modern medical facilities, but where the costs of medical care are much lower than in the traveler’s home country.
Reasons for seeking medical care abroad vary. One reason is that often the desired procedure is not covered by insurance (for instance, plastic surgery, LASIK eye surgery, or dental implants) and the need to pay out-of-pocket motivates the search for the lowest price for care of reasonable quality. Some countries have become centers for particular types of surgery not usually covered by health insurance plans; for instance, Thailand is a leading center for sex reassignment surgery.
Another motivating force is the need to pay out-of-pocket for medical care because of a lack of health insurance. This reason applies in particular to the United States, where about 45 million people were uninsured in 2005. As with procedures not covered with medical insurance, having to pay out-of-pocket for medical procedures encourages the patient to seek out the best price.
A third motivating factor is the long waiting period for elective surgical procedures in some countries; for instance, citizens of Great Britain and Canada may have to wait a year or longer for hip replacement surgery. Organ transplants are another type of surgery that often motivates medical tourism, since in most industrialized countries there is a long waiting list for available organs. The supply may be greater in poor countries, in particular for organs such as kidneys that can be transplanted from a live donor, although it raises issues of medical imperialism as well as the complications that may ensue from a complex medical procedure undertaken away from the patient’s home country.
Finally, some procedures may not be available in the patient’s home country. Procedures based on stem cells are a good example of this. Because of restrictive laws and lack of funding in the United States, other countries have taken the lead in stem cell research, and some therapies based on stem cells not available in the United States are offered in Singapore and Thailand. For instance, as of August 2007, five hospitals in Thailand and Singapore offered stem cell therapy for end-stage heart disease. The treatment procedure involves harvesting blood from the patient, isolating and expanding angiogenic precursor cells (a procedure that is performed in Israel), then injecting the cells into the heart muscle or reinfusing them via an angiographically directed catheter. Stem cells are a relatively new area of medical research, and it is likely that more such procedures will be developed in the future, and if they remain unavailable in the United States, more Americans will become medical tourists in order to seek them out.
The lower costs of surgery abroad have motivated some U.S. insurance companies to pay for overseas surgery that previously would have been conducted in an American hospital. The commercial Web site medicaltourism.com estimates that a heart bypass conducted in the United States costs about $130,000, versus $11,000 in Thailand or $10,000 in India. The same Web site estimates the cost of hip replacement at $43,000 in the United States versus $12,000 in Thailand or Singapore, and costs for a hysterectomy to be $20,000 in the United States versus $3,000 in India. Among the insurance companies that now offer reimbursement for medical care abroad are Health Net of California, which will pay for healthcare services delivered in Mexico, and Blue Cross/Blue Shield and BlueChoice HealthPlan, both of South Carolina, which include Thailand’s Bumrungrad International Hospital among the hospitals for which they will reimburse care.
While some medical tourism is clearly professional there is also a dark side. People with terminal diseases will seek treatments within clinics offering “stem cell treatment”—often costing $40,000 or more. Great caution should be applied until these treatments are validated in well controlled studies.
