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Medical Tourism: The Ethical Challenges of a New Frontier


Medical Tourism: The Ethical Challenges of a New Frontier

Desperate parents fly their terminally child to a clinic in Mexico for dangerous stem cell research. A wealthy business person buys a kidney from a seller in Iran and travels to a private clinic in Iran for transplant surgery. An American who can’t afford to pay $70,000-133,000 for a coronary bypass surgery at home is urged by her health insurance company to travel instead to Taiwan for the procedure. These are all instances of medical tourism, a byproduct of globalization that has become increasingly popular over the course of the last half-century.

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What is medical tourism? Why is this issue so contentious amongst bioethicists? More importantly, what are the ethical impacts of the medical tourism industry on the healthcare sectors in developing and developed countries?

Medical tourism is the practice of travelling to another country for the purpose of receiving medical care. Before we delve deeper into the bioethical issues surrounding this phenomenon, let’s look into the various types of medical tourism. It can be divided into two distinct categories: legal and illegal medical treatment.

 

 

Traveling for legal medical treatment

Traveling for illegal medical treatment

What is it?

Patients receive treatments that they could legally receive in their home countries

Patients travel to bypass rules in their home country that ban certain procedures

Examples of treatments offered

Coronary bypass surgery, dental surgery, hip replacements, endoscopic surgery, laser vision correction, cosmetic surgery, PET/CT/MRI scans

Physician-assisted suicide, abortion, stem-cell therapy, chelation therapy, invasive cosmetic procedures, transplanting a purchased kidney

Reasons for travel

– Low cost of surgery abroad compared to prices at home. There are around 48 million underinsured Americans who see medical tourism an alternative to expensive treatments at home

– Technological advancement in the medical tourism destination (ex. South Korea specializes in cosmetic surgery)

– Staying at a 5-star hotel and getting all procedures done at once may seem appealing

– Shorter wait times for treatment (ex. Canadians travelling south for surgery to have more control over when the procedure is performed)

– Immigrants sometimes return to their country of origin since they are more comfortable with the language and the medical system there.

– Legal courses of treatment have been tried by prove ineffective for the patient (ex. patient who has been on the organ transplant list for years)

– Home country is not accepting of procedures such as abortion and doctor-assisted suicide

– Often, patients are desperate and willing to take risks in less regulated facilities abroad because there is no viable alternative

Q: Are there different models of medical tourism in different parts of the world? If so, how are they different?

Medical tourism is a complex industry since different countries involved in this exchange of medical services have different policies. In the map below, you can see the countries that have the highest rates of medical tourism.

 

 

The nature of medical tourism in a developed country, for instance, is very different from that of a developing country. In order to better understand the various system’s around the world, let’s look at three countries—South Korea, Switzerland, and Mexico—whose different approaches to medical tourism are representative of the problems currently facing this lucrative industry. Click through the four pages of my infographic below.

 

Medical Tourism by Vivian Zhang

 

Q: Is medical tourism a new phenomenon? How has it changed over the past century?

The concept of medical tourism is by no means new. However, in the past, medical tourism often involved families from developing countries travelling to the developed world to receive higher quality treatment. A shift towards residents of developed countries moving into developing countries started in the ’60s, when US veterans travelled to Mexico and Cuba for low-cost procedures. As a result, countries such as Mexico, Thailand, and Taiwan have invested in increasingly sophisticated medical technology. The influx of medical tourists in these countries has also resulted in US and UK-trained physicians seeking employment in developing countries. The developing countries are able to offer high-standard treatments at low costs and short waiting times. Residents in the developed world now frequently seek treatment in private facilities in developing countries.

 

Welcome to the Grand Oasis Medical Centre:

How Medical Tourist Centres Market Themselves

Sign up now with your local medical tourism agency! You can get your plastic surgery at a low cost with a top surgeon. Our most recent deal allows you to get “1st world health care at 3rd world costs.”

Medical tourism destinations frequently market themselves as places where you can get cheap treatment, stay at a 5-star hotel while you recover, and spend the money that you saved by treating the trip as a kind of vacation for your family. Mexican companies, for instance, frequently advertise the Mesoamerican ruins, the beach resorts, and the biodiversity in the country.

 

What are the ethical challenges to this system of marketing/medical tourism in general?

 

 

Take a quiz on fun facts about medical tourism here:

 

What is the next step?

  • Have doctors from around the world create an international platform with a list of legitimate and qualified surgeons and doctors from around the world.
  • Require that private clinics at the tourist destination provide patient with information about the specific risks of medical tourism. These risks, as mentioned before, include the difficulty of having followup appointments or long-term care after the patient leaves the tourist destination. Another problem could be in the communication between a doctor at home and a doctor at the medical tourist destination.
  • As individuals, we should be more careful before making decisions to travel abroad for important medical procedures. We should try to speak to people who have been to the clinics we are travelling to and take a moment to understand the implications of medical tourism.

 

Works Cited

Baer, Drake. “Why South Korea Is the Plastic Surgery Capital of the World.” Business Insider, Business Insider, 22 Sept. 2015, www.businessinsider.com/south-korea-is-the-plastic-surgery-capital-of-the-world-2015-9.

Cohen, I. Glenn. Patients with Passports: Medical Tourism, Law and Ethics. Oxford Univ. Press, 2015.

“Euthanasia & Physician-Assisted Suicide (PAS) around the World – Euthanasia – ProCon.org.” Should Euthanasia or Physician-Assisted Suicide Be Legal?, euthanasia.procon.org/view.resource.php?resourceID=000136.

InternationalLiving.com. “Save Thousands As A Medical Tourist In These 5 Countries.” The Huffington Post, TheHuffingtonPost.com, 7 Dec. 2017, www.huffingtonpost.com/internationallivingcom/medical-tourism_b_11573814.html.

Kastner, Jens. “Taiwan’s Medical Tourism Boom.” Taiwan’s Medical Tourism Boom | YaleGlobal Online, 20 Oct. 2010, yaleglobal.yale.edu/content/taiwans-medical-tourism-boom.

Marx, Patricia. “The World Capital of Plastic Surgery.” The New Yorker, The New Yorker, 19 June 2017, www.newyorker.com/magazine/2015/03/23/about-face.

McArdle, Elaine. “Patients Without Borders.” Harvard Law Today, Harvard Law Bulletin, 2013, today.law.harvard.edu/feature/patients-without-borders-i-glenn-cohen-on-the-rise-of-medical-tourism/.

Neustatter, Angela. “Assisted Dying: How Does It Work in a Dutch End-of-Life Clinic?” The Guardian, Guardian News and Media, 11 Sept. 2015, www.theguardian.com/lifeandstyle/2015/sep/11/assisted-dying-dutch-end-of-life-netherlands-unbearable-suffering.

Park, Ju-min. “Trouble Brewing in South Korea’s Plastic Surgery Paradise.” Reuters, Thomson Reuters, 2 Nov. 2014, www.reuters.com/article/us-southkorea-surgery/trouble-brewing-in-south-koreas-plastic-surgery-paradise-idUSKBN0IM00F20141102.

Wilson, Jacque. “’Suicide Tourism’ to Switzerland Has Doubled.” CNN, Cable News Network, 7 Oct. 2014, www.cnn.com/2014/08/20/health/suicide-tourism-switzerland/index.html.

Woodman, Josef. “7 Reasons to Consider Traveling for Medical Care.” U.S. News & World Report, U.S. News & World Report, 2008, health.usnews.com/health-news/articles/2008/10/01/7-reasons-to-consider-traveling-for-medical-care.

 

 

 

 

 

 

 

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COMMENTS: 18
  1. April 26, 2018 by Emily

    Wow! This is a super interesting lens. With rising healthcare costs in the US it would make sense that individuals would look towards other countries for necessary treatment. Do you think that the actual problem is seeking the treatment abroad? Or is the real problem the healthcare costs in the original countries where people later choose to leave? If US healthcare was more affordable perhaps people would not be motivated in the same way. Furthermore, do you think that this kind of development stands to make a positive impact in the medical communities of developing comunities or will poorer individuals never receive trickle down effect even if overall medical care improves? I’d love to hear a response.

    • April 27, 2018 by Vivian

      Thanks Emily! In response to your question about whether it’s really a problem with healthcare at home, I think that medical tourism definitely involves both push and pull factors. People choose to travel because they know that care abroad could be more relaxing, of higher quality, etc. At the same time, high costs at home also push them to look across the border to countries that provide cheaper but equally high-quality healthcare. In response to your second question, you’re right to point out that there could be a trickle down effect. In other words, when foreigners inject money into the healthcare system at the medical tourist destination, it also means that locals have better access to newer and more expensive technologies (the hospital has money to invest in new X-ray machines, for instance). However, we also need to balance this marginal benefit with the fact that the quantity demanded of health care at the tourist destination will increase. This would make basic treatments less affordable to locals.

  2. April 26, 2018 by Arianna.Carpati

    I never really thought about medical tourism before on an ethical level, so it’s really interesting to see it portrayed in that light here. I hadn’t really thought about implications/consequences of it like lack of communication or follow up appointments, so I think it’s really important that you explained those. I also like that you included lots of helpful images. I’m definitely interested in learning more about medical tourism after reading your project!

    • April 27, 2018 by Vivian

      Thanks for taking the time to read through my webpage, Arianna!

  3. April 28, 2018 by Peter.Wess

    I honestly had no idea this medical tourism was so prevalent. I also certainly didn’t think about the impact on the countries where people get these procedures done. It was interesting to see this idea in this kind of light. When it said ethic concerns I was only thinking about the person getting the procedure, I was like it’s their body and they can do what they want with it. As medical care becomes more expensive, medical tourism will just increase. I am curious about the medical assisted suicide and what countries that is legal in. I feel that that could be a whole other project about the ethics for that. I was wondering what the most common procedure is to get done by Americans abroad?

    • April 28, 2018 by Vivian

      Thanks Peter! Suicide tourism is definitely a super interesting topic! It’s legal in Switzerland, Cambodia, Mexico, the Netherlands, and certain US states. I found it really interesting that in Canada, doctors can only grant medical assisted suicide to people eligible for Canadian health care coverage (permanent residents and citizens). This was actually a law made deliberately to prevent suicide tourism in Canada.

      The question about the most common procedure Americans seek abroad is definitely an interesting one. It’s very difficult to find a breakdown (by a credible source) of where Americans are travelling and what treatments they are receiving. That’s part of the reason why I think that the international community needs to get together to collect more accurate data on medical tourism. However, hip replacements and cosmetic surgery are two common procedures that Americans seek abroad.

  4. April 29, 2018 by Avery.Courts

    Hey! I really enjoyed reading through your page! I think that discussing medical tourism through a bioethical lens is super interesting and needs to be talked about more. I also thought that it was super interesting to look at this concern through an economical standpoint as well.

    • April 29, 2018 by Vivian

      Thanks Avery!

  5. April 29, 2018 by Sofia.Carr

    I really liked your table about legal versus illegal travel for medical treatment. I think this table really showed the dimensionality of the issue instead of just saying one thing was good and one thing was bad. It really made me see somethings in a different light.

    • April 29, 2018 by Vivian

      Thank you so much Sofia!

  6. April 30, 2018 by Rio.Townsend

    Vivian, I love your page and you really opened my eyes to something I had little knowledge about before reading your well crafted and detailed project. I knew that there was a huge trend towards having your stomach stapled in Mexico especially for people traveling from North America but I had no idea that it was such a global phenomenon. After looking through the infographic on Switzerland, Korea, and Mexico, I started to wonder if this was a prevalent issue for Canada as well. Our medical system has left some patients on wait lists as long as two years which was what I was supposed to wait for while trying to get an MRI and knee replacement surgery. That was until I decided to do it privately. I guess what I am asking is, do you believe, as a Canadian yourself, that it is fair for Canadians to feel that the best way of getting procedures done is by searching for medical tourism destinations where the operation could be done quicker? How do you think this need to search for alternative health care services is affecting the Canadian system and also the countries that the Canadians are having them done in?

    • April 30, 2018 by Vivian

      Rio, thank you so much for taking the time to look through my project!! You are totally right to point out that Canadians are often forced to leave the country to escape wait times. We have the luxury of universal healthcare, but this also means that it’s harder to get everyone’s treatments performed quickly. From a bioethical point of view, this prevents us from achieving the “distributive principle of justice” or an equal distribution of healthcare resources. Canadians who have money can pay to either get private healthcare or travel abroad to get faster treatment. According to the Fraser Institute last year, more than 50,000 Canadians travel abroad for medical tourism each year and British Columbians make up a large portion of that. This definitely affects countries that Canadians are travelling to, since the average of $440 million that they’re spending abroad (Vancouver Sun) is boosting the economies of many tourist destinations. In response to your question about how this affects the Canadian system, I think that there are both positive and negative aspects to this. On the plus side, this lessens the wait times for patients who can’t afford to travel abroad and decreases the pressure on the public system in Canada. However, sometimes patients seeking unregulated treatments return with complications (common especially in patients undergoing bariatric/weight-loss surgery abroad) and dealing with complications can actually cost more for the Canadian system.

  7. April 30, 2018 by Emi Amaki

    Thanks Vivian for helping me understand more about his topic. I did not realize that so many people go outside their country to have medical procedures done, especially in developed countries. Why do some countries, like America, charge so much for a surgery that many either have to leave their country or pile up debt?

    • April 30, 2018 by Vivian

      Hi Emi! Thanks for taking the time to read through my project! That’s definitely a good question. Part of the reason why it costs more than certain developing countries is because the cost of living and the cost of other materials is higher in America than Thailand, for instance. Personally, coming from Canada (where we have universal healthcare), I believe that the government should do more to prevent patients from going into debt after having a medical procedure done.

  8. April 30, 2018 by Victoria.Gospodinov

    Hi Vivian! I loved your page because it focused on a topic that I definitely didn’t know much about. I loved all your interactive features and pictures and you made it really easy to follow along! I might have missed this in your page but what about follow-up appointments and check-ups? Would these treatments still be done abroad? Anyway, it was super interesting and I loved reading through it!

    • May 01, 2018 by Vivian

      Thank you so much Victoria! Good question about follow-up appointments! Ideally, follow-up appointments happen at the medical tourism destination since it is helpful for the patient (both from a psychological and medical standpoint) to have the same doctor doing check-ups and procedures. Some patients choose to return to the medical tourism destination to have follow-ups. However, for many patients, travelling repeatedly abroad is not financially viable. This is why many return home to have follow-up. The problem with this right now is the lack of communication sometimes between the physician to performed the initial procedure and the one responsible for follow-up. That’s why it would be helpful to have better communication between the physicians in the different countries.

  9. May 01, 2018 by Hannah Siegel

    This project was really fascinating! I knew nothing about this topic beforehand and found your project easy to navigate and very educational. I liked that you analyzed the four pillars of bioethics before applying them to medical tourism. I also loved the variety of media that you presented. Overall, it was well-organized and very informative. I do have one follow-up question: do you know if the majority of medical tourists to Mexico (from the U.S.) are immigrant returnees? I would think that one of the risks of the trip, if these patients are undocumented, would also be potential deportation. Thanks!

    • May 01, 2018 by Vivian

      Thank you Hannah! That’s a good question! A lot of people choose to return to their countries if origin to get medical treatment because they are more comfortable with the language and more familiar with the medical system. Mexican-Americans do make up a significant portion of those travelling as medical tourists to Mexico, although Mexico is a popular destination for Americans who aren’t of Mexican origin as well. Medical treatment for undocumented immigrants is a big problem in general — it would likely be difficult for them to access treatment in the US out of fear of revealing identity.

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