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Brief analytical summaries or syntheses #28

Medical Tourism: Treatments, Markets and Health System Implications:
A scoping review

Summary

This broad OECD review examines 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. It highlights the different organisations and groups involved in the industry. It highlights treatment processes (quality, safety and risks) and system-level implications for countries of origin and destination (financial issues, equity and the impact on providers and professionals of medical tourism).

Background

The global growth in the flow of patients and health professionals as well as medical technology, capital funding and regulatory regimes across national borders has given rise to new patterns of consumption and production of healthcare services over recent decades. A significant new element of a growing trade in healthcare has involved the movement of patients across borders in the pursuit of medical treatment and health; a phenomenon commonly termed “medical tourism.” Medical tourism occurs when consumers elect to travel across international borders with the intention of receiving some form of medical treatment. This treatment may span the full range of medical services, but most commonly includes dental care, cosmetic surgery, elective surgery, and fertility treatment. There has been a shift towards patients from richer, more developed nations travelling to less developed countries to access health services, largely driven by the low-cost treatments available in the latter and helped by cheap flights and internet sources of information.

Analysis and results

Despite high-profile media interest and coverage, there is a lack of hard research evidence on the role and impact of medical tourism for OECD countries. Whilst there is an increasing amount written on the subject of medical tourism, such material is hardly ever evidence-based. Medical tourism introduces a range of attendant risks and opportunities for patients. This review identifies the key emerging policy issues relating to the rise of “medical tourism‘.

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. It highlights the different organisations and groups involved in the industry, including the range of intermediaries and ancillary services that have grown up to service the industry. Treatment processes (including consideration of quality, safety and risk) and system-level implications for countries of origin and destination (financial issues; equity; and the impact on providers and professionals of medical tourism) are highlighted. The review examines harm, liability and redress in medical tourism services with a particular focus on the legal, ethical and quality-of-care considerations.

Conclusion

This broad review outlines key health policy considerations, and draws attention to significant gaps in the research evidence. The central conclusion from this review is that there is a lack of systematic data concerning health services trade, both overall and at a disaggregated level in terms of individual modes of delivery, and of specific countries. This is both in terms of the trade itself, as well as its implications. Mechanisms are needed that help us track the balance of trade around medical tourism on a regular basis. The evidence base is scant to enable us to assess who benefits and who loses out at the level of system, programme, organisation and treatment. Research and evaluation has not kept pace with the development of medical tourism and there is a need for national governments and potentially international bodies (e.g. EU, OECD, WHO) to invest in research this area.

Implications and recommendations

Medical tourism raises challenges for health systems in terms of financing and regulation. At present, medical tourism is driven by commercial interests that are outside the reach of organised and state-run health policymaking and delivery. Are there possibilities to bring it more within the remit of domestic policy competency, involving for example third-party payers sending patients overseas? Given the heavily politicized nature of health care in all countries, there will also be concerns about the threats this poses, including brain drain, quality of care and equity.

It is important, therefore, to explore bilateral trade in more detail, and to assess how it compares to multi-lateral trade. Such a focus would move discussion from the level of global medical tourism to more specific bilateral exchanges – for particular treatments, under specific quality-assured conditions.

There is currently a lack of agreed international standards for assessing and ensuring quality and safety of medical tourism providers and health professionals, and no obligation for them to ensure quality and safety other than an ethical one.

Research is needed on the economic impact for source and destination countries, particularly those low- and middle-income countries where there is speculation but little evidence about the impact of medical tourism treatments on local citizens, either in a health sense or indeed an economic sense.

In terms of management of services and treatments, there are continuing questions about the range of information and its quality.

The roles and responsibilities of clinicians and healthcare providers within both provider countries and countries of origin, and organisations responsible for credentialing and continuing professional development of clinicians in provider countries, require clarification regarding their duties in relation to patients who seek help and advice in advance of engaging in medical tourism.

Source

Medical Tourism: Treatments, Markets and Health System Implications: A scoping review