Regulating Medical Tourism

Letter to Lancet on need for regulation of medical tourism

Medical Treatment not Approved yet? No Problem! Welcome to Circumvention Tourism

China, Russia and countries in the Caribbean are positioning themselves as destinations for a new kind of medical tourist: the circumvention tourist. Increasingly people are traveling abroad for care that is unapproved by regulators in their home countries. In some cases, these so-called circumvention tourists may be seeking unproven and untested medical interventions.But why would someone want to skirt domestic regulations aimed at protecting patient safety? Our research about medical tourism in the Bahamas offers some insights

Interpreting the Results of a Modified Gravity Model: Examining Access to Primary Health Care Physicians in Five Canadian Provinces and Territories

Primary health care (PHC) encompasses an array of health and social services that focus onpreventative, diagnostic, and basic care measures to maintain wellbeing and address illnesses.In Canada, PHC involves the provision of first-contact health care services by providers suchas family physicians and general practitioners – collectively referred as PHC physicians here.Ensuring access is a key requirement of effective PHC delivery. This is because havingaccess to PHC has been shown to positively impact a number of health outcomes.MethodsWe build on recent innovations in measuring potential spatial access to PHC physicians usinggeographic information systems (GIS) by running and then interpreting the findings of amodified gravity model. Elsewhere we have introduced the protocol for this model. In thisarticle we run it for five selected Canadian provinces and territories. Our objectives are topresent the results of the modified gravity model in order to: (1) understand how potentialspatial access to PHC physicians can be interpreted in these Canadian jurisdictions, and (2)provide guidance regarding how findings of the modified gravity model should be interpretedin other analyses.ResultsRegarding the first objective, two distinct spatial patterns emerge regarding potential spatialaccess to PHC physicians in the five selected Canadian provinces: (1) a clear north–southpattern, where southern areas have greater potential spatial access than northern areas; and (2)while gradients of potential spatial access exist in and around urban areas, access outside ofdensely-to-moderately populated areas is fairly binary. Regarding the second objective, weidentify three principles that others can use to interpret the findings of the modified gravitymodel when used in other research contexts

Guidelines for Reducing the Negative Public Health Impacts of Medical Tourism

Étude de cas / Case studyLes voyages internationaux pour des soins médicaux, ou le tourisme médical, créent des problèmes d’éthique et de sécurité pour les patients. Des lignes directrices pourraient être développées et distribuées pour aider à répondre à ces préoccupations, mais ils peuvent en même temps sembler entériner cette pratique.International travel for medical care, or medical tourism, creates ethical and safety concerns for patients. Guidelines could be developed and distributed to help address these concerns, but they may at the same time appear to endorse this practice

Examining the Practice of Informal Caregiving in Medical Tourism

Medical tourism refers to the process whereby patients purchase health care abroad, outside of their home health care systems, and pay privately for care. Some reasons patients engage in this form of private health care include: real or perceived wait times, desire to obtain experimental procedures not available at home, and mistrust of the domestic health care system. While the literature provides accounts of the experiences of medical tourists and industry facilitators, the friends and family who accompany medical tourists abroad as informal caregivers are under-researched. In this study, funded by the Canadian Institutes of Health Research, we have uncovered these caregivers\u27 experiences through four datasets collected from different stakeholder groups: i) 32 former Canadian medical tourists interviewed between July and November 2010; ii) 7 Canadian medical tourism facilitators surveyed in 2012; iii) 21 international patient coordinators in destination facilities interviewed in 2012; and iv) 20 Canadian caregivers interviewed between September 2013 and February 2014. Data triangulation enabled us to compare, contrast and augment the results from these separate datasets to arrive at the following findings and recommendations

Chronically Ill Canadians\u27 Experiences of Being Unattached To a Family Doctor: A Qualitative Study of Marginalized Patients in British Columbia

Background: Unattached patients do not have a regular primary care provider. Initiatives are being developed toincrease attachment rates across Canada. Most existing attention paid to patient unattachment has focused onquantifying the problem and health system costs. Our purpose is to qualitatively identify the implications ofchronically ill patients’ experiences of unattachment for health policy and planning to provide policy-relevantinsights for Canadian attachment initiatives.Methods: Three focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city inBritish Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledgethat by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada’shealth care system Focus groups were structured as an open conversation organized around a series of probingquestions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed.Results: Twenty-six individuals participated in the focus groups. The most common chronic illnesses reported were activedrug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identifiedlife transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessfulattempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having atrusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency.One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access topreventative care. Participants were also concerned about having a discontinuous medical record due to unattachment.Conclusions: Participants perceived that there are many benefits to be had by having attachment to a regular familydoctor and that experiencing unattachment challenged their health and access to health care. We encourage moreresearch to be done on the lived experience of unattachment in order to provide on-the-ground insights thatpolicy-makers require in order to develop responsive, patient-centred supports and programs

A Qualitative Exploration of how Canadian Informal Caregivers in Medical Tourism use Experiential Resources to Cope with Providing Transnational Care

Canadians travelling abroad for privately arranged surgeries paid for out-of-pocket are engaging in what  has come to be known as medical tourism. They are often accompanied by friends or family members, who we call caregiver-companions. Caregiver-companions provide care in and across a variety of formal and informal settings, such as in hotels, airplanes and at home. This qualitative study examines the experiences  of informal caregivers in medical tourism to learn more about the lived experiences or ‘experiential  resources’ they draw upon to cope with providing care and avoiding caregiver burden. The care-giving literature has demonstrated that such burden can negatively impact caregivers’ well-being. The unique, transnational context of care-giving in medical tourism and recent growth in popularity of this practice means that there are few supports or resources currently in place to assist informal caregivers. In this article, we report on an analysis that sought to detail how caregiver-companions draw upon their previous lived experiences to cope with providing transnational care and to minimise or avoid the onset of caregiver burden. We conducted semi-structured telephone interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery between September 2013 and January 2014. Thematic analysis revealed the ways that participants had developed practical strategies to deal with the challenges they faced in medical tourism. The interviews revealed three important experiential resources drawn upon by participants: (i) previous experiences of international travel; (ii) previous experiences of informal care-giving; and (iii) dimensions of the existing relationship with the care recipient. Differences in access to and use of these experiential resources related to participants’ perspectives on medical tourism and the outcomes of the trip. By identifying the experiential resources drawn upon by informal caregivers in medical tourism, we  can more effectively identify supportive interventions

Policy Implications of Medical Tourism Development in Destination Countries: Revisiting and Revising an Existing Framework by Examining the Case of Jamaica

Background: Medical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in locations where it is not yet established. Numerous governments and private hospitals in the Caribbean have recently identified medical tourism as a priority for economic development. We explore here the projects, activities, and outlooks surrounding medical tourism and their anticipated economic and health sector policy implications in the Caribbean country of Jamaica. Specifically, we apply Pocock and Phua\u27s previously-published conceptual framework of policy implications raised by medical tourism to explore its relevance in this new context and to identify additional considerations raised by the Jamaican context.   Methods: Employing case study methodology, we conducted six weeks of qualitative fieldwork in Jamaica between October 2012 and July 2013. Semi-structured interviews with health, tourism, and trade sector stakeholders, on-site visits to health and tourism infrastructure, and reflexive journaling were all used to collect a comprehensive dataset of how medical tourism in Jamaica is being developed. Our analytic strategy involved organizing our data within Pocock and Phua\u27s framework to identify overlapping and divergent issues.   Results: Many of the issues identified in Pocock and Phua\u27s policy implications framework are echoed in the planning and development of medical tourism in Jamaica. However, a number of additional implications, such as the involvement of international development agencies in facilitating interest in the sector, cyclical mobility of international health human resources, and the significance of health insurance portability in driving the growth of international hospital accreditation, arise from this new context and further enrich the original framework.   Conclusions: The framework developed by Pocock and Phua is a flexible common reference point with which to document issues raised by medical tourism in established and emerging destinations. However, the framework\u27s design does not lend itself to explaining how the underlying health system factors it identifies work to facilitate medical tourism\u27s development or how the specific impacts of the practice are likely to unfold. &nbsp

"I didn\u27t even know what I was looking for": A qualitative study of the decision-making processes of Canadian medical tourists

BACKGROUND:Medical tourism describes the private purchase and arrangement of medical care by patients across international borders. Increasing numbers of medical facilities in countries around the world are marketing their services to a receptive audience of international patients, a phenomenon that has largely been made possible by the growth of the Internet. The growth of the medical tourism industry has raised numerous concerns around patient safety and global health equity. In spite of these concerns, there is a lack of empirical research amongst medical tourism stakeholders. One such gap is a lack of engagement with medical tourists themselves, where there is currently little known about how medical tourists decide to access care abroad. We address this gap through examining aspects of Canadian medical tourists\u27 decision-making processes.METHODS:Semi-structured phone interviews were administered to 32 Canadians who had gone abroad as medical tourists. Interviews touched on motivations, assessment of risks, information seeking processes, and experiences at home and abroad. A thematic analysis of the interview transcripts followed.RESULTS:Three overarching themes emerged from the interviews: (1) information sources consulted; (2) motivations, considerations, and timing; and (3) personal and professional supports drawn upon. Patient testimonials and word of mouth connections amongst former medical tourists were accessed and relied upon more readily than the advice of family physicians. Neutral, third-party information sources were limited, which resulted in participants also relying on medical tourism facilitators and industry websites.CONCLUSIONS:While Canadian medical tourists are often thought to be motivated by wait times for surgery, cost and availability of procedures were common primary and secondary motivations for participants, demonstrating that motivations are layered and dynamic. The findings of this analysis offer a number of important factors that should be considered in the development of informational interventions targeting medical tourists. It is likely that trends observed amongst Canadian medical tourists apply to those from other nations due to the key role the transnational medium of the Internet plays in facilitating patients\u27 private international medical travel

Ethics of Care in Medical Tourism: Informal Caregivers\u27 Narratives of Responsibility, Vulnerability and Mutuality

This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists