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Do we actually know anything about medical tourism?

Research into medical tourism

Ian Youngman from IMTJ comments on a recent academic review of medical tourism, and asks whether we actually know anything about the real numbers involved in medical tourism.

Asking if we know anything about medical tourism may seem a strange question for a journal and a writer that has been publishing information on medical tourism for the last four years. But as we have reported in IMTJ News over the last few months, several serious academic studies have been set up to explore the subject.

Those who have read my MedicalTourism Facts and Figures 2010 will know that although I have collected much information on the subject, there are serious problems. I have recorded all the known numbers on medical travellers into and out of individual countries, country targets and where travellers come from. I have added comments where I do not believe the “official” figures. The main problem is that most of the information we have, even on numbers, consists of local estimates. These are often inflated for political or marketing purposes. Some medical tourism numbers that I once considered to be reasonably accurate, are starting to fall apart. These numbers of medical travellers are found to include:

  • People travelling with those going for treatment
  • Non-nationals being treated at hospitals e.g. expatriates, overseas military personnel, business travellers, diplomats, and holidaymakers
  • Those getting drugs or outpatient treatment
  • Visitors to spas and wellness centres

And we also have the problem that in many countries, governments and tourism authorities have no interest in counting medical tourists, so large parts of the industry are ignored.

A new academic scoping review asks, “What is known about the effects of medical tourism in destination and departure countries?“ The Canadian authors are Rory Johnston, Valorie Crooks, Jeremy Snyder and Paul Kingsbury. It is published in the International Journal for Equity in Health, November 2010.

Academic studies can take years over one paper, while scoping studies are a quick overview of research undertaken on a topic in a few weeks. A scoping review can be used to determine the range of studies that are available on a specific topic.

This new scoping review makes the following points:

  • Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad
  • Growth in the popularity of this practice has resulted in a significant amount of attention being given to it from researchers, policy-makers, and the media
  • There has been little effort to systematically synthesize what is known about the effects of this phenomenon
  • The scoping review examines what is known about the effects of medical tourism in destination and departure countries

The review draws on academic articles, grey literature, and media sources extracted from 18 databases to synthesize what is known about the effects of medical tourism in destination and departure countries.

The review design has three main stages:

  1. Identifying the question and relevant literature;
  2. Selecting the literature;
  3. Charting, collating, and summarizing the data.

Review findings

The large majority of the 203 sources accepted into the review offer a perspective of medical tourism from the “Global North”, focusing on the flow of patients from high-income nations to lower and middle-income countries. This greatly shapes any discussion of the effects of medical tourism on destination and departure countries.

Five interrelated themes that characterize existing discussion of the effects of this practice were extracted from the reviewed sources.

These themes frame medical tourism as a:

  1. User of public resources;
  2. Solution to health system problems;
  3. Revenue generating industry;
  4. Standard of care;
  5. Source of inequity.


It is observed that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation.

Review conclusions

Given its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a highly significant and contested phenomenon. This is especially true given its potential to serve as a powerful force for the inequitable delivery of health care services globally.

It is recommended that empirical evidence and other data associated with medical tourism be subjected to clear and coherent definitions, including reports focused on the flows of medical tourists and surgery success rates. Additional primary research on the effects of medical tourism is needed if the industry is to develop in a manner that is beneficial to citizens of both departure and destination countries.

My view

They are correct that we do not know a lot about the numbers either globally or by country. Where their analysis falls down is that they have only used free articles and sources, many of which are generated by journalists and travel writers who may have a less than scientific approach to their analysis and commentary. The scores of professionally researched, published and charged for medical tourism reports, often giving detailed numbers for a specific country don’t get a mention. This is akin to a surgeon being trained by self–help books and online advice rather than going to a teaching hospital.

The problem of people who have no previous experience or knowledge of medical tourism is that they do not understand the difference between real information, and the huge amounts of spin and ”advertising puffery” produced by people seeking to make a living from the medical tourism industry rather than from medical tourists. They also seem to have misunderstood that the provision of and payment for medical tourism is in many cases from private funding; very little is paid for by the government or uses state hospital resources. I fully accept that some state run and owned hospitals are in medical tourism, but it is rare that they use resources that would otherwise have been used for state care. The main example they use to justify their logic is Cuba, a minor destination totally untypical of anywhere else. Criticising a hospital for using spare resources or generating income from medical tourism is like arguing for all hospital shops and restaurants to be closed as they use space that could be used for patients. There are complex economic arguments on cost and opportunity-cost, but the simplistic version is that these hospitals are using resources that otherwise would not be used to gain income that otherwise they would not get.

Academics are mostly academics because they live in the academic world, not in the real world of business. Yes we need much better information, and yes I distrust many of the so-called sources of “facts”. But as the UK NHS has found to its cost, there comes a point where the time and effort used to collect and analyse information become self-defeating….you collect statistics by the lorryload rather than the few crucial items of information. If a fact cannot be used to help make a decision, it is worthless.

So we as an industry have to be very careful about national or global initiatives to collect comparative statistics, unless they truly measure quality in a way that customers can use.

I know the Hilton offers better accommodation than a tent, but comparing the two is pointless, as I cannot afford Hilton prices for a family holiday!


Profile of the author

Ian Youngman

Ian Youngman is a writer and researcher specialising in insurance and health. He writes regularly for a variety of magazines, newsletters, and on-line services. He also publishes a range of insurance reports and undertakes research for companies. An ACII, with an honours degree in Economics from the University of Liverpool, Ian was a co-founder of The General Insurance Market Research Association. He also has widespread experience within the insurance industry at management level, working for brokers, a bank and an insurance company.  

Add your comments below

Comments provided below do not represent the views of IMTJ. Comments will be published "as is" and will not be edited by IMTJ staff. IMTJ is hosting these comments, and is not  undertaking an editorial role in the content of these comments. However, it is editorial policy not to publish comments which have been submitted anonymously.

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How can we count it when so many disagree on an exact definition for medical tourism / medical travel / cross-border healthcare / treatment abroad / health travel etc...?

Rob Dickman (11/11/2010 17:03:00)

Ian has done a very good job of telling us what we know we do not know.
Hence the recently launced concerted action initiative "Health Tourism Satellite Account" - a standard system of collecting, processing and reporting Health Tourism Activity - which includes Medical Tourism (and the other 7 Health Tourism Segments).
The way forward will be discussed and decided upon at the various Health Tourism-related events (e.g., the Event in Turkey in December 2000 and the several events during 2011).

And of course, Ian and other interested partries are very welcome to join the other Consortium members, to participate and contribute to the effort.

See: www.healthtourismsatelliteaccount.com

Constantine Constantinides (11/11/2010 15:44:42)

As a former operator of a medical tourism hospital in Mexico, it is refreshing to see an analytical approach to determining the true number of medical tourists. I believe it will be difficult to consult governmental sources for determining the number of medical tourists, the data will need to be collected from the medical tourist destinations providing the service. Specifically, defining a medical tourist and then poling the providers to determine actual patient seen. I can state from our own experience and understanding the volume of our competitors in Mexico, the numbers reported by the MTA, McKinsey and Deloitte appear grossly inflated. My comments are not negative towards medical tourism as I am a starch proponent of the concept and completely believe that it is a valuable alternative for patients seeking elective care.

Jerome Mee (11/11/2010 15:17:59)