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
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
Identifying the question and relevant literature;
Selecting the literature;
Charting, collating, and summarizing the data.
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
These themes frame medical tourism as a:
User of public resources;
Solution to health system problems;
Revenue generating industry;
Standard of care;
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.
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.
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!
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.
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