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Web-based medical facilitators in medical tourism: the third party in decision-making
Abstract
The emergence of web-based medical tourism facilitators (MTFs) has added a new dimension to the phenomenon of cross-border travel. These facilitators are crucial connectors between foreign patients and host countries. They help patients navigate countries, doctors and specialties. However, little attention has been paid to the authenticity of information displayed on the facilitators' web portals, and whether they follow ethical guidelines and standards. This paper analyses the available information on MTF portals from an ethics perspective. It compares 208 facilitators across 47 countries for the services offered. Data were collected from the databases of the Medical Tourism Association and World Medical Resources. India was the most common destination country linked to 81 facilitators. The five countries with the maximum number of facilitators were the USA, the UK, India, Canada and Poland. This paper identifies concerns regarding the information displayed about patients' safety, and the maintenance of confidentiality. There is a need to develop ethical standards for this field.
... Medical tourism websites provide a variety of medical, travel, financial, and legal information (8). Patients' access to accurate and complete information helps them with making informed choices about their health which in turn may lead to increased satisfaction (14,17,18). The information content of these websites is an element of the quality of their service (19). ...
... However, rarely if ever, the content of such websites are evaluated. Accordingly, these websites do not meet health seekers' needs due to their susceptibility to inaccurate or poor information (18,20). Given the importance of the information offered on medical tourism websites and the evergrowing number of their users, managers and stakeholders in this sector must take the information content of such websites more seriously (21) and implement strategies to provide the clients with clear and relevant information (18). ...
... Accordingly, these websites do not meet health seekers' needs due to their susceptibility to inaccurate or poor information (18,20). Given the importance of the information offered on medical tourism websites and the evergrowing number of their users, managers and stakeholders in this sector must take the information content of such websites more seriously (21) and implement strategies to provide the clients with clear and relevant information (18). ...
Background: The information content of medical tourism websites could influence the decisions patients and their families make regarding medical centers. This study aimed to investigate the information content of medical tourism websites.
Methods: This systematic review was carried out in 2017. Key terms used for searching consisted of, but not restricted to, medical tourism, information content, information needs, and medical tourism website. The terms were searched on PubMed, Science Direct, Web of Science, Embase, ProQuest and Cochrane. One hundred and ninety-two articles out of 1185 retrieved were duplicated and removed from the study. Titles and abstracts of the remaining identified studies were scanned considering the aim of the study. Finally, 31 relevant studies were included in the study.
Results: The information content of medical tourism websites can be grouped into three main categories including general information (with six subgroups), medical information (with eight subgroups) and tourism information (with one subgroup). The subgroups include information about medical centers, target country, costs and insurance, contact details, website information, photo galleries, the quality of services, trustworthiness, the quality of supportive services, risks, patient rights, physicians and their specialties, and patient instructions for receiving medical and tourism services.
Conclusion: The medical tourism websites should provide a wide range of information. Considering the important role of medical tourism websites in meeting patients’ information needs, the relevant bodies should improve the information content of medical tourism websites to help patients to make their decisions reliably.
... Medical tourism websites provide a variety of medical, travel, financial, and legal information (8). Patients' access to accurate and complete information helps them with making informed choices about their health which in turn may lead to increased satisfaction (14,17,18). The information content of these websites is an element of the quality of their service (19). ...
... However, rarely if ever, the content of such websites are evaluated. Accordingly, these websites do not meet health seekers' needs due to their susceptibility to inaccurate or poor information (18,20). Given the importance of the information offered on medical tourism websites and the evergrowing number of their users, managers and stakeholders in this sector must take the information content of such websites more seriously (21) and implement strategies to provide the clients with clear and relevant information (18). ...
... Accordingly, these websites do not meet health seekers' needs due to their susceptibility to inaccurate or poor information (18,20). Given the importance of the information offered on medical tourism websites and the evergrowing number of their users, managers and stakeholders in this sector must take the information content of such websites more seriously (21) and implement strategies to provide the clients with clear and relevant information (18). ...
This review article addresses this key point that information content of medical tourism websites could help patients and their next of kin in finding relevant information when making their choice of provider. There are a variety of the websites out there, but to what extent information content of these websites is helpful for patients and their relatives remains under question.
... The emergence of commercial facilitation services has been a notable feature of healthcare in recent decades, as individuals and companies offer to organise and mediate access to healthcare in return for payments. Often the focus of these activities has been to cater to the growing number of people who cross borders to search of care: one study identified 208 web-based facilitation companies globally [8], and many more operate on an informal basis in countries such as Mexico [9], Malaysia [10] and India [11]; while some focus on global markets for specific services such as assisted reproduction [12][13][14] or cosmetic surgery [15]. There are also small but growing markets for facilitation services in a domestic context, for example the high-end 'concierge' services being offered in some countries [16]. ...
... In spite of some examples of collaboration, this environment appears to incentivise exploitation and a commodification of users whose associated commissions are highly prized and who become targets for "snatching". There are reported instances of exploitative practices being performed by facilitation companies in a range of settings: Holliday et al. [15] open their article with a powerful account of unethical practice as a healthcare user in Tunisia is left with unexpectedly limited support after the surgeon left with a suitcase of money and the facilitator followed soon after; Kaspar and Reddy [19] describe interpreters requesting inflated bills in order to receive higher commission, and taking healthcare users elsewhere if a provider refuses to oblige them; while several commentators have voiced concerns with the selective representation of information on facilitator websites [8,[48][49][50]. ...
Background:
The formation of domestic and global marketplaces during the past 50 years has opened up new commercial opportunities for third-party activity in healthcare systems. Commercial mediation of access to healthcare is one recent area of activity that sees companies and individuals offering to organise healthcare and travel in return for payment. With varying degrees of control over the location, type, cost and experiences of healthcare provisioning, these intermediaries occupy potentially influential positions in healthcare systems and yet much of their work is poorly understood.
Methods:
Drawing on social science theories of brokerage, this article presents a novel analysis of commercial healthcare facilitation. It focuses on facilitation companies and their workers as central, intermediating actors for people to access healthcare in markets characterised by complexity. Semi-structured interviews were conducted with people working in domestic and international healthcare facilitation in London and Delhi, and data were analysed using a framework approach that emphasises the structural features and personal agencies for this area of work.
Results:
Findings point to an institutional environment for commercial healthcare facilitation marked by competition and the threat of obsolescence. The activities of rivals, and the risk that users and providers will bypass intermediaries, compels facilitation companies to respond strategically and to continuously pursue new populations and activities to mediate - to go for broke. These pressures percolate into the lives of people who perform facilitation work and who describe a physical and mental burden of labour incurred by onerous processes for generating and completing facilitation work. The need for language interpretation services introduces an additional set of relations and has created further points of tension. It is an environment that engenders mistrust and anxiety, and which incentivises exploitation and a commodification of users whose associated commissions are highly prized.
Conclusion:
Brokerage analysis provides valuable insights into the strategies and strains for commercial mediation of access to healthcare, and the findings indicate opportunities for further research on the contributions of interpreters, diplomatic and business networks, and new technologies, and on the growth of new forms of mediation in domestic and overseas settings.
... Such mobilising work is of great importance in several respects: first, it encourages patients who would not feel confident in seeking medical care abroad on their own to explore this option; second, acquiring new clients is essential for medical travel facilitators to sustain the business; third, healthcare providers benefit from the facilitators' efforts of reaching out to patients abroad and referring them to their hospital. Several studies have analysed the websites of medical travel companies as an important medium for patient acquisition, though mostly focusing on companies and patients based in the Global North (Lee et al. 2014;Wagle 2013;Snyder et al. 2012;Cormany and Baloglu 2011;Gan and Frederick 2011;Sobo, Herlihy, and Bicker 2011). However, setting-up a website and engaging in online marketing as a way of mobilising patients is complicated by the major difficulty in building trust over distance. ...
... The Internet acts as a medium for communication in two directions. On the one hand, it provides a platform that allows medical travel facilitators to communicate with a broader audience, to give information and promote their services (Wagle 2013;Crooks et al. 2011). On the other hand, potential clients are invited to contact facilitators directly through their websites. ...
Medical travel facilitators play an important role in mobilising patients towards transnational healthcare markets. However, little is known about the actual mobilising work of medical travel facilitators located at destination sites, such as Delhi, India. The following ethnographic study suggests conceptualising medical travel facilitators as brokers who are productive of a mobility infrastructure. This allows categorising three mobilisation strategies: direct patient mobilisation, channel partner mobilisation and patient testimonial mobilisation. These strategies draw attention to practices that build trust over distance, the power of word-of-mouth and the importance of nurturing personal relationships that translate into transnational channels that direct people to particular destinations.
... Trends such as third-party mediators and consultation services have aided in Bremoving the physicianf rom the medical process. One division of these internetbased services are those of stem cell clinic liaisons, who help to connect prospective patients with the clinic and mediate treatment plans [69]. As with the industry at large, these liaisons are not regulated, are not required to have any standardized training, and are not likely to present impartial adviceall of which puts the patient's safety in jeopardy [69]. ...
... One division of these internetbased services are those of stem cell clinic liaisons, who help to connect prospective patients with the clinic and mediate treatment plans [69]. As with the industry at large, these liaisons are not regulated, are not required to have any standardized training, and are not likely to present impartial adviceall of which puts the patient's safety in jeopardy [69]. ...
... While these technologies have significantly facilitated the recall of information on medical procedures and details, they have also opened up a new arena for privacy intrusions. Wagle [44] provided evidence that websites regularly display patient information in the form of testimonials and photographs, along with the type of treatment administered. Even though this information serves as a marketing tool for foreign healthcare service providers, there is a strong likelihood that their use is without the tourist patients' knowledge and consent [45]. ...
Medical tourism has witnessed significant growth over the last decade. This nascent sector creates a new tourist class with access to affordable healthcare services by combining healthcare services with tourism and hospitality. Information technology is an essential factor, which can enable the growth of medical tourism. Technology enables the search process for information about the available services, costs, hospitality, tourism and post-treatment options. However, these technologies are primarily legacy systems and lack interoperability. Several questions arise, including the potential patient-tourist ability to verify crucial factors such as the quality of care and the credentials of the medical professionals and medical facilities. Moreover, questions arise regarding patient-doctor trust, procedure and risk transparency‚ medical record privacy and other health-related hazards in specific procedures. In this conceptual paper, we investigate the potential benefits of Blockchain technology to address some of the open questions in medical tourism. We conclude that Blockchain technology can benefit medical tourism, and we lay the foundation for future research.
... While these technologies have significantly facilitated the recall of information on medical procedures and details, they have also opened up a new arena for privacy intrusions. Wagle (2013) provided evidence that websites regularly display patient information in the form of testimonials and photographs, along with the type of treatment administered. Even though this information serves as a marketing tool for foreign healthcare service providers, there is a strong likelihood that their use is without the tourist patients' knowledge and consent (Culnan & Armstrong, 1999). ...
Medical tourism has witnessed significant growth over the last decade. By combining healthcare services with tourism and hospitality, this nascent sector creates a new tourist class with access to affordable healthcare services. Information technology is an essential factor, which can enable the growth of medical tourism. Technology enables the search process for information about the available services, costs, hospitality, tourism and post-treatment options. However, these technologies are primarily legacy systems and lack interoperability. Several questions arise, including the ability of the potential patient-tourist to verify crucial factors such as the quality of care and the credentials of the medical professionals and medical facilities. Moreover, questions arise regarding patient-doctor trust, procedure and risk transparency‚ medical record privacy and other health-related hazards in specific procedures. In this conceptual paper, we investigate the potential benefits of Blockchain technology to address some of the open questions in medical tourism. We conclude that Blockchain technology can benefit medical tourism, and we lay the foundation for future research.
... While these technologies have significantly facilitated the recall of information on medical procedures and details, they have also opened up a new arena for privacy intrusions. Wagle (2013) provided evidence that websites regularly display patient information in the form of testimonials and photographs, along with the type of treatment administered. Even though this information serves as a marketing tool for foreign healthcare service providers, there is a strong likelihood that their use is without the tourist patients' knowledge and consent (Culnan & Armstrong, 1999). ...
Medical tourism has witnessed significant growth over the last decade. By combining healthcare services with tourism and hospitality, this nascent sector creates a new tourist class with access to affordable healthcare services. Information technology is an essential factor, which can enable the growth of medical tourism. Technology enables the search process for information about the available services, costs, hospitality, tourism and post-treatment options. However, these technologies are primarily legacy systems and lack interoperability. Several questions arise, including the ability of the potential patient-tourist to verify crucial factors such as the quality of care and the credentials of the medical professionals and medical facilities. Moreover, questions arise regarding patient-doctor trust, procedure and risk transparency‚ medical record privacy and other health-related hazards in specific procedures. In this conceptual paper, we investigate the potential benefits of Blockchain technology to address some of the open questions in medical tourism. We conclude that Blockchain technology can benefit medical tourism, and we lay the foundation for future research.
... Another study, relatively similar to the present research, was Wagle's research in 2013, which was a study on web-based facilitators in the field of medical tourism; he suggested that low costs of medical travel in destination country were considered as a major attraction on medical tourism websites. [21] This component was also presented in the present study as one of the most significant components of information. ...
Background:
Given the substantial role of information systems in planning and simplifying the decision-making process for the government, organizations, health centers, and facilitators, in order to attract medical tourists from less developed and neighboring countries, the comprehensive Iranian Medical Tourism Information System can be used. The objective of this study was to designing a conceptual model for Iranian medical tourism information system.
Methodology:
This study was carried out in a three-step applied and combined method. In the first step, a systematic review was done on the studies and then the reliability of the results was checked during a semi-structured in-depth interview with 11 experts in medical tourism through open questions. In the third step, the Delphi method was conducted quantitatively to get the ideas of 26 experts. SPSS software version 22 was used for factor analysis.
Results:
The proposed conceptual model for Iranian Medical Tourism Information System includes a variety of services from the first moment of decision to travel until the moment of returning from a medical journey, following up the treatment, and sharing the patients' experiences.
Conclusion:
It could be concluded that considering the commercial importance and financial benefits of medical tourism, it should provide the necessary facilities to expedite the provision of services to these foreign patients; consequently, an appropriate basis for attracting more medical tourists from neighboring countries, developing countries, and even developed countries will be provided.
... On the portals the information regarding potential risks of a procedure, as well as any risk associated with their travel and stay, should be stated before a decision to use medical tourism has been made. The relevant health regulations and ethical guidelines in the country where the patient is going for treatment must be outlined on the website (Wagle, 2013). Is it necessary to develop stricter international regulations to minimize undesirable outcomes in medical tourism around the world? ...
Medical Tourism, as one of the main components of international trade in health, has an increasing importance for the developing countries. Medical tourism attracts the attention of many actors of the medical profession, medical tourism facilitators, medical tourism agencies, health analysts and policy makers. Key criteria in selecting specific destinations for medical tourism are primarily the quality and the price of medical services, the accreditation of the facilities, its equipment as well as the attractiveness of the location in terms of tourism. The purpose of the research is exploratory and policy oriented. It is based on predictions of the theoretical literature findings and subsequent analysis of over 78 portals specialized in medical tourism. The questions raised refer to role of government, credibility, ethical concept, content information and internet marketing strategy. Research results point out to the need for further research and development of the national framework on on-line medical tourism information providers in the Republic of Serbia.
... Globalization through the internet provides an opportunity to market services, including health care, across the world. Marketing health care services over the internet and social media is an increasing practice carried out by medical tourism facilitators (MTFs) so as to reach a wider audience (1). Traveling from one country to another to seek health care services has been termed medical tourism. ...
Globalization through the internet provides an opportunity to market services, including health care, across the world. Marketing health care services over the internet and social media is an increasing practice carried out by medical tourism facilitators (MTFs) so as to reach a wider audience (1). Traveling from one country to another to seek health care services has been termed medical tourism. In addition to marketing health care services, MTFs mediate between medical tourists and potential caregivers at medical tourist destinations (2). The internet remains the medium by which potential medical tourists learn about the services offered at possible medical tourist destinations several miles away. Occasionally, advertisements by MTFs contravene the laws of their target countries. An earlier paper from Nigeria identified that the code of medical ethics of the country did not allow in-country medical practitioners to advertise the services rendered at their practices (3). However, this code of ethics was regularly violated by MTFs marketing health care services over the internet and social media.
Purpose
The purpose of this paper is to explore the possibilities and the growth prospects of medical tourism in Greece, while particularly focusing on the dialysis process. Patients with end-stage renal failure have the right to any treatment deemed necessary during their journey to another city or country away from the place where their treatment normally takes place.
Design/methodology/approach
The survey has been conducted among 193 kidney disease patients that underwent extra-renal dialysis in two public and three private artificial kidney units in Thessaloniki. The study population consists of patients with end-stage chronic renal failure (CRF) that undergo dialysis. For the purpose of this study, quantitative research was carried out via a structured and anonymous questionnaire. The design and structure of the study were based upon questionnaires from two relevant questionnaires. The questionnaires were modified appropriately to respond to the subject in question. Finally, for the analysis of the data, the SPSS software has been used.
Findings
One of the most obvious results is that patients on dialysis treatment have limited both the frequency and the duration of their vacation. The 8.3% of patients that did not use to travel increased to 37.8%, whereas only 22.3% continue to travel 2–4 times a year. Patients that keep on going on vacation frequently claim that a break from the daily routine improves their quality of life. Most of the participants (up to 36.3%) claim they feel healthier, while 34.2% stated they experience a normal life when they escape their everyday life and travel far from home. The 69.9% claim that Greece has the potentials to be a popular medical tourism destination. However, a well-structured and government-financed assistance programme is absent. The processing of data has revealed a positive correlation between age and tourism behaviour. Additionally, according to the research results, younger patients tend to be better informed regarding medical tourism in comparison with older ones.
Social implications
Considering the patients to be potential travellers facilitates the development, realization and promotion of medical tourism.
Originality/value
This study attempts to investigate, for the first time, the tourism behaviour of chronic kidney disease patients. The study highlights a sensitive issue, patients’ right to treatment without geographical or distance-related obstacles.
Promoting the products and services to the people located in different areas of the World and interacting with the target markets have always been a hard process for the enterprises that operate in the field of health tourism. With the developments in information and communication Technologies, internet and mobile Technologies has smoothed the ways of accessing information, shopping, socializing, having fun, and seeking for information without any time or place constraints with very low costs. The enterprises which want to benefit from the digitalized World have started to move their marketing activities to digital platforms. In this context, the aim of this study was identified as to evaluate the digital marketing activities of thermal facilities and JCI accredited hospitals, and to make a comparison between them. This study was designed as a descriptive study. Content analyzing method was used to evaluate the digital marketing activities of thermal facilities and JCI accredited hospitals. Totally, 73 thermal facilities’ and 30 JCI accredited hospitals’ digital marketing activities were evaluated. The collected data was coded by the researcher. Frequency and percentage distributions were calculated. It has been found that 38,4%of the thermal facilities do not have a web page in English or in another language. Also, it has been seen that, opposite to accredited hospitals, there was no enough information about the staff. It can be concluded for the enterprises that operate in the field of health tourism to use web sites and social media channels more efficient. Efficient use of these channels can allow the health tourism enterprises to interact with their target market through producing content according to the needs or wants of them. In addition, sharing information and creating content can be considered as a strategy to pull the target market.
Existing research on the formation of Asian medical travel destinations has highlighted a variety of activities that attract and accommodate patients from abroad. This paper contributes to the literature by drawing insights from an Indian case study, a major transnational health care hub in Asia which has gained little scholarly attention thus far. Using connectivity as an analytical lens, we understand medical travel destinations as a contingent product of relating, connecting and assembling. We study how connectivity is embodied and how it unfolds in care encounters at corporate hospitals in the capital New Delhi and surrounding urban areas. The following entities are the most effectual in the networks that constitute medical travel destinations in the NCR: (a) circulating narrations of personal experiences, (b) language interpreters, and (c) commission fees. We further elaborate on how these connectors work to link foreign patients to Indian hospitals and how they affect itineraries as well as patients and other involved actors. Finally, we suggest that the approach deployed provides a suitable framework for future research aimed at gaining a better understanding of the wider impacts of medical travel by following the connections and examining their workings at places, close and distant.
Los servicios internacionales de salud son el resultado del auge de la mercantilización de este tipo de intangibles, en la que el ciudadano es un consumidor. El actual contexto económico, político, demográfico y social presiona la gestación de personas responsables de su propia salud que buscan opciones de atención incluso fuera de su país. El turismo médico, que es una de estas alternativas, se refiere al comercio internacional de servicios como las intervenciones quirúrgicas básicas y electivas. Las cifras del mercado global de esta actividad no son muy precisas y a veces parecen exageradas; sin embargo, se calcula que crecen entre 15 y 20 por ciento anual. La globalización y los altos costos de los sistemas de salud impactan en la atención médica a ciertos segmentos de la población de los países desarrollados. Estado Unidos, uno de los más grandes emisores de pacientes, seguirá siendo a la vez el principal país exportador de servicios médicos. Su vecindad con México y el gran volumen de inmigrantes mexicanos en ese país posiblemente favorezcan este intercambio en ambos sentidos. Estudios sobre el tema de prestigiosas universidades y grandes consultoras de todo el mundo, destacan que México es uno de los principales destinos mundiales del sector. En este libro se presentan posibles elementos de ventaja competitiva y estrategias para lograr una mayor proyección en el mercado internacional del clúster turismo médico Jalisco. Se analiza con mayor detalle tres aspectos clave que deben desarrollar los hospitales privados. La calidad de los servicios médicos, sus convenios con aseguradoras privadas y la vinculación de la educación médica con estas instituciones de salud.
Advances in diagnostics, drugs, and devices have revolutionized cardiology practice, and improved quality of life of the patients. However, awareness, achievements, and advances in cardiac health care have enhanced the demands and expectations of the community, which lacks awareness about the social, economic, administrative, professional, and technical constraints or limitations of implementation. Being unfamiliar with medical ethics and legal aspects of care, and suboptimal virtues among physicians, have led to patients and the public utilizing legal remedies. In addition, sophistication of medical practice, increasing costs of health care, involvement of insurance systems, increased awareness and high expectations from the community and patients, and increased participation of the media have altered the attitude toward claiming compensation and acquisition of health care delivery among the public. In view of the changing trends of consumers and emerging areas in health care, providers must get accustomed to patient empowerment and come up to their expectations. Interactive programs on these aspects in medical education will help students understand not only the intricacies of medical ethics and the laws and shortcomings of health professionals and/or health systems, but also strengthen their knowledge of ethics and laws to improve their practice. Principles of ethics and legal issues have to be discussed at every stage of medical education. To improve the quality of the physician-patient encounter, we need to develop formal and informal curricula about effective communication skills. This chapter also highlights preventive measures and educational aspects of cardiology practice.
The growing trend of traveling outside of one's country for medical services, commonly known as “medical tourism” is expected to continue to grow exponentially in the next ten years (Keckley, 2008). With multiple destinations from which to select, and available information representing this type of travel being of variable reliability, many prospective medical travelers turn to the use of a “medical tourism facilitator”, who perform a variety of trip coordination responsibilities for the medical traveler. These medical tourism facilitators, themselves a new phenomenon to support travel to various global regions, may operate within the traveler's home country or the destination region. This study explores the services offered on medical tourism facilitators' websites to the prospective traveler. Through the application of correspondence analysis, it was discovered that differences in both website content and in services offered varied by the continent upon which the facilitator operated. With little yet known as to the motivations of a medical traveler in the selection of a specific destination, these discovered differences may be a first insight into regional differences that may play a role in such destination selection.
Globalisation has prompted countries to evaluate their position on trade in health services. However, this is often done from a multi-lateral, rather than a regional or bi-lateral perspective. In a previous review, we concluded that most of the issues raised could be better addressed from a bi-lateral relationship. We report here the results of a qualitative exercise to assess stakeholders' perceptions on the prospects for such a bi-lateral system, and its ability to address concerns associated with medical tourism.
30 semi-structured interviews were carried out with stakeholders, 20 in India and 10 in the UK, to assess their views on the potential offered by a bi-lateral relationship on medical tourism between both countries. Issues discussed include data availability, origin of medical tourists, quality and continuity of care, regulation and litigation, barriers to medical tourism, policy changes needed, and prospects for such a bi-lateral relationship.
The majority of stakeholders were concerned about the quality of health services patients would receive abroad, regulation and litigation procedures, lack of continuity of care, and the effect of such trade on the healthcare available to the local population in India. However, when considering trade from a bi-lateral point of view, there was disagreement on how these issues would apply. There was further disagreement on the importance of the Diaspora and the validity of the UK's 'rule' that patients should not fly more than three hours to obtain care. Although the opinion on the prospects for an India-UK bi-lateral relationship was varied, there was no consensus on what policy changes would be needed for such a relationship to take place.
Whilst the literature review previously carried out suggested that a bi-lateral relationship would be best-placed to address the concerns regarding medical tourism, there was scepticism from the analysis provided in this paper based on the over-riding feeling that the political 'cost' involved was likely to be the major impediment. This makes the need for better evidence even more acute, as much of the current policy process could well be based on entrenched ideological positions, rather than secure evidence of impact.
Medical tourism is a global health practice where patients travel abroad to receive health care. Voluntourism is a practice where physicians travel abroad to deliver health care. Both of these practices often entail travel from high income to low and middle income countries and both have been associated with possible negative impacts. In this paper, we explore the social responsibilities of medical tourists and voluntourists to identify commonalities and distinctions that can be used to develop a wider understanding of social responsibility in global health care practices.
Social responsibility is a responsibility to promote the welfare of the communities to which one belongs or with which one interacts. Physicians stress their social responsibility to care for the welfare of their patients and their domestic communities. When physicians choose to travel to another county to provide medical care, this social responsibility is expanded to this new community. Patients too have a social responsibility to use their community's health resources efficiently and to promote the health of their community. When these patients choose to go abroad to receive medical care, this social responsibility applies to the new community as well. While voluntourists and medical tourists both see the scope of their social responsibilities expand by engaging in these global practices, the social responsibilities of physician voluntourists are much better defined than those of medical tourists. Guidelines for engaging in ethical voluntourism and training for voluntourists still need better development, but medical tourism as a practice should follow the lead of voluntourism by developing clearer norms for ethical medical tourism.
Much can be learned by examining the social responsibilities of medical tourists and voluntourists when they engage in global health practices. While each group needs better guidance for engaging in responsible forms of these practices, patients are at a disadvantage in understanding the effects of medical tourism and organizing responses to these impacts. Members of the medical professions and the medical tourism industry must take responsibility for providing better guidance for medical tourists.
Medical tourism is understood as travel abroad with the intention of obtaining non-emergency medical services. This practice is the subject of increasing interest, but little is known about its scope.
A comprehensive scoping review of published academic articles, media sources, and grey literature reports was performed to answer the question: what is known about the patient's experience of medical tourism? The review was accomplished in three steps: (1) identifying the question and relevant literature; (2) selecting the literature; (3) charting, collating, and summarizing the information. Overall themes were identified from this process.
291 sources were identified for review from the databases searched, the majority of which were media pieces (n = 176). A further 57 sources were included for review after hand searching reference lists. Of the 348 sources that were gathered, 216 were ultimately included in this scoping review. Only a small minority of sources reported on empirical studies that involved the collection of primary data (n = 5). The four themes identified via the review were: (1) decision-making (e.g., push and pull factors that operate to shape patients' decisions); (2) motivations (e.g., procedure-, cost-, and travel-based factors motivating patients to seek care abroad); (3) risks (e.g., health and travel risks); and (4) first-hand accounts (e.g., patients' experiential accounts of having gone abroad for medical care). These themes represent the most discussed issues about the patient's experience of medical tourism in the English-language academic, media, and grey literatures.
This review demonstrates the need for additional research on numerous issues, including: (1) understanding how multiple information sources are consulted and evaluated by patients before deciding upon medical tourism; (2) examining how patients understand the risks of care abroad; (3) gathering patients' prospective and retrospective accounts; and (4) the push and pull factors, as well as the motives of patients to participate in medical tourism. The findings from this scoping review and the knowledge gaps it uncovered also demonstrate that there is great potential for new contributions to our understanding of the patient's experience of medical tourism.
An emerging trend is what has become commonly known as ‘Medical Tourism’ where patients travel to overseas destinations for specialised surgical treatments and other forms of medical care. With the rise of more affordable cross-border travel and rapid technological developments these movements are becoming more commonplace. A key driver is the platform provided by the internet for gaining access to healthcare information and advertising. There has been relatively little attention given to the role and impact of web-based information to inform Medical Tourism decisions.
This article provides a brief overview of the most recent development in Medical Tourism and examines how this is linked to the emergence of specialized internet web sites. It produces a summary of the functionality of medical tourist sites, and situates Medical Tourism informatics within the broader literatures relating to information search, information quality and decision-making.
This paper is both a call to strengthen the empirical evidence in this area, and also to advocate integrating Medical Tourism research within a broader conceptual framework.
Web and attendant e-Commerce phenomena are irretrievably at odds with the traditional structure and hence legal regulation of health delivery. E-Health delivers healthcare information, diagnosis, treatment, care, and prescribing of drugs in a nonlinear, nonhierarchical manner that encourages patients to "enter" the system at an infinite number of points, thus defying current regulatory constructs. Similarly, e-Commerce fundamentals such as disintermediation and disaggregation result in medical information being delivered through unfamiliar channels, creating immensely difficult questions for health lawyers.
The citizens of many countries have long traveled to the United States and to the developed countries of Europe to seek the expertise and advanced technology available in leading medical centers. In the recent past, a trend known as medical tourism has emerged wherein citizens of highly developed countries choose to bypass care offered in their own communities and travel to less developed areas of the world to receive a wide variety of medical services. Medical tourism is becoming increasingly popular, and it is projected that as many as 750,000 Americans will seek offshore medical care in 2007. This phenomenon is driven by marketplace forces and occurs outside of the view and control of the organized healthcare system. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have increasing impact on the healthcare landscape in industrialized and developing countries around the world.
'Health Tourism is a fascinating read... This book provides a unique look at a rapidly emerging issue for social and public policy as well as developmental studies, and would lend itself to animated debates, particularly at the graduate level.'
Medical tourism, where patients travel overseas for operations, has grown rapidly in the past decade, especially for cosmetic surgery. High costs and long waiting lists at home, new technology and skills in destination countries alongside reduced transport costs and Internet marketing have all played a role. Several Asian countries are dominant, but most countries have sought to enter the market. Conventional tourism has been a by-product of this growth, despite its tourist packaging, and overall benefits to the travel industry have been considerable. The rise of medical tourism emphasises the privatisation of health care, the growing dependence on technology, uneven access to health resources and the accelerated globalisation of both health care and tourism.
This exploratory study analyzed the content of medical tourism Web sites in an attempt to examine how they convey information about benefits and risks of medical procedures, how they frame credibility, and the degree to which these Web sites include interactive features for consumers. Drawing upon framing theory, the researchers content analyzed a sample of 66 medical tourism Web sites throughout the world. The results indicated that medical tourism Web sites largely promote the benefits of medical procedures while downplaying the risks, and relatively little information regarding the credibility of these services appears. In addition, the presentation of benefits/risks, credibility, and Web site interactivity were found to differ by region and type of facility. The authors discuss the implications of these findings concerning the framing of medical tourism Web site content, future directions for research, and limitations.
Patients are crossing national borders in search of affordable and timely health care. Many medical tourism companies are now involved in organizing cross-border health services. Despite the rapid expansion of the medical tourism industry, few standards exist to ensure that these businesses organize high-quality, competent international health care. Addressing the regulatory vacuum, 10 standards are proposed as a framework for regulating the medical tourism industry. Medical tourism companies should have to undergo accreditation review. Care should be arranged only at accredited international health-care facilities. Standards should be established to ensure that clients of medical tourism companies make informed choices. Continuity of care needs to become an integral feature of cross-border care. Restrictions should be placed on the use of waiver of liability forms by medical tourism companies. Medical tourism companies must ensure that they conform to relevant legislation governing privacy and confidentiality of patient information. Restrictions must be placed on the types of health services marketed by medical tourism companies. Representatives of medical tourism agencies should have to undergo training and certification. Medical travel insurance and medical complications insurance should be included in the health-care plans of patients traveling for care. To protect clients from financial losses, medical tourism companies should be mandated to contribute to compensation funds. Establishing high standards for the operation of medical tourism companies should reduce risks facing patients when they travel abroad for health care.
Medical tourism is a term to describe the rapidly-growing practice of traveling across international borders to obtain health care. Services typically sought by travelers include elective procedures as well as complex specialized surgeries. Over 50 countries have identified medical tourism as a national industry. This article deals with the situation of India that is promoting the "high-tech healing" of its private healthcare sector as a tourist attraction. The government hopes to encourage a building trade in medical tourism, selling foreigners the idea of travelling to India for low-cost but world-class medical treatment and India is becoming a "global health destination". This policy however does not develops into better services for the local population as corporale hospitals are clustered in urban settings, their prices are out of reach to the locals and the quota of beds reserved free of charge to the domestic population is often disregarded.
MedCERTAIN (MedPICS Certification and Rating of Trustworthy Health Information on the Net, http://www.medcertain.org/) is a recently launched international project funded under the European Union's (EU) "Action Plan for safer use of the Internet". It provides a technical infrastructure and a conceptual basis for an international system of "quality seals", ratings and self-labelling of Internet health information, with the final aim to establish a global "trustmark" for networked health information. Digital "quality seals" are evaluative metadata (using standards such as PICS=Platform for Internet Content Selection, now being replaced by RDF/XML) assigned by trusted third-party raters. The project also enables and encourages self-labelling with descriptive metainformation by web authors. Together these measures will help consumers as well as professionals to identify high-quality information on the Internet. MedCERTAIN establishes a fully functional demonstrator for a self- and third-party rating system enabling consumers and professionals to filter harmful health information and to positively identify and select high quality information. We aim to provide a trustmark system which allows citizens to place greater confidence in networked information, to encourage health information providers to follow best practices guidelines such as the Washington eHealth Code of Ethics, to provide effective feedback and law enforcement channels to handle user complaints, and to stimulate medical societies to develop standard for patient information. The project further proposes and identifies standards for interoperability of rating and description services (such as libraries or national health portals) and fosters a worldwide collaboration to guide consumers to high-quality information on the web.
Knowledge and capabilities, particularly of a new technology or in a new area of study, frequently develop faster than the guidelines and principles needed for practitioners to practice ethically in the new arena; this is particularly true in medicine. The blending of medicine and healthcare with e-commerce and the Internet raises many questions involving what sort of ethical conduct should be expected by practitioners and developers of the medical Internet. Some of the early pioneers in medical and healthcare Web sites pushed the ethical boundaries with questionable, even unethical, practices. Many involved with the medical Internet are now working to reestablish patient and consumer trust by establishing guidelines to determine how the fundamentals of the medical code of ethical conduct can best be adapted for the medical/healthcare Internet. Ultimately, all those involved in the creation, maintenance, and marketing of medical and healthcare Web sites should be required to adhere to a strict code of ethical conduct, one that has been fairly determined by an impartial international organization with reasonable power to regulate the code. This code could also serve as a desirable, recognizable label-of-distinction for ethical Web sites within the medical and healthcare Internet community. One challenge for those involved with the medical and healthcare Internet will be to determine what constitutes "Medical Internet Ethics" or "Healthcare Internet Ethics," since the definition of medical ethics can vary from country to country. Therefore, the emerging field of Medical/ Healthcare Internet Ethics will require careful thought and insights from an international collection of ethicists in many contributing areas. This paper is a review of the current status of the evolving field of Medical/Healthcare Internet Ethics, including proposed definitions and identification of many diverse areas that may ultimately contribute to this multidisciplinary field. The current role that medicine and health play in the growing area of Internet communication and commerce and many of the ethical challenges raised by the Internet for the medical community are explored and some possible ways to address these ethical challenges are postulated.
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