Content uploaded by Margaret Walton-Roberts
Author content
All content in this area was uploaded by Margaret Walton-Roberts on Oct 14, 2015
Content may be subject to copyright.
238
23. Migration: the mobility of patients and
health professionals
Margaret Walton- Roberts
23.1 INTRODUCTION: MOBILITY OF PATIENTS AND
PROFESSIONALS
Health is a global concern and part of this interest in the global stems from the increas-
ing mobility of humans through advances in global travel and communication. Health
practitioners and scholars have focused on mobility in the broadest sense, including
population movement and global disease epidemiology (Castelli, 2004; Gushulak
and MacPherson, 2006), the importance of physical activity in the prevention of non-
communicable diseases (Dishman et al., 2012), and the emerging role of mobile technol-
ogy in healthcare monitoring and delivery, or m- health (Istepanian et al., 2006).
Global health concerns are also evident in the mobility of people themselves, not just
the disease they may carry or the type and method of treatment they receive. Patients
and health workers migrate, and this form of human mobility poses important chal-
lenges for those promoting health for all through ‘universal access to timely, affordable,
accessible and quality health information and services’ (Global Health Advocates, 2013).
Geographical inequality frames access to healthcare, and one way to overcome this ine-
quality of access is to move. Movement is sometimes an option for those seeking health-
care, and for those providing it. These two migration processes of workers and patients
cumulatively affect the ability of health systems to equitably and adequately delivery
healthcare. This chapter examines the issue of migration in the health context in terms
of worker and patient mobility through four topics. First, the inverse care law is used
to explain how access to health services and workers is shaped by the level of urban and
economic development. Second, healthcare worker mobility and nascent management at
the global scale is explored. Third, medical tourism is introduced and the problematics of
its management are considered. Fourth, as with health workers, the issue of management
and at what scale it is directed is addressed by considering patient charters. A conclu-
sion is then offered to highlight how the migration of both patients and health workers
are tendencies of a globalizing healthcare system marked by increased public- private
marketization. The mobility of both of these human inputs must be understood as one
of circulation that is a central element of an increasingly global health services landscape.
Before entering into this assessment some definitions will help frame the chapter.
Migration generally refers to permanent movement from one jurisdictional unit to
another; the process can be further defined in terms of the spatial, temporal and politi-
cal nature of movement. In spatial terms the nature of jurisdictional borders, rather
than the distance travelled, determines which kind of migrant you are; an internal
migrant moves within one political unit or an immigrant travels into a different inter-
national jurisdiction. Temporally migrants may be temporary or permanent settlers,
LUNT 9781783471188 PRINT (M3684) (G).indd 238 15/04/2015 16:29
Migration: the mobility of patients and health professionals 239
or circular in that over a period of time they circulate between their home and the
receiving nation, for example ‘physician voluntourism’ references medical students and
providers who engage in temporary mobility in order to provide services in different
national contexts (Synder et al., 2011). Though medical tourists may travel for only a
short period of time, they do cross international borders in search of healthcare services
they cannot (or choose not to) access in their home country. Politically migration is also
demarcated as either voluntary or forced, yet this definition is increasingly problematic.
The political distinction is most important in terms of the UN declaration on the rights
of refugees, but this instrument is increasingly tested by climate change and global ine-
qualities that have produced millions of stateless and internally displaced people who
cannot claim political refugee status because they are unable to cross an international
border to present themselves to nations that are signatories to the refugee convention.
Additionally, some individuals or groups do not face explicit political threats in their
homeland, but the economic distress they endure is tantamount to a threat to their live-
lihood, and distress migration results. This cannot simply be defined as either voluntary
or forced, because migrants are effectively compelled to migrate to secure their and their
families’ livelihoods.
Across this definitional terrain of migration we see diverse needs and desires for
healthcare. In those locations where better quality healthcare is available, we see a sig-
nificant attraction for those seeking care, but also for those with in- demand healthcare
skills. Healthcare workers have become the desired migrants many nations attract. The
convergence of policies that entail greater migrant selectivity can be seen in the growing
orthodoxy of skilled points- based immigration systems across immigrant receiving states
(Shachar, 2006). These tendencies toward global competition for skilled workers place
health professionals as one of the key labour market sectors open to international trans-
fer. Nursing in particular presents one case where skilled labour migration is evident
(Kingma, 2006), and indeed in some regions the opportunities for overseas migration
are often one of the main reasons candidates enter the profession (Bhutani et al., 2013).
These workers generally seek a better life for themselves and their families, and in the
process their migration contributes to an ongoing differentiation of the healthcare deliv-
ery map. Thus a focus on human migration in terms of health necessitates viewing both
of these flows–patients and workers—together.
Analysis of the migration of health workers and patients can also be framed in terms
of mobility. Mobility refers to movement, but under conditions of hyper- globalization
there is theoretical valence to identifying how mobility is embedded in practices and
processes that at first glance appear static (Urry, 2002; Cresswell, 2006). This intellec-
tual engagement with ‘mobililties’ is relevant to our interest in health because there are
several indicators of mobility embedded in all aspects of health (international health
corporations, pharma companies, trade agreements, global health agencies, research in
health treatments and drugs, key public and private actor- networks etc.), and the inter-
national migration of patients and workers is just one of the more obvious examples of
widespread mobility that has important consequences for the nature of healthcare access
and delivery. In this chapter I examine two obvious markers of human mobility within
health, the migration of workers and patients.
LUNT 9781783471188 PRINT (M3684) (G).indd 239 15/04/2015 16:29
240 Handbook on medical tourism and patient mobility
23.2 THE INVERSE CARE LAW: MAPS OF INEQUALITY AND
MIGRATION
Any assessment of the migration of health workers and patients must consider certain
tendencies that hold across different scales. The inverse care law (Tudor Hart, 1971:
405) refers to the fact that the ‘availability of good medical care tends to vary inversely
with the need for it in the population served. This [. . .] operates more completely where
medical care is most exposed to market forces, and less so where such exposure is
reduced.’
At the regional scale we see the inverse care law at work in terms of the differential
access available to people in rural vs. urban centres, and the range, quality and availabil-
ity of health services tend to increase as we move up the urban hierarchy. In countries
with poorly developed public health systems, income is especially determinate of the
level of healthcare accessible. At the national scale, countries with contiguous borders
and significant relative differences in healthcare services can result in trans- border
movements of patients seeking healthcare services. We also see this in terms of patients
seeking cheaper and more readily available pharmaceuticals, such as in the Mexico- US
and US- Canadian border context (Homedes and Ugalde, 2012). Cross- border flows can
also occur for medical treatment, and in some cases this movement might be managed
through jurisdictional agreements as patients are transferred between national health
systems, such as in the case of the EU (Brekke et al., 2014). There are also regional health
hubs that are increasingly utilized by those seeking specialized care, and this can be both
state- directed or by individual choice, for example India and Kuwait recently signed an
agreement to promote cross- border mobility of health workers and patients (Embassy
of India, 2012).
Increasingly, people are choosing to cross international borders to access health
treatments. For example, the global medical tourism market is estimated to be worth
$40billion to $60 billion, and with growth rates of about 20% per annum; and while it
is difficult to get precise figures, estimates suggest that globally 3–4% of people travel
abroad for health treatment (IPK International, 2012: 23). While the inverse care law
might explain some of this patient travel, there are other factors driving the process.
There are legal and ethical factors that shape medical tourism, particularly in reproduc-
tive technology where surrogate and artificial reproduction may be restricted in one
country compared to another (Van Hoof and Pennings, 2013).
Arguably, the inverse care law is most obvious at the international scale between health-
care systems in low- and high- income nations, but this geographical division is increas-
ingly blurred by the presence of specialty corporate hospitals in large urban centres in
low- and mid- income nations that provide world- class medical care for patients who can
afford it (Crone, 2008). Notwithstanding this spatial complexity, the burden of disease
continues to be more concentrated in the poorest nations of the world, and in many cases
these regions are also home to hundreds of thousands of refugees and asylum seekers,
internally displaced and stateless people (Connolly et al., 2004). For these populations
access to healthcare is precarious, and their ability to move to seek health is highly con-
strained. States receiving an influx of patients from neighbouring regions facing poverty,
war and crisis, may result in local health systems suffering without increased resources,
leading to even greater public health crises (Kalipeni and Oppong, 1998). Once health
LUNT 9781783471188 PRINT (M3684) (G).indd 240 15/04/2015 16:29
Migration: the mobility of patients and health professionals 241
systems buckle under such pressure, working conditions and the state’s ability to manage
health system access begins to falter. Long- term declines in state investment in health
also produce reduced morale in the health workforce and international migration is
one option such workers adopt to manage such challenges. Once this migration pattern
becomes entrenched, curtailing it demands more than just financial incentives – system-
wide transformation is needed to enhance retention (Willis- Shattuck et al., 2008). As
workers leave, the system suffers and a cycle of decline is engendered (Chikanda, 2005).
23.3 ETHICAL HIRING PROTOCOLS: FROM DRAINS, TO
COMPENSATION, TO ‘MUTUALITY’
Due to the uneven geographical distribution of health workers (World Health
Organization, 2006), the deliberate recruitment of health professionals from countries
with health systems crippled by staff shortages is seen as unethical recruitment. Such
recruitment is seen to result in a ‘perverse subsidy’ that perpetuates a pattern of poorer
countries investing in the training of health professionals who migrate to provide
health care to developed nations (Mackintosh et al., 2006). Consider the fact that Sub-
Saharan Africa continues to be an exporter of nurses even as the region is projected to
reach an estimated shortfall of 60 000 nurses (Packer et al., 2007). Ethical International
Recruitment codes were developed in response to this crisis after 1997 when Nelson
Mandela (then President of South Africa) raised the issue internationally. Global health
diplomacy was subsequently effective in the creation of a series of voluntary codes of
conduct to discourage health worker recruitment from countries experiencing critical
shortfalls in medical staffing. The WHO Global Code of Practice on the International
Recruitment of Health Personnel (adopted in May 2010) is considered a landmark agree-
ment that ‘suggests evolution in the capacity of the WHO Secretariat, Member States,
and civil society to engage in global health “law- making”.’(Taylor and Dhillon, 2011:22).
The migration of health professionals is one of the nascent areas where we witness
global governance frameworks emerging. These codes, while limited in application,
have gone through a series of evolutions (Connell and Buchan, 2011). Codes are typi-
cally limited in coverage since they normally only apply to large public institutions or
government health sectors. It is also difficult to characterize international migration as
a problem when fiscally constrained health systems generate unemployed and underem-
ployed health professionals (Lorenzo et al., 2007). Migration is also driven by families,
and migrant social networks, and is often supported by the state for purposes of remit-
tance generation, leading to the creation of a ‘migration culture’ (Connell and Conway,
2000). In such contexts it may be difficult and impractical to curtail migration using
voluntary codes. Codes are also generalized, whereas stakeholders (unions, employ-
ers, migrants, governments) have very specific needs and interests that may contradict
aspects of recruitment addressed in voluntary codes. These codes are voluntary, meaning
they include few enforcement or penalty options, and they are further constrained by
poor health resource data that leads to uncertainly about the type of shortages occurring
in different markets.
One of the main motivations for these voluntary codes is a desire for transnational
social justice, because the ‘brain drain’ of health workers represents an inequitable
LUNT 9781783471188 PRINT (M3684) (G).indd 241 15/04/2015 16:29
242 Handbook on medical tourism and patient mobility
distribution of training investments made by the sending region. However, the justice
dimension of ethical codes is limited by the fact that in some cases out- migration is pro-
moted by the sending state as a form of labour export policy (Rodriguez, 2010). In light
of this reality, the language of ethical recruitment codes and labour agreements increas-
ingly references seeking ‘mutuality’ through the migration process rather than compen-
sation for the sending region (Connell and Buchan, 2011). This mutuality approach
suggests other types of trade- offs be used to balance against source- region loses from
the out- migration of health workers. This could include the use of health trade services
agreements and training exchanges to compensate sending regions (Stilwell et al., 2004).
This policy language in such labour agreements reflects how globalization of healthcare
systems has been spurred on by trade in health related services under the World Trade
Organization for the General Agreement on Trade in Services (Smith et al., 2009). This
increase in trade in health services has been characterized as a ‘paradigm shift’ in our
understanding of the delivery of health services (Lunt et al., 2011: 6).
23.4 PATIENTS ON THE MOVE: MEDICAL TOURISM
There has been a veritable explosion of research on the existence of ‘medical tourism’,
one form of trade in health services defined as ‘the organized travel outside one’s natural
healthcare jurisdiction for the enhancement or restoration of the individual’s health
through medical intervention’ (Carrera and Bridges, 2006: 447). Medical tourism is dis-
tinct from health tourism, which is ‘the provision of health facilities utilizing the natural
resources of the country, in particular mineral water and climate’ (IUTO, 1973: 7 cited
in Hall, 2011: 5). While statistics are difficult to compile, estimates suggest that globally
about 8 million patients per year seek medical treatment overseas, and by some estimates
this is growing by 15% to 25% a year (Woodman, 2013). There has been a long history
of patients seeking treatment from world- class health specialists, and the locations of
‘Harley Street’ (London, UK) and ‘Mayo Clinic’ (Rochester, USA) have a resonance
with wealthy elites who have long seen healthcare as just one more global service option
open to them. Recently though, emerging and developing nations have entered the
global trade in healthcare services by, among other things, seeking international stand-
ards accreditation in order to provide specialized quality healthcare at competitive prices
relative to more developed and well- established markets (MacReady, 2007). In Asia and
the Middle East it is this investment and ‘advancement of healthcare in these countries
that is, in effect, globalizing healthcare’ (Crone, 2008: 117).
Medical tourism occurs for a variety of reasons, but generally we can group them
as economic issues (cost and timing), socio- cultural issues (combining diaspora and
tourism travel with medical treatments), and regulatory issues (certain treatments may
be prohibited or denied generally or specifically to certain groups) (Hall, 2011). In terms
of economic reasons, cost and wait times are among the major factors driving people to
consider seeking health treatments overseas. For example, cardiac surgery in an Apollo
Hospital in India could cost only about 20% of the same treatment in the USA (Herrick,
2007). Wait times also influence the decision to seek treatment overseas, especially for
hip and joint replacements (Eggertson, 2006). Medical tourism may also be promoted
through socio- cultural factors whereby touristic and diaspora visits are combined with
LUNT 9781783471188 PRINT (M3684) (G).indd 242 15/04/2015 16:29
Migration: the mobility of patients and health professionals 243
medical travel; highlighting the globalization of both health and tourism (Connell, 2006;
Newland and Taylor, 2010). Patients seek treatments that are not available in their
own countries, be it because they are experimental or prohibited (Patra and Sleeboom-
Faulkner, 2009), and in cases where treatments may be denied certain groups, such as
reproductive technologies for same sex couples (Van Hoof and Pennings, 2013).
Individually, patients have various reasons to travel for treatment, but the growth
of this phenomenon is raising a number of concerns for researchers and policy makers.
The main issues of concern can be clarified as medical travellers posing biosecurity risks
for global public health (Hall and James, 2011), as well as ethical questions about the
costs and benefits of medical tourism for public health systems (Johnston et al., 2010).
These questions are currently driving significant research in the area of medical tourism,
including calls for more effective data collection (Hopkins et al., 2010; Lunt et al., 2011),
better regulation of companies that organize medical tourism (Turner, 2011), and the
development of policies to address the inequities medical tourism creates in national
health systems (Chen and Flood, 2013).
The problems associated with the global mobility of patients suggests there might
be a need for some kind of global regulation, just as we have seen in the case of heath
professional migration. While the migration of health professionals has seen efforts to
introduce nascent governance at the global level through the WHO’s voluntary Code
of Practice on the International Recruitment of Health Personnel, the case of medical
tourism, though one of the oldest forms of migration (Reisman, 2010), has not yet
resulted in any kind of global code of practice. Rather, what exists is a patchwork of
bilateral agreements and national patients’ charters that have limited influence on the
increasingly global mobility of patients.
23.5 PATIENT CHARTERS, FOLLOW- UP CARE, WELL- BEING
Currently health systems are differentiated by national and regional systems of provision.
While the idea that adequate healthcare treatment is a human right, advanced by the UN
and others (Farmer, 1999), it is also a service that can be purchased. As such an interna-
tional market for healthcare exists, and those with the resources to attain it do so. Medical
tourism is also seen as part of a wider neoliberal transition from state welfare to market
system where the citizen is posited as consumer (Ormond, 2011). While many nations do
have patient charters, their enforcement is often difficult because in most cases these char-
ters are ‘fuzzy’ since they articulate values more than specific service metrics, and they tend
to be legally non- binding (Vogel, 2010). Patient charters are also nationally bounded; they
do not apply in the context of patients who move outside of their country of residence in
order to achieve medical attention. Indeed healthcare access is an important modality of
citizenship: ‘Different models of the patient- physician relationship – which can also rep-
resent the citizen- state relationship – have been developed, and these have informed the
particular rights to which patients are entitled’ (WHO, 2014). If we consider healthcare
an important citizenship right, then the rise of global patient mobility suggests patients
move themselves out of one set of protections, to either a new set of protections articu-
lated in terms of the health provider’s own assurances, or protections articulated under
separate national public systems, which the international patient may have no right to.
LUNT 9781783471188 PRINT (M3684) (G).indd 243 15/04/2015 16:29
244 Handbook on medical tourism and patient mobility
Patients who have received international treatments resulting in complications may have
returned home already, and then they become the default responsibility of their domestic
healthcare system. Some have argued that patients must be more socially responsible in
their medical travel decisions and behaviours (Synder et al., 2011), since there are few
protections medical tourists can fall back on beyond the insurance included in their treat-
ment package. Global agreements on levels of care and patient rights are unlikely to pass
muster with many nations, since healthcare as a public good is increasingly restricted for
non- nationals (Cole, 2007). There are possibilities for developing effective relationships
in medical tourism using bilateral agreements between nations, but the complexities of
such agreements between distinct national health systems do pose considerable challenges
(Álvarez et al., 2011). Add to this the increasing public- private interest in health services
(Buse and Walt, 2000) and it becomes apparent that international regulation of patient
rights and medical provider responsibilities is difficult to advance.
23.6 CONCLUSION: THE TALE OF TWO MIGRATIONS
The mobility of both health workers and patients can be seen as produced by the glo-
balization and marketization of healthcare, which in itself is a form of mobility in terms
of ideas, ideologies and discourses (Levitt and Rajaram, 2013). We may be moving
toward ‘flat medicine’ for certain socio- economic classes in a global landscape of health
services integration (Crone, 2008), and international accreditation agencies such as the
Joint Commission International mark the rise of a global standard for healthcare that is
explicitly aimed at international clients with means (MacReady, 2007). Health workers,
whose international migration has in the past been spurred by differences in opportunity
between national systems, are now increasingly distributed between public and private
systems within national contexts, as well as across them. Internationally oriented health
systems are seeking health professionals with international training, and the circula-
tion of medical professionals between health systems in the Global North and South
transmits both skills (Hagander et al., 2013), and ideas about the role of markets in the
health system (Levitt and Rajaram, 2013). How might medical ‘tourism’ influence global
inequality and health marketization, processes that are cause and consequence of health
worker migration, but also how is patient mobility affected by these same processes?
Health worker migration and global patient mobility are core issues of concern when
considering health for all, and the continuing relevance of the inverse care law at the
global scale. Marketization causes and is reproduced through patient and worker inter-
national mobility. The process to ameliorate the negative consequences of such mobility
for those who cannot easily avail themselves of the options this mobility offers remains a
central issue for health and migration researchers and policy makers.
REFERENCES
Álvarez, M.M., R. Chanda, R.D. Smith (2011), ‘The potential for bi- lateral agreements in medical tourism: a
qualitative study of stakeholder perspectives from the UK and India’, Globalization and Health, 7 (11). DOI:
10.1186/1744- 8603- 7- 11.
LUNT 9781783471188 PRINT (M3684) (G).indd 244 15/04/2015 16:29
Migration: the mobility of patients and health professionals 245
Bhutani, S., P. Gupta, M. Walton- Roberts (2013), ‘Nursing education in Punjab and its role in overseas migra-
tion’, in K.D. Sharma, H.S. Mangat, K. Surjit Singh (eds), Readings in population, environment and spatial
planning, Panchkula: Institute for Spatial Planning and Environment Research (pp. 203–214).
Brekke, K.R., R. Levaggi, L. Siciliani, O.R. Straume (2014), Patient mobility, health care quality and welfare,
CESifo Working Paper, 4576, Munich: CESifo.
Buse, K., G. Walt (2000), ‘Global public- private partnerships: part II – what are the health issues for global
governance’, Bulletin of the World Health Organization, 78 (5), 699–709.
Carrera, P., J. Bridges (2006), ‘Globalization and healthcare: understanding health and medical tourism’,
Expert Review of Pharmacoeconomics & Outcomes Research, 6 (4), 447–454.
Castelli, F. (2004), ‘Human mobility and disease: a global challenge’, Journal of Travel Medicine, 11 (1), 1–2.
Chen, Y.Y., C.M. Flood (2013), ‘Medical tourism’s impact on health care equity and access in low- and middle-
income countries: making the case for regulation’, The Journal of Law, Medicine & Ethics, 41 (1), 286–300.
Chikanda, A. (2005), ‘Nurse migration from Zimbabwe: analysis of recent trends and impacts’, Nursing
Inquiry, 12 (3), 162–174.
Cole, P. (2007), ‘Human rights and the national interest: migrants, healthcare and social justice’, Journal of
Medical Ethics, 33 (5), 269–272.
Connell, J. (2006), ‘Medical tourism: sea, sun, sand and . . . surgery’, Tourism Management, 27 (6), 1093–1100.
Connell, J., J. Buchan (2011), ‘The impossible dream? Codes of practice and the international migration of
skilled health workers’, World Medical & Health Policy, 3 (3), 1–17.
Connell, J., D. Conway (2000), ‘Migration and remittances in island microstates: a comparative perspective
on the South Pacific and the Caribbean’, International Journal of Urban and Regional Research, 24 (1),
52–78.
Connolly, M.A., M. Gayer, M.J. Ryan, P. Salama, P. Spiegel, D.L. Heymann (2004), ‘Communicable diseases
in complex emergencies: impact and challenges’, The Lancet, 364 (9449), 1974–1983.
Cresswell, T. (2006), On the move: mobility in the modern western world, New York: Routledge.
Crone, R.K. (2008), ‘Flat medicine? Exploring trends in the globalization of health care’, Academic Medicine,
83 (2), 117–121.
Dishman, R.K., G. Heath, I.M. Lee (2012), Physical activity epidemiology, Champaign, IL: Human Kinetics.
Eggertson, L. (2006), ‘Wait- list weary Canadians seek treatment abroad’, Canadian Medical Association
Journal, 174 (9), 1247.
Embassy of India (Kuwait) (2012), Memorandum of Understanding (MoU) on Medical Cooperation Signed
between India and the State of Kuwait on April 23, 2012, in New Delhi.
Embassy of India (Kuwait) (2014), India, Kuwait: Embassy of India.
Farmer, P. (1999), ‘Pathologies of power: rethinking health and human rights’, American Journal of Public
Health, 89 (10), 1486–1496.
Global Health Advocates (2013), Civil Society Manifesto on Global Health, Paris: GHA.
Gushulak, B.D., D.W. MacPherson (2006), ‘The basic principles of migration health: population mobility and
gaps in disease prevalence’, Emerging Themes in Epidemiology, 3 (3), 1742.
Hagander, L.E., C.D. Hughes, K. Nash, K. Ganjawalla, A. Linden, Y. Martins, K. Casey, J.G. Meara (2013),
‘Surgeon migration between developing countries and the United States: train, retain, and gain from brain
drain’, World Journal of Surgery, 37 (1), 14–23.
Hall, C.M. (2011), ‘Health and medical tourism: a kill or cure for global public health?’, Tourism Review, 66
(1/2), 4–15.
Hall, C.M., M. James (2011), ‘Medical tourism: emerging biosecurity and nosocomial issues’, Tourism Review,
66 (1/2), 118–126.
Herrick, D.M. (2007), Medical tourism: global competition in health care, Dallas: National Centre for Policy
Analysis.
Homedes, N., A. Ugalde (2012), ‘Mexican pharmacies and antibiotic consumption at the US- Mexico border’,
Southern Medical Review, 5 (2), 9.
Hopkins, L., R. Labonté, V. Runnels, C. Packer (2010), ‘Medical tourism today: what is the state of existing
knowledge & quest’, Journal of Public Health Policy, 31 (2), 185–198.
IPK International (2012), ITB World Travel Trends Report (2012), Berlin: Messe Berlin GmbH.
Istepanian, R., S. Laxminarayan, C.S. Pattichis (2006), M- health, New York: Springer Science & Business
Media, Inc.
Johnston, R., V.A. Crooks, J. Snyder, P. Kingsbury (2010), ‘What is known about the effects of medical
tourism in destination and departure countries? A scoping review’, International Journal for Equity in Health,
9 (1), 24.
Kalipeni, E., J. Oppong (1998), ‘The refugee crisis in Africa and implications for health and disease: a political
ecology approach’, Social Science & Medicine, 46 (12), 1637–1653.
Kingma, M. (2006), Nurses on the move: migration and the global health care economy, Ithaca and London:
Cornell University Press.
LUNT 9781783471188 PRINT (M3684) (G).indd 245 15/04/2015 16:29
246 Handbook on medical tourism and patient mobility
Levitt, P., N. Rajaram (2013), ‘Moving toward reform? Mobility, health, and development in the context of
neoliberalism’, Migration Studies, 1 (3), 338–362.
Lorenzo, F.M.E., J. Galvez-Tan, K. Icamina, L. Javier (2007), ‘Nurse migration from a source country per-
spective: Philippine country case study’, Health Services Research, 42 (3p2), 1406–1418.
Lunt, N., R. Smith, M. Exworthy, S. Green, D. Horsfall, R. Mannion (2011), Medical tourism: treatments,
markets and health system implications: a scoping review, Paris: OECD, Directorate for Employment, Labour
and Social Affairs.
Mackintosh, M., P. Raghuram, L. Henry (2006), ‘A perverse subsidy: African trained nurses and doctors in
the NHS’, Soundings, 34, 103–113.
MacReady, N. (2007), ‘Developing countries court medical tourists’, The Lancet, 369 (9576), 1849–1850.
Newland, K., C. Taylor (2010), Heritage tourism and nostalgia trade: a diaspora niche in the development
landscape, Washington, DC: Migration Policy Institute.
Ormond, M. (2011), ‘Shifting subjects of health- care: placing “medical tourism” in the context of Malaysian
domestic health- care reform’, Asia Pacific Viewpoint, 52 (3), 247–259.
Packer, C., R. Labonté, D. Spitzer (2007), ‘Globalization and health worker migration’, Globalization and
Health Knowledge Network Research Papers, Ottawa: University of Ottawa Institute of Population Health–
Globalization and Health Equity.
Patra, P.K., M. Sleeboom- Faulkner (2009), ‘Bionetworking: experimental stem cell therapy and patient
recruitment in India’, Anthropology and Medicine, 16 (2), 147–163.
Reisman, D.A. (2010), Health tourism: social welfare through international trade, Cheltenham, UK and
Northampton, MA, USA: Edward Elgar.
Rodriguez, R. (2010), Migrants for export: how the Philippine state brokers labor to the world, Minneapolis:
University of Minnesota Press.
Shachar, A. (2006), ‘The race for talent: highly skilled migrants and competitive immigration regimes’, New
York University Law Review, 8 (April), 148–206.
Smith, R.D., R. Chanda, V. Tangcharoensathien (2009), ‘Trade in health- related services’, The Lancet, 373
(9663), 593–601.
Snyder, J., S. Dharamsi, V.A. Crooks (2011), ‘Fly- by medical care: conceptualizing the global and local social
responsibilities of medical tourists and physician voluntourists’, Globalization and Health, 7 (6). DOI:
10.1186/1744- 8603- 7- 6.
Stilwell, B., K. Diallo, P. Zurn, M. Vujicic, O. Adams, M. Dal Poz (2004), ‘Migration of health- care
workers from developing countries: strategic approaches to its management’, Bulletin of the World Health
Organization, 82 (8), 595–600.
Taylor, A.L., I.S. Dhillon (2011), ‘The WHO Global Code of Practice on the International Recruitment of
Health Personnel: the evolution of global health diplomacy’, Global Health Governance, 5 (1), Fall.
Tudor Hart, J. (1971), ‘The inverse care law’, The Lancet, 297, 405–412.
Turner, L.G. (2011), ‘Quality in health care and globalization of health services: accreditation and regulatory
oversight of medical tourism companies’, International Journal for Quality in Health Care, 23 (1), 1–7.
Urry, J. (2002), Sociology beyond societies: mobilities for the twenty- first century, London: Routledge.
Van Hoof, W., G. Pennings (2013), ‘Cross- border reproductive care around the world: recent controversies’, in
D. Botterill, G. Pennings, T. Mainil (eds), Medical tourism and transnational health care, London: Palgrave
Macmillan (pp. 98–112).
Vogel, L. (2010), ‘International patient charters are often nonbinding or feature fuzzy metrics’, Canadian
Medical Association Journal, 182 (13), E641–E642.
Willis- Shattuck, M., P. Bidwell, S. Thomas, L. Wyness, D. Blaauw, P. Ditlopo (2008), ‘Motivation and reten-
tion of health workers in developing countries: a systematic review’, BMC Health Services Research, 8 (1),
247.
Woodman, J. (2013), Patients without borders: everybody’s guide to affordable world class healthcare, North
Carolina: Healthy Travel Media.
World Health Organization (2006), World Health Report: Working Together for Health, Geneva: WHO.
World Health Organization (2014), Patients’ Rights, Geneva: WHO Genomic Resource Centre.
LUNT 9781783471188 PRINT (M3684) (G).indd 246 15/04/2015 16:29
