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INTRODUCTION
The last two decades has seen the concept of tourism
for medical purposes evolve. Medical tourism is
dened as the practice of travelling across borders for
medical treatment.1 In simple parlance in “Medical
Tourism” patient travels off shore to another country
1. Nazia Mumtaz, PhD (Rehabilitation Sciences)
Head of Department & Professor,
Department of Speech Language Pathology,
Faculty of Allied Health Sciences,
Riphah International University,
Lahore, Pakistan.
2. Ghulam Saqulain, FCPS (Otorhinolaryngology)
Head of Department & Professor,
Department of Otorhinolaryngology,
Capital Hospital PGMI,
Islamabad, Pakistan.
Correspondence:
Dr. Ghulam Saqulain,
Head of Department & Professor,
Department of Otolaryngology,
Capital Hospital PGMI, G 6/2,
Islamabad, Pakistan.
Email: ghulam_saqulain@ yahoo.com
* Received for Publication: August 30, 2023
* Revision Received: August 27, 2024
* Revision Accepted: September 20, 2024
to obtain medical care. “Medical Tourists” is a term
used by medical centers in recipient countries for
those individuals from one country to another country.
This is interestingly not only limited to patients going
from low and middle income countries to centres of
excellence in developed nations, but availability of
cheaper medical care also attracting patients from
developed nations to countries such as India, Thailand,
United Arab Emirates for medical and other health
care related needs which is not just limited to dentistry,
fertility issues etc. Costs of medical care abroad are
sometimes blurred between the healthcare systems
of recipient and originating country when patients
from developed countries like United Kingdom obtain
treatment abroad and return to their own country for
treating complications which instead causes an inequity
in the health systems of the originating country.2
The essential requirement to be awarded the status
of “destination of choice” for medical tourism is for a
healthcare institution, clinic or laboratory to acquire
international accreditation thus inspiring trust and
assurance for patients intending to travel for such
treatment. This is in fact benecial for the institutes,
clinics, laboratories since they also grow in terms of
human resource, nances and technical upgradation.
In most countries offering medical tourism, this
has resulted from the private sector being at the
forefront though the involvement of governments is
Review Article
Reviving medical tourism in
Pakistan - A narrative review
Nazia Mumtaz1, Ghulam Saqulain2
SUMMARY
Medical and health care traverse geographical boundaries in the form of “Medical Tourism” with patients travelling from
low and middle-income countries to developed nations and vice versa as well. Aordable medical care is also attracting
patients from developed nations to countries like India, Thailand, UAE and others with international accreditation
playing a key role. This also yields economic benets for the recipient countries. Pakistan unfortunately lags behind in
acquiring “destination of choice” status for medical tourism which undisputedly can benet its constrained economy.
There being a dearth of literature current narrative review was conducted to highlight the integrity and benets of
medical tourism. For this, literature search was conducted using google, Bing, google scholar, PubMed, web of science
to search engines and data bases. One hundred eighty articles, reports & publications were downloaded of which 25
non-English & duplicates, and 75 irrelevant records were excluded. Hence, 34 references of relevant English language
articles, publications, reports and online resources were utilized for the review.
KEYWORDS: Clinical services, Healthcare, Joint Commission International, Medical Tourism, Rehabilitation, Speech
therapy.
doi: https://doi.org/10.12669/pjms.40.11.8673
How to cite this: Mumtaz N, Saqulain G. Reviving medical tourism in Pakistan - A narrative review. Pak J Med Sci. 2024;40(11):2720-2725.
doi: https://doi.org/10.12669/pjms.40.11.8673
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Nazia Mumtaz et al.
Pak J Med Sci December 2024 Vol. 40 No. 11 www.pjms.org.pk 2721
advantageous and has wide scope.3 Medical tourism
earns huge revenues for states facilitating it as well
as there are associated economic advantages for
hospitality and travel industry too.4
It was highlighted in a 2015 Medical Tourism
Association Medical Tourism patient survey that
healthcare costs on an average remains in the range
of USD $3600 to $7600 on medical healthcare on a
single medical tourism sojourn abroad. Health care
costs are affordable in Thailand for the residents of
USA as spinal fusion costs uctuate from USD $62000
in USA to as low USD $7000.5 The reduced costs and
waiting time and technology are resultantly changing
the dynamics of this growing industry.1 It is high time
for Pakistan, being a developing country, to strive for
its share in medical tourism to benet its constrained
economy. Also, the research gap persists in Health
Tourism research as identied by Crooks VA et al.6
Hence, the current review was conducted to highlight
the integrities and benets of medical tourism. The
study is important since it may initiate discussions,
mobilize public opinion and spur policy decision
making to help develop Pakistan as a Medical Tourist
Hub beneting it by improving its health care system
and economy.
METHOD
This narrative review was conducted with a literature
search using google, Bing, google scholar, PubMed,
web of science search engines and data bases utilizing
keywords like medical, tourism, travel, healthcare,
and combination of terms. For this 180 records were
downloaded of which 25 duplicate and non-English
leaving behind 155 pertinent English articles, material,
reports, online resources and publications which were
skimmed to identify 80 relevant, English language, full
text documents out of which 33(18.33%) were reviewed in
detail utilized for the current narrative review. (Figure).
Keeping in view the importance of the topic, no limitation
of time period was placed.
DISCUSSION
To improve the economy and health care system
in the current world, Pakistan needs to transform
to a Medical Tourist Hub. For this current study
reviewed the literature to highlight the integrity and
benets of medical tourism. This may help realize
and reenact medical tourism in Pakistan. For this,
we discuss below Medical Tourism in Pakistan &
Asian States; Accreditation including i) International
accreditation, ii) E-health accreditation, iii) Prots and
JCI accreditation; Extent and scope of medical tourism;
Lack of evidence around medical tourism; Risks of
medical tourism; JCI supports medical tourism; &
Rehabilitation and Brain Drain:
Medical tourism: Pakistan & Asian states: Pakistan lags
behind as regards medical tourism which is restricted
to Pakistanis living in England opting for treatment in
Pakistan due to long waiting time of the UK National
Health Services and also due to the fact that they still have
relatives in Pakistan, where they avail cheaper treatment
which also includes dental and cosmetic procedures.
Though Pakistan’s reputation is improving in medical
tourism yet lags far behind in becoming a regional
medical tourism hub. The reasons behind this might be
that majority of health care institutions, medical centers
and laboratories lack international accreditation, making
patients uncomfortable since they lack assurance of
provision of care conforming to international regulatory
parameters.7
International accreditation achieved by regional
South Asian states and neighboring India, Thailand and
Malaysia have resulted in high returns on investments
as regards accreditation and are thus booming with
medical tourism.8 On the other hand the Korean
government realized that medical tourism could be
a signicant industry and evolved medical, legal, and
policy strategies with the goal of ultimately soliciting
700,000 foreign patients by the year 2027. In this
backdrop integrated two projects were converted into
a Wellness and Medical Tourism Convergence Cluster
strategically run at three major cities. South Korea
lagged behind many Asian countries and realizing this
it achieved excellence in the eld of cancer surgery and
cancer treatment with its medical prowess surpassing
countries such as England, Spain, Italy, the Netherlands,
Germany, France, and England, United States and
Canada. South Korea’s extremely well developed health
care systems based on national health insurance may
have increased its overall competitiveness both in price
and in cancer treatment strengthened by issuance of
visas for foreigners, hospital certication system and its
medical tourism convergence cluster project.9
The scope of medical tourism can cover surgical
procedures as well as rehabilitation of stroke patients
along with the treatment and management of speech,
hearing, communication and swallowing disorders, the
availability of which is widespread in Pakistan.
Accreditation:
International accreditation: A number of international
accreditation organizations including Joint Commission
International (JCI) of USA are recognized and contacted
for accreditation in South Asia, Far and Middle East.4 The
JCI of United States accreditation demands compliance
to standards and bench marks with detailed inspection
be it a hospital, laboratory, research center and/or other
clinical care programs like dental implant clinic, mental
care center, ENT center, diabetes units, stroke center,
communicable diseases center or palliative care or an
academic medical center.10
Though owners of hospital setups consider
accreditation as a tool for marketing, the health
professionals look at these programs as demanding
and more bureaucratic with concerns regarding cost
of accreditation.11 Still, Joint Commission International
has accredited more than one thousand programs
in 70 plus nations in Asia, Middle East, Europe,
Africa, and Latin America.12 For accreditation, the
Pak J Med Sci December 2024 Vol. 40 No. 11 www.pjms.org.pk 2722
applicant organization has the option to apply to
JCI for accreditation of entire hospital or specify a
specic unit of hospital for accreditation. This follows
JCI inspection which includes evaluation of quality
of clinical services, safety of patient, assessment of
competence of clinical and administrative manpower,
assessment of quality of equipment and scrutiny of
policies and protocols and procedures being employed.
Further to maintain accreditation institutions may
face snap inspections. The hospitals may apply for
re-accreditation and comply and conform to latest
criteria.12 There are challenges to JCI accreditation
however accreditation positively impacts culture of
patient safety and accredited hospitals demonstrate
improved team working, communication as well as
involvement of patients in hospital care.13
E-Health Accreditation: E-Health is a neglected
multidisciplinary eld in Pakistan. Pakistan has a
population of around 230 million justifying E-health as a
cost effect service which can support healthcare. During
the Covid-19 pandemic E-health usage was developed
to some extent especially for the rehabilitation services,
however its use almost relapsed back to pre-pandemic
period with dearth of access to such services in the far-
ung areas. There are ethical concerns in use of such
E-health data and the World Health Organization and
United Nations Educational Scientic and Cultural
Organization have given ethical guidelines for provision
of health information which has been made digitally
available for the public. The scope and coverage of E
health is useful for complementing rehabilitative services
like speech therapy to patients in far ung areas not easily
accessible and not having enough density of population
to justify physical presence of such clinical services.14 The
international medical tourists balance low cost of medical
treatment with high-quality medical service destination
wise – Digitization and international tele medicine as a
form of Medical Tourism is Recommended
Prots and JCI accreditation: Medical Tourism has
positive nancial impact on recipient economies and
growth.15 Medical tourism worldwide is estimated to
generate revenues in the range of 60-70 billion US dollars
and in spite of having reliable and competent medical
professionals and medical, rehabilitative and healthcare
services Pakistan is not grabbing any signicant
proportion of the revenue with the bulk going to India,
Malaysia, Thailand, Costa Rica, Turkey, Mexico etc.16 The
Indian sector alone is worth one billion US dollar
estimated by 2012.17
The need brought forward by medical tourism is
a stimulant for improving the quality of healthcare
measured against common health-quality metrics
Nazia Mumtaz et al.
Fig.1: PRISMA ow diagram.
Pak J Med Sci December 2024 Vol. 40 No. 11 www.pjms.org.pk 2723
worldwide considering factors of accessibility and
risks of acquiring post-operative infection. Pakistan
can have a slice of the pie and enter the sector of
medical tourism but it would need to have more of its
institutes as JCI accredited. A medical tourist is not
alone and accompanied usually by his family members
and in case of minor procedures social tourism is an
additional agenda.18
Extent and scope of medical tourism: The economic
aspect of medical tourism cannot be ignored. More
revenues require more research in the medical and public
health domain. Advancement in medical technology
and machines leads to faster and accurate diagnosis and
improved treatment. The increase in air travel over the
last few decades has increased the patient and healthcare
professionals ow across international borders with
changing patterns of medical tourism, however this
can also result in risks for patients.19,20 Medical tourism
patterns are changing with improving technologies and
skills in different countries with a number of Asian states
becoming dominant and others entering the market.21
According to Lunt et al. & Carrera et al, in Medical
Tourism the patient as a medical trade consumer
conscientiously and by his will opts to travel for medical
treatment across borders. Most popular treatments
availed include cosmetic and dental surgical procedures
and treatment for fertility as well as better quality
transplant and elective surgical option with cost being an
important deciding factor. On account of standardization
of procedures and JCI accreditation patients from
wealthier and advanced nations prefer obtaining
treatment in less developed countries at signicantly
reduced expenditures.22
Lack of evidence around medical tourism: Despite a
number of media hypes, evidence on the role and impact
of medical tourism for which Organization for Economic
Cooperation and Development (OECD) countries work
together for the promotion of sustainable economic
growth and development is not abundantly available.
The evidence available to date with OECD academic
institutes suggest that medical tourism includes a range
of attendant risks and opportunities for patients and
highlights the degree of involvement of a mushrooming
industry of intermediaries and ancillary services.23
Caution needs to be exercised in Medical Tourism
treatment processes since quality of care and risks
involved may have implications for this trade and services
in the country of origin as well. This requires monitoring
and research to determine efcacy of such travel for
medical needs, regulatory issues and standardization of
medical facilities in host states before considering and
promoting medical tourism to such countries.24 Authentic
data on the scope and success of such tourism is lacking
in reliability and epidemiological data shows statistics of
60-70 billion US dollars generated due to medical tourism
in the year 2015 alone.25
Risks of medical tourism: The basic compulsion of medical
tourists is low costs in recipient countries like India to get
management for a condition or simply get a procedure
in recipient country at low cost. These procedures may
at times be risky, may be new innovations, or even
procedures like traditional Indian healing or yoga for a
condition requiring standard medical regimen.26,27
To obtain cheap and convenient treatment medical
tourists at times overlook the risks involved in
acquisition of treatment like infections as the surgical
interventions they may receive from recipient countries
may vary and tourists may be at risk with varying
immunity level against infections of wounds, blood
born infections, donor related infections and diseases
like hepatitis and AIDs. Similarly, the elements
of licensure maintenance, credentialing as well as
accreditation may have been marked at variance
compared to that need in the United States, even if it
doesn’t negatively impact patient care. Also, there is
risk of immediate travel following invasive surgical
procedures with complications like intravascular
coagulation and thrombosis which can take place hence
post op follow up may be difcult in another country.28
From an academic and industry perspective medical
tourism is a eld which has not been extensively
researched. Medical tourism has to be accompanied with
leisurely and comfortable tourism to attract international
patients. The Asian nancial crisis of 2008 drastically
reduced the paying capacity of Asians to obtain private
healthcare compelling private medical institutions to shift
their marketing practices towards international patients
in order to generate revenue. The respective governments
also supported these actions on the premise of generating
valuable foreign exchange. Presently 28 countries are
competing worldwide or perhaps on a regional grid for
the medical tourism business.29 Developing countries
which are engaged in facilitating medical tourism present
a combination of regulation and policies to support the
industry. However, there is an ugly side as well including
illegal services like organ sales and services which are
deemed illegal in the patient’s own country but legal in
the recipient country like stem cell therapies etc.30
JCI supports medical tourism: Joint Commission
International has been instrumental in global
improvement in quality and safety in health care for
the last few decades and is striving for improving such
services through education, advisory service, provision
of solutions online and providing accreditation and
certication. The JCI accreditation provides comfort
and assures the tourist that their destination country
like India, Thailand, Turkey, United Arab Emirates
etc., have the necessary level of accreditation which is
advantageous for the tourist. Hence, all such hospitals in
destination countries try to obtain JCI accreditation since
their aim is to gain revenues by attracting tourists and
retaining highly trained manpower.31,32
In Pakistan four hospitals are JCI accredited
namely Agha Khan University Hospital Karachi,
Shifa International Hospitals Ltd. Islamabad, Shaukat
Khanum Memorial Cancer Hospital and Research
Centre Lahore and Shaukat Khanum Memorial Cancer
Hospital and Research Centre Peshawar. Pakistan, the
Nazia Mumtaz et al.
Pak J Med Sci December 2024 Vol. 40 No. 11 www.pjms.org.pk 2724
sixth populous country in the world, has no public
sector hospital or medical center or research center
with JCI recognition.31 Worldwide and especially
in tourism hubs the JCI hospitals and institutes and
centers include Indonesia 30, Malaysia 16, Singapore 8,
Japan 30, Turkey 46, Pakistan 7, Saudi Arabia 111, Qatar
22, Oman 7, UAE 212, China 46 and Bangladesh with
two. India’s health policy makers have in a concerted
manner supported in rapidly acquiring a status of
“Preferred Healthcare Destination” and healthcare
centers, laboratories and hospitals are attempting to
acquire the ‘Gold Seal of Approval’ from JCI.31
Rehabilitation and brain drain: A study by Kirigia JM
et al. in 2006 revealed that the cost incurred to produce
a medical graduate from primary onwards is of an
amount of 65,997 US dollars and if the doctor leaves the
country approximately 517,931 US dollars of return on
the initial investment goes down the drain. Similarly,
for any nurse that emigrates to a developed country
the return on the initial investment is in the range of
338,868 dollars which is indirectly nanced by every
citizen of the developing country. Such estimates of
nancial losses do not capture invisible costs (interests
on bank loans) of medical education.33
As developed countries continue to plunder scarce
medical and health human resource of countries such
as Pakistan and carry out poaching at will the mindset
that has developed and become entrenched in the minds
of leading healthcare experts is that centers of medical,
health and academic excellence cannot be established in
Pakistan. The same experts extol the virtues of conducting
research on the huge populace and unethically sharing
with academia in the developed nations. National
pride has taken a backseat it seems amongst medical
professionals and they are content to play second ddle
internationally being shamefaced of the academic
institutes of which they are graduates.
Pakistan, though a developing country, has an
increasing pool of rehabilitation professionals essentially
including speech language pathologists (SLPs) at
bachelors and masters (Rehabilitation Sciences) level and
institutes. The role of these SLPs as health professionals
is vital in identication, treatment and management
of the paediatric and geriatric population, speech and
language and communication disorders and feeding and
swallowing disorders.34 The situation is better than in
India where the brain drain is almost 48 % for SLP and
hearing sciences post graduates.35
Sending patients home from acute medicine or
emergency departments without rehabilitation causes
them to suffer as a result they often end up dying from
complications. Such a callous approach underscores the
need to retain rehabilitation professionals and adopting
these rehabilitative practices is an integral component of
excellence in medical tourism to inspire condence and
trust in the system. In short, the brain drain has done
more damage to health care systems in the developing
countries than the benet.36
The JCI accreditation for rehabilitation centres
of academic learning and training and also clinical
centres would boost national and international health
tourism as well open opportunities for SLPs. Another
significant advantage of international accreditation is
that brain drain is considerably reduced as revenues
start pouring into the medical and health sector
which creates the fiscal space for procuring advanced
medical instruments and machinery which will
improve the quality of healthcare services. Tele health
can be strengthened if international accreditation is
achieved and the scope and extent of E health can be
national or international. The patient or the “medical
tourist” will make a beeline for a medical tourism hub
if the language and culture is similar to his and he has
beforehand checked and verified the credentials of the
hospital where he intends to be treated. The health
authorities in Pakistan have failed to make Pakistan
attractive for medical tourism therefore the private
hospitals in Pakistan and the medical and health
professionals have to take up the cudgels to make
Pakistan relevant in the international environment.
Prior to seeking international accreditation research
should be carried out to gauge the regional and
national potential and ability of healthcare services
to respond to an influx of visitors immediately after
international accreditation is achieved. Crooks et al.6,
have highlighted four issues catering to which may
improve medical tourism prospects including material
for promotion of such tourism which may also
highlight advances in technologies. Developing states
have to prove safe and current facilities and avoidance
of claims of cost saving and low cost of treatment
etc. may give a hidden message of poor quality. For
Pakistan it is essential that government get involved to
cater to the macroeconomic needs of medical tourism,
facilitating foreigners as well as private sector
including hospitals to meet the microeconomic needs
including upgradation of hospitals.37
Limitations: Dearth of local literature on the subject was
a limitation.
CONCLUSION
It is dismal to note that the healthcare system in
Pakistan is not geared towards national and international
medical tourism compelling medical and healthcare
professionals to move abroad. Patient care quality may
not reach the desired level as few healthcare institutions
possess international accreditation. To promote medical
tourism private sector hospitals, health and medical
and rehabilitation professionals will have to take the
lead and awareness campaigns need to be aggressively
launched. Initial capital investments would pay off in
the medium term and the trickle of medical tourists
can be substantially increased. To substantially
increase medical tourism in Pakistan, legislation is
not required and perhaps not even major executive
decisions and the private sector can pull it off. Pakistani
Pak J Med Sci December 2024 Vol. 40 No. 11 www.pjms.org.pk 2725
healthcare professionals may ock back once sufcient
internationally accredited hospitals and centers are
established providing medical tourists the comfort that
international safety standards for patients are complied
and quality care is available at comparable costs.
Acknowledgement: ChatGPT was only partially used in
the study.
Conict of interest: None.
Grant support & nancial disclosures: None.
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Authors Contribution:
NM: Conception, literature review, writing of manuscript
& critical revision of article.
GS: Methodology & responsible for the integrity of
research and publication of the article.
Nazia Mumtaz et al.
