Published on November 23, 2009
Summary Overview of Medical Tourism for eHealth Defining medical tourism Several organisations and individuals have tried to identify formally the term ‘medical tourism’. The conditions of the emergence of the defining principles of the term means that medical tourism has been used to classify the range and scope of its application from commercially led organisations, to the media as well as more official Government agencies including the NHS. What is important to note is that there is no standard or representative definition of the term – Generally this is viewed as ‘something’ to do with treatment abroad and it currently holds a very broad and open definition. The ‘tourism’ tag implies something casual or otherwise outside conventional health seeking behaviour. Review of web‐based resources There is a striking range in the quality and usability of the web‐based resources available to visitors of medical tourism websites and services. The consultation of one source was unlikely to be an effective repository of reliable health related information. In particular, the commercial marketing of sites was often emphasised over the publication of easy access literature and services. This indicates an implied active role for the visitor who directs their own selection of information as an effective and efficient way of extracting knowledge and services. The range in the quality of information is widespread. Some sites have a poor level of usability and navigation, particularly when they represent organisations that are finance‐led – e.g. offering financial services including health insurance and brokerage deals as an addition to medical services. For the UK, the NHS website for information about medical tourism is limited in its publication and access to professional resources. The information and functionality was based on key public health issues rather than advice on reliable sources of knowledge or validated services for patients. The least useful sites have ‘dead’ links, making them hardest to navigate and give out confusing or poor quality information. For example the site medibroker.com rather than promoting health or medical information exhibits poor web‐design with confusing array of links, and display of information. Much of the site is given over to the promotion of advertising space. 2
Table 1. Overview of the functions of medical tourism web portals Information Connectivity Exchange Commerce Care Search and Can include Peer‐to‐peer Based on Emphasis on retrieve of official sources information consumer ‘self‐care’ with information/data such as clinical sites e.g. behaviour and little and public newsgroups ‘online’ coordination health systems and message purchasing for with official Offer a range of boards treatment medical health resources treatment Most likely to centres or be Web‐based Most likely to The individual organisations Pro‐active user: and search include sign‐up is seen (and ‘back home’ Based on engine led e.g. to newsletters treated as) as informed decision Google and registration ‘consumer’, making to commercial rather than a Unlikely to be sites ‘patient’. In this exchange or Limited health way they are sharing of service and ‘pro‐active’ health records system both in terms integration with of profile and more sourcing of Little ‘shared’ commercial information clinical decision organisations making or treatment management – particularly for ‘after‐care’ following patients return back home Some key points Medical tourism refers to the recent new EU Cross‐border Health Directive that has meant since 2007 restrictions have been lifted on patients who want to travel for treatment to other EU countries. In the UK this means that patients are able to reclaim from the NHS for the cost of ‘essential treatment’ and will ‘only have to pay their travel and accommodation costs, plus any top‐up fees if charges in the foreign hospitals are higher than the NHS cost’ (European Health & Medical Tourism Association EHMTA, 2007). Medical tourism also has a more commercial and consumer‐led meaning that refers to the rise in travel agencies and medical services that offer medical treatment (usually for cosmetic procedures) abroad. Such services are typically elective and concerned with cosmetic, dentistry and IVF treatment. Factors that have contributed to the rise in medical travel include the high cost of health care, the range of health care services, waiting times for procedures, improvements in the standard of care in other countries, outbreak of ‘super bug’s’ such as MRSA in the UK as well as the relative ease and affordability of travel within the EU. In addition, the ‘hotel service’ aspect of medical care can be a factor in that private rooms, high patient staff ratios and so forth are possible in 3
facilities that are located in countries where wages bills and so forth are considerably lower than in the UK. Legislation underwrites the EU market (which is not the least costly compared to e.g. India) because medical qualifications are recognised across some EU States. Caution is need here (and further research) in that the situation is complex and while UK qualifications may be well recognised the same is not true of for example Polish. The implication is that while marketing hype might seek to paint a different picture to consumers the qualifications of staff, health regulations etc will be different form the UK. In other words consumers may be exposed to risks that they would not have been in the UK. A call for research Statistics for medical tourism are restricted and generally limited to the United States. A report by Deloitte Consulting published in 2008, projected that 750, 000 Americans went abroad for health‐care in 2007. The same report speculates that medical tourism could increase ten‐fold in the next decade (Johnson, 2008). At present there is little research in this area. In addition, the range of web related ‘health investors’ – including ‘lay’ or public users as well as those from the commercial and professional sectors – is increasing exponentially. The latest buzzwords ‘health 2.0’, ‘ehealth’, ‘webhealth’ emphasise the change in the relationship from what has been the traditional top‐down, professional and patient care, to bottom‐up, pro‐active patients and health information that may, or may not, be related to professional bodies or individuals. References Bishop R, Litch JA. (2000) Medical tourism can do harm, BMJ Apr 8;320(7240):1017. Chambers, D., McIntosh, B. (2008) Using authenticity to achieve competitive advantage in medical tourism in the English‐speaking Caribbean, Third World Quarterly 29 (5), pp. 919‐937. Chen, J.S., Prebensen, N., Huan, T.C. (2008) Determining the motivation of wellness travellers, Anatolia 19 (1), pp. 103‐115. Chinai, R. & Goswami, R. (2007) Medical visas mark growth of Indian medical tourism. Bull World Health Organ, v. 85, n. 3 [cited 2008‐12‐08], pp. 164‐165. Connell J. (2006) Medical tourism: Sea, sun, sand and ... surgery, Tourism Management, 27 (6), pp. 1093‐1100. Johnson, L.A. ‘Americans look abroad to save on health care: Medical tourism could jump tenfold in next decade’, The San Francisco Chronicle, 3 August. Jones CA, Keith LG. (2006) Medical tourism and reproductive outsourcing: the dawning of a new paradigm for healthcare, Int J Fertil Womens Med. Nov‐Dec; 51(6):251‐5. Turner, L. (2008) 'Medical tourism' initiatives should exclude commercial organ transplantation, Journal of the Royal Society of Medicine 101 (8), pp. 391‐394. 4
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