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Why Patients Are Turning to Medical Tourism

Statistics, Benefits, and Risks

Planning Ahead

Frequently asked questions.

Medical tourism is a term that refers to traveling to another country to get a medical or dental procedure. In some instances, medical tourists travel abroad seeking alternative treatments that are not approved in the United States.

Medical tourism is successful for millions of people each year, and it is on the rise for a variety of reasons, including increasing healthcare costs in the United States, lack of health insurance, specialist-driven procedures, high-quality facilities, and the opportunity to travel before or after a medical procedure.

According to a New York Times article from January 2021, pent-up demand for nonessential surgeries, as well as the fact that many Americans lost their health insurance during the coronavirus pandemic led to a surge in medical tourism once other countries re-opened.

However, there are specific risks that come with traveling overseas for surgery. If you're thinking of pursuing a medical procedure in another country, here's what to know about the benefits and the risks.

Medical Tourism Benefits

The most common procedures Americans go abroad for include dental care, cosmetic procedures , fertility treatments, organ transplants , and cancer treatment.

This is not to be confused with having an unplanned procedure in a foreign country due to an unexpected illness or injury.

Among the reasons a person might choose to go abroad for a medical procedure are:

Lower Costs

Medical tourists can save anywhere from 25% to 90% in medical bills, depending on the procedure they get and the country they travel to. There are several factors that play into this:

• The cost of diagnostic testing and medications is particularly expensive in the United States.
• The cost of pre- and post-procedure labor is often dramatically lower overseas. This includes labor costs for nurses , aides, surgeons , pharmacists, physical therapists , and more.
• High cost of malpractice insurance—the insurance that protects medical professionals against lawsuits—in the United States.
• Hospital stays cost far less in many overseas countries compared to the United States. In other words, quality care, hospital meals, and rehabilitation are far more affordable abroad for many people.

For someone who doesn't have insurance , or someone having a procedure that is not covered by insurance , the difference can be enormous.

Popular Countries for Medical Tourism

Dominican Republic

South Korea

Culture and Language

Many immigrants prefer to have treatments and procedures done in their country of origin—a sensible decision, considering just how much language barriers alone can affect the quality of their care.

Furthermore, at least 25% of immigrants and noncitizen residents in the United States are uninsured, compared to 9% of American citizens. Children with at least one noncitizen parent are also more likely to be uninsured.

Practicalities aside, many people choose to have their procedure done in their country of origin simply because it allows them to be close to family, friends, and caretakers who can assist them through their recovery .

Insurance Incentives

Some insurance companies have started promoting medical tourism. The reason behind this is simple: savings for the insured means savings for the insurance provider and vice versa.

Several insurance providers, including Aetna have programs specifically geared at promoting safe medical tourism. Some insurance providers even offer financial incentives for medical tourism, like discounts on medical bills .

That said, many insurance companies will not pay for surgery performed outside of the country unless it is an emergency.

Luxury and Privacy

Medical tourism is a lucrative business for many countries, and much of the money brought in by medical tourists is reinvested into the local economy and health infrastructure.

The effect of this is apparent in the spa-like luxury that some foreign hospitals offer, providing medical tourists the opportunity to be pampered during their stay for a fraction of the cost they would pay at home.

Some facilities offer hospital rooms that are more like a hotel suite than a traditional hospital room. Other hospitals offer one-on-one private nursing care, which is far more generous and attentive than the staffing ratios that most hospitals allow.

Medical tourists who seek that added layer of privacy can find it abroad. Many can return home from their "vacation" without anyone knowing they had a procedure at all.

Vacation in a Foreign Country

Medical tourists often take advantage of their stay in a foreign country to travel for pleasure by scheduling a vacation before or after their procedure.

This is an especially inexpensive way to travel to a foreign country, especially if their insurance provider is paying for the flight and the cost of staying is low. 

While it seems logical to recover on a beach or in a chalet by the mountains, keep in mind that it's important not to jeopardize your recovery.

Swimming isn't recommended until your incisions are completely closed. You may not feel up to doing much more than napping in the days following your procedure, either.

Don't let your vacation disrupt your recovery. Any time you have a procedure done, especially a surgery, it's important to listen to your body, take your medications as directed, and follow your doctor's recommendations closely.

Bypassing Rules and Regulations

Some travelers seek surgery abroad to bypass rules that are set in place by their own government, insurance company , or hospital. These rules are typically in place to protect the patient from harm, so getting around them isn't always the best idea.

For example, a patient may be told that their weight is too low to qualify for weight loss surgery . A surgeon in a foreign country may have a different standard for who qualifies for weight loss surgery, so the patient may qualify overseas for the procedure they want.

Talented Surgeons

Surgeons in certain countries are known for their talent in a specific area of surgery. For example, Brazilian surgeons are often touted for their strong plastic surgery skills .

Whereas in the United States, insurance companies might only cover cosmetic procedures if it is medically necessary, cosmetic surgery is often free or low-cost in Brazil's public hospitals—giving cosmetic surgeons there ample practice.

Thailand is reported to be the primary medical tourism destination for individuals seeking gender reassignment . It is often easier to qualify for surgery and the cost is significantly reduced. Surgeons are performing the procedures frequently, and as a result, many have become quite specialized in them.

It is often surprising to many medical tourists that their physician was trained in the United States. Not all physicians are, of course, but a surprisingly high percentage of them working in surgery abroad are trained in English-speaking medical schools and residency programs and then return to their home country. These physicians often speak multiple languages and may be board certified in their home country and a foreign country, such as the United States.

Medical tourism isn’t limited to countries outside of the United States, either. Many people travel to the United States for medical care due to the country's cutting-edge technology, prescription medication supply, and the general safety of healthcare.

Medical Tourism Risks

The financial and practical benefits of medical tourism are well known, and you may even know someone who had a great experience. Nonetheless, the downsides of medical tourism can be just as great if not greater. Sometimes, they can even be deadly.

If you are considering a trip abroad for your procedure, you should know that medical tourism isn't entirely without obstacle and risks. These include:

Poorly Trained Surgeons

In any country—the United States included—there will be good surgeons and bad. And just as there are great surgeons abroad, there are also some surgeons who are less talented, less trained, and less experienced.

Regardless of what procedure you are getting or where, you should always do some preliminary research into the surgeon or physician who will be treating you as well as the hospital you will be treated at.

In the United States, it is fairly easy to obtain information about malpractice lawsuits , sanctions by medical boards, and other disciplinary actions against a physician.

Performing this research from afar can be challenging, especially if you don't speak the local language. Yet countless people take the risk anyway, without knowing whether the physicians who will treat them are reputable.

A physician should be trained in the specific area of medicine that is appropriate for your procedure. For example, you should not be having plastic surgery from a surgeon who was trained to be a heart doctor. It isn’t good enough to be a physician, the physician must be trained in the specialty .

Prior to agreeing to surgery, you should also know your surgeon’s credentials : where they studied, where they trained, and in what specialty(s) they are board-certified. Do not rely on testimonials from previous patients; these are easily made up for a website and even if they are correct, one good surgery doesn’t mean they will all be successful.

Quality of Staff

Nurses are a very important part of healthcare, and the care they provide can mean the difference between a great outcome and a terrible one.

A well-trained nurse can identify a potential problem and fix it before it truly becomes an issue. A poorly trained nurse may not identify a problem until it is too late. The quality of the nursing staff will have a direct impact on your care.

Once again, it's important to research the hospital staff where you will be having your procedure done. Read the reviews but don't trust them blindly. If you can, seek out a recommendation from someone who can vouch for the medical staff where you will be going.

Quality of the Facility

While researching healthcare facilities for your procedure, you want to learn not just about the quality of the facilities themselves, but about the country's healthcare system as a whole.

In some countries, there is a marked distinction between public hospitals and private hospitals. In Turkey, for example, private hospitals are considered on-par with hospitals in the states, while many locals will advise you to steer clear of public hospitals if you can.

You will also want to seek out facilities that are internationally accredited. In the United States, the Joint Commission evaluates hospitals and certifies those that provide safe, quality care. The international division does the same for hospitals outside the United States.

Once you have a few options for potential facilities, you can start to investigate specifics. For one, you should find as many pictures and reviews of the facility as you can. Ask yourself whether the facility is state of the art or whether it seems dirty and outdated.

You will also need to find out if the facility has ICU level care available, in case something goes wrong. If not, there should be a major hospital nearby so that you can be transferred quickly.

To learn more about a healthcare facility, consider joining expat groups on social media for the city or country you will be traveling to. Ask the group for recommendations, or inquire about any positive or negative experiences they may have had at a particular facility.

Flying Home After Surgery

Any surgery comes with risks, including infection and blood clots . Flying home increases the risk of blood clots, especially on long-haul flights that are longer than four hours.

Try to avoid flying home in the days immediately after surgery; waiting a week will decrease the chances of developing a blood clot or another serious complication during the flight.

For longer flights, plan on getting up and walking up and down the aisles each hour to improve blood flow in your legs. You might also benefit from wearing compression socks with your doctor's approval.

If you are taking blood thinners or are at-risk of blood clots , be sure to talk to your doctor about how you can reduce your risk of blood clots after your procedure and while traveling.

Furthermore, you should know the symptoms of blood clots and stay alert.

Unplanned Illness

Any time you travel abroad, you run the risk of catching an illness that you have never been exposed to or that your body is not prepared to fight off. This is especially a concern when spending time in a foreign hospital.

If you have a sensitive stomach, you may also want to think long and hard about having surgery abroad. The food is often very different in foreign hospitals, and in some areas, there is a risk that even the water will be upsetting to your body.

Having diarrhea or postoperative nausea and vomiting makes for a miserable recovery experience, especially if you do not have a friend or family member nearby who can help you through it.

Before you travel abroad, check with your doctor to see if you need any vaccines to travel to your destination or if there are any foreign illnesses you should be aware of. Picking up an illness abroad, particularly after your surgery, can potentially be life-threatening.

Language Barriers

If you are having surgery in a country where English is not the primary language, you will need to make preparations in order to be able to communicate with the staff.

You may be pleasantly surprised to learn that the staff speaks your primary language well. If not, then you will need to consider how you will make your wishes and needs known to the surgeon, the staff, and others you will meet.

Whether you are at home or abroad, remember to speak up and advocate for yourself to make sure your needs are met. If you don't speak the local language, download a language translation app on your smartphone and don't hesitate to use it to communicate your needs. Hiring a translator is another option.

A Word About Transplant Tourism

Transplant tourism is one area of medical tourism that is strongly discouraged by organ and tissue transplant professionals in multiple countries. Most international transplants are considered “black market” surgeries that are not only poor in quality, but ethically and morally wrong.

China, for example, the country that is believed to perform more international kidney transplants than any other country, is widely believed to take organs from political prisoners after their execution.

In India, living donors are often promised large sums of money for their kidney donation, only to find out they have been scammed and never receive payment. Selling an organ in India is illegal, as it is in most areas of the world, so there is little recourse for the donor.

Then there is the final outcome: how well the organ works after the surgery is complete. With black market transplants, less care is often taken with matching the donor and recipient, which leads to high levels of rejection and a greater risk of death. Furthermore, the new organ may not have been screened for diseases such as cytomegalovirus , tuberculosis , hepatitis B , and hepatitis C . It is often the new disease that leads to death, rather than the organ rejection itself.

Finally, transplant surgeons are often reluctant to care for a patient who intentionally circumvented the donor process in the United States and received their transplant from an unknown physician.

It is important to arrange your follow-up care prior to leaving your home country.

Many physicians and surgeons are hesitant to take care of a patient who received care outside the country, as they are often unfamiliar with medical tourism and have concerns about the quality of care overseas.

Arranging for follow-up care before you leave will make it easier to transition to care at home without the stress of trying to find a physician after surgery .

Just be sure to inform your follow-up care physician where you are having your procedure done. After you return, they will also want to know what prescription medications you were given, if any.

What are popular countries for medical tourism? 

Mexico, India, Costa Rica, Turkey, Singapore, Canada, and Thailand are among the many countries that are popular for medical tourism.

How safe is medical tourism?

Medical tourism is generally considered safe, but it's critical to research the quality of care, physician training, and surgical specialties of each country. There are several medical tourism organizations that specialize in evaluating popular destinations for this purpose.

What countries have free healthcare? 

Countries with free healthcare include England, Canada, Thailand, Mexico, India, Sweden, South Korea, Israel, and many others.

A Word From Verywell

If you are considering medical tourism, discuss the risks and benefits with your doctor, and consider working with your insurance provider to arrange a trip that balances financial savings with safety. (Also, before you embark on a trip overseas for your procedure, make sure you are financially prepared for unexpected events and emergencies. Don't go abroad if you don't have enough money to get yourself home in a crisis.)

A medical tourism organization such as Patients Without Borders can help you evaluate the quality and trustworthiness of healthcare in various countries. Making sure a high level of care is readily available will lead to a safer, more relaxing experience.

Centers For Disease Control and Prevention. Medical Tourism: Getting medical care in another country . Updated October 23, 2017.

University of the Incarnate Word. Center for Medical Tourism Research .

Patients Beyond Borders. Facts and figures .

Kaiser Family Foundation. Health coverage of immigrants . Published July 2021.

Paul DP 3rd, Barker T, Watts AL, Messinger A, Coustasse A. Insurance companies adapting to trends by adopting medical tourism . Health Care Manag (Frederick). 2017 Oct/Dec;36(4):326-333. doi: 10.1097/HCM.0000000000000179

Batista BN. State of plastic surgery in Brazil .  Plast Reconstr Surg Glob Open . 2017 Dec;5(12):1627. doi:10.1097/GOX.0000000000001627

Johns Hopkins Bloomberg School of Public Health - Global Health Now. Brazilians' risky right to beauty . Published May 2018.

Chokrungvaranont P, Selvaggi G, Jindarak S, et al. The development of sex reassignment surgery in Thailand: a social perspective .  Sci World J . 2014 Mar;2014(1):1-5. doi:10.1155/2014/182981

The Joint Commission. For consumers .

Centers for Disease Control and Prevention. Blood clots and travel: what you need to know . Reviewed February 2021.

Hurley R. China harvested organs from political prisoners on substantial scale, says tribunal . BMJ . 2018 Dec;363(1):5250. doi:10.1136/bmj.k5250

Ambagtsheer F, Van Balen L. I'm not Sherlock Holmes: suspicions, secrecy, and silence of transplant professionals in the human organ trade . Euro J Criminol . 2019 Jan;17(6):764-783. doi:10.1177/1477370818825331

Centers for Disease Control and Prevention. Transplant Surgery. Key facts . Reviewed January 2019.

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

What is health tourism and why is it growing?

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Health tourism is a growing trend around the world. But what is health tourism and why is it so popular? Read on to find out…

What is health tourism?

The growth of health tourism, why is health tourism important, health tourism activities, health tourism- further reading.

Health tourism is a tricky one to define. It is more of an umbrella term, encompassing both wellness tourism and medical tourism. These two types of tourism may seem quite different, but they both fundamentally have health at their core. So, health tourism can be defined as follows:

Health tourism covers those types of tourism which have as a primary motivation, the contribution to physical, mental and/or spiritual health through medical and wellness-based activities which increase the capacity of individuals to satisfy their own needs and function better as individuals in their environment and society.

This definition comes from an executive summary published by the World Tourism Organization and the European Travel Commission in 2018. As you can see, the exploration of health tourism in itself is a relatively new idea. The two organisations also provided the following definitions of wellness and medical tourism respectively:

Wellness tourism is a type of tourism activity which aims to improve and balance all of the main domains of human life including physical, mental, emotional, occupational, intellectual and spiritual. The primary motivation for the wellness tourist is to engage in preventive, proactive, lifestyle enhancing activities such as fitness, healthy eating, relaxation, pampering and healing treatments.       

Medical tourism is a type of tourism activity which involves the use of evidence-based medical healing resources and services (both invasive and non-invasive). This may include diagnosis, treatment, cure, prevention and rehabilitation.   

There are many reasons as to why health tourism as an industry is growing. People are keener than ever to put their health and wellbeing first – especially now we are 2 years into a global pandemic. As a population , we are more aware now than ever before how our health can hang in the balance. And just knowing this, coupled with all of the other changes brought about by the pandemic as well as the general ease of accessing information, mean that life is generally more stressful. So it is no wonder that we are looking for wellness trips to calm and soothe ourselves – and to affordable and accessible medical procedures that may be unavailable at home…

The UK sees health tourism as a distinct and negative phenomenon. The media uses the term to refer to people who travel to the UK deliberately in order to access free medical treatment from the National Health Service. This is seen as leeching off the state, and as you can imagine is particularly frowned upon by many in the country. However, reports show that the government estimates ‘health tourism’ costs the NHS only £300m annually – or 0.3% of their budget! But due to this, new laws are in place to charge people who do not ‘ordinarily reside’ in the UK if they use the NHS.

Health tourism is important for many reasons. Looking at it from an economical point of view, it provides a boost to local economies when people travel to a destination for any reason. So heading to a summer yoga retreat in Santorini or getting some dental work done in Turkey is contributing to the local economy. And it’s not just the cost of your treatment or stay – you will also purchase food and drink, maybe even souvenirs. You might extend your trip and do some sightseeing with local tour companies too. All of these things mean a cash injection for the area and its inhabitants.

Linked to this is that health tourism often provides a cheaper opportunity to do something you were going to do at home. Travelling for optional surgery or going to a small spa in a remote village might be much cheaper than doing so in your home country. In this way, health tourism actually provides people with a way to save money.

Health tourism is also important as it is a reflection of my earlier point – people are taking more of an interest in their health. Regardless of whether it’s wellness tourism or medical tourism, health tourists are travelling with the primary focus of improving their mind, body or life in some way. This is obviously a positive factor for society.

As health tourism combines wellness and medical tourism, the activities it involves are anything which falls under these categories. Essentially, anything you do as a tourist which is aimed at improving your health is classed as health tourism. See a list of activities below:

• Dental/dentistry
• Orthopedics
• Cosmetic/plastic surgery
• Bariatric surgery 
• Fertility treatment
• Eye surgery
• Ears, nose and throat
• Organ transplants
• Rehabilitation
• Alternative medication access
• Yoga retreats
• Writing retreats
• Meditation centres
• Weight loss or healthy eating retreats
• Sensory deprivation

Popular health tourism destinations

There are many destinations you can visit as a health tourist. Your home country may also be a health tourism location for people from other countries. It is all contextual and subjective, depending on what exactly you are looking to get out of your trip…

This is a popular place for health tourism – particularly when it comes to wellness. With its geothermal pools, breathtaking scenery, infinity pools and mountain hiking areas the options are endless! A very popular part of Iceland for wellness activities is Myvatn Nature Baths, where the alkaline in the water has a lot of minerals and is incredibly beneficial for the treatment of skin conditions. Because of this, it can also be seen as a destination which works for medical purposes – making it a dead cert for health tourism.

Ever heard of the saying ‘Turkey teeth’? It doesn’t come from nowhere! The reason this term exists is because many people (particularly younger people, celebrities, and influencers) flock to Turkey to have dental treatment done for cosmetic purposes. They want straighter, whiter and brighter teeth. Something like this might cost double or triple in the UK, for example, than what it would in Turkey. Plus, visitors get to combine their trip with sun, sea and sand!

India is a big one for health tourism as it has a big wellness tourism industry combined with many options for medical tourists to have cheaper procedures done. Being such a spiritual country, it is no wonder that people come here for wellness purposes. The Indian government readily promotes the country as a hub for yoga, Sidha, naturopathy and Ayurveda – citing the ‘spiritual philosophy that has been integral to the Indian way of life’. There are retreats right across the country, particularly in countryside areas but also in the bustling cities which mean it works for both primary AND secondary wellness tourism.

Primary wellness tourism is when someone’s whole trip is focused on wellness; it is their sole reason for travel, and the major component of their trip. Every aspect of their holiday is tailored to wellness. Secondary wellness tourism is when general tourists incorporate some aspect of wellness (a massage on the beach during an all-inclusive Mexican vacation) into their holiday.

India is also a huge destination when it comes to medical tourism. Locations such as Chennai, Maharashtra and Kerala are really popular for medical procedures, with costs being about one tenth of those in either the UK or the USA. Medical tourists travel to India for alternative medicine, cardiac procedures, bone-marrow transplants, eye surgery and hip replacements in particular.

Beautiful Hawaii is like one big spa in itself. Primary wellness tourists visit here in droves to experience the therapeutic salt water, the laid back atmosphere, the glorious sunshine and the traditional practices of omilomi massage and pohaku (hot stone treatment). With scenery that will leave you lost for words, it is one of the most relaxing places in the world which is why wellness tourism is so big here – and so, by extension, is health tourism.

This stunning country has cutting edge technology and beautiful spaces to relax – making it ideal for health tourism encompassing both wellness and medical tourism. People tend to head here for small elective surgeries, choosing to get the procedure done for a lower price and recover somewhere beautiful! And there are so many options for wellness tourists, too. From Thai massage parlours to serene meditation retreats on beaches where the sunsets are bright pink and shiny gold, you couldn’t ask for somewhere more suited to a relaxing wellness trip.

If you enjoyed this article on health tourism, I am sure that you will like these too-

• What is birth tourism and is it legal?
• What is special interest tourism and why is it so popular?
• What is alternative tourism and why is it growing so fast?
• What is dental tourism and why does it exist?

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Why Medical Tourism Is Drawing Patients, Even in a Pandemic

The coronavirus pandemic has devastated medical tourism, but pent-up demand remains for affordable treatment in foreign lands.

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By Ceylan Yeginsu

On a cold February morning last year, as she lay curled up in a fetal position on her kitchen floor, Melissa Jackson called her manager at a New Jersey beauty salon to ask for some unpaid time off.

It was the sixth consecutive week that the 39-year-old beauty technician was unable to work full time because of the debilitating pain in her pelvis caused by endometriosis, a chronic condition triggered by the growth of uterine tissue outside of the uterus.

As her symptoms worsened, she started exploring options to get less costly medical care abroad.

In recent years, while still on her ex- husband’s health insurance policy, she had received hormonal treatments to ease the pain so she could go about her daily life. But since her divorce last year and the coronavirus restrictions placed on the beauty industry in March, those treatment costs have become prohibitive, especially with no insurance.

“There is no real cure for endometriosis, but if I want to free myself from this pain then I need to get a hysterectomy,” Ms. Jackson said, her voice shaking as she described the procedure to remove her uterus. “As if the surgery isn’t bad enough, I need to find 20,000 bucks to pay for it, which is just crazy so I’m going to have to find a way to go to Mexico.”

The coronavirus pandemic has pushed millions of Americans into poverty and stripped more than 5.4 million American workers of their health insurance, according to a study by the nonpartisan consumer advocacy group, Families USA. Many people like Ms. Jackson have experienced a significant deterioration in their health because they have delayed medical procedures. The fear of large medical bills has outweighed fear of contagion for some, giving rise to an increased number of patients seeking medical treatment in a foreign country.

“We are seeing a pent-up demand for medical tourism during the pandemic, particularly in the U.S. where a fast-growing number of Americans are traveling across the land border with Mexico for health purposes,” said David G. Vequist IV, the founder of the Center for Medical Tourism Research , a group based in San Antonio, Texas, and a professor at t he University of the Incarnate Word in San Antonio.

Even before the pandemic, millions of Americans traveled to other countries for savings of between 40 to 80 percent on medical treatments, according to the global medical tourism guide Patients Beyond Borders. Mexico and Costa Rica have become the most popular destinations for dental care, cosmetic surgery and prescription medicines while Thailand, India and South Korea draw in patients for more complex procedures including orthopedics, cardiovascular, cancer and fertility treatment.

In 2019, 1.1 percent of Americans traveling internationally did so for health treatments, according to the National Travel and Tourism Office , although that figure only accounts for those who traveled by air and does not include the thousands of travelers who crossed the United States-Mexico border. Definitive statistics on medical tourism are hard to come by because countries have different recording methods and definitions of the sector.

Medical tourism has been decimated by coronavirus restrictions, but, even so, the twin crises of the economy and the enormous strain that Covid-19 has placed on the already faulty American health care system are pushing many patients to travel. Demand for nonessential surgeries has also been building up after more than 177,000 scheduled surgeries were postponed in the United States between March and June in 2020, according to the Center for Medical Tourism Research.

“Our market has always been what I call the ‘working poor’ and they just keep getting poorer,” said Josef Woodman, the chief executive of Patients Beyond Borders. “The pandemic has gutted low-income and middle-class people around the world and for many of them the reality is that they have to travel to access affordable health care.”

In April, following the initial global lockdown to curb the spread of the coronavirus, medical travel bookings were down by more than 89 percent in the most popular destinations, including Mexico, Thailand, Turkey and South Korea, according to Medical Departures, a Bangkok-based medical travel agency. Since August, the numbers have slowly been rebounding, but bookings in Mexico, which has seen an uptick in American travelers in recent months, are still down by 32 percent compared to the same period of August to December in 2019.

“Covid-19 has devastated the whole medical tourism ecosystem because of all the uncertainty over travel restrictions and quarantine measures that keep changing across the world,” said Paul McTaggart, the founder of the agency.

“Despite this, we are still seeing a growing number of people traveling and booking trips to address their urgent health needs, especially between the U.S. and Mexico border where patients can travel safely by car,” Mr. McTaggart said. The Center for Medical Tourism Research found that Google searches in the United States for the terms “Mexico medical tourism” went up by 64 percent since July, compared to pre-pandemic levels before travel restrictions were imposed in March.

“Google searches are almost directly correlated with consumer behavior when it comes to travel across borders,” Mr. Vequist said.

Before the winter resurgence of the coronavirus, Ms. Jackson had started to plan and save for a trip to Mexicali, a border city in northern Mexico, where she can get a hysterectomy for $4,000, one-fifth the cost of the procedure offered in New Jersey. Her best friend had offered to drive her there and pay for the gas and accommodations.

“We wanted to make a vacation out of it and have some fun before the surgery because it’s such a heavy and dark thing with real consequences,” Ms. Jackson said. “At 39, I have to come to terms with the reality that I’ll never have kids. That’s even more painful than my condition.”

For now, Ms. Jackson has put the surgery on hold and will wait until the virus is brought under control. Her doctor had pointed to cheaper options for the operation in New Jersey, starting at $11,000 in a local outpatient facility. But Ms. Jackson is adamant about having it in the hospital and says the aftercare is more thorough in Mexico.

“Going for the cheaper option at home means getting lower quality care and taking a risk. That just isn’t the experience for people who do this in specialized hospitals in Mexico,” she said. “It’s cheap and safe.” (Many hospitals and clinics in Mexico and other countries have accreditation to ensure their standards are equivalent to medical facilities in the United States.)

In recent weeks, Ms. Jackson has had a flare up of symptoms, which is common when the condition goes untreated.

“I’m not sure if I will be able to wait for Covid to get better,” she said. “This thing cripples every part of my life.”

The land border with Mexico — closed to tourists — has remained open for essential travel, which includes all medical treatment, and a handful of Americans cross the border every day into Los Algodones (also known as Molar City ) to receive dental treatment or purchase pharmaceuticals.

“It’s just Americans over there getting dental care,” said Jeff Somerville, a Delta Air Lines flight attendant who visited the Supreme Dental Clinic in Los Algodones in September to get his crowns replaced. “You park on the U.S. side and just walk across. It’s easy and felt very safe.” He said the procedure would have cost around $25,000 in Tampa, Fla., close to where he lives in the city of Clearwater. In Mexico, he paid $7,000.

Now, Mr. Somerville, 47, is preparing to travel to Turkey in February for a hair and beard transplant, which will cost $3,000 and includes plasma treatments, medications, hotel lodging for three nights and a translator.

“I’m going to live my life, but I’m going to take my precautions while I do that,” he said. “I’m not going to sit at home and be scared.”

Turkey has remained open to tourists throughout the latest surge of the pandemic in Europe and only visitors from Britain are required to take a test as a precaution against a new, more transmissible variant of the virus. On weekends in Turkey a strict curfew is imposed on local residents to curb the spread of the virus, but foreign visitors are allowed to roam free without any restrictions. On Istanbul’s main Istiklal Avenue, men recovering from hair transplant procedures can easily be spotted with bandages around their heads.

“This is the best time to get surgery,” said Martin Wright, a British tourist, who had a hair transplant in Istanbul in December, before the new variant of the virus was identified in Britain. “Hotels are cheap, sites are empty and you get to have down time in a foreign city where you don’t have to explain to anyone why or how you got a hair transplant.”

Over the summer, when lockdown restrictions were eased across Europe, Britons traveled to the continent to receive medical treatment, after waiting lists for elective surgery on the National Health Service reached record levels. With British hospitals operating at reduced capacity to accommodate patients with Covid-19, hundreds of thousands of patients, who have been waiting for more than a year for non-urgent surgery, are facing further delays, N.H.S. figures show.

Cynthia Hedges, a 77-year-old retired nurse from Plymouth in southwest England, traveled to France in August for a knee replacement after waiting more than 19 months to get the procedure at her hospital.

“It just became hopeless, I could barely walk and was just living off pain medication, which is not good for my health,” she said in a telephone interview. “I know we can’t go far these days, but I became very depressed not even being able to walk to my garden. I know it was risky to travel at the time, but it was the best thing I did. It was worth it.”

Even as travel restrictions tighten, experts in the medical tourism industry see an opportunity as demand builds and health care becomes more inaccessible in people’s home countries.

“It doesn’t matter if you’re in Europe or the Americas,” said Mr. McTaggart of Medical Departures. “Financially challenged individuals will seek out and be more receptive to the idea that you can travel abroad and see substantial savings for medical treatment and get past the line.”

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An earlier version of this article gave an incorrect name for a global medical tourism guide. It is Patients Beyond Borders, not Patients Without Borders.

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Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

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Medical Tourism

The future of medical tourism: emerging trends and growth opportunities.

Medical tourism is a rapidly growing industry, with more and more patients seeking medical treatments and procedures in countries other than their own. This trend is expected to continue in the coming years, as the industry adapts to changing patient needs and preferences. In this article, we will explore the latest trends in medical tourism and the potential for future growth opportunities.

One of the main trends in medical tourism is the shift toward wellness and preventive care. Patients are no longer seeking treatment solely for an illness or condition, but also for procedures and treatments that will help them maintain their health and prevent future health issues. This trend is in line with a broader societal shift towards a focus on health and wellness and is expected to continue as more people become aware of the benefits of preventive care.

Another important trend in medical tourism is the increased use of technology. Telemedicine, for example, is becoming more widely used, allowing patients to consult with doctors remotely and reducing the need for travel. Virtual reality is also being used to help patients prepare for medical procedures and reduce anxiety. This technology not only enhances patient care but also improves the patient experience and can make medical tourism more accessible and appealing to a broader range of patients.

Personalized medicine is also an emerging trend in medical tourism. With advances in genetic testing and other diagnostic tools, patients can now receive treatment plans tailored to their individual needs and genetic makeup. This approach to medicine is expected to become increasingly popular in the future, as patients seek out more personalized and targeted treatments.

The growth of medical tourism is creating new opportunities for players in the industry. Travel agencies, for example, are now offering medical tourism packages, and more hospitals and clinics are catering specifically to medical tourists. This is creating a more competitive market, with more options and services available to patients.

However, despite the growth in medical tourism, there are also challenges that need to be addressed. Quality of care, patient safety, and ethical concerns are all issues that must be taken seriously in order to maintain the industry's growth and reputation. The industry must continue to focus on ensuring high-quality care and treatment for patients, while also addressing these challenges and maintaining patient safety and ethical standards.

In conclusion, the future of medical tourism looks promising, with new trends and growth opportunities emerging. As the industry continues to evolve, it will be important to address the challenges and ensure that patients receive high-quality care and treatment. By doing so, medical tourism will continue to grow and thrive, benefiting both patients and the industry as a whole.

To receive a free quote please click on the link: https://www.medicaltourism.com/get-a-quote

Patients are advised to seek hospitals that are accredited by Global Healthcare and only work with medical tourism facilitators who are certified by Global Healthcare Accreditation or who have undergone certification from the Certified Medical Travel Professionals (CMTP). This ensures that the highest standards in the industry are met. Click the link to check out hospitals accredited by the Global Healthcare Accreditation: https://www.globalhealthcareaccreditation.com/

It is recommended that consumers do not share their personal and confidential information on random medical tourism platforms as they may not be secure. Consumers must be cautious when disclosing their private information as some organizations may not protect their privacy and could misuse their information. Additionally, there are agencies that may prioritize their commissions over the well-being of the patients. Consumers should avoid choosing the cheapest price and instead make a thorough comparison across multiple facilitators to make an informed decision.

Exploring the Surge of Cosmetic Tourism: Trends and Considerations in Aesthetic Procedures Abroad

Holistic healing: exploring integrative medicine and wellness retreats, meeting the surge: the growing demand for knee replacement surgeries and advances in the field, innovations in medical technology: how cutting-edge technology drives medical tourism, stem cells have powerful anti-aging properties, new shift for thailand’s medical travel landscape as mta launches new moves, continue reading, best countries for stomach cancer treatment: a global perspective, ponderas academic hospital: elevating medical tourism with jci accreditation and personalized care, brno and south moravia - a hidden treasure of central europe, featured reading, dominican republic’s giant strides to becoming a global leader in medical tourism, exploring niche markets in medical tourism, medical tourism magazine.

The Medical Tourism Magazine (MTM), known as the “voice” of the medical tourism industry, provides members and key industry experts with the opportunity to share important developments, initiatives, themes, topics and trends that make the medical tourism industry the booming market it is today.

UN Tourism | Bringing the world closer

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• Exploring Health Tourism

The ETC/UNWTO publication on Exploring Health Tourism aims to provide a better understanding of the growing segment of wellness and medical tourism. The study introduces the evolution of health-related tourism products and services from all around the world and provides insights into the current situation of the industry, as well as the future potential. It also includes a comprehensive taxonomy that serves as a common reference for tourism destinations operating in this field, as well as a practical toolkit to assist NTOs and DMOs with their planning and management of health-related tourism activities.

Click here   for the Executive Summary of this publication.

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Tourism and Health: Understanding the Relationship

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Health Tourism: Exploring the Industry, Types, and Top Destinations

April 23, 2023.

Health tourism, also referred to as medical tourism or wellness tourism, is a rapidly growing sector within the global tourism industry. It encompasses a diverse range of activities and services, all aimed at improving or maintaining an individual's health and well-being. This article presents an overview of the health tourism industry, discusses different types of health tourism, examines the top 100 destinations, and provides insights into the number of travelers engaging in health tourism. ‍

Definition of Health Tourism

Health tourism is broadly defined as the practice of individuals traveling outside their country of residence to seek medical treatments, procedures, or wellness experiences. The motivations behind such travel may vary but often include factors such as cost savings, access to specialized treatments, shorter waiting times, or the opportunity to combine medical procedures with leisure travel. ‍

Types of Health Tourism

• Medical Tourism: This category of health tourism focuses on individuals that travel for medical treatments and procedures abroad. Common medical treatments sought by medical tourists include elective surgeries, dental treatments, fertility treatments, and cosmetic procedures. Often, providers offer medical tourism packages that include treatment costs, physician fees, ground transportation and, in some cases, hotel accommodation.
• Wellness Tourism: Wellness tourism, on the other hand, emphasizes the pursuit of well-being through activities and experiences that promote physical, mental, and spiritual health. Examples include spa treatments, yoga retreats, and mindfulness workshops.
• Preventative Healthcare Tourism: This type of health tourism revolves around the concept of proactive health management. Travelers in this category may seek routine medical check-ups, diagnostic tests, or alternative medical treatments to prevent potential health issues.

Top Destinations for Health Tourism

While it is beyond the scope of this article to provide an exhaustive list of the top health and medical tourism destinations; some notable countries and regions have emerged as leaders in this industry, particularly for combining medical and wellness services. These include:

• Thailand: Renowned for its state-of-the-art medical facilities and cost-effective treatments, Thailand has become a popular destination for medical tourists from around the world.
• India: With its combination of advanced healthcare infrastructure, skilled medical professionals, and affordable treatment options, India has emerged as a prominent player in the health tourism sector.
• Singapore: Known for its high-quality healthcare system, Singapore attracts health tourists seeking top-notch medical treatments and wellness experiences.
• Turkey: Offering high-quality medical care at competitive prices, Turkey has become a preferred destination for health tourists, particularly for cosmetic procedures and dental treatments.
• Hungary: Hungary is well-known for its dental and medical spa tourism, thanks to its high-quality services and natural thermal springs.
• Costa Rica: This Central American country has made a name for itself in the medical tourism industry by providing affordable, high-quality healthcare services in a beautiful natural setting.
• South Korea: Boasting world-class healthcare infrastructure and cutting-edge medical technology, South Korea is a top destination for cosmetic surgery and advanced medical treatments.
• Malaysia: Offering a range of healthcare services at competitive prices, Malaysia has become a popular destination for medical and wellness tourism in     Southeast Asia.
• Brazil: With its expertise in cosmetic surgery and dental treatments, Brazil attracts health tourists from across the globe.
• Spain: Spain's modern healthcare infrastructure and affordable treatment options make it an attractive destination for European health tourists.

Travelers Engaging in Health Tourism

The number of travelers engaging in health tourism has been steadily increasing in recent years. According to the Medical Tourism Association, the global medical tourism industry was valued at $58.6 billion in2020, with an estimated 14 million patients traveling for medical treatments each year. This figure is expected to grow at a compound annual growth rate (CAGR)of 12% through 2025, reaching an estimated market value of $142.2 billion.

Wellness tourism, on the other hand, has also witnessed significant growth in recent years. According to the Global Wellness Institute, the wellness tourism market was worth $639 billion in 2019 and is projected to grow at a CAGR of 7.5%, reaching $919 billion by 2022. This growth is driven by the increasing global demand for health and wellness experiences, as well as the rise in disposable incomes and greater awareness of preventive healthcare measures.

Several factors have contributed to the growth of health tourism. Some of these include:

Cost Savings: One of the main driving forces behind the growth of health tourism is the potential for significant cost savings. The cost of medical treatments and procedures can vary dramatically between countries due to factors such as labor costs, government subsidies, and differences in the cost of living. By traveling to countries with lower healthcare costs, health tourists can save a considerable amount of money. For example, a heart bypass surgery in the United States may cost around $100,000,while the same procedure in India could cost approximately $7,000. These cost savings can be particularly attractive for patients who are uninsured, underinsured, or require elective procedures that are not covered by insurance.

Access to Specialized Treatments: Another factor driving health tourism is the opportunity to access specialized treatments that may not be available or have limited availability in one's home country. This can be due to a lack of cutting-edge medical technology, a shortage of medical professionals with specialized skills, or restrictive regulations on certain treatments. Health tourists may choose to travel abroad to receive state-of-the-art care or treatments that are considered experimental or unapproved in their home country.

Shorter Waiting Times: In some countries, patients may face long waiting times for certain medical treatments or procedures due to factors such as limited healthcare resources or high demand. These waiting times can be particularly challenging for patients with chronic pain, deteriorating conditions, or urgent medical needs. Health tourism offers the opportunity for patients to bypass these waiting times and receive the necessary treatments more quickly. For example, a patient in the United Kingdom may face a waiting period of several months for a hip replacement surgery, while the same procedure could be readily available in countries such as Spain or Turkey.

Higher Quality of Care: Some health tourists perceive that the quality of care in another country may be higher than what is available in their home country. This perception can stem from factors such as the reputation of the destination country's healthcare system, the use of advanced medical technology, or the expertise of the medical professionals. For example, Singapore is renowned for its world-class healthcare system, attracting health tourists seeking top-notch medical treatments and wellness experiences. Additionally, countries like South Korea have gained a reputation for excellence in cosmetic surgery, drawing patients from around the world to receive high-quality care from skilled surgeons.

Combining Medical Procedures with Leisure Travel: Health tourism also offers the unique opportunity for individuals to combine medical treatments or wellness experiences with leisure travel. Many health tourists choose to extend their stay in the destination country to explore the local culture, visit tourist attractions, or simply relax and recuperate in a beautiful setting. This combination of medical and leisure travel can contribute to the overall well-being of the patient and enhance their recovery process. For example, a patient undergoing dental treatment in Costa Rica might also take the time to visit the country's beautiful beaches, rainforests, and national parks during their stay.

Health tourism has emerged as a significant sector within the global tourism industry, fueled by factors such as cost savings, access to specialized treatments, and a growing focus on wellness and preventative healthcare. As the industry continues to expand, more countries are investing in their healthcare infrastructure to attract health tourists, offering a wide range of medical and wellness services to meet the diverse needs of these travelers. With the increasing popularity of health tourism, it is essential for healthcare providers, governments, and tourism organizations to work together to ensure the highest standards of care and services for health tourists while promoting sustainable and responsible practices within the industry.

Image credits: Image by <a href="https://www.freepik.com/free-photo/top-view-glove-with-stethoscope_9469085.htm#query=health%20tourism&position=25&from_view=search&track=ais">Freepik</a>

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Medical travel facilitator certification.

GHA’s Medical Travel Facilitator Certification is conducted online and focuses on validating the capacity of facilitator companies to provide appropriate services to clients that enhance safety and patient experience along the entire Medical Travel Care Continuum (patient journey) as appropriate to the to the particular healthcare provider and the facilitator company’s business model.

• Medical Tourism
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Medical Tourism Statistics and Facts | Health-Tourism.com

An essential fact sheet and guide on medical tourism statistics, medical tourism: the full picture, medical tourism facts: why do people go abroad to get medical treatment.

• Approximately 2.5 million foreign patients traveled to hospitals in Thailand in 2013. In Bangkok's prestigious Bumrungrad International Hospital, over 520,000 international patients received treatment at the hospital.
• Singapore has been a growing medical tourism center in South East Asia with 850,000 medical tourists arriving in 2012. In January 2019 however, a report was released by RHB Research , the article quotes analyst Juliana Cai saying "As healthcare costs in neighbouring countries like Malaysia and Thailand are much lower, they have been attracting medical tourists from the region – thereby eating into Singapore's market share."
• Latin America , particularly Costa Rica and Panama , are fast becoming tourist spots for medical travelers with approximately 40,000 foreign patients seeking healthcare in Costa Rica in 2011.
• Due to its close proximity to the U.S., Mexico has become a top medical tourism destination with 40,000 to 80,000 American seniors spending their retirement there with a considerable number receiving nursing home and health care. According to Politico however, the recent events with Donald Trump and the wall could damage the flow of medical tourism across the border.
• After visitors number more than doubling in the last 5 years, Malaysia is also becoming a famous destination with 770,134 medical travelers in 2013. In 2016 Malaysia received numerous awards and global recognition from International Medical Travel Journal . Among the awards won by The Malaysia Healthcare Travel Council (MHTC) were ‘Health & Medical Tourism: Destination of the Year’, International Hospital of the Year, ‘International Cosmetic Surgery Clinic of the Year, ‘International Dental Clinic of the Year’, ‘International Fertility of the Year’, and ‘Best Marketing Initiative of the Year’.
• India has become a medical tourism hot spot, with 166,000 international patients in 2012 coming to the country due to the selection of highly skilled doctors and improved medical infrastructure. In 2016 the numbers kept rising, with over 170,000 medical visas awarded . This represents only a fraction of the total medical tourists entering the country.
• South Korea has now entered the top ten countries in the world in terms of tourist volume. At the last available count in 2016, 390,000 people travelled to Korea as a medical tourist compared to the overall patient volume of 14 million.
• The UK has recently announced the need for improved quality standards for cross border care. There seems to be room for more private inbound medical tourism but there needs to be a change in the cap on numbers allowed currently.
• In Spain , the demand for medical tourism has skyrocketed, especially in the town of Marbella. Over 330 million euros a year are generated in the province. The Quirón business group is the biggest medical supplier in Spain and it treats up to 20,000 foreign patients a year, with most of the patients coming from the UK, Netherlands and Finland.
• As fertility decreases in the MENA region the demand for IVF and related services grows. In North Africa and the Middle East there is a $1 billion market, serviced by Turkey but also increasingly by the United Arab Emirates and Saudi.

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Johnson Shoyama Graduate School of Public Policy, 101 Diefenbaker Place, Saskatoon, SK S7N 5B8 Canada

Amy Zarzeczny

Although a growing body of literature has emerged to study medical tourism and address the policy challenges it creates for national health care systems, the comparative scholarship on the topic remains too limited in scope. In this article, we draw on the existing literature to discuss a comparative research agenda on medical tourism that stresses the multifaceted relationship between medical tourism and the institutional characteristics of national health care systems. On the one hand, we claim that such characteristics shape the demand for medical tourism in each country. On the other hand, the institutional characteristics of each national health care system can shape the very nature of the impact of medical tourism on that particular country. Using the examples of Canada and the United States, this article formulates a systematic institutionalist research agenda to explore these two related sides of the medical tourism-health care system nexus with a view to informing future policy work in this field.

In this era of globalized medicine, when international travel and access to online health information are readily accessible, medical tourism is an important issue both for national health care systems and from a global health perspective [ 1 – 3 ]. Patients from countries around the world are exercising increasing degrees of autonomy over their health care options by obtaining information from sources other than their regular health care providers and, in some cases, by electing to pursue care alternatives outside their domestic medical system. Medical tourism is a broad and inclusive term that captures a wide range of diverse activities [ 3 ]. It has been defined as “the practice of travelling to another country with the purpose of obtaining health care (elective surgery, dental treatment, reproductive treatment, organ transplantation, medical checkups, etc.),” and is generally distinguished from both care sought for unplanned medical emergencies that occur abroad and from formal bi-lateral medical trade agreements [ 4 , 5 ]. Individual motivations for engaging in medical tourism vary widely and may include imperatives such as avoiding wait times, reducing costs, improving quality, and accessing treatments not available or legal in the home jurisdiction, or for which the individual is not eligible [ 5 – 8 ].

While medical tourism is far from new, shifting patient flow patterns and a growing recognition of the complex ethical, social, economic, and political issues it raises are underscoring renewed efforts to understand this phenomenon and its future [ 3 , 9 , 10 ]. Some of the current attention focused on medical tourism concerns its implications and potential risks for individual patients and health care systems [ 11 – 13 ]. Medical tourism impacts both importing and exporting health care systems, albeit in different ways [ 14 ]. Various terms exist to describe trade in health services [ 15 ]. For the purpose of this discussion, we will use importing or destination to describe systems whereby patients come from other jurisdictions to receive care, and exporting to describe the departure of individuals from their domestic medical system to pursue health services elsewhere. Recognizing that there are important knowledge gaps and a need for definitional clarity and further empirical work to understand the effects of medical tourism on the countries involved [ 16 ], concerns for importing or destination systems include, though are not limited to, ethical questions about inequity of access for local residents versus high paying visitors and about the “brain drain” of local talent into private, for-profit organizations focused on non-resident care [ 15 ]. Conversely, the issues exporting systems face often revolve around implications for domestic health care providers, the potential for patients to avoid domestic wait lists, and the costs of follow-up care upon patients’ return [ 12 ]. For example, research from Alberta, Canada, suggests that the financial costs associated with treating complications from medical tourism for bariatric surgery are substantial, and complication rates are considerably higher than similar surgeries conducted in Alberta (42.2–56.1% versus 12.3% locally) [ 6 ].

Although a growing body of literature has emerged to study medical tourism and address the policy challenges it creates for health systems [ 3 , 16 ], the comparative scholarship on medical tourism remains too limited in scope, a remark that should not hide the existence of a number of recent comparative studies in the field [ 17 – 19 ]. These studies demonstrate that comparative research is helpful in identifying both the unique and the most common policy challenges facing each country [ 20 ] and can, if done appropriately, offer learning opportunities [ 21 ]. Indeed, this process can facilitate policy learning (related terms include lesson drawing, policy transfer, diffusion, and convergence) whereby ideas, policies, or practices (e.g., regulatory tools) in one jurisdiction inform or shape those in another [ 22 , 23 ].

With a view to ultimately informing policy related to medical tourism, this article discusses the value of a comparative research agenda about medical tourism that stresses the multifaceted relationship between medical tourism and the institutional characteristics of national health care systems. On the one hand, these characteristics may shape the content of the demand for medical tourism among the citizens of a particular country [ 24 ]. From this perspective, as argued, existing typologies of health care systems can shed light on the varying features of the demand for medical tourism across countries. In other words, different types of health care systems are likely to produce different configurations of demand for medical tourism, which influences the range of policy instruments available to governments and other actors seeking to influence decision-making and behavior within their particular context [ 25 ]. On the other hand, the institutional characteristics of each national health care system may also shape the very nature of the impact of medical tourism on that system. Accordingly, the institutional characteristics of health care systems, such as insurance structures [ 26 ], may impact both citizens’ demand for medical tourism and the ways in which medical tourism affects each country. Obtaining a better understanding of these relationships may inform new ways of thinking about both the challenges and opportunities medical tourism presents. As medical tourism markets continue to grow and diversify, and as domestic health care systems increasingly feel the stress of limited resources, this kind of work will be critical to support policymakers and health system leaders in their efforts to mitigate the potential harms of medical tourism while, at the same time, responding to the needs of the citizens they serve [ 3 ].

Using the examples of Canada and the United States (US), this article proposes the use of an institutionalist research agenda to explore these two related sides of the medical tourism-health care system nexus as a central element of future policy strategies. We first take a comparative perspective on medical tourism and present what we see as key aspects of the issue from a policy perspective. Drawing on current evidence and leading literature in the field, we highlight ways in which national health care systems shape the demand for medical tourism and then, in turn, how medical tourism impacts national health care systems. From this discussion, we identify four key lines of enquiry that we suggest are of critical importance in the medical tourism policy landscape and propose an agenda for future comparative research on medical tourism and national health care systems that could play an important role in informing future policy decisions in this area.

Medical tourism in comparative perspective

Although gathering robust data on the magnitude of medical tourism continues to be a challenge and more empirical work in this area is needed [ 3 , 5 , 10 , 12 ], a strong body of literature addresses different aspects of the issue. For example, research is improving understandings of how medical tourism impacts destination and departure jurisdictions [ 16 , 27 ], affects relationships with domestic health care providers [ 28 ], relates to economic factors including health system costs [ 29 ], and impacts clinical outcomes for patients [ 30 ], among other important lines of enquiry. However, much of this valuable scholarship focuses on particular forms of medical tourism in specific contexts (bariatric surgery [ 31 ], dental care [ 32 ], reproductive services [ 33 ], etc.) or on the policy and health system implications for individual jurisdictions [ 13 ]. There is an increasing amount of comparative research exploring how different features of health care systems may in some cases help drive demand for medical tourism and in other cases constrain it (i.e., push/pull factors), and how they relate to the impact of medical tourism [ 24 ], but more work remains to be done in this important area [ 4 , 10 ]. The potential value of data on the impact of medical tourism in one jurisdiction to structurally- similar systems (e.g., other universal public health care systems) has already been recognized [ 34 ]; we agree and suggest that going further with an associated analysis considering the role of their institutional features is critical. This approach is particularly valuable from a policy perspective, especially when it comes to maximizing opportunities for policy learning from other jurisdictions and to identifying and evaluating the respective strengths and limitations of different policy options for decision-makers seeking to, for example, discourage particular forms of medical tourism (e.g., organ transplant tourism [ 35 ]).

The governance of medical tourism in its various forms is complex and highly fragmented given its broad range of influential stakeholders (both state and non-state, individual and institutional), its international market-based nature, and its engagement of vastly different and often competing priorities and interests (e.g., profit-driven, patient care, autonomy, ethics, etc.). As a result, policy makers and health system leaders face considerable challenges when it comes to seeking to influence medical tourism markets, whether by encouraging their development or restricting access to them. Obtaining a better understanding of the institutional forces that shape the demand for, and impact of, medical tourism—and connecting those forces to the policy context—may help identify a broader range of tools and options decision- makers can employ to achieve their particular objectives with respect to medical tourism.

Looking at Canada and the US is an appropriate starting point for this comparative work and we use this comparison to ground our analysis of the value of an institutional research agenda as a policy strategy for addressing potential concerns and opportunities associated with medical tourism. While these neighboring countries are similar in many ways, there are dramatic differences in important institutional features of their respective health care systems, including funding and delivery models. The US is both an established importer and exporter of medical tourists, the latter supported in part by insurers offering medical tourism coverage in an effort to reduce the high costs associated with domestic health care services [ 11 , 36 ]. In contrast, the structure of Canada’s largely publicly-funded, single-payer medical system limits foreign access to non-emergent care and makes it challenging for Canadians to be reimbursed for care received abroad via medical tourism [ 7 ]. It also makes the current involvement of Canadians in medical tourism [ 37 ] a public policy issue because of its implications for the public purse.

How national health care systems shape demand for medical tourism

Because health care systems can be understood as relatively stable institutional settings that shape human behavior [ 38 , 39 ], their features are likely to impact the demand for medical tourism in a particular country or even, in the case of decentralized health care systems subject to considerable regional variation, in a particular region. Health care systems can vary greatly from one country to the next, or even from one region to the next within the same country. Accordingly, what citizens might be looking for when they seek medical treatment abroad is likely to fluctuate based on the nature of health care coverage, financing, and regulation they have at home. Research about these and other drivers is growing but important gaps in knowledge remain [ 5 ]. In other words, alongside factors like geographical mobility and travel costs, the institutional configurations of health care systems likely shape, at least in part, the types of services people are looking for based on what health services they can access in their home country, with what degree of quality and timeliness, and at what cost [ 24 ].

A comparison between Canada and the US is illustrative here. Starting with the Canadian context, universal coverage has existed in Canada since the early 1970s [ 40 , 41 ]. Under this framework, regardless of the province or territory in which they live, Canadian citizens and permanent residents are entitled to medically necessary health care services with no user fees, which are strictly prohibited under the 1984 Canada Health Act (CHA). Yet, although the CHA mandates comprehensive coverage for “all insured health services provided by hospitals, medical practitioners or dentists,” many services do not fall under this umbrella and the Canadian health care system has long waiting lists for many non-emergency surgeries like hip replacement [ 40 , 42 ]. Wait times vary from province to province but they are a source of frustration for many Canadians, some of whom elect to go abroad to get their non-emergency procedure done faster, even if they have to pay for it themselves, instead of relying on the slower public system back home [ 7 ]. Gaps in coverage within the single-payer system in important areas such as prescription drugs [ 43 ] and dentistry [ 44 ] also sometimes push Canadian citizens and permanent residents to go elsewhere for care to reduce costs. There are also a wide variety of medical treatments and health-related interventions offered in private markets that are either not available or not publicly funded in Canada. There are a variety of reasons for this lack of public funding, including those related to evidence (or, more precisely, the lack thereof) regarding safety and efficacy. For example, there is a large international market for unproven stem cell interventions that are not part of the approved standard of care in Canada or available in the publicly funded health care system [ 45 ]. Therefore, key motivations underlying the pursuit of Canadian medical tourism often relate to a desire to access care faster, to reduce out of pocket costs for care not covered by provincial health insurance, and/or to access options that are not available in Canada [ 7 ].

In the US healthcare system, where about 9% of the population remains uninsured despite the enactment of the Affordable Care Act (ACA) in 2010 [ 46 ], people who lack insurance coverage but who face a medical need might go abroad to seek cheaper treatment. In fact, the high cost of care in the US has been recognized as a major factor pushing Americans to seek care at lower cost outside the US, an option that is facilitated by health care globalization [ 2 ]. For example, there is research documenting the strong market in the Mexican border city of Los Algodones for Americans seeking dentistry, optometrist, and pharmacy services [ 47 ]. Others may be motivated to return to systems with which they are more familiar, as is the case with the Mexican diaspora [ 24 ]. In the US, in contrast to Canada where universal coverage prevails, the lack of health care coverage is likely to be a key factor driving the demand for medical tourism. At the same time, waiting times are much less likely to drive the demand for medical tourism in the US, where waiting lists are less of an issue [ 40 ].

These brief remarks highlight how key institutional features in both Canada and the US shape patterns in the demand for medical tourism in these two countries, creating both similarities and differences between them. At the same time, regional differences in health system institutions within the two countries can also shape the demand for medical tourism within their borders. For instance, in states like Texas, where elected officials have thus far refused to expand Medicaid as part of the ACA [ 48 ], more people live without health care coverage than elsewhere (about 18% of the population as of March 2016 [ 49 ]), which may push them to look to Mexico for cheaper health care. Here the institutional characteristics of a state’s health care system and the geographical proximity to Mexico, coupled with the presence of a large population of Mexican descent who speak Spanish, are likely to favor cost-saving medical tourism from Texas to Mexico. This example highlights how geographical and even ethno-cultural factors can shape medical tourism alongside and even in combination with the institutional features of a particular health care system. This is also the case when we deal with issues such as dental care and cosmetic surgeries, which are not covered by many US public and private insurance plans [ 50 ].

How medical tourism impacts national health care systems

At the most general level, existing national and sub-national institutions may mediate the impact on particular countries of transnational processes stemming from globalization [ 20 , 51 ]. This general remark also applies to global medical tourism, which is unlikely to affect all national health care systems in the same way. Put bluntly, systems will react differently to external pressures, based in part on their own institutional characteristics. Those same institutional characteristics also form part of the policy matrix that shapes the options available to decision makers.

There are two central aspects to this story. First, we can look at how domestic health care institutions are specifically impacted by inbound medical tourism (i.e., destination countries at the receiving end of medical tourism). Research suggests that the way in which health care systems cope with foreign users, and what impact those foreign users have on the system, will vary according to the institutional characteristics of that system [ 16 ]. For instance, countries that attract many medical tourists could witness price increases and the diversion of services away from their less-fortunate citizens [ 1 ]. At the same time, the institutional features of national health care systems can explain why some countries attract more medical tourists than others. The comparison between Canada and the US is particularly revealing here. On the one hand, although some provinces have considered alternate approaches that would encourage inbound medical tourism as a source of revenue generation [ 52 ], at present the limited scope of private health care in Canada restricts the availability of medical tourism opportunities for wealthy foreigners seeking treatments. On the other hand, the large scope of private health care in the US makes that country an obvious target for wealthy medical tourists who can afford its high medical costs.

Second, and more important for this article, national health care institutions may also shape the way in which each country is affected by outbound medical tourism. For example, in a single-payer health care system such as Canada’s, both routine follow-up care and complications resulting from medical acts performed abroad are typically dealt with within the public system, engendering direct costs to taxpayers and potentially impacting access for others in the system (i.e., if physicians’ time is diverted to attend to emergent issues) [ 6 ]. The extent of these concerns varies depending on the urgency of the issue and whether it falls within hospital and physician services covered by the universal system (versus, for example, dental care where public coverage is more limited) [ 52 ]. By comparison, within the fragmented public-private US health care system, public programs may only absorb a fraction of the costs of complications related to outbound medical tourism, thus reducing their direct negative impact on taxpayers, whereas private insurance companies or individuals themselves might bear the majority of these costs.

The potential savings for outbound countries medical tourism generates are also likely to depend on the institutional features of each national or sub-national health care system [ 16 ]. In Canada, for instance, people who decide to go abroad for non-emergency surgeries might help reduce the length of waiting lists, although this positive impact might be limited by the fact that some of these surgeries are simply not available in Canada or, at least, not available to the individuals who seek treatments abroad (e.g., because of their age or health status). Because waiting lists are much less of an issue in the US [ 40 ], this potential benefit of medical tourism to domestic health care systems may be less relevant there.

Conversely, the prospect of affordable medical tourism may convince people in the US who do not have access to Medicaid, Medicare, or employer-based coverage that they do not need coverage at all, because they can always go abroad and save money should they need medical treatment. In this context, global medical tourism could interact with the question of whether people will seek coverage or not. At the same time, to save money, “US companies, such as Anthem Blue Cross and Blue Shield and United Group Programs, are now exploring the idea of including medical tourism as a part of their coverage,” a situation that could increase their administrative burden and create further complications along the road [ 53 ].

Policy implications

Our aim with the preceding high-level overview was to draw on existing knowledge to highlight not only that national health care institutions may shape the demand for medical tourism in a particular country or region, but also that the consequences of such tourism for national health care systems are likely similarly mediated by the institutional features of these systems. These connections have a number of important potential implications for health system governance of medical tourism and, more specifically, for the options available to policy makers seeking particular objectives. For example, depending on the jurisdiction, efforts to reduce demand for medical tourism could include a range of options such as investing resources targeted at reducing domestic wait times, expanding public health insurance, limiting public coverage for follow-up care needs, or educating the public about the potential risks associated with medical tourism [ 2 ], among other options. Conversely, efforts to encourage the development of a medical tourism industry within a particular jurisdiction might involve regulatory change to expand options for private system offerings and targeted marketing campaigns, again among other possibilities [ 5 , 17 ].

In fact, it has long been recognized the governments have a variety of tools or policy levers at their disposal when they seek to influence behavior [ 54 ]. Identifying which tool (or combination of tools) is likely to be most effective in a particular set of circumstances, such as medical tourism, requires a nuanced understanding of relevant institutional characteristics and situational factors. Accordingly, we propose that a comparative research agenda should be a key element of future analysis and decision-making efforts in this field. Such an agenda would not only help empirically test the above hypotheses about the institutional-medical tourism nexus, it could also help facilitate lesson drawing between jurisdictions that have attempted different approaches by helping pinpoint salient commonalities and points of difference between the systems that might initially explain, and ideally ultimately even predict, the likely results of particular policy initiatives.

Research agenda

We propose a comparative research agenda that aims to explore the relationship between medical tourism and key institutional features of national health care systems. Although some aspects of our research agenda are already present in the existing literature, we think studying these elements together and with a comparative policy lens would be of tremendous value to health system decision -makers seeking to navigate different objectives including, for example, avoiding “brain drain” from public to private health care, minimizing added costs to publicly funded systems, protecting vulnerable individuals, and facilitating patient autonomy.

Drawing on our review of the health care systems in Canada and the US, we have identified three key institutional features that we suggest are particularly relevant to medical tourism and its broader policy context. These key features are health care funding models, delivery structures (e.g., public/private mix, provider payment models, role of user choice, and competition between providers), and governance systems (e.g., location of authority, health care provider regulation, liability systems). Future empirical research may identify other more salient features and certainly an iterative approach may be valuable. Nonetheless, we suggest that these features would provide a useful starting point for the next step, which we propose be an exploration of how these institutional features relate to the following areas:

• (i) Patient flow patterns – e.g., inbound versus outbound, treatment destinations, types of treatment sought.
• (ii) Patient motivations – e.g., cost reduction, wait list avoidance, pursuit of quality, circumvention tourism.
• (iii) Health system interactions – e.g., costs and options for follow-up treatment, roles of domestic health care professionals.
• (iv) Existing policy levers – e.g., public and private insurance structures, incentive schemes, information campaigns, regulation.

These four areas are not intended to serve as a comprehensive list of all relevant lines of enquiry. However, they present a valuable starting point, particularly because of their relevance to policy instrument selection processes. Having said that, and although it is beyond the scope of this piece to go further than laying a foundation for this proposed research agenda, we suggest that future research take a broad and scoping approach to draw on existing data and information and, where possible, conduct new empirical work addressing these critical areas. With a view to identifying patterns and generating hypotheses, researchers will likely need to continually refine the initial assumptions, outlined above, about the relationships between different institutional features and aspects of medical tourism. Doing so will require careful thought regarding the selection of an appropriate scientific paradigm, with a view to research validity and reliability [ 55 ].

We also anticipate that end-users and important stakeholders, including elected officials, civil servants, health care providers, and patients and families, would have an important contribution to make to the research design and with respect to interpreting the findings, particularly as they relate to the identification and evaluation of policy options. One important limitation in this type of work will relate to data availability. We expect that comparative work of this nature and any future empirical analyses it includes will highlight gaps in knowledge and potentially trigger future research agendas. Overall, the research envisioned here should complement and augment ongoing efforts in the field to improve understandings of important factors including patient flows, expenditure trends, system impacts, and individual decision-making determinants, among others.

Conclusions

This article discussed the relationship between medical tourism and key institutional aspects of national health care systems with a view to highlighting the value in a comparative research agenda focused on identifying and evaluating policy options. First, we argued that these characteristics directly affect the demand for medical tourism in each country. Second, we suggested that such institutional characteristics shape the actual impact of medical tourism on that particular country . This discussion led to the formulation of an institutionalist research agenda about medical tourism. It is our hope that this proposed agenda will trigger discussion and debate, help develop future research, and inform new ways of thinking about medical tourism in the global landscape. Medical tourism is a complex phenomenon and we suggest that applying a comparative, institutional lens will shed new light on its drivers, constraints, and impacts and, in so doing, ultimately help inform policy development in this area.

Acknowledgements

The authors thank Rachel Hatcher for the copy-editing support and anonymous reviewers for their helpful suggestions. DB acknowledges support from the Canada Research Chairs Program, and AZ funding from the Canadian National Transplant Research Program.

Authors’ contributions

DB wrote the theoretical paragraphs and AZ the paragraphs focusing more directly on medical tourism. Both authors read and approved the final manuscript.

Authors information

DB has published extensively on institutionalism and on health care systems, and AZ has published extensively on health law and policy issues, including topics related to medical tourism.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Daniel Béland, Phone: 306 966-1272, Email: [email protected] .

Amy Zarzeczny, Email: [email protected] .

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Overview of the Medical Tourism industry

Many developing countries don’t have proper healthcare treatment. They are unable to carry out severe operations and surgeries. That’s the reason patients travel to other cities or countries to resolve problems related to healthcare. Health tourism has immense possibilities and success rates. Many people travel to find better, affordable, and hassle-free healthcare services in other parts of the world.

What is Medical Tourism?

Medical tourism refers to travel where tourists travel from one country to another for health treatment purposes. Typically, when people travel from one place to another, then that is for entertainment purposes. Still, this travel aims to cure some diseases, take up therapies, or for rehabilitation purposes. Hence, it is considered medical tourism.

People come from various places to a specific country to have good nursing, care, doctors, therapies, and medication that solves their health problems.

Pollard, International Medical Tourism Journal in 2011 defined a medical tourist as, “A medical tourist is someone who travels outside of his or her own country for surgery or elective treatment of a medical condition.”

History of Medical Tourism

The Medical Tourism industry began its set of experiences during the 1930s. It became mainstream among the USA and European nation’s well-off inhabitants, who needed excellent quality wellbeing services abroad. Since 1983, maintaining good health has been consumers’ first concern, and, as indicated by the Future Foundation’s Changing Lives Survey, it will continue to be the same way in the future.

Types of Medical Tourism

People going for clinical consideration because of moderateness, better admittance to mind, or a more elevated level of nature of care is called  International Medical Tourism .

International Medical tourism is further divided into two types:

• When people come from other countries to a country, then this is known as inbound medical tourism.
• When people go out of a country from their origin to other countries, this is called outbound tourism.

Individuals who live in one nation and travel to another city, area, or state to get clinical, dental, and careful consideration while simultaneously getting equivalent to or more prominent consideration than they would have in their home city is known as  Domestic Medical Tourism.

Benefits of Medical Tourism

Medical Tourism contributes massively to the tourism sector. Many people travel from less-developed healthcare countries to developed healthcare countries. This increases travel and contribute to the country’s economy. It creates healthcare-related jobs and facilities, incorporating the latest technology, participation in global healthcare, socio-political, and economic benefits, participation in global healthcare and increased global healthcare standards, and improves the quality of life.

Reasons to Choose Healthcare Services Abroad

Medical tourism has become popular in post-pandemic times. It has been proving an effective way of availing excellent healthcare services if good services and care are not available in your area or country. People consider traveling abroad either for leisure or for treatment purposes. Following are some of the reasons why people travel abroad for medical purposes:

• They are disappointed with the current treatment in their origin country. They are not satisfied with the treatment, and the problem is not sorted out.
• The treatment can be time-consuming.
• The treatment can cost a lot of money as there are fewer doctors available in that area.
• To practice greater mobility.
• To have a zest for traveling the world.
• Unlike local treatment, there is no waiting list.
• High tech technology is used with high accuracy, speed, and success rate.
• Because of the growing popularity of medical services abroad.
• Also, to escape from the current country.

Drawbacks of Medical Tourism

Though medical tourism can be a good solution for advanced healthcare treatments, it also possesses various issues and challenges. Some of them are as follows:

Follow-up Problems – follow up care is extremely challenging in the clinical and travel industry. If a patient gets a disease or different issues after a medical procedure after returning to his own country, then, at that point, there aren’t any grounded follow-up cares in medical tourism.

• Language Barrier 

Cultural and language obstructions are a significant issue before the clinical travel industry. Assuming the clinical staff doesn’t comprehend the patients’ language, the entire cycle becomes hard.

• Lack of Infrastructure 

People are going from one country to another developing country for clinical treatment. These developing countries do not have well-established and advanced infrastructure. There are numerous issues like appropriate water and power supply, low-quality food, and an unclean hospital environment.

• Lack of Professionalism 

The clinical staff in most developing nations needs polished communication skills. The soft abilities of the medical workforce like warmth, concern, and amicability are yet to develop in the staff. The staff may be rude and arrogant to the patients. This costs the country its reputation.

• Difficulties in Promotion 

The developing nations are experiencing the issues of advancement in medical tourism. There is an absence of value accreditation and guideline in emergency clinics and other medical service providers. There is no uniform evaluation and normalization of administration, which creates a boundary in building client’s confidence in the offered services.

• Rules and Regulations 

One of the genuine worries in medical tourism is identified with contrasts in law in various nations. There is no standard law in the medical tourism industry all around the globe.

• Organ Trafficking

Most of the world restricts transplant tourism since organs regularly come from weak individuals. Nonetheless, organs can, in any case, be bought on the black market. Sometimes the cost of organ transplantation could be too high.

Apart from the drawbacks, health tourism upholds a great future. The more developed the health care system in a country, the more it will improve people’s lives. Countries like Dubai, UK, India, Japan, Spain, Singapore, and Canada are some of the healthcare tourism destinations in the world.

As indicated by the Medical Tourism Index, which assesses the appeal of nations for clinical travel, a nation’s economy and public picture, medical care expenses, and nature of care are the central point that drives the clinical medical industry development in an objective.

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